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

CHAPTER 12. Month 9: Weeks 33 to 36

My wife and I are having a baby quite late: I am 41 years old and she is 36. I worry about the physical changes my wife is going through, and I am sorry that she has to endure the discomforts that come with the pregnancy. On the other hand, it is great to see via the ultrasounds that the baby is growing, or to feel with my hand the baby kicking through her belly. This helps me realize that this is for real. Perhaps it is good that the pregnancy lasts 10 months, because it gives us some time to get ready for the arrival of this new member in our family. — Sylvaine

This can be a busy month as you prepare your home, your life and yourself for a new baby. It can also be a long month. The anticipation is tormenting you — and so are your back, feet and most everything else! The discomforts of late-stage pregnancy may now reach their peak. But keep in mind that your perseverance and patience are soon about to pay off.

BABY’S GROWTH

These days baby is gaining weight almost as quickly as you are, putting on about a half-pound a week.

Week 33 The next four weeks will be a period of extraordinary growth. Next month, as your pregnancy approaches term, weight gain will occur a bit more slowly. At week 33, baby is almost fully developed. The pupils of his or her eyes can now constrict and dilate in response to light. Your baby’s lungs are much more completely developed, which allows for greater optimism if he or she is born this week. Will their birth isn’t yet welcome, most babies born at this age will be healthy.

Week 34 The white, waxy coating protecting your baby’s skin (vernix) thickens this week. When your baby is born, you may see traces of vernix firsthand, especially under your baby’s arms, behind the ears and in the groin area. At the same time, the soft, downy hair that has grown on the skin for the past several months (lanugo) is now almost completely gone.

At 34 weeks into your pregnancy, your baby weighs about 5½ pounds and is about 12½ inches long from his or her crown to rump.

Week 35 Baby continues to pack on the pounds, accumulating fat all over his or her body, especially around the shoulders. Your baby’s most rapid period of weight gain will occur over the next three weeks, with weekly gains of up to a half-pound. Given the crowded conditions inside your uterus, you may feel fewer of your baby’s movements this week. Crowding may make it harder for this bigger, stronger baby to give you a punch, but you’ll probably feel lots of stretches, rolls and wiggles.

Week 36 During week 36, your baby continues to add more fat underneath his or her skin. If you could sneak a peek at your baby this week, you’d see an infant you could almost describe as plump, with a little but fully rounded face. The fullness of your baby’s face is the result of recent fat deposits and powerful sucking muscles that are fully developed and ready for action.

At 36 weeks into your pregnancy, the end of your ninth month, your baby weighs about 6 pounds or a little more.

YOUR BODY CHANGES

Your baby is big and may be disturbing your sleep. Your muscles are sore from carrying this large bundle. Put it all together, and you’re probably feeling tired most of the time. If you’re worn out, take a break. Rest and relax with your feet up. Fatigue is your body’s way of telling you to slow down.

What’s happening and where Your body is working hard this month to prepare for labor and delivery.

Respiratory system Because your diaphragm is pushed upward, you may continue to feel like you can’t get enough air. If your baby drops lower into your uterus and pelvis this month, as some do, breathing may get a little easier.

Breasts The milk-producing glands inside your breasts continue to grow. Tiny oil-producing glands that moisturize the skin around your nipples and areolas may be more noticeable now.

Uterus This month, baby will settle into position inside your uterus, getting ready to make his or her grand entrance. If your baby is in the proper position, as most are — his or her head is down, with arms and legs pulled up tightly against the chest — you’re ready to go.

You may actually feel your baby drop this month, settling deeper into your pelvis in preparation for delivery. This is what’s known as lightening, although that’s a somewhat misleading term. Although your upper abdomen may feel relief, that’s usually more than compensated for by increased pressure in the pelvis, hips and bladder.

Some women, especially first-time moms, experience lightening several weeks before delivery. Others experience it the day labor begins. It’s hard to say when your baby will drop in the pelvis or if you’ll notice it when it happens.

Digestive system If your baby drops this month, you may notice an improvement in some of your gastrointestinal problems, such as heartburn or constipation. However, not all women experience this so-called ‘lightening.’ As baby grows, he or she may continue to press under your ribcage as he or she descends down the birth canal.

Urinary tract If your baby drops this month, your urinary problems are likely to intensify. As your baby moves deeper into your pelvis, you’ll feel more pressure on your bladder. Suffice it to say that you’ll become very familiar with the bathroom. In the final weeks of your pregnancy, you may wake up several times a night just to urinate. This all will most likely disappear soon after your baby is born.

Bones, muscles and joints The connective tissues in your body continue to soften and loosen in preparation for labor and delivery. This may be especially noticeable in your pelvic area. You may feel as if your legs are becoming detached from the rest of your body — for the record, they’re not.

Don’t give up your exercise program, but be careful about exercising this month. Given all the softening and loosening going on, it’s easy to suffer a muscle or joint injury.

You may continue to have hip pain or low back pain caused by your growing uterus. You may also experience sciatic pain — tingling or numbness in your buttocks, hips or thighs caused by the pressure of your uterus on your sciatic nerves. As baby drops into the pelvis this pain may let up.

Vagina Your cervix may begin to dilate this month. Dilation can begin weeks, days or hours before labor begins. Or your cervix might not dilate at all before labor. Every woman is different. During dilation, you may feel a sharp, stabbing pain in your vagina. This doesn’t mean that you’re in labor. The cause of this pain isn’t well understood, but it doesn’t pose a threat to you or your baby. Vaginal pain late in pregnancy usually isn’t anything to be concerned about, but tell your care provider if you have a lot of discomfort.

You’ll almost certainly have some contractions (labor pains) this month. It’s possible they won’t bother you at all, and you may not even notice them. If you do feel cramps at the same time as your uterus seems to tighten and get hard, pay attention to how regular and frequent the contractions are. Practice, or false, contractions are unpredictable, and even when frequent, they don’t settle into a regular rhythm. The contractions of true labor are frequent — five minutes apart or closer — and are repeated at regular intervals.

Skin Some pregnancy-induced skin changes that may become more apparent this month include:

 Varicose veins, particularly on your legs and ankles

 Vascular spiders, especially on your face, neck, upper chest or arms

 Dryness and itching on your abdomen or all over your body

 Stretch marks on the skin covering your breasts, abdomen, upper arms, buttocks or thighs

Many of these changes will fade or disappear after your baby is born. Some evidence of stretch marks will likely remain, although they usually fade to grayish stripes.

Weight gain This is a weight-producing month. You’ll probably gain about a pound a week this month, for a total of about 4 pounds.

PREPARING YOUR BODY FOR LABOR

In addition to your monthly exercises, here are a couple of other exercises that can help you prepare for labor. These exercises concentrate on the muscles that will receive the most stress during labor and delivery.

Kegel exercises The muscles in your pelvic floor help support your uterus, bladder and bowel. Toning them by doing Kegel exercises will help ease your discomfort during the last months of your pregnancy and may help minimize two common problems that can begin during pregnancy and continue afterward: leakage of urine and hemorrhoids. Strengthening your pelvic floor muscles appears to reduce your risk of developing urinary incontinence, both during and after pregnancy.

How to do them Identify your pelvic floor muscles — the muscles around your vagina and anus. To make sure you’ve found the right muscles, try to stop the flow of urine while you’re going to the bathroom. If you stop it, you’ve found the right muscles. Don’t make this a habit, though. Doing Kegel exercises while urinating or when your bladder is full can actually weaken the muscles. It can also lead to incomplete emptying of the bladder, which can increase your risk of developing a urinary tract infection.

If you’re having trouble finding the right muscles, try a different technique. Place a finger inside your vagina and feel your vagina tighten when you squeeze. The muscles you squeezed are your pelvic floor muscles.

Once you’ve identified your pelvic floor muscles, empty your bladder and get into a sitting or standing position. Then firmly tense your pelvic floor muscles. Do this at frequent intervals for five seconds at a time, four or five times in a row. Work up to where you can keep the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions. Do three sets of 10 Kegel exercises throughout the day, and also do three sets of mini-Kegels. Count quickly to 10 or 20, contracting and relaxing your pelvic floor muscles each time you say a number.

While you’re doing Kegel exercises, don’t flex the muscles in your abdomen, thighs or buttocks. This can actually worsen the muscle tone of your pelvic floor muscles. And don’t hold your breath. Just relax and focus on contracting the muscles around your vagina and anus.

Perineal massage Massaging the area between your vaginal opening and anus (perineum) in the last weeks before labor may help to stretch these tissues in preparation for childbirth. This may help minimize stinging when your baby’s head emerges from your vaginal opening. It may even help you avoid the need for an incision in your perineum that enlarges your vaginal opening (episiotomy) as the baby’s head is emerging. Nurse midwives have long recommended perineal massage. There isn’t yet definitive evidence that it prevents trauma to the perineum, but some studies have indicated promising results.

How to do it Wash your hands thoroughly with soap and hot water and make sure your nails are trimmed. Then put a mild lubricant on your thumbs and insert them inside your vagina. Press downward toward the rectum, stretching the tissues. Repeat daily for about eight to 10 minutes. Your partner can help with this process, if you wish. You may experience a little burning or other discomfort as you massage your perineum. This is normal. However, stop if you begin to feel sharp pain.

A couple of additional points: You don’t have to practice perineal massage if the idea of it makes you feel uncomfortable. And if you do it, it’s no guarantee that you won’t have an episiotomy. Certain birth situations, such as those involving a large baby or a baby in an abnormal position, may require an episiotomy.

YOUR EMOTIONS

You’re probably thinking a lot this month about when labor will start and how your childbirth experience will go. A growing sense of tension during this time is understandable, as are worries and fears about whether your baby will be healthy.

You may also be spending some time contemplating what the pain will be like during childbirth. How bad will it really be? How long will it last? How well will I cope?

Preparing yourself for labor It’s to be expected that you may feel anxious about labor and childbirth, but realize that women go through labor and give birth every day. It’s a natural process. To help you prepare, and stay calm:

 Educate yourself. Knowing what’s going to happen to your body when you give birth will make you less tense and fearful as it actually takes place. With less fear and tension, your pain may be less, too. Childbirth classes are an excellent place to meet other moms-to-be and learn about the changes your body goes through in labor and childbirth. Also, make sure to read the chapters on labor and delivery in this book.

 Talk with women who have had positive birth experiences. Learn what techniques worked for them during the labor and childbirth process.

 Tell yourself that you’ll just do the best you can. How the process goes depends on the circumstances and your strengths. There’s no right or wrong way to have a baby.

 Familiarize yourself with the various pain relief options available to you during labor. Read Chapter 23 to learn more about pain medications used during labor and natural childbirth techniques. But try not to develop fixed ideas about what you’ll use and what you won’t. Until you’re actually in the moment, you won’t know what your needs will be. It’s best to be informed, but flexible.

PRENATAL CHECKUP

You’ll probably see your care provider twice this month. As during previous visits, he or she will likely check your weight and blood pressure, as well as the activity and movements of your baby. Your care provider will measure your uterus, which will probably measure between 33 and 34 centimeters in the first half of this month — roughly equal to the number of weeks of your pregnancy.

Strep test At this point in your pregnancy, your care provider may screen you for group B streptococcus (GBS), if he or she hasn’t already. This test is commonly referred to as the group B strep test. A culture taken from just inside the vagina and rectum is tested for the bacterium. GBS typically lives harmlessly in the body, and although it usually poses no risk to you, women who harbor it may pass the bacterium to their babies during labor and delivery. Newborns don’t yet have the proper immunity to live with this bacterium without risk of complications. If group B strep is found, antibiotics will likely be given to you once you go into labor. This reduces the risk that your baby will acquire the bacterium.

Checking baby’s position During your visits this month, your care provider will check baby’s position. The position baby is at by the 33rd week of your pregnancy will likely be the position he or she will be in for delivery, whether it’s headfirst, rump-first or feet-first. However, if you’ve had several children, there’s a greater possibility that your baby may change position in the final weeks.

To determine how your baby is positioned inside your uterus, your care provider can check to see which part of your baby’s body is farthest down in your pelvis, ready to be born first. This is called the presenting part.

To determine your baby’s presentation, your care provider will carefully press on the outside of your abdomen. As your due date nears, your care provider may perform a vaginal exam if there’s uncertainty about the baby’s position. With a vaginal exam, your care provider reaches inside the vagina to feel which part of the baby is above the opening to the cervix. If your care provider is still uncertain about the baby’s position, an ultrasound may be performed.

If your baby is positioned headfirst, you’re good to go. If your baby is positioned rump-first or feet-first, he or she is in what’s called a breech position.

If your baby isn’t already too far down in your pelvis, your care provider may try to turn the baby into the more ideal position in the weeks before birth. This is called an external version. Your care provider applies pressure to your abdomen in certain spots to try to move your baby into the proper position. Medication is often used to relax the uterus and relieve pain. External version is generally tried two to four weeks before the due date.

YOUR BIRTH PLAN

A birth plan encourages you to think about your labor and delivery before it happens. You can record you preferences regarding labor, delivery and postpartum care. A birth plan also gives you an opportunity to talk about your preferences with your care provider.

Keep in mind that you birth plan is not set in stone. No one can predict how birth will go and things may change. For example, you may think that you don’t want any pain relief, but you may change your mind during labor. But a plan does help ensure your experience will come as close to your expectations as reasonably possible.

Your care provider may ask you to fill out a form stating your preferences. Or you may create a birth plan of your own or as part of your childbirth classes. Be sure to communicate your wishes to your care provider.

BIRTH PLAN CHECKLIST

Your birth plan may include details such as:

 When to come to the hospital or birthing center.

 What to bring with you — your favorite nightgown, personal items, music, breast cream, contact phone numbers.

 Concerns you may have regarding giving birth.

 Things you look forward to during birth.

 Your support person during labor and delivery.

 Natural pain relief preferences — shower, birthing ball, music, dim lights, walking, rocking chair.

 Pain medication preferences — epidural or other.

 Goals in terms of medication use — no medications, some medications, wait and see.

 Hydration preferences — do you wish to sip water during labor, have unrestricted access or have no oral intake?

 Positions for pushing and delivery — sitting up in bed, lying on your back and using stirrups, lying on your side, squatting.

 Episiotomy preferences — although your doctor may do what he or she considers best under the circumstances.

 Preferences regarding the delivery — do you want to observe with a mirror? Do you want to have your family observe?

 Preferences for what happens right after birth — do you want the baby handed directly to you or wrapped in a blanket and then handed to you?

 Circumcision preference.

 How you plan to feed your baby.

 Rooming-in or nursery preferences.

 Mom and baby follow-up care.

 Preferences regarding being present at the baby’s first bath and exams.

 Cesarean birth preferences.

Pain control If you haven’t decided yet how you’re going to manage the pain that accompanies childbirth, now is the time to do so. Yes, childbirth is painful — but the pain is also manageable. To help labor and delivery go as smoothly as possible, it’s best to know how you want to deal with the pain when it arrives.

Knowing your options There are various options for controlling labor-related pain. Some women take classes to learn breathing and relaxation techniques, and they rely on these techniques to manage the pain. Other women prefer to use pain-relieving medications. There are two main types: analgesic medications lessen the pain, while anesthetic medications block the pain. You may also use a combination of options — breathing techniques and medication. You might choose to go unmedicated through the first part of labor — generally the easier part — and then use medication in the later part of labor when the pain may be more intense.

To figure out which approach is best for you, familiarize yourself with all of your options and then decide. Also talk to friends who’ve been through labor and ask them what they found worked best. Most of all, remember that it’s completely your choice.

For more information on the various pain relief options and what to expect with each, see pain relief during childbirth in Chapter 23.