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Pregnancy Week by Week : Week 37 (part 1) - How Your Actions Affect Your Baby’s Development

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1. How Big Is Your Baby?

Your baby weighs almost 6⅓ pounds (2.8kg). Crown-to-rump length is 14 inches (35cm). Its total length is around 19 inches (48cm).

2. How Big Are You?

The size of your uterus may not have changed much since your last visit. Measuring from the pubic symphysis, the top of the uterus is about 14¾ inches (37cm). From the bellybutton, it is 6½ to 6¾ inches (16 to 17cm). Your total weight gain by this time should be about as high as it will go at 25 to 35 pounds (11.3 to 15.9kg).

3. How Your Baby Is Growing and Developing

Your baby continues to grow and to gain weight, even during these last few weeks. A change in pressure on your tummy, such as laying a book there, may cause baby to react by kicking vigorously.

Baby’s head is usually directed down into the pelvis around this time. But in about 3% of all pregnancies, the baby’s bottom or legs enter the pelvis first, called a breech presentation

4. Changes in You

Pelvic Exam in Late Pregnancy

Your healthcare provider may do a pelvic exam to help evaluate your pregnancy. One of the first things he or she will look for is whether you’re leaking amniotic fluid. If you think you are, it’s important to tell your healthcare provider.

He or she will examine your birth canal and cervix during the pelvic exam. Think of the birth canal as a tube going from the pelvic girdle down through the pelvis and out the vagina. The baby travels through this tube from the uterus. During labor, the cervix usually becomes softer and thins out. Your cervix may be evaluated for its softness or firmness and the amount of thinning.

Before labor begins, the cervix is thick. When you’re in active labor, the cervix thins out; when it is half-thinned, it is “50% effaced.” Immediately before delivery, the cervix is “100% effaced” or completely thinned out.

The amount the cervix is open is also important. This is measured in centimeters. The cervix is fully open when the diameter of the cervical opening measures 10cm. The goal is to be a 10! Before labor begins, the cervix may be closed or open a little way, such as 1cm (nearly ½ inch).

You will be checked to see if baby’s head, bottom or legs are coming first; this may be referred to as the “presenting part.” The shape of your pelvic bones is also noted.

The station is then determined. Station describes the degree to which the presenting part of the baby has descended into the birth canal. If the baby’s head is at a -2 station, it means the head is higher inside you than if it were at a +2 station. The 0 point is a bony landmark in the pelvis, the starting place of the birth canal.

Your healthcare provider may describe your situation in medical terms. You might hear you are “2cm, 50% and a -2 station.” This means the cervix is open 2cm (about 1 inch), it is halfway thinned out (50% effaced) and the presenting part (baby’s head, feet or buttocks) is at a -2 station.

Write down this important information. It’s helpful to know when you go to the hospital and are checked there. You can tell the medical personnel what your dilatation and effacement were at your last checkup so they can know if your situation has changed..

5. How Your Actions Affect Your Baby’s Development

Cesarean Delivery

Most women plan on a vaginal birth, but a Cesarean delivery is always a possibility. With a Cesarean, the baby is delivered through an incision made in the mother’s abdominal wall and uterus. An emergency Cesarean delivery is one that is unplanned. An elective Cesarean delivery is planned and done without a medical reason.

The main advantage to having a Cesarean delivery is delivery of a healthy infant. A Cesarean may be the safest way for your baby to be born. The disadvantage is Cesarean delivery is a major operation and carries with it all the risks of surgery.

It would be nice to know you’re going to need a Cesarean so you wouldn’t have to go through labor. Unfortunately, you don’t know ahead of time if you will have problems.

Some women believe if they have a Cesarean, “it won’t be like having a baby.” They falsely believe they won’t experience the birth process. That’s not true. If you have a Cesarean delivery, try not to feel this way. You haven’t failed in any way!

It may be difficult at times to tell the exact location of different parts of the baby. You may have a good idea according to where you feel kicks and punches. Ask your doctor to show you on your tummy how the baby is lying. Some doctors will take a marking pen and draw on your stomach to show you how baby is lying. You can leave it so you can later show your partner how baby was lying when you were seen in the office that day.

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Delivery of a baby by Cesarean section.

Remember, having a baby has taken 9 long months. Even with a Cesarean delivery, you have accomplished an amazing feat.

Reasons for Cesareans. Cesareans are done for many reasons. They are often performed when there’s a problem during labor. The most common reason for having one is a previous Cesarean delivery. Nine out of 10 women who have had a previous Cesarean delivery choose a repeat Cesarean for the next birth.

Some women who have had Cesareans may be able to have a vaginal delivery with later pregnancies; this is called vaginal birth after Cesarean (VBAC).

Nonmedical factors for having a Cesarean include maternal choice, more conservative practice guidelines and legal pressures. If you’re exhausted when you begin labor, you may also be at a higher risk for a Cesarean section. Pre-eclampsia or an active herpes sore may require a Cesarean delivery.

A Cesarean may be necessary if your baby is too big to fit through the birth canal, called cephalo-pelvic disproportion (CPD). CPD may be suspected during pregnancy, but usually labor must begin before it can be confirmed. A Cesarean may be recommended if an ultrasound shows your baby is very large—9½ pounds or larger—and may not be easily delivered vaginally.

Fetal stress is an important reason a Cesarean delivery may be performed. The fetal heartbeat and its response to labor is often monitored. If the heartbeat indicates baby is having trouble with labor contractions, a Cesarean may be necessary.

It’s possible for you to dilate during labor without the baby moving down through the pelvis. When baby’s head is too large to fit through the birth canal, it results in failure to progress. This situation is one of the most common reasons for a Cesarean delivery.

If the umbilical cord is compressed, a Cesarean may be necessary. The cord may come into the vagina ahead of the baby’s head or the baby can press on part of the cord. This is a dangerous because a compressed cord can cut off baby’s blood supply.

A Cesarean may be needed if you’re older. The Cesarean-delivery rate for mothers between 40 and 54 years old is more than double the rate for women younger than age 20.

A Cesarean is often necessary if baby is in a breech presentation, which means baby’s feet or buttocks enter the birth canal first. Delivering the shoulders and the head after baby’s body may damage the baby’s head or neck, especially with a first baby.

Placental abruption or placenta previa are also reasons for a Cesarean delivery. If the placenta separates from the uterus before delivery (placental abruption), the baby loses its supply of oxygen and nutrients. This is usually diagnosed when a woman has heavy vaginal bleeding. If the placenta blocks the birth canal (placenta previa), the baby can’t be delivered any other way.

A Cesarean delivery for a first baby increases a woman’s chances for placenta previa or placental abruption in her next pregnancies. A repeat Cesarean increases a woman’s risk of placenta accreta in subsequent pregnancies if the placenta implants low in the uterus and grows into the area of the previous Cesarean-delivery incision.

If complications arise during pregnancy or while you’re in labor, your CNM, NP or PA will consult a physician specializing in pregnancy.

Rising Rate of Cesarean Deliveries. In 1965, only 4% of all deliveries were by C-section. Between 1996 and 2007, there was a 71% increase in Cesarean births. In 2007, 32% of all live births in the United States were Cesarean deliveries (more than 1.2 million); in 2008 that number rose to 32.3%. Today in the United States, Cesarean deliveries account for over 30% of all deliveries. In some areas, this percentage is even higher.

The rising rate is related in part to closer monitoring during labor and safer procedures for Cesarean deliveries. Part of the increase can also be attributed to the increase in multiple births, but the Cesarean rate actually increased more for singletons than for multiples.

Babies delivered by a scheduled Cesarean delivery between 37 and 39 weeks have more respiratory problems than babies born vaginally or by emergency Cesarean at the same point in pregnancy. It’s believed hormones released during labor help baby deal with fluid in the lungs. The compressions of the baby’s chest from labor are also believed to help clear amniotic fluid from baby’s lungs.

Elective Cesarean Deliveries. Part of the increase in Cesarean deliveries in the United States is due to Cesarean delivery on maternal request (CDMR). It is also called patient-requested Cesarean.

There are many reasons for choosing a Cesarean delivery, including fear of labor, concern over vaginal tearing and worry about incontinence later. Some women believe a Cesarean will help them retain their prepregnancy figure; however it’s pregnancy, not giving birth, that stretches the waistline. Other women believe a Cesarean is safer for baby.

In some parts of the world, elective Cesarean delivery is not a big issue. In many Latin American countries, the rate of elective Cesareans is 40 to 50%. One survey conducted in Brazil showed private hospitals, where the wealthiest patients go, had an 80 to 90% rate of elective Cesareans.

U.S. doctors are split on the question of elective Cesarean delivery. There’s evidence supporting both sides. Some believe with improved anesthesia, antibiotics, infection control and pain management, a Cesarean is no riskier than vaginal delivery. However, ACOG, the federal government, the American College of Nurse-Midwives and Lamaze International believe we should look more closely at the present Cesarean-delivery rate.

The point in pregnancy when a Cesarean is scheduled is also important. It’s amazing how much difference a few days can make to the health of your baby. The latest recommendations are that a woman not schedule a Cesarean delivery any earlier than 39 weeks, unless tests show the baby’s lungs are mature. Research shows a baby will do better if he or she is born within 7 days of its due date. If a baby is delivered earlier than this, he or she may have more problems. When compared with babies delivered at 37 or 38 weeks, those born at 39 weeks or more had significantly lower rates of problems.

How Is a Cesarean Delivery Performed? If problems arise during pregnancy and/or labor, if your care has been provided by a CNM, PA or NP, he or she may consult a physician. In most areas, an obstetrician performs a Cesarean. In small communities, a general surgeon or a family practitioner may perform Cesarean deliveries.

If you’re scheduled to have a Cesarean, follow directions for eating before surgery. You are often awake when a Cesarean is done. If you are, you may be able to see your baby immediately after delivery!

You’re first visited by the anesthesiologist to discuss pain-relief methods. Up to 90% of all elective Cesarean deliveries are done with spinal anesthesia.

After you receive anesthesia, your doctor begins by making a 5- to 6-inch incision in the area above your pubic bone. A cut is made through tissue down to the uterus, where a horizontal incision is made into the lower part of the uterus. After all the incisions are made, the doctor reaches into the uterus and removes the baby, then the placenta. Each layer is sewn together with absorbable sutures; the entire procedure takes 30 minutes to an hour.

In the past, a Cesarean was often done with a classical incision, in which the uterus was cut down the midline. This incision doesn’t heal as well because it is made in the muscular part of the uterus. It’s more likely to pull apart with contractions (as in a vaginal birth after Cesarean). This can cause heavy bleeding and injure the baby. If you have had a classical Cesarean section in the past, you must have a Cesarean delivery every time you have a baby.

Today, most Cesarean deliveries are low-cervical Cesareans or low-transverse Cesareans. This means the incision is made low in the uterus. Or a T-incision may be used. It goes across and up the uterus in the shape of an inverted T. It provides more room to get baby out. If you have a T-incision, you may need a Cesarean delivery with all subsequent pregnancies because it may be more likely to rupture.

After Your Cesarean Delivery. If you’re awake for baby’s birth, you may be able to hold him or her immediately. You may also have a chance to begin nursing.

You may need pain relief for the incision. One device to help deal with the pain after a Cesarean is ON-Q. A small catheter is inserted underneath the skin, which sends a local painkiller to the incision area of the Cesarean so very little, if any, medication gets to baby through your breast milk. Studies show moms who receive ON-Q after a Cesarean are able to get out of bed and walk around more quickly, and their hospital stays are shorter. Ask your doctor about it at one of your prenatal visits.

You’ll probably stay in the hospital 2 to 4 days. Recovery at home from a Cesarean delivery takes longer than recovery from a vaginal delivery. The normal time for full recovery is usually 4 to 6 weeks.

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