Pregnancy Week by Week : Week 38 (part 1) - Tests You May Have during Labor, Breech and Other Abnormal Presentations

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1. How Big Is Your Baby?

At this time, your baby weighs about 6¾ pounds (3.1kg). Crown-to-rump length is still about 14 inches (35cm). Total length is around 19⅔ inches (49.5cm).

2. How Big Are You?

Many women feel uncomfortable during the last weeks of pregnancy because their uterus is so large. It’s about 14½ to 15¼ inches (36 to 38cm) between your uterus and the pubic symphysis. From your bellybutton to the top of your uterus is about 6½ to 7¼ inches (16 to 18cm).

3. How Your Baby Is Growing and Developing

Specific cells in the lungs produce chemicals needed for breathing immediately after birth. An important factor is the chemical surfactant. A baby born before its lungs are mature may not have surfactant in its lungs. It can be introduced directly into a newborn’s lungs and baby can use it immediately. Many premature babies who receive surfactant do not have to be put on respirators—they can breathe on their own!

4. Changes in You

Tests You May Have during Labor

If you think you may be in labor and go to the hospital, you will have a labor check. Vital signs will be taken, a monitor will be placed on your abdomen and a pelvic exam will be done. Tests are done to find out if you’re in labor and if your pregnancy is doing OK. If you’re not in labor, you’ll be given advice and sent home. Instructions may include precautions and warning signs. No one wants to be sent home, but don’t fret. You’ll be back soon.

Fetal blood sampling is one way to measure how well a baby can stand the stress of labor. Before the test can be performed, your water must have broken, and the cervix must be dilated at least 2cm (about an inch). An instrument is placed into the vagina, through the dilated cervix, to the top of the baby’s head and makes a small nick in baby’s scalp. Baby’s blood is collected in a small tube, and acidity is checked. This signals whether baby is having any trouble or is under stress and helps your healthcare team decide whether labor can continue or if a Cesarean delivery is needed.

In many hospitals, a baby’s heartbeat is monitored with external fetal monitoring or internal fetal monitoring. External fetal monitoring can be done before your water breaks. A pair of belts is strapped to your tummy. One strap holds a device that monitors baby’s heart rate, the other holds a device to measure the length of contractions and how often they occur.

Internal fetal monitoring monitors the baby more precisely. An electrode, called a scalp electrode, is placed through the vagina and attached to baby’s scalp to measure its heart rate. A thin tube is used inside the uterus to monitor the strength of the contractions. This is done only after membranes have ruptured. It may be a little uncomfortable, but it’s not painful.

Information is recorded on a strip of paper; results can usually be seen in your room and at the nurses’ station. In some places, your healthcare provider can check results on his or her computer.

In most cases, while you’re being monitored, you must stay in bed. In some places, wireless monitors are available so you can move around.

5. How Your Actions Affect Your Baby’s Development

Breech and Other Abnormal Presentations

It’s common for a baby to be in the breech presentation early in pregnancy. However, when labor starts, only 3 to 5% of all babies, not including multiple pregnancies, are a breech or other abnormal presentation.

Certain factors can make a breech presentation more likely. One of the main causes is a baby’s prematurity. Near the end of the second trimester, a baby may be in a breech presentation. By taking care of yourself, you may avoid going into premature labor, which gives baby the best opportunity to change its position naturally.

Although we don’t always know why a baby is in the breech presentation, we know breech births occur more often when:

• you have had more than one pregnancy

• you’re carrying twins, triplets or more

• there is too much or too little amniotic fluid

• the uterus is abnormally shaped

• you have abnormal uterine growths, such as fibroids

• you have placenta previa

• your baby has hydrocephalus

New research shows a breech position may be inherited from either the mom-to-be or the dad-to-be. Both men and women who were delivered in a breech presentation have more than twice the risk of having their firstborn child in a breech presentation at the time of birth.

Tip for Week 38

If baby may be in a breech presentation, your healthcare provider may order an ultrasound to confirm it. It helps determine how baby is lying in your uterus.

There are different kinds of breech presentations. A frank breech occurs when the legs are flexed at the hips and extended at the knees. This is the most common type of breech found at term or the end of pregnancy; feet are up by the face or head. With a complete breech presentation, one or both knees are flexed, not extended.

Other unusual presentations are also possible. One is a face presentation. The baby’s head is hyperextended so the face comes into the birth canal first. This type of presentation may need to be delivered by Cesarean delivery.

In a shoulder presentation, the shoulder presents first. In a transverse lie, the baby is lying almost as if in a cradle in the pelvis. The baby’s head is on one side of your abdomen, and its bottom is on the other side. The only way to deliver these types of presentation is by Cesarean delivery.

Studies show 30% of all abnormal presentations aren’t detected before labor begins; your risk increases if you’re overweight. Your healthcare provider may order a fetal ultrasound to check your baby’s position toward the end of pregnancy if you’re overweight.

Delivering a Breech Baby. If your baby is breech when labor begins, the chance of problems increases. This has led to debate over the best way of delivering a breech baby. For many years, breech deliveries were done vaginally. Then it was believed the safest method was by Cesarean, especially with a first baby. Today, experts believe a baby in the breech position can probably be delivered more safely by Cesarean delivery before labor begins or during early labor.

Some experts believe a woman can deliver a breech presentation if the situation is right. This usually includes a frank breech in a mature baby if the woman has had previous normal deliveries. Most agree a footling breech presentation (one leg extended, one knee flexed) should be delivered by Cesarean delivery.

If your baby is in an abnormal presentation, your healthcare provider may suggest you get on your hands and knees, with your hips above your heart, then lower yourself onto your forearms. This position may help baby turn into a head-down position.

If you know baby is breech, tell them when you get to the hospital. If you call with a question about labor and have a breech presentation, mention it to the person you talk with.

Turning a Breech Baby. Attempts may be made to turn the baby from a breech to a head-down (vertex) position before your water breaks, before labor begins or in early labor. Using his or her hands, the healthcare provider turns baby into the head-down birth position. This is called external cephalic version (ECV) or just version.

Problems can occur with ECV; it’s important to know about them. Talk with your physician about whether this procedure is an option for you. Possible risks include:

• rupture of membranes

• placental abruption

• affect on baby’s heart rate

• onset of labor

More than 50% of the time, turning baby is successful. However, some stubborn babies shift again into a breech presentation. ECV may be tried again, but version is harder to perform as your delivery date draws closer.

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