Forty weeks and waiting
You know those last few weeks of pregnancy when your feet are swollen (not that you can see them!), your pubis symphysis aches, and you’d really just like to inally meet your baby? Like, yesterday! You’re not alone in feeling that the last few weeks seem to take forever. But for those still waiting past their due date, the minutes and hours drag on, and on, and on. The fact is that less than 5% of babies are born on their due date and 50% of pregnancies extend into their tenth month.
The physiological processes leading up to labour are complex and serve many purposes. The dance of hormones which prepare you, your baby and your placenta for birth is best left to its own devices, unless there’s reason to suspect something’s wrong.
Hormones are chemical messengers, sending messages back and forth to tissues and organs.
In the inal weeks of pregnancy, your uterus transforms from being hospitable and relatively dormant to a coordinated, strongly contracting organ at the time of birth. The exact physiological events leading up to birth are still not completely understood. We do know that the ratio of progesterone to oestrogen changes (in favour of oestrogen) in the weeks prior to birth, triggering an increase in prostaglandins. This leads to, among other things, an upregulation of the effect of oxytocin. Simply put, this culminates in rupture of foetal membranes, ripening of the cervix and uterine contractions. When you know what it takes to get labour going, it seems pretty ridiculous to bank on a so-called “due date”! Auckland
midwife Amanda Fergus explains it to clients as an estimated month of birth. It’s healthy and normal to give birth anywhere from 37 to 42 weeks of pregnancy with the average irst birth at 40 weeks and ive days. Amanda points out that if you haven’t had your baby by your due date, it’s good to re-frame the situation. Rather than being overdue, remember that your baby will come when she’s ready. That can be hard in the face of lead maternity carers that jump to talk of induction. Where she works, inductions closer to 41 weeks and ive days are for healthy mums and babies who are purely “postdates”, with earlier inductions reserved for mums with complications. Of course, if there are complications, it’s very important to monitor mum and baby’s health. Sometimes getting baby out sooner will provide the best outcome. Medical investigations and interventions If you’re past 40 weeks of pregnancy it may be suggested that you have a few investigations to monitor yours and baby’s health. Scans An ultrasound is used to check levels of amniotic luid. The volume can reduce as pregnancy progresses and too little is a sign that baby would be better on the outside. A scan may also determine if a baby is small for gestational age and needs intervention. Stretch and sweep This procedure is relatively low on the intervention scale. Midwife Amanda explains that it’s still intervention, but can help avoid other interventions. Your lead maternity carer
IN THE FINAL WEEKS OF PREGNANCY, YOUR UTERUS TRANSFORMS FROM BEING HOSPITABLE AND RELATIVELY DORMANT TO A COORDINATED, STRONGLY CONTRACTING ORGAN AT THE TIME OF BIRTH
sweeps their inger in a circular motion to try to separate the amniotic sac (membranes) from the cervix. Yep, it sounds very middle ages and un-technologically advanced! It also sounds painful and I’ve heard from some women that it was unbearable, while from others that it hardly hurt at all. As with everything, you’re in control, and if you wanted the procedure to stop that’s your right. Essentially, the aim is to trigger prostaglandins which in turn initiate labour.
A review of all the literature on stretch and sweeps was published in the British Journal of Obstetrics & Gynaecology recently. It showed a 24% increase in the chance of delivering within 48 hours and a 46% increase in the chance of delivering within a week.
Once a pregnancy has gone past 40 weeks, you may start to hear the word induction thrown around. It’s important to ask the relevant questions so you know why induction is being
recommended. Medical reasons may include:
- To relieve gestational diabetes
- Lack of amniotic luid
- Small gestational size
- High blood pressure
- Slowed foetal movements
- Rupture of your membranes with no sign of labour Induction of labour without a medical reason doesn’t meet the criteria that the beneits to mum and baby outweigh the risks.
An honest discussion with your lead maternity carer will help you understand the best way forward. Keeping in close contact (usually twice a week) past your due date is essential.
Help steer your body in the right direction during those last few weeks of pregnancy.
Pregnancy itness classes have sprung up everywhere and there’s no doubt being it for labour can be helpful. There is some suggestion that plenty of time in a forward position
helps baby get into a good labouring position. Leaning forward slightly rather than slouching back into the couch, or sitting with the chair back against your belly with a pillow for comfort.
Deep squats may nudge baby downwards with the help of gravity while bouncing on an exercise ball forces your pelvis into a good position. The lower baby is the better, as the
pressure can promote ripening of the cervix. I have a feeling stair-walking helped me go into labour. I certainly did a lot of them! The rocking of the hips is key here. You can mimic this repetitive hip tilting by doing the bridge pose and moving the hips from side to side. It’s always wise to ask your midwife or itness instructor what’s safe for you at every stage.