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Going the full 40 Prenatal Care

Going the full 40

Those last few weeks of gestation are critical to your baby’s health and development. Don’t rush perfection!

You’ve been pregnant for what seems like forever. Heartburn haunts your days and nights, your feet are starting to resemble overstuffed sausages, your once roomy maternity duds are bursting at the seams, and sleep has long since abandoned you. What’s more, you’re anxious to finally meet the baby you’ve been daydreaming about for almost nine months.

It’s easy to see why delivering a couple weeks early might be tempting, especially when your doctor is willing to induce labor or schedule a C-section at your command. But try to hang in there! Baby will be more likely to thrive if you deliver closer to your due date.

A change to the lingo
Until recently, a pregnancy was considered “term” when a woman carrying one baby reached 37 weeks of gestation. That changed in fall of 2013, when the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) redefined “term pregnancy” by dividing the period into four more specific labels:

Early term: 37 to 38 weeks
Full term: 39 to 40 weeks
Late term: 41 weeks
Postterm: 42 weeks and beyond

Why the change? It turns out, 10 to 15 percent of U.S. deliveries are elective, performed before 39 weeks, even though studies have shown healthier birth outcomes at 39 weeks rather than 37 or even 38. ACOG hopes that the new labels will help to dissuade patients (and their doctors) from scheduling “nonmedically indicated” inductions before 39 weeks. According to ACOG, “Elective deliveries before 39 completed weeks of gestation can pose both short-term and long-term health risks for the newborn.”

What baby’s up to those last few weeks
Baby is still busy developing in the last weeks of pregnancy. His brain is making new connections, he’s shedding the vernix and lanugo that have protected his skin in the womb, and he’s digesting amniotic material as he prepares for his first bowel movement. Baby puts on about a half pound a week near the end, adding a layer of fat beneath the skin that will cover his blood vessels and help him to maintain body temperature after birth.

Perhaps most importantly, baby’s lungs are preparing for life outside the womb. Baby is producing surfactant, a liquid that fills the inside of the lungs before birth; without a sufficient coating, the lungs could collapse, and baby would suffer from respiratory distress syndrome. In fact, breathing difficulties land many early-term babies in the NICU.

Baby’s nervous system is also developing in his last gestational weeks. An early delivery could mean a more “sensitive” baby who exhibits signs of colic as his body struggles to adapt to conditions outside the womb. Some moms of early-term babies report sleeping and eating difficulties, which translate into many frustrating nights for mom and dad.

What your body’s up to those last few weeks
Just as baby needs time to reach his full birth day potential, your body also needs those last weeks to prepare. Your cervix is opening (dilation) and thinning (effacement). Baby is moving into position—with his head down—and will drop into your pelvis to prepare for birth. When your body is allowed to progress at its natural pace without medical intervention, you lower the risk of complications during delivery, and you’ll have a better chance of being able to deliver vaginally, whether you choose to do so with or without pain medication. Rushing the process with Pitocin before your body is really ready could have you facing an unintended C-section. (And while having a C-section is not the end of the world, it does mean a longer recovery period and potential difficulties with future pregnancies.)

You may also be dealing with some of the unpleasant side effects of the third trimester. Expect swelling, heartburn, irregular bowel movements, frequent trips to the bathroom and difficulty sleeping. Unfortunately, these symptoms are just part of the process for many expectant mamas. To lessen your discomfort, alternate between sitting and moving throughout the day, eat mild foods and sleep on your left side with plenty of pillows.

While you wait
The upside of an elective induction is the knowing—the ability to circle a date on the calendar and identify just how much time you’ll have to prepare before the birth. When you wait for your body to go into labor naturally, it’s normal to feel some anxiety over the uncertainty of it all. Where will you be when you go into labor? Will your water break in a public place? What if labor comes on hard and strong, leaving little time for a dash to the hospital?

All you can do is prepare. Attend all doctor appointments, so your OB can check the position of the baby and tell you where you stand on dilation and effacement. Depending upon how you are advancing, your OB can predict how soon you’ll deliver (although, of course, predictions aren’t always accurate). Keep your hospital bag ready and waiting by the door, or stash it in the car if doing so makes you feel better. Have a couple of standby drivers ready to take you to the hospital when you call. Stay close to home as you near 40 weeks, but rest assured: Most women do not lose their fluid in public (except in the movies!), and labor typically gives you plenty of time to make it to the hospital before you’re close to delivering.

Forty full weeks may seem like an eternity, but remember that baby’s health is the end goal. Best wishes for a timely and healthy delivery!