Pregnancy information related to 29 - 32 weeks

Caesarean Birth and Vaginal Birth After Caesarean (VBAC): Discussion at 29 - 32 Weeks

Caesarean section is a surgical method of delivering a baby that involves making an incision through a woman`s abdomen and uterine muscle; removing the child and then suturing (stitching) each layer back together. While it can be a lifesaver for mother and/or child, a Caesarean birth can be a cause for anxiety if you lack information or have not been prepared for this type of delivery.

Caesarean birth, or C-sections, are performed whenever it appears that a vaginal delivery cannot be completed safely or when your baby`s immediate birth is necessary. Our doctors and nurses may decide well before labour begins that a change in your medical condition or your baby will require intervention. For example, you may have severe diabetes or your baby may be too large to pass through the pelvic bones. In such cases, you and our doctors and nurses may decide on an appropriate date and schedule a Caesarean delivery for that day.

Sometimes, however, our doctors will not know until after your labour has begun that a change in your or your baby`s medical condition requires intervention. If the baby experiences sudden distress or if your labour fails to progress, for example, a Caesarean could be appropriate.

If a Caesarean birth is anticipated, preparations will be made as for any similar type of abdominal surgery. Since the incision will most likely be a 'bikini cut', a horizontal incision down near the level of your pubic hair, some of your pubic hair will be shaved. You may also have a catheter inserted to empty your bladder as needed during surgery. If you are having a repeat Caesarean, the incision will probably be made at the site of your last incision.

If our doctors and nurses decide that regional anaesthesia (an epidural or spinal block) is preferred, you will be able to be awake during the surgery and see your baby immediately after delivery. If needed, you may receive general anaesthesia instead, depending on the reasons for the Caesarean. If so, you will be 'put to sleep' before the surgery begins.

When your Caesarean is anticipated, you will have the opportunity to discuss it thoroughly with our doctors and nurses, just as you would any other surgery. You will have time to participate in any classes your hospital might have to offer and to plan for your recovery. Since hospital policies vary, be sure to ask whether your partner will be allowed in the operating room with you. If you know the date of your 'planned' Caesarean, you may wish to organize your household ahead of time. You will have a longer recovery period after a Caesarean birth, so it will be helpful to plan ahead for assistance with meals, childcare, and household chores. Since all Caesareans are not anticipated, you may want to discuss Caesarean procedures with our doctors and nurses during one of your regular visits as well as with your childbirth educator.

If you have previously delivered a child by Caesarean, you may still be able to have other children vaginally. The following are good indicators of whether you may be a candidate for vaginal birth after Caesarean:

• You are in good physical health.
• This has been a healthy pregnancy, and your baby is not too large.
• Your previous Caesarean was performed for a problem that is unlikely to occur again (twins).
• You have access to a hospital that is supportive of VBAC.
• Our doctors and nurses have access to the records from your previous Caesarean birth.

VBAC is a good option for many women. Advantages of a VBAC include:

• Less risk to both mother and baby.
• A faster and easier recovery period.
• A shorter hospital stay.

With our doctors` and nurses` approval you can go into labour planning a vaginal delivery. However, you will need to be carefully monitored and choose a hospital that is prepared for a Caesarean birth if labour does not progress smoothly.

Not every woman who has had a Caesarean birth is a candidate for vaginal birth with her following pregnancies. If our doctors and nurses determine that Caesarean birth is the best birth method for you and your baby, discuss the details of the surgery, the possible risks involved, and your obstetrical history with them until you are satisfied with the decision. Share your feelings and concerns with your partner and family.

Hypertension in Pregnancy at 29 - 32 Weeks

Your blood pressure is checked at each prenatal visit. This simple test allows our doctors and nurses to monitor your blood pressure throughout your pregnancy in order to detect any changes from your normal reading.

For approximately 7% of all pregnant women, high blood pressure or hypertension does become a problem. If your blood pressure is elevated, it can affect you and your baby`s well-being.

Some women enter pregnancy with higher than normal blood pressure readings. For others, high blood pressure is pregnancy induced (high blood pressure that develops after 20 weeks of pregnancy). If, at a prenatal visit, your blood pressure is higher than what is normal for you, your blood pressure will be re-checked and our doctors and nurses may order further testing.

The four categories of hypertension in pregnancy are:

• Chronic hypertension

High blood pressure that occurs before pregnancy or before 20 weeks of pregnancy.

• Gestational hypertension

High blood pressure that develops after 20 weeks of pregnancy.

• Preeclampsia

High blood pressure that develops after 20 weeks of pregnancy accompanied by increased swelling and protein in the urine.

• Chronic hypertension with preeclampsia (both)

High blood pressure that occurs before pregnancy and becomes worse during pregnancy.

Gestational hypertension is usually diagnosed in the third trimester of pregnancy and can occur after delivery. Pregnant women most at risk for this disorder include:

• Those under age 20 or over age 35.
• Those pregnant for the first time.
• Those who have had hypertension in a previous pregnancy.
• Those whose mother had gestational hypertension.
• Those with kidney disease.
• Those with diabetes.

If our doctors and nurses tell you that you have or are at risk for hypertension, follow their instructions completely. Promptly contact our doctors and nurses if any of the following symptoms occur:

• A sudden weight gain (2 or more pounds in a few days).
• Headache, blurred vision, or spots before the eyes.
• Pain in the upper abdomen ('epigastric pain').
• Unusual swelling or puffiness in the face and/or hands.

Treatment for hypertension may include:

• Urine, blood pressure, and weight checks.
• Medication.
• Dietary changes.
• Restricted activity.

Restricted activity can refer to anything from periodic rest periods during the day, to complete bed rest. The purpose of restricted activity is two-fold:

• Resting on your side (left side is best) decreases your blood pressure.
• A side lying position also improves the blood flow to the baby.

Talk with our doctors and nurses to find out specifically what activity is best for you.

If restricted activity or bed rest is prescribed for you, take it very seriously. It is important to follow our doctors` and nurses` instructions carefully.

Pain Management During Labour and Delivery Discussion at 29 - 32 Weeks

Like many women, you are probably concerned about how much pain you will have during the delivery of your baby. Rest assured, there are a number of effective and safe pain management options available to birthing mothers today. Working with your doctors and nurses, you should be able to receive a level of pain relief that:

• Responds to your needs.
• Is consistent with your medical condition.
• Is appropriate to the progress of your labour and any special situations that arise during delivery.

Women who choose 'natural' childbirth use a combination of relaxation and breathing techniques along with the support of their family and delivery coach. These women choose not to take any medications during labour. On the other hand, many women do choose to receive medication during their birth experience. This decision is an important one, which can be affected by the circumstances of your labour. Therefore, it is best to keep an open mind until actual labour occurs. Information about various medication options, combined with the advice of our doctors and nurses, will help you arrive at a pain management approach that is right for you.

There are two approaches to relieving any type of pain - analgesics and anaesthetics.

• Analgesia

Alters the brain`s perception of pain. In other words, the nerves are still registering pain, but the individual`s awareness of that feeling is reduced. With an analgesic, you may still be aware of some discomfort, but the sensation will be less intense. Our doctors and nurses may offer an analgesic for you during labour to make you more comfortable and help you relax.

• Anaesthesia

Works directly on the nerves to block sensation. The anaesthetized area becomes numb or 'deadened' and you will feel no pain at all. A 'local' anaesthetic or an anaesthetic block will give you temporary numbness in a limited area without any loss of consciousness. Locals and various kinds of blocks are regularly used during childbirth; however, 'general anaesthesia' (being 'put to sleep') is usually only used in certain circumstances.

These medications can be administered in several ways: subcutaneously (injected under the skin), intramuscularly (injected into a muscle), or intravenously (injected into the blood stream). The way the medication is delivered will affect how quickly it acts, the length of time it is effective, and how quickly it may affect the baby.

Numerous analgesics are available; our doctors and nurses may choose to use a combination of medications to help you relax. Analgesics do have some risks. Because they enter the bloodstream, these drugs can be transferred to the baby through the placenta and suppress breathing at birth. However, our doctors and nurses will administer any drugs with this in mind, and the baby should be able to metabolize, or break down, the drugs prior to delivery. In addition, a special drug (Narcan®) is available in the delivery room in case the analgesic affects the baby`s breathing.

With the exception of general anaesthesia, anaesthetic medications are directed only to the areas to be numbed, just as your dentist applies Novocaine® to a limited area of your mouth. The following types of anaesthesia may be used during your delivery:

• Local anaesthesia

A local is typically injected in the area between the vagina and rectum when an Episiotomy (incision to help in the delivery) is to be performed.

• Pudendal or paracervical blocks

Anaesthetics are injected into the walls of the vagina and sometimes around the cervix to ease pain associated with labour and delivery. The Episiotomy area may not be numbed, so additional anaesthetics may be needed at the time of delivery.

• Regional blocks

Regional blocks are given by injecting medication near the nerves in the spinal cord to block sensation in areas larger than those affected by the methods mentioned above. Regional blocks numb your body from your midsection down.

Both epidural and spinal blocks can be used to provide anaesthesia during Caesarean birth. Either will allow you to be awake during the procedure and to see your baby immediately after delivery. General anaesthesia also may be used, and it is sometimes the safest choice for delivery, depending on your condition. Our doctors and nurses can discuss with you the possibility of Caesarean birth and available anaesthesia options.

Each type of anaesthesia has certain risks associated with it. These include allergic reactions or lowered blood pressure for the mother and reduced heart rate and respiration for the baby.

Feel free to ask our doctors and nurses about anaesthetic medication they may use and the precautions that will be taken to reduce any risk to you and your baby.

Preparing Your Breasts for Breast Feeding at 29 - 32 Weeks

Health care professionals have different opinions about how pregnant women should prepare their nipples for breast feeding. Some experts say that nipples should be "toughened" during the 8th and 9th month of pregnancy and others say that no special preparation is required. Discuss the options with our doctors and nurses to see what they recommend.

In order for you to fully understand breast care, it may be helpful for you to first understand how your breasts function. Your breasts are actually glands. Inside them are tiny sacs that contain milk-secreting cells. These sacs are clustered together into lobes. It is from these lobes that a single milk duct carries milk to the nipple. Throughout your pregnancy, your breasts have slowly increased in size and weight, gaining as additional 500 Gms. each. Your nipples have probably gotten larger along with the darker circle of skin around the nipple (areola).

The small bumps on you areola are openings to glands that contain a creamy lubricant. This lubricant moistens and protects your nipples during pregnancy and breast feeding. In the last few months of pregnancy a clear yellowish fluid may come out of the many tiny openings in your nipples. The fluid is called colostrum. Colostrum is your baby`s first food. It`s especially rich in nutrients and offers protection against many illnesses. If you don`t leak colostrum before your baby is born, don`t worry, many women don`t. It will be there when you are ready to breast feed. The basics of breast care begin during your normal daily shower. Gently wash your nipples with warm water, but avoid using soap because soap tends to remove the natural lubricants that help to keep the breast soft and supple. Stay away from special creams, as they may block the openings in your nipples.

Because your breasts are larger while you`re pregnant, you will want to wear a bra that offers adequate support during the last few months of pregnancy. Night time bras are also available that will give you added support and comfort while you sleep. When you start breast feeding, you can then switch to a nursing bra.

The process of preparing your breasts for breast feeding usually takes place during the third trimester of pregnancy. However, if you have a history of premature or early birth with a previous pregnancy, this preparation is not recommended. Nipple stimulation may cause your uterus to contract. Again, it is important to talk to our doctors and nurses and ask for their advice.

If our doctors and nurses do recommend that you perform some type of nipple preparation, there are various procedures available. The more common method is by gently pulling, twisting, or rolling the nipples. To roll your nipples, place your thumb and forefinger around your nipple and gently roll it for a few seconds. Repeat on both nipples a few times each day or as recommended by our doctors and nurses.

Though old wives` tales exist about what kinds of breasts can and cannot satisfy a baby, quantity and quality of breast milk is not the least bit dependent on outward appearance. All combinations of breasts and nipples have the capacity to produce and provide milk.

If you have inverted (turned in) or flat nipples, you may require special nipple preparation before delivery in order to successfully breast feed. To determine whether your breasts may require special preparation, gently squeeze the areola right next to the nipple with your thumb and forefinger. If your nipples move inward or flatten, or if they extend outward only slightly, you may wish to prepare them for breast feeding by wearing breast shields.

Worn inside the bra, the breast shield presses gently on the areola, making the nipple push outward through the shield`s opening. The shields should be worn the latter half of your pregnancy on a daily basis. Most maternity shops sell breast shields. Consult our doctors and nurses regarding their thoughts on the benefit of breast shields. Many women with inverted nipples or flat nipples are unnecessarily discouraged from breast feeding before they even attempt it, so don`t give up before you have at least tried. Even if nursing is awkward at first, after a little extra effort to help the baby "latch on", the nipples generally protrude and the baby nurses with ease. Our doctors and nurses or lactation specialist may be able to offer support and assistance as you get started. There is also an international organization that specializes in breast feeding support and information called the La Leche League.

Relaxation and Stress Reduction at 29 - 32 Weeks

As your pregnancy continues, it becomes more and more important for you and your partner to reduce and manage the old, the familiar and the new stresses in your lives.

These points may help you maintain your physical and mental well-being:

• Review and reinforce what you`re learning about pregnancy, what is being taught by our doctors and nurses and in childbirth preparation classes, the books you`ve read, and the videos you`ve watched.
• Identify and utilize available support services.
• Take time to communicate openly and frequently with each other.
• Investigate pregnancy stress-management methods; these are designed to teach pregnant couples how to reduce stress through active relaxation, a coping strategy to deal with the changes encountered during pregnancy. Specifics may include:
  • Breathing awareness.
  • Breathing and imagery.
  • Relaxation exercise for body muscles, which is sometimes accompanied by imagery.
  • Massage therapy.

Your Body`s Change and Your Baby`s Growth at 29 - 32 Weeks

Your baby continues to grow and more fat is forming beneath the skin. This layer of fat is important as it allows the baby to maintain an adequate body temperature after birth. The lanugo hair is disappearing. The baby can hear outside noises through the wall of the uterus.

As your uterus continues to enlarge, it presses on the muscles that separate your chest and abdomen (diaphragm), possibly causing some shortness of breath.

You may have some difficulty sleeping. Aching pains in the hips, lower abdomen and vagina may occur due to hormonal changes, pressure on blood vessels and stretching band of tissue holding the uterus in place (round ligaments).

You`re now 29 weeks into your pregnancy, and that "eight month" mark is growing closer. As your uterus continues to grow larger, it presses on the diaphragm, the muscle that separates your chest and abdomen.

If this causes shortness of breath, try the following:

• Maintain correct body mechanics and proper posture.

This allows your lungs to expand fully.

• Several times a day, stand up, stretch your arms above your head and take a deep breath.

This allows you to get extra oxygen into your lungs and also helps relieve tension. You may feel the need to sigh more often as a result of the need to take in extra oxygen during pregnancy.

It may be more difficult to sleep during this phase of your pregnancy. You may find it helpful to:

• Continue to avoid beverages containing caffeine.
• Lie on your side with one pillow between your legs and another supporting your stomach.
• Breathe deeply, visualizing yourself in a quiet, peaceful environment.
• Relax by having your partner give you a backrub.
• Listen to restful music or relaxing sounds.
• Avoid disturbing conversations or exciting entertainment before bedtime.
• Practice your prepared childbirth relaxation breathing.

While the thought of using sleeping pills or alcohol to help you sleep may cross your mind, it is safest to avoid these substances during pregnancy. The chemicals in these drugs can cross the placenta and affect your developing baby. Certain discomforts, such as round ligament pain, haemorrhoids, constipation, and sleeplessness, are a common part of late pregnancy.

By 32 weeks of gestation, your baby weighs about 2 kgm, and is about 30 cm. in length. He/she can now hear outside noises through the wall of the uterus. Fingernails now reach the end of the fingers, and toenails are growing. The fine 'lanugo' hair that covers the body is disappearing, and more fat is forming beneath the skin. This fat deposit not only gives the skin a smoother appearance, it is an important 'insulator' to help the baby maintain a normal body temperature after birth.

This is also the time of pregnancy that your baby begins to prepare for the journey of birth. After months of turning and moving freely in the amniotic fluid, most babies now move into a vertex (or head down) position.