WEEKS 38 – 40

Well, the time has come and you are finally ready for the delivery. By now you and your baby are fully prepared for delivery. It is time to put together all your stuff and start packing for your labour and delivery.

Common Complaints

Unfortunately till your labour you will be experiencing all the difficulties that you have been experiencing till 37 weeks.Your due date is nearing and you must know about what is true labour and what is false labour.
If properly understood, it will avoid unnecessary rushes to your doctor even when you are not in labour and on the other hand may also help you in seeking timely help when in labour.

False Labour

You may experience pain BUT

1. It is not associated with regular contraction which increases in frequency and intensity.
2. It is vague and generalized pain and not localized to back and lower abdomen and around the uterus.
3. It can subside if you:

• Walk,
• change position,
• take an enema, or
• go off to sleep, or
• spontaneously.

4. Pain is not associated with "SHOW".    
5. Foetal movements increase rather than decrease briefly during the pain.

As against this "TRUE LABOUR" is characterised by:

1. Pain associated with uterine contractions which increase in frequency and intensity gradually. Initially this may occur at 10 min – 15 min interval, lasting for few seconds. But in active labour and at their peak, they may occur 3 – 4 times in 10 minutes and each contraction may last for 30 – 60 seconds.
2. Pain and contractions are associated with "SHOW". Show is the passage of a blood stained mucus clot from your vagina. During pregnancy, the opening of the uterus (cervix) is closed with a mucus plug. When labour starts, the opening of the uterus (cervix) dilates and this protective plug is dislodged. This is mixed with some blood from the dilating cervix and is seen as "SHOW".
3. Pain and contractions may be associated with passage of amniotic fluid if the bag of water ruptures. This is usually clear. If it is red/ greenish/ yellow then it indicates some problem in labour. It has to be reported to your doctor immediately.
4. The pain and contraction don’t decrease by resting / walking/enema etc. They keep on increasing as time goes by.
5. The pain may begin in the back, lower abdomen or around the whole uterus and then radiate to the other places, thighs and legs. Though it is not always a text book pattern and vary from one woman to another in terms of origin, intensity and spread.

These are the signs that you have to look out for and then report to your place of delivery.But in case of doubt, or to be on the side of caution.Better to be safe than sorry!

Foetus / Your Baby Within

PICTURE:

 As said earlier,the foetal development is complete. The foetus measuring approxiatmetely 20 " or 50 cms. and weight normally 2.5 – 4.0 kg. Any baby move than 4.5 kg is a large baby and needs investigations and may also pose some problems during labour. During labour, chemicals called "Prostanords" are released in you which may reduce your foetal respiratory and body movements.

Your Body and You

The baby’s head may have gone in to the pelvis. The head is fixed and hence the movements seem to be reduced.Your breathing is much easier and your abdomen may be feeling slightly lighter.The pressure on you urinary bladder by the feotal head may cause difficulty in passing urine or increase in frequency. Sometime between now and labour, some of you may experience a sudden increase in the energy levels
a "Second wind". This is known as "nesting instinct". This is in preparation of your child birth. Don’t waste it by taking extra work and over doing things.
Emotionally, you may have come to terms with your pregnancy as it is coming in an end. You may be thinking of the proud moment when you will be holding the wonderful little one. Or, on the contrary some of you may be a bit restless and want to get it over with. It is just natural. It is been a long journey and you needn’t feel bad about it.You can blame it on the hormones!

Visit To Your Doctor

The visits to your doctor will become even more frequent than before.You may be called at weekly intervals or whenever you have any problem and when in labour.Your monitoring and investigation will follow the same lines as mentioned in the earlier weeks    
This is the time to discuss and clarify various doubts that you have regarding labour and the other points on your "Birthing Plan"
    .

Possible Problems
Some of the common problems that may be seen are:

1. PIH (pregnancy included hypertension).
2. Gestational diabetes.
3. IUGR (Intra uterine growth retardation).
4. Bleeding due to Placenta praevia (placenta covering the uterine opening or cervix) or Abruptio placentae (separation of placenta).
5. Premature rupture of membranes (rupture of membrane before labour).
6. Postdatism (pregnancy going beyond 40 weeks).
7. Post maturity (pregnancy going beyond 42 weeks).
8. Caesarian section:    

Important Instructions
Apart from signs of labour, there are few "alerts" that should be kept in mind and reported promptly to your doctor

1. increased blood with show or frank bleeding,
2. yellow, brown or greenish amniotic fluid leak,
3. increased foetal activity or absent foetal activity,
4. Warning signs of PIH like headache, vomiting, pain in the upper abdomen on right side or in the center, blurring of vision, convulsion etc.      
5. watery discharge without pain.

It is also a wise thing to make a list of things to be taken to the hospital. This will help you to arrange your packing for labour.

A tentative list can be as follows:

(You may add or delete as per your necessity)

1. Books for light reading and may be a book on pregnancy and after as you may not be able to access us from the hospital.
2. A pack of cards, radio and a cassette player.
3. Still/ Video camera.
4. Toiletries like soap, shampoo, toothpaste, powder, oil, perfume, lotion, sanitary napkins, hairbrush, make up kit etc… You need not look haggard and like a patient when in the hospital.
5. A tennis ball or rolling pins to massage your back during labour to reduce the backache.
6. Hard-boiled sweets to prevent you from feeling thirsty.
7. Wash cloth and towel for sponging preferably not white or light colored.
8. Robes nightgown, nursing bra, under clothes, and other clothes that you may need. Don’t take your best ones as they can get bled on.
9. Nappies, clothes, towels and blankets for the little one.
10. Change /coins for making phone calls.
11. Some snacks and drinks for yourself and those with you.
12. And lastly your "SPOUSE" or "LABOUR PARTNER"!!

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