Mayo Clinic Guide to a Healthy Pregnancy: From Doctors Who Are Parents, Too!

CHAPTER 10. Month 7: Weeks 25 to 28

During the “honeymoon” stage of our pregnancy, we knew virtually nothing about babies. So we studied. A lot. I memorized a chart describing different baby cries so I would know when baby was hungry, had a dirty diaper or was just plain bored. I could tell you the difference between types of diaper rashes before I even changed a diaper. I’m ashamed to say that what brand of stroller I had really mattered to me. All the hip moms had it, and I wanted one. Plus a cool diaper bag and baby carrier. Now, I don’t remember half of the stuff we actually got. You can guess where all this is leading, I’m sure. Your child cares not a lick about your hip stroller or funky, awesome changing pad. If you want to get them, fine. But they’re for you. Your baby only needs to be comfortable, well-fed and most of all, loved. — Patty

You are now on the home stretch — the last three months (actually three and a half months) of your pregnancy. And, the word stretch is appropriate! These are the months that your baby will grow in size by measurable amounts and, yes, your tummy will stretch.

BABY’S GROWTH

This month, your little boy or girl will add more body fat, which will make his or her skin look more smooth and less wrinkled. The skin will also begin to take on a little more color.

Week 25 At this time, your baby’s hands are now fully developed, complete with miniature fingernails and the ability to curl his or her fingers into a tiny fist. This week, he or she is probably using these hands to discover different body parts. Your little one is exploring the environment and structures inside your uterus, including the umbilical cord. The nerve connections to your baby’s hands have a long way to go, however. If she or he wants to grasp a big toe, success will be an accident.

Week 26 Your baby’s eyebrows and eyelashes are now well formed, and the hair on his or her head is longer and more plentiful. Your baby still looks red and wrinkled, but more fat is accumulating under the skin with each passing day. As your baby continues to gain weight over the next 14 weeks until birth, this wrinkly suit of skin will become a better fit.

Your baby’s footprints and fingerprints are now formed. And all the components that make up the eyes have developed, but your baby probably won’t open his or her eyes for about two more weeks. By 26 weeks, your baby weighs between 1½ and 2 pounds.

Week 27 By the 27th week, your baby looks like a thinner, smaller, redder version of what he or she will look like at birth. Baby’s lungs, liver and immune system aren’t yet fully mature, but they’re getting close. If birth were to occur this week, your baby’s chances of survival would be at least 85 percent.

Baby may start recognizing your voice this week, as well as your partner’s. But it’s probably a little hard to hear clearly, given that his or her ears are covered with vernix, the thick, fatty coating that protects the skin from becoming chapped or scratched. It’s also hard for your baby to hear through the amniotic fluid in your uterus — similar to the difficulty in hearing under water.

At 27 weeks, baby is now three to four times as long as he or she was 12 weeks into your pregnancy.

Week 28 Your baby’s eyes, which have been sealed shut for the last few months, may begin to open and close this week. If you could sneak a peek at your baby this week, you might be able to determine the color of his or her eyes. But many times baby’s eyes change in color during the first six months of life, especially if his or her eyes are blue or gray-blue at birth. So, the color they are now may not reflect what they’ll be in life.

Your baby’s brain also continues to develop and expand rapidly this week. In addition, he or she continues to accumulate layers of fat underneath the skin.

Your baby is now sleeping and waking on a regular schedule, but this schedule isn’t like that of an adult or even of a newborn. Baby probably sleeps for only 20 to 30 minutes at a time. You’re most likely to notice baby’s movements when you’re sitting or lying down.

By the 28th week of your pregnancy, the end of your seventh month, your baby is about 10 inches long, crown to rump, and weighs about 2 pounds.

YOUR BODY CHANGES

As you watch your stomach get bigger, you may wonder if there’s any room left for your womb to grow. Yes, there is — it’s amazing what the body can do.

What’s happening and where This month your uterus will expand to midway between your navel and breasts. Your baby will become increasingly active, especially in the second half of the month.

Heart and circulatory system Your blood pressure may begin to increase, returning to where it was before you became pregnant. In addition, you may experience episodes of fluttering or pounding in your chest — as if your heart has skipped a beat. As you uterus enlarges, it may impede the return of blood to your heart. This sensation may worry you but it usually doesn’t signify anything serious, and it often lessens later in pregnancy. Still, if you experience this feeling, tell your care provider, especially if you also have chest pain or shortness of breath.

Respiratory system Your lung capacity continues to increase this month, stimulated by the hormone progesterone. This respiratory change allows your blood to carry in more oxygen and carry out more carbon dioxide than normal. As a result, you may continue to breathe slightly faster and experience some shortness of breath.

Digestive system The movement of food through your digestive system remains slow, and your expanding uterus continues to crowd and press on your intestines. As a result, you’ll likely continue to experience heartburn or constipation or both.

Breasts You may notice the development of tiny, bump-like skin glands encircling your areolas. This is another way that your body is preparing for breast-feeding. When the time comes, these glands will secrete oils to moisturize and soften the skin around your nipples and areolas. This helps keep your nipples from cracking and chafing as you breast-feed.

Uterus This month your uterus will reach the midway point between your navel and breasts. Eventually, it will occupy the area from your pubic bone to the bottom of your rib cage.

Baby will likely become more active this month, particularly in the second half of the month. For many babies, their most active time is between 27 and 32 weeks. They are now big enough to pack a punch, and they still have room to do so. With the increased activity, you may have trouble telling the difference between false contractions, true contractions and your baby’s kicks or punches. Remember a couple of things. False labor contractions (Braxton Hicks) have no predictable rhythm. They vary in length and strength and occur irregularly. True labor contractions follow a pattern — they get longer, stronger and closer together. If you’re having contractions that concern you, contact your care provider.

Urinary tract Your urine flow continues to be slow this month, due to your expanding uterus and relaxed muscles in the tubes carrying urine from the kidneys to the bladder (ureters). As a result, you’re at continued risk of developing a urinary tract infection. If you’re urinating more frequently and also experiencing burning, pain, fever, or a change in the odor or color of your urine, you may have an infection. Contact your care provider.

Bones, muscles and joints The ligaments supporting your pelvic bones become even more elastic this month. Ultimately, this will make it easier for your pelvis to expand during childbirth so that your baby can pass through. Now, however, lack of usual support from these ligaments increases your risk of back strain. Joints in your pelvis may hurt with this newfound flexibility as well. The pain is in the middle-front of your pelvis or on either side of the midline of your back.

Vagina Vaginal discharge may increase. If it’s thin and white with little or no odor, there’s no cause for concern.

Weight gain This month you’ll probably continue to gain around a pound a week, for a total of about 4 pounds. Most of the weight you’re gaining is not fat. It stems from baby weight gain, an increasing placenta, additional amniotic fluid and fluid accumulation in your body tissues.

YOUR EMOTIONS

From now until the day your baby arrives is an exciting time, but it can also be a bit stressful. You may be busy purchasing supplies, finishing baby’s room, attending childbirth classes and making more- frequent visits to your care provider. Plus, the last three months of pregnancy can bring new physical demands on your body.

Enjoy a little break Slow down, sit back, and relax — while you can. Make an effort to enjoy this month of your pregnancy — before the craziness and discomforts of the final months begin. You might even write down your thoughts in a journal, play soft music or talk soothingly to your baby. Take photos so that you can show your baby what you looked like when he or she was “under construction.” Do whatever works for you to revel in the emotions and sensations of being pregnant.

LOSING YOUR PERSONAL SPACE

There are some interesting things that happen to you when you’re pregnant. Personal boundaries seem to melt away. You have no more personal bubble. Your belly is fair game for everyone from your great aunt May to the greeter at Walmart.

I myself never had a problem with any family member giving my tummy a rub or pat. It was when people outside of the family reached for it that I cringed. I have to admit that with 9 and 10 pound babies, my tummy made a tempting target. I got very good at noticing the telltale signs: rapidly approaching, hands outstretched, the words “Oh you don’t mind …,” uttered with a smile after the stranger’s hands were already patting my tummy. I would try to get my hands on my tummy first and block the planned assault. Rarely was I successful. The little old ladies were the fastest of them all, I think.

Another amazing phenomenon is the loss of discretion or sensitivity for your feelings. This takes different forms and the results are not nice. It causes people, friends, family, neighbors and complete strangers to comment on how big you are or aren’t. They ask if you’re having twins because you’re so big. This loosening of tongues and sensitivities causes some people to feel free to comment on the amount of weight they think you’ve gained.

The third part to this unique experience is the one that baffles me the most. This is where all the women you know — and some you don’t — tell you all the horrible experiences they or a friend of theirs had, or a relative had.

We are so vulnerable, especially with our first baby, and yet these well-meaning women strike terror into our souls with tales of 92-hour labors, epidurals that paralyzed them for two days, and bottoms that were never the same after episiotomies or stitches. Let me not forget a subset of this group, the women who tell you how painful, uncomfortable and time-consuming breast-feeding is.

I, of course, have recommendations. Look at the woman talking to you. Does she have only one child? Is she still breast-feeding her 9-month-old? Don’t believe everything you hear. Take everything with a grain of salt. My strongest recommendation to everyone is don’t become one of these people. If you feel the phenomena starting to suck you in, resist!


Mary,

Mother and Mayo Clinic nurse midwife

PRENATAL CHECKUP

At this month’s visit, your care provider may be able to tell you whether your baby is positioned headfirst or feet- or rump-first in your uterus. Babies in the feet- or rump-first position are in what’s called the breech position. However, your baby still has lots of time to change position and probably will. So don’t be worried if you hear your baby is lying breech.

At this point in your pregnancy, you need to be alert to the possibility of preterm labor — contractions that begin opening (dilating) your cervix before the end of the 37th week. Babies born this early usually have a low birth weight — less than 5½ pounds — which can put them at risk of health problems. Signs and symptoms of preterm labor include:

 Uterine contractions that feel like abdominal tightening

 Contractions accompanied by low back pain or a feeling of heaviness in your lower pelvis and upper thighs

 Light spotting or bleeding, watery fluid leaking from your vagina, or thick discharge tinged with blood

At this month’s checkup, you may also have a glucose challenge test to check for gestational diabetes, a temporary form of diabetes that develops in some women during pregnancy. In addition, if you’re rhesus (Rh) factor negative, you’ll likely be tested for Rh antibodies and may receive your first injection of Rh immunoglobulin (RhIg).

Glucose challenge testing Glucose challenge testing is usually done sometime during weeks 24 through 28 of your pregnancy, although your care provider may perform the test earlier if risk factors warrant it. For this test, you drink a full glass of a glucose solution, and then after about an hour, blood is drawn from a vein in your arm so that your blood glucose level can be checked. If the results are abnormal, you’ll likely have to come back for a second test.

If you need the second test, you’ll be asked to fast overnight. When you arrive at your care provider’s office, you’ll drink another, more concentrated glucose solution. Over the next three hours, your blood will be drawn several times, yielding several different blood glucose measurements. Among women whose first glucose test result was abnormal, studies show that only a small percentage are diagnosed with gestational diabetes after follow-up testing.

If you are diagnosed with gestational diabetes, you’ll need to carefully control your blood glucose for the remainder of your pregnancy so that your baby doesn’t become too large. You’ll also need to have your blood glucose checked regularly.

Rh antibodies testing Rh factor is a type of protein found on the surface of red blood cells. More than 85 percent of people have it and are known to be Rh positive. Those who don’t have it are Rh negative.

When you’re not pregnant, your Rh status has no effect on your health. During pregnancy, if you’re Rh positive, there’s no cause for concern. But if you’re Rh negative and your baby is Rh positive — which can happen if your partner is Rh positive — a problem called Rh incompatibility may result.

If you are Rh negative, this month you may receive an injection of Rh immune globulin (RhIg). This injection is like an insurance policy. The RhIg coats any Rh positive cells that may be floating around in your bloodstream, preventing them from being recognized as foreign. With no Rh factor to fight, antibodies won’t form. Think of it as a pre-emptive strike against the formation of Rh antibodies.

THE BREAST OR BOTTLE QUESTION

If you haven’t come to a decision already, it’s probably time to think about how you plan to feed your baby, once he or she is born. Clearly, breast-feeding is the optimal way to nourish a newborn — it provides numerous benefits. And Mayo Clinic experts encourage you to breastfeed. However, depending on your circumstances, certain factors may lead you to consider formula-feeding.

A tough decision for some women Some women know right from the start what they’ll do — breast-feed or bottle-feed — while others struggle. If you’re one of those women who aren’t certain whether to breast-feed or bottle-feed with formula, now is a good time to do some research and explore your options. It’s better if you know ahead of time what your plans are, rather than making that decision once you have your child.

If you think you prefer to formula-feed your children, at least learn about breast-feeding and its benefits before solidifying your decision. Chapter 22 of this book is a wonderful resource for learning more about your options. The chapter covers a variety of issues and topics related to breast-feeding. It also provides information on formula-feeding.

For some women who prefer formula-feeding, their decision to forgo the breast for the bottle can bring tremendous feelings of guilt. They may feel that they’re not being good mothers or putting the needs of their children first. If you’re among this group, such negative thinking isn’t good for you — or for your baby. Don’t shower yourself in guilt. The best thing you can do is read about both methods of feeding, and then be comforted knowing that you made an informed decision.

If after reading through Chapter 22, you’re still undecided about what to do, here’s a suggestion: Give breast-feeding a try. If you’re able, try to breast-feed for a few weeks. If it doesn’t work for you, you can always stop and switch to a bottle. This way, you’ll have the satisfaction of knowing that you gave it a shot. And who knows, maybe the experience will be very different from what you imagined.

Breast-feeding is a wonderful way to bond with your baby and it has been scientifically proven to enhance your baby’s emotional well-being. Certainly, you can lovingly bond with your baby without breast-feeding, but you will be giving up a valuable tool toward that end.

QUESTION & ANSWER

Are sagging breasts inevitable after breast-feeding? I’m worried about the toll breast-feeding may take on my breasts.

It’s normal to wonder how breast-feeding will affect your breasts, but take heart. Research has shown that breast-feeding doesn’t negatively affect breast shape or volume.

Still, sagging breasts are a concern. During pregnancy, the ligaments that support your breasts may stretch as your breasts get fuller and heavier. This stretching may contribute to sagging breasts after pregnancy — whether or not you breast-feed your baby. Sagging breasts may be more noticeable with each subsequent pregnancy, especially if you have large breasts. Other factors also contribute to sagging breasts, including aging and smoking — both of which reduce skin elasticity. Being overweight can have a similar effect.

Remember, breast milk is the ideal food for most babies. Don’t let a fear of sagging breasts stop you from breast-feeding. To maintain the appearance of your breasts at any stage of life, make healthy lifestyle choices. Include physical activity in your daily routine. Eat a healthy diet. If you smoke, ask your doctor to help you quit.