Pregnancy information related to 37 - 40 weeks

Labour and Delivery Discussion at 37- 40 weeks

Knowing what to expect when it comes time for labour and delivery can help ease any anxiety you may have about the birth process, especially if this is your first baby. Reviewing these facts will help, as will talking to our doctors and nurses and taking advantage of childbirth classes.

• Before you are formally admitted to your hospital`s labour and delivery area, you will probably be given a vaginal exam to determine the progress of your labour. This exam will determine your cervical effacement and dilation, and how far your baby has descended into your pelvic cavity.
• You will be asked for general information that includes the following:
  • Your partner`s or support person`s name.
  • The name of the doctor you have chosen for your baby.
  • Your participation in any type of childbirth classes.
  • Your plans for breast feeding.
  • Your plans for circumcision if the baby is a boy.
• You will be asked for specific information that includes the following:
  • The date and time your contractions began and the average length (duration) of your contractions.
  • How frequently your contractions are occurring.
  • The date, time, colour, and amount of vaginal discharge.
  • The date, time, and colour of fluid if your 'water broke' (amniotic membranes rupture).
  • When you last ate, had a bowel movement, and any occurrence of diarrhoea.
• Your complete medical and prenatal history will be reviewed.

• A hospital patient I.D. bracelet will be attached to your wrist.
• Measurements will be taken of your temperature, pulse, breathing rate, and blood pressure.
• Blood and urine samples and vaginal cultures may be taken.
• A test may be performed to determine whether your amniotic membranes ('bag of water') have broken or is still intact.
• An estimation of foetal age and weight and presentation of your baby will be made.
• You may receive an intravenous (IV) line that can be used to give fluids that prevent dehydration and/or administer medication quickly.
• You probably will not be allowed to eat during labour. Ice chips are usually allowed.

Our doctors and nurses may use one particular method, or possibly a combination of methods, to help them determine how your baby is reacting to labour.

- Auscultation Monitoring
This method involves listening to the foetal heartbeat with a Doppler device or stethoscope and recording it at specific intervals between contractions. Our doctors and nurses will also place their hands on your stomach to feel for uterine contractions.

- Electronic Monitoring
This method measures the response of your baby`s heart rate to the contractions of your uterus, and provides a continuous printout of information that can be read by our doctors and nurses. Monitoring is done through one of two different methods:

• The external monitor is secured to your abdomen with two elastic belts, one holds a sensor that measures your contractions, and the other secures an ultrasound device that uses sound waves to pick up your baby`s heartbeat.
• Internal monitoring is done by attaching an electrode (a thin spiral wire) to your baby`s scalp to provide a recording of his heart rate. At the same time, a transducer (pressure gauge) is placed on your uterus to measure the strength and frequency of your contractions. Internal monitoring can`t be used until your amniotic sac has ruptured and your cervix has begun to dilate.

The length and difficulty of each woman`s labour and delivery will vary. Factors that play a role include the size and shape of your pelvis, the size and position of your baby, your cervical status at the time labour begins, and the strength and frequency of your contractions.

Labour is described as having four stages. The first stage is defined as the time from the onset of progressive labour contractions until the cervix is completely dilated. The second stage is from complete dilation of the cervix until the baby is born. The third stage is from the birth of the baby until the placenta is delivered. And finally, the fourth stage is from the delivery of the placenta until the mother`s medical condition is stable and safe.

The progression through the four stages of labour varies among women. For some women, labour starts slowly and then speeds up unexpectedly, while for others labour starts rapidly and then slows down. In some cases, our doctors may decide that it is time for your baby to be born even though true labour has not yet started. Induction of labour is the process of starting labour artificially by the use of medication, primarily oxytocin.

This stage is almost always the longest and may last approximately 8 to 20 hours if this is your first pregnancy, or 5 to 14 hours if you have previously given birth. Early, or latent, labour begins with the onset of regular contractions and ends when your cervix is approximately 3 centimetres dilated. Contractions last approximately 30 seconds and may occur every 10 to 20 minutes from the beginning of one to the beginning of the next, with your uterus relaxing between each one. Much of your time in this early phase of labour may be spent trying to figure out if you are in true labour or not. The most common sign and symptoms of this phase include backache, menstrual-like cramping, indigestion, diarrhoea, and bloody show. You may experience all of these or just one or two.

Active labour begins when your cervix is dilated to 3 centimetres and ends when it is fully dilated to 10 centimetres. Effacement, or thinning of the cervix, is usually complete or almost complete. Contractions are stronger and longer (30 to 60 seconds) and occur every two to three minutes. You may become serious and quite, focused on only one thing, labour. At this point, support, encouragement, help, and comforting gestures from your partner will be appreciated. You may experience emotional ups and downs throughout your labour, at times even becoming weepy and frustrated. But if you know what to expect and accept labour as it comes, these periods will be easier to tolerate.

During your labour, the nurse may place her fingertips over your uterus and feel your contractions from the time one begins to the time another begins. This helps determine the timing and strengths of your contractions. If an electronic foetal monitor is used, contractions are measured from the peak of one to the peak of the next.

Membranes can rupture at any time during early or active labour, resulting in a gush, trickle, or leakage of fluid from your vagina. To determine whether your membranes have ruptured, an exam may be done to obtain a sample of amniotic fluid. In some cases, our doctors and nurses may choose to artificially rupture membranes. This procedure may speed up a slow labour. Vaginal exams may also be performed throughout the course of your labour to determine cervical effacement and dilation and/or to apply an internal foetal monitor. This examination may not be done if you are experiencing vaginal bleeding.

At some point during active labour, you may experience irritability, extreme heat or cold, trembling of your arms and legs, nausea, vomiting, and diarrhoea. If you have chosen an epidural for pain management, it is generally given when your cervix is dilated to between 3 and 7 centimetres.

Changing positions every 20 to 30 minutes, kneeling on your hands and knees, alternating application of an ice pack and a hot pack, can relieve back pain and a firm massage with the fist or heel of the hand. Breathing and relaxation techniques learned in childbirth preparation classes may provide you additional relief.

The choice for body position during labour may be determined by custom, comfort, foetal well-being, and the need for certain procedures, such as listening to your baby`s heart rate. Positions that may assist in the first stage of labour and in reducing pain include standing and walking, sitting or squatting, and laying on either your left or right side. For the safety of you and your baby, it is recommended that you avoid lying on your back for prolonged periods of time during labour. When your uterine contractions become very strong or you have been given pain medication, you will probably be asked to remain in bed to avoid injury.

As you complete labour and prepare for actual birth, known as the "transition phase", your cervix is dilated from 7 or 8 centimetres to 10 centimetres. You may feel almost out of control, as if you are being swept along in a wave of intense sensation. It becomes even more important for you to focus on relaxing; tensing up and fighting each contraction will only slow labour and exhaust you. However, you may feel the urge to push. Be sure to tell our doctors and nurses if you feel this urge. It is very important to resist the urge to push until your cervix is completely dilated and our doctors and nurses have instructed you to do so.

Also called the 'pushing stage', this stage of labour begins when your cervix is 10 centimetres dilated, and ends with the delivery of your baby. If this is your first baby, this stage may last about one to two hours. If you have previously given birth, it may last 15 to 60 minutes. The pushing stage is the most exhausting and demanding part of labour, but it is also an exciting time, with lots of cheering and praise for your efforts.

There are many positions for pushing and you may wish to discuss these with our doctors and nurses in advance. Lying on your side is a good position if the baby is coming fast, if you have painful haemorrhoids, or if you must lie down for some reason. Squatting allows more room for the baby to come down through your pelvis than any other position. Resting on your hands and knees may help if the baby is large. Semi-setting is a good position because you can see our doctors and nurses and the baby as he/she come out. Lying flat is the least effective and can cause problems with blood flow to the baby. You may use several different positions during the pushing phase. Whatever position helps you feel the most comfortable is most likely the one you should use

You will be directed to push with each contraction in order to move the bay down and out the birth canal. An Episiotomy, if necessary, is usually done at this time. This incision is made into the area between your vagina and rectum (perineum). It enlarges the vaginal opening for delivery of your baby and protects the surrounding area from tearing. As your baby`s head is being delivered, you may be asked to stop pushing so that excess mucus can be suctioned from the baby`s nose and mouth. This is an exciting and intense time. You know that the baby is almost here and may be tempted to push as hard as you can to get the baby out quickly. It is important for you not to push hard at this time because a sudden push could make the baby come out too quickly and may also damage your perineum. Wait until our doctors and nurses instruct you to push again, and then let your uterus do most of the work. This will allow our doctors and nurses to safely deliver your baby. Babies usually begin to cry on their own, and you can now see and perhaps hold your baby.

This stage begins after the delivery of your baby and ends with the delivery of the placenta, which usually occurs within 5 to 30 minutes. You will continue to have mild contractions during this stage and you may be asked to push to assist in the delivery of the placenta. Our doctors and nurses will examine you and the placenta to make sure the entire placenta is delivered. After the delivery of the placenta, the Episiotomy or tear will be repaired (sutured) if necessary.

This is the 1 to 4 hour period of time after delivery of the placenta. During this stage, the mother`s body systems stabilize. Your pulse, blood pressure, and respiratory rate will be taken frequently, and your vaginal area will be checked for bleeding. A nurse may massage your uterus or instruct you to do so. This helps the uterus to contract and will help to reduce blood loss. After the excitement and the work of the delivery is done, you may feel tired, thirsty, and even hungry. Now is the time to relax and take pride in you accomplishment.

Your nurse will:

• Monitor your temperature, pulse, respiratory rate, and blood pressure.
• Massage your uterus.
• Check for vaginal bleeding and change pads.
• Check for urination and bowel movements.
• Check Episiotomy or Caesarean incision.
• Check for haemorrhoids.
• Evaluate ambulation (ability to turn over, walk, etc.).
• Administer an analgesic, stool softener or laxative as prescribed by our doctors and nurses.
• RhoGam immunization is given as prescribed by our doctors and nurses (if your blood type is Rh negative).
• Monitor blood pressure (gestational hypertension can occur after delivery).
• Check breast feeding status.
• Check appetite, diet, and fluid intake.
• Discontinue intravenous fluids and urinary catheter as indicated.
• Monitor your admission to the recovery or postpartum area.

• Umbilical cord clamped.
• Dried and warmed.
• Nose and throat suctioned.
• Apgar score taken (performed at 1 minute and 5 minutes after birth, this is a method of evaluation a newborn`s state of well-being, including respiratory effort, heart rate, muscle tone, skin colour, and reflex irritability).
• Hospital I.D. bracelet attached to wrists or ankles.
• Overall physical exam performed.
• Weighed on a special scale for babies.
• Measured for body length.
• Temperature, blood pressure, and pulse taken.
• Taken to the nursery.
• Gestational age determined.
• Blood glucose level measured.
• Vitamin K (for normal blood clotting) given.
• Umbilical cord treated to prevent infection and promote drying.

Pregnancy Pointers at 37 - 40 weeks

Discuss with our doctors and nurses when you should contact them about labour and when you should go to the hospital. The following will help you know if you`re in labour:

• True Labour Contractions
  • Occur at regular intervals.
  • Rest periods between contractions become shorter.
  • Gradually become stronger.
  • Felt in abdomen and back.
  • Cervix dilates.
  • Your activity does not change contractions.
• False Labour Contractions
  • Occur at irregular intervals.
  • No change in rest periods between contractions.
  • Strength of contractions varies.
  • Felt mostly in lower abdomen.
  • Cervix does not dilate.
  • May lessen with activity such as walking.

When you arrive at the hospital in labour, you may expect some of the following:

• Review of your complete medical and pregnancy history.
• Measurement of your temperature, pulse, breathing rate, and blood pressure.
• Test to check if your water has broken (rupture of membranes).
• Measurement of the baby`s heart rate.

Start thinking about ways to protect your baby`s safety once you return home:

• Prepare to use a car seat.
• Never leave your baby alone on high surfaces.
• Never eat, drink, or carry anything hot near your baby.
• Never leave small items near your baby that he/she could put in his/her mouth and choke on.
• Never give your baby small, hard pieces of food.

The Signs and Symptoms of Labour at 37 - 40 weeks

Even though you`ve been anticipating the birth of your baby for several months, it may be difficult to tell when labour actually begins. People say, 'you`ll just know', but that`s hardly reassuring. You will need to interpret your body`s changes as labour approaches. Every woman`s pregnancy is unique, but there are a number of signals that will tell you that your body is getting ready for labour. However, they will not tell when your labour will exactly start. Ask our doctors and nurses when you should call him/her and when you should go to the hospital. Listed below are several common signs and symptoms of approaching labour.

Usually clear mucous, but sometimes streaked or tinged with brown or pink. This is sometimes referred to as 'bloody show'. This discharge may appear at the same time that contractions begin or a few days before. Your mucous plug, which has blocked the cervix throughout the pregnancy to protect your baby from infection, may loosen and be expelled. Any amount of vaginal bleeding should be reported to our doctors and nurses at once.

The baby`s movement into your pelvis in preparation for birth (also called 'lightening' or 'the baby dropping'). It can happen anywhere from a few weeks to a few hours before labour begins. You will find that it will be easier to breathe and heartburn may be lessened. But the additional pressure of your baby`s head on your bladder may make you need to urinate more frequently.

As a result of changes in your hormone levels, you may lose 1 to 3 pounds in the week before labour begins. This is mostly a loss of fluid that has been held in your tissues.

Dull, lower backache that may come and go.

You may experience one or more of these conditions before or at the beginning of labour, often accompanied by cramping. This is just your body`s way of responding to the labour process.

The breaking of your 'bag of water'. This may happen several hours before labour begins, but in most cases, the fluid-filled sac that surrounds your baby during pregnancy doesn`t rupture until later in the labour process. Discharge may be a continuous trickle or a gush of watery fluid from your vagina. If you are not already in the hospital when you rupture your membranes, notify our doctors and nurses immediately to describe the time of rupture, the colour and amount of fluid.

The most obvious sign of labour, but often confusing because irregular cramps of false labour pains occur. You may have experienced these 'Braxton Hicks' or 'practice' contractions throughout your pregnancy, but you will notice an increase in frequency and intensity in these last weeks before delivery. Your abdomen may feel like it is tightening or hardening. Some women have compared it to strong menstrual or intestinal cramps. The following descriptions may help you to distinguish between true and false labour contractions:

• True Labour Contractions
  • Occur at regular and frequent intervals.
  • Rest periods between contractions become shorter.
  • Gradually become stronger.
  • Felt in abdomen and back.
  • Your activity does not change the contractions.
  • Cervix dilates and effaces.
• False Labour Contractions
  • Often occur at irregular intervals.
  • No change in rest periods between contractions.
  • Strength varies.
  • Felt mostly in lower abdomen.
  • May change depending on your activity, such as walking versus resting.
  • Cervix does not dilate or efface.