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

CHAPTER 11. Month 8: Weeks 29 to 32

At this stage in my pregnancy, I’ve been feeling really good. I usually have motivation and energy for about two days, but by the third day I’m finding that I need to slow down and take it easy or take a nap. I’ve also noticed lately that I feel very stretched and uncomfortable after I eat, even though I’m not full. I found out at a recent appointment that the baby likes to lie horizontal, and that because baby is getting bigger and taking up more room, that may be contributing to the extra-stretched feeling. — Lori

Now that your due date is getting closer, your pregnancy may start to get a little uncomfortable, if it hasn’t already. During month eight you may experience leg cramps, pelvic pressure, increased back pain, swollen ankles and hemorrhoids — all of the stuff that occurs as baby starts growing at a more rapid rate. But these aches and pains are an indication that you’re soon going to see that little miracle.

BABY’S GROWTH

During these last couple of months, your baby is working on the finishing touches — the remaining steps that need to occur before he or she is fully developed.

Week 29 With the major developments finished, baby now starts to gain weight very quickly. As space becomes tighter, you may not feel baby’s sharp jabs and punches as much as you did earlier. Baby is also developing a sleep and wake cycle. During periods of sleep, baby will be quiet.

Week 30 As baby gains weight, he or she is also adding layers of fat. From now until about your 37th week of pregnancy, baby will gain about a half-pound a week. Baby may also begin practicing breathing movements this week by moving his or her diaphragm in a repeating rhythm. These movements may give your baby a case of hiccups. As your baby continues to make these movements, you may occasionally notice a slight twitching in your uterus from baby’s hiccups. It may feel like little spasms.

At 30 weeks into your pregnancy, your baby weighs about 3 pounds and is about 10½ inches long, crown to rump.

Week 31 During week 31, baby’s reproductive system continues to develop. If your baby is a boy, his testicles are moving from their location near the kidneys through the groin on their way into the scrotum. If your baby is a girl, her clitoris is now relatively prominent. However, the labia are still small and don’t yet cover it.

Your baby’s lungs are now more developed, but they’re not yet fully mature. If your baby is born this week, he or she will probably need to stay six weeks or more in a neonatal intensive care unit (NICU) and will need the help of a ventilator to breathe. However, because your baby’s brain is more mature than it was several weeks ago, he or she will be at reduced risk of having bleeding in the brain.

Week 32 Lanugo, the layer of soft, downy hair on your baby’s skin, starts to fall off this week. Baby will lose most of his or her lanugo over the next few weeks. Right after your baby’s birth, you may see some remnants on his or her shoulders or back.

Some women may notice a change in baby’s movements this week, now that he or she has grown to the point of being crowded inside your uterus. Although your baby is moving around just as much, kicks and other movements may seem less forceful. For many women, this change becomes more apparent about week 34.

CHANGES IN BABY’S MOVEMENT

Most pregnant women get to know their baby’s patterns of movement and are attuned to changes in the frequency or intensity of those movements. You may notice a slight decrease in your baby’s activity in the last few days before birth. In late pregnancy, the number of fetal movements you perceive often declines gradually. The baby has less room to move around in the uterus, especially after his or her head drops into the pelvis.

In addition, babies establish movement and sleep patterns as the pregnancy progresses, and you may notice times of increased or decreased activity for periods of one to three hours. Although a baby who isn’t very active in the womb may be perfectly healthy, decreased fetal movement can be a sign that something is wrong. A significant drop in fetal activity in the last trimester of pregnancy may indicate that the baby is in jeopardy, possibly because of umbilical cord or placenta problems.

Self-care for decreased baby movement If you’re concerned about the baby’s activity, take a break from other activities. Sit down and drink a glass of juice or regular — not diet — soda. Concentrate on your baby’s movements. In most cases, you’ll find your baby is more active than you realized. Almost all babies will move at least four times each hour.

When to seek medical help Contact your care provider if you’re worried about a decrease in your baby’s movement. You may be asked when was the last time you felt fetal movement or how many times you felt movement in the last couple of hours. Your care provider may want to check the condition of your fetus. Usually, everything is fine. If a problem is found, it’s possible the baby may need to be delivered early, or other steps may need to be taken. Prompt action can prevent serious problems.

You may want to check on your baby’s movements from time to time, especially if you think you’ve noticed decreased activity. To do this, sit down and keep a tally of how often you feel your baby move. Your baby’s kicks or movements may seem a little muffled, given the space constraints inside your uterus. If you notice fewer than 10 movements in two hours, contact your care provider.

By 32 weeks, your baby weighs about 4 pounds and is almost 11½ inches long, crown to rump. Although no one would welcome the early arrival of your baby, it’s comforting to know that almost all babies born at this age will survive without life-threatening complications.

YOUR BODY CHANGES

This month, your uterus will continue its expansion toward the bottom of your rib cage, creating a new set of physical changes and signs and symptoms. You may also find that you tire more easily.

What’s happening and where One thing you may notice this month is a change in your hair. It may seem fuller and more luxuriant. This is due to a change in your hair’s growth cycle. Normally, hair grows about a half-inch each month for two to eight months. It then goes into a resting phase, stops growing and eventually falls out. During pregnancy, your hair tends to remain in the resting phase longer. Because fewer hairs fall out each day, you have a fuller head of hair.

Once your baby is born, the resting phase will shorten, and you’ll lose hair each day. For a few months, your hair may even feel thinner. It will eventually return to normal.

Heart and circulatory system To meet the demands of your pregnancy, your body is making more blood than normal, and your heart is pumping it faster. Unfortunately, the changes in your circulatory system that support your growing baby may be causing some new and unpleasant side effects for you. As your veins become larger to accommodate your increased blood flow, they may protrude, and you may notice bluish or reddish lines beneath the surface of your skin, particularly on your legs and ankles.

Some pregnant women develop varicose veins, caused by weaknesses in the valves within the veins. They typically show up in the later months of pregnancy, when the veins in your legs have expanded and your uterus has grown to the point that it’s putting increased pressure on the veins. You may also develop spider veins. These tiny reddish spots with raised lines branching out from the center, like spider legs, are another consequence of increased blood circulation. You may notice them on your face, neck, upper chest or arms. They’ll probably disappear a few weeks after your baby is born.

If you’re really unlucky, you may also have hemorrhoids. These are varicose veins in your rectum. They’re caused by increased blood volume and increased pressure from your growing uterus. Constipation increases the risk. Some women develop hemorrhoids for the first time during pregnancy. For others who’ve had them before, pregnancy makes them larger and more troublesome.

In addition, you may notice that your eyelids and face are becoming puffy, mostly in the morning. This, too, is the result of increased blood circulation.

Respiratory system Your diaphragm — the broad, flat muscle that lies under your lungs — is now pushed up and out of its normal place by your expanding uterus. As a result, you’re probably feeling short of breath, as if you just can’t get enough air. This may be a bit disconcerting for you, but there’s no need to worry about your baby. Your lung capacities may be rearranged, but you’re breathing more deeply. With each breath, you’re taking more air into your lungs than you did before you were pregnant.

Breasts Your breasts continue to grow this month. Although it may feel at times as though you’re carrying all of your extra weight in your breasts, that’s not the case. Over the course of your pregnancy, your growing breasts will account for about 1 to 3 pounds of the weight you gain. Only a small portion of this extra weight will be from fat. The majority of the weight you gain in your breasts will come from enlarged milk-producing glands and increased blood circulation.

Since the beginning of the pregnancy, your pituitary gland has been making prolactin, one of the hormones that prepares and stimulates the production of milk from the glands of your breasts. Over the next couple of weeks, you’ll begin to make colostrum. Colostrum is the protein-laden substance that nourishes your baby during his or her first few days of life. If you haven’t yet started to leak colostrum from your breasts, you may this month. However, some women don’t leak any colostrum during pregnancy. Don’t view it as a sign that you won’t be able to make milk for your baby.

Uterus Your uterus may continue to practice for labor and delivery by producing false labor (Braxton Hicks contractions). Remember, false labor contractions are sporadic, while true labor contractions follow a progressive pattern. They get progressively longer, stronger and closer together. If you’re having contractions that concern you, contact your care provider, especially if they’re painful or if you have more than five in an hour.

WATCHING OUT FOR PRETERM LABOR

The risk of preterm labor continues this month. Here’s a reminder of the signs and symptoms to watch for:

 Uterine contractions — possibly painless — that feel like a tightening in your abdomen

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

 Changes in vaginal discharge, such as light spotting or bleeding, watery fluid leaking from your vagina or a thick discharge tinged with blood

If you notice more than six contractions in an hour that last at least 45 seconds, contact your care provider or your hospital, even if the contractions aren’t painful. This is especially important if you have vaginal bleeding along with abdominal cramps or pain.

Urinary tract Given the increased pressure of your growing uterus on your bladder, don’t be surprised if you leak urine this month, especially when you laugh, cough or sneeze. This is one of the most annoying side effects of pregnancy, but it won’t last forever. It generally disappears after baby is born.

You continue to be at risk of developing a urinary tract infection. If you’re urinating more often than normal, experiencing burning on urination, or have a fever, abdominal pain or backache, contact your care provider. These could be signs and symptoms of urinary tract infection and shouldn’t be ignored.

Vagina If you have bright red bleeding from your vagina at any time this month, contact your care provider immediately. The bleeding could be a sign of placenta previa, a condition in which the placenta partially or completely covers the opening of the cervix and tears away from the cervix as your uterus expands (see placenta previa in Chapter 27). This condition is a medical emergency. Most often, placenta previa is diagnosed early in the pregnancy during an ultrasound exam.

Bones, muscles and joints In your pelvic area, the joints between the bones are becoming more relaxed. This is a necessary preparation for childbirth, but it may be causing hip pain, probably just on one side. Low back pain resulting from your growing uterus may be adding to your discomfort.

Your growing uterus may also be putting pressure on your two sciatic nerves, which run from your lower back down your legs to your feet. This may cause pain, tingling or numbness running down your buttocks, hips or thighs — a condition called sciatica. Sciatica is unpleasant, but it’s temporary and generally not serious.

Skin The skin across your abdomen may be dry and itchy from all of the stretching and tightening. About 20 percent of pregnant women have itchiness on their abdomens or all over their bodies. If your itching is severe and you have reddish, raised patches on your skin, you may have a condition called PUPPP, which stands for pruritic urticarial papules and plaques of pregnancy. PUPPP usually appears first on the abdomen and then spreads to the arms, legs, buttocks or thighs. Scientists aren’t sure what causes PUPPP, but it tends to run in families. It’s also more common among women who are pregnant for the first time and among women who are carrying twins or other multiples.

You may also notice pink, reddish or purplish indented streaks on the skin covering your breasts, abdomen, or perhaps even upper arms, buttocks or thighs. These are stretch marks. Contrary to popular belief, stretch marks aren’t necessarily related to weight gain. They seem to be caused, quite literally, by a stretching of the skin, coupled with a normal increase in the hormone cortisol, which may weaken the elastic fibers of your skin. Scientists think your genes play the biggest role in determining whether you’ll get stretch marks.

There’s nothing you can do to prevent stretch marks. Because they develop from deep within the connective tissue under your skin, applying creams or ointments to your skin will have no effect. With time, they should fade to light pink or grayish stripes, but it’s unlikely that they’ll completely disappear.

Weight gain You’ll probably gain about a pound a week this month, for a total of about 4 pounds. As the month progresses, you may notice some burning, numbness, tingling or pain in your hands. These are symptoms of carpal tunnel syndrome, a consequence of weight gain and swelling in pregnancy that affects some pregnant women.

With the extra weight and fluid in your body, the nerve inside the carpal tunnel in your wrist can become compressed, causing the telltale carpal tunnel symptoms, which should disappear after baby is born.

FINDING A COMFORTABLE SLEEP POSITION

As your belly continues to grow, you may find sleep becomes more difficult. In addition to heartburn and back pain, which can affect sleep, finding a comfortable sleep position gets tougher. Sleeping facedown is no longer possible. Sleeping on your back isn’t comfortable either because all of the weight of your uterus rests on your spine and back muscles. In addition, lying on your back generally isn’t recommended in later pregnancy because doing so may compress major blood vessels.

The best sleep position at this point is on your side. The left side is preferable to allow for maximum blood flow, but either side is fine. You may find the most comfortable position is to lie on your side with your knees bent and a pillow between your knees. Some women also like to place a pillow under their abdomen. Or, you might try a full-body pillow.

Few people remain in the same sleep position all night long so, if you wake up and find yourself lying on your back, don’t panic. You haven’t done anything to harm your baby. Just roll back onto your side and try to fall asleep.

YOUR EMOTIONS

In just a few weeks, you’ll be responsible for a new human being. As a result, you may feel more anxious than ever, especially if this is your first child.

Handling anxiety To help keep anxiety at bay, review some of the decisions that need to be made before your baby is born.

 Is your baby going to see a pediatrician or a family doctor?

 Are you going to breast-feed or use formula?

 If your baby is a boy, are you going to have him circumcised?

Taking stock of where you stand on these issues will help you feel more in control of the situation. Plus, it will make your new responsibilities seem less daunting once baby arrives.

In addition, the natural anticipation you’re feeling about your baby’s arrival may make it difficult for you to get to sleep or to sleep through the night. If you’re feeling restless or anxious at night, try some of the relaxation exercises you learned in your childbirth classes. They may help you rest, and doing them now will be good practice for the big event.

PRENATAL CHECKUP

This will likely be your last monthly visit to your care provider. Beginning next month, you’ll likely see your care provider more frequently — every two weeks at first, and then once a week until your baby is born. During this month’s prenatal visit, your care provider will again check your blood pressure and weight and ask you about any signs and symptoms you may be having. He or she may also ask you to describe your baby’s movements and activity schedule — when baby is active and quiet. As with other prenatal appointments, your care provider will track baby’s growth by measuring your uterus.

BABY GEAR ESSENTIALS

Now for some fun. It’s time to go shopping, if you haven’t already! You will spend a lot of time over the next few weeks purchasing items for your baby. Chances are, you’ve already bought some things. As you walk down the store aisles, the anticipation and excitement of having a little boy or girl to dress up and play with is more than you can bear — and it’s hard not to buy something. You simply can’t resist!

There are a couple of items, though, you want to pay attention to when you purchase them. That’s because for these items, safety is key. Make sure that you’re purchasing baby gear that’s designed specifically to keep your baby as safe as possible.

Buying a car seat One of the most important pieces of baby equipment is a car seat, which you’ll use right away, starting with your baby’s first ride home from the hospital. Car seats are required by law in every state, and correct and consistent use of them is one of the best ways that parents can protect their children. It’s never safe to hold an infant or child on your lap in a moving vehicle. And an infant must never ride in the front seat of a vehicle that has passenger air bags.

The safest place for all children to ride is in the back seat. And it’s critical that the car seat be installed so that it’s rear-facing, which is the only safe position for infants in cars. In a collision, a forward-facing baby is at greater risk of head and neck injuries because the head may be thrown forward.

Types of car seats There are two types of car seats for infants: infant-only seats and convertible seats, which accommodate both babies and toddlers.

Infant-only seats. These car seats are designed for babies who weigh up to about 20 pounds, depending on the seat. They’re best for newborns, and they may be the best fit for premature infants. Many models come with a detachable base, which allows you to carry your baby in and out of the car in the car seat without having to reinstall the base. The base attaches to the car, and the car seat easily snaps into the base.

Infant-only car seats come with a five-point harness, which provides the best protection. The harness is made of straps that secure your baby into the seat. The harness straps come over the infant’s shoulders, across each hip and through the crotch area, and are buckled in place. If you have an older car seat that has a three-point harness, you can use it as long as your child fits properly in the restraint. Smaller infants cannot be securely restrained in a three-point harness.

Infant-only seat

Convertible seats. These are bigger and heavier than infant-only seats, and they can be used for children until they reach at least 40 pounds. All convertible car seats manufactured today come with five-point harnesses. Although you’ll save some money using a convertible seat, an infant-only seat may be easier to use and may fit a newborn better.

Convertible seat

Choosing a car seat How do you know which car seat to buy? The best car seat is one that fits your child’s age, weight and height, can be installed correctly, and has easy-to-use features.

When you’re shopping, look at several different models. When you find a seat you like, try it out. Try adjusting the harnesses and buckles. Be sure you understand how to use it. If possible, try installing the car seat in your vehicle before you buy it.

A car seat with upholstered fabric may be more comfortable for your baby. Today’s car seats cater to most every possible taste: plain colors, plaids and animal motifs. Keep in mind that babies are messy, so washable fabric is a plus, if not a must. Some upholstery requires hand-washing and line drying. If this is the case, make sure you don’t have to pretty much dismantle the car seat in order to get the fabric off.

Some other key features to look for when purchasing a car seat include:

 Wide, twist-free straps. A twisted strap is less effective in restraining a child in a crash.

 Two-piece chest clips. They help protect your child and are difficult for a child to detach.

 Front-harness adjustments. Some car seats have a mechanism in the front that adjusts the tightness of the harness.

 Head-impact protection. Most car seats have an added layer of foam or special plastic to improve head protection in case of an accident. The foam or plastic is recessed into the shell of the car seat around the head.

Avoiding common mistakes Here are some common mistakes that parents often make when it comes to car seat safety, and how to avoid them.

 Buying a used car seat without researching its history. If you’re considering a used car seat, make sure the car seat meets safety standards, comes with instructions, hasn’t been recalled, hasn’t been in an accident, and has no visible cracks or missing parts. If you don’t know the car seat’s history, don’t use it.

 Placing the car seat in the wrong spot. The safest place for your baby’s car seat is the back seat, away from active air bags. If the air bag inflates, it could hit the back of a rear-facing car seat — right where your child’s head is — and cause a serious or fatal injury. Placing a car seat next to a door with a side air bag may not be appropriate either. If you’re only putting one car seat in the back seat, place the car seat in the center of the seat.

 Incorrectly buckling up your child. Before you install the seat, read the manufacturer’s instructions. Make sure the seat is tightly secured — allowing no more than one inch of movement from side to side or front to back — and facing the correct direction. Take time to secure your child in the seat correctly. Place the harness or chest clip even with your child’s armpits — not at the abdomen or neck.

 Improperly trying to keep your child upright. Recline the car seat back according to the manufacturer’s instructions, usually a 45-degree angle. This is so that your newborn’s head doesn’t flop forward on impact in case of an accident.

 Moving to a forward-facing car seat too soon. As your child gets older, resist the urge to place your child’s car seat in the forward-facing position so that you can see his or her face in your rearview mirror. Riding rear-facing is generally recommended until a child reaches 30 to 40 pounds.

 Using the car seat as a replacement crib. Remember that a car seat isn’t a crib. A 2009 study showed that sitting upright in a car seat may compress a newborn’s chest and can lead to reduced levels of oxygen. Although it’s essential to buckle your child into a car seat during travel, don’t let your child sleep in or relax in a car seat for long periods of time when you’re out of the car.

Buying a crib Because your newborn will spend at least half of his or her time sleeping, where you put your son or daughter to sleep is no small matter. Accidents can happen if an infant is placed in an unsafe crib. When purchasing or borrowing a crib, make sure that it meets safety guidelines from the Consumer Product Safety Commission and the American Academy of Pediatrics.

By June of 2011, cribs with drop sides will no longer be sold in the United States. The Consumer Product Safety Commission recently voted to implement a new federal crib safety standard that no longer allows the traditional drop-side crib design.

Dozens of infant deaths in the United States over the past decade have resulted from drop-side cribs. The design of these cribs can cause babies to become entrapped and suffocate.

Some couples also purchase a portable crib or a playpen for traveling. If you do so, keep in mind that portable cribs aren’t subject to the same federal safety requirement as permanent cribs. Therefore, it’s important to examine the unit carefully to make sure it is safe.

Crib safety Make sure your crib meets these requirements:

 The mattress should be firm and tightfitting so that baby can’t get trapped between the mattress and the crib. If you can fit two fingers between the mattress and the side of the crib, the crib shouldn’t be used. Use only a fitted bottom sheet made specifically for crib use.

 There should be no missing, loose, broken or improperly installed screws, brackets, or other hardware.

 The crib’s slats should be no more than 2⅜ inches apart — about the width of a soda can.

 The corner posts shouldn’t be over  inch high so a baby’s clothing can’t catch.

 There should be no cracked or peeling paint. All surfaces should be covered with lead-free paint.

 Use a baby sleeper instead of a blanket.

 Don’t put pillows, quilts, comforters, sheepskins, pillow-like bumper pads or pillow-like stuffed toys in the crib. They can lead to suffocation.

 Hanging crib toys should be out of the baby’s reach.

Buying a baby carrier Infant carriers allow you to keep your baby nestled close to your body while your hands are free for other activities. A variety of carriers are available, including front carriers, slings and back carriers. Front carriers and slings are especially useful the first several months. By the time your baby is 15 to 20 pounds, he or she may be too heavy to carry this way. Back carriers are best used when baby is older and better able to support himself or herself.

A front carrier consists of two shoulder straps supporting a deep fabric seat. A sling is a wide swath of fabric worn across your torso and supported by a shoulder strap. Some parents find slings to be cumbersome, while others love them.

Carrier safety When choosing a baby carrier, look for these features:

 You want a carrier that holds and supports your baby securely. Look for padded head support.

 Make sure the carrier is comfortable for both you and your baby. Look for wide padded shoulder straps, a padded waist or hip belt, adjustable straps and leg holes that aren’t too tight. Make sure a sling isn’t so large that your baby gets lost in it.

 Is it easy to use? Make sure you can easily slip the carrier on and off.

 Select a carrier with a fabric that’s durable and easy to clean. Cotton is a good choice because it is warm, soft and washable.

 Choose a carrier that allows the baby to face both inward and outward.

 Look for a carrier with pockets or zippered compartments, which are handy for storing frequently used items.