36 Weeks Pregnant
The choices and challenges of delivery
36 weeks pregnant:
eyesEyesThe retinas of the eyes appear as dark spots, and the eyelid folds are beginning to form around them.
limbsLimbsSince your baby's movements are bigger and more defined, you may be able to see an outline of an elbow or heel under your skin.
What's happening with you:
You're approaching your ninth month so prenatal visits will become more frequent -- you'll be in to see your doctor or midwife every week now until you deliver your baby. Third trimester discomforts that have demanded your attention are likely still with you, but you'll have more breathing space if your baby has dropped down into your pelvis. Don't presume labor is right around the corner, though: many women who feel their baby engage during week 36, especially those who are carrying their first child, may have a few more weeks to wait before other signs of labor fall into place. Think of these little changes as a careful acceleration to the big day -- after all, you would be completely overwhelmed if everything was to happen at once!
Your baby is taking up most of the space in your uterus, so her movements will probably feel slower, bigger and more defined. Little fists and feet have given way to elbows and knees, so don't be surprised if you see a small outline on your belly where you feel her pokes. You may find that the sharpest or strongest nudges come up by your ribs, as most babies have assumed a head down, rump up position by now. If you're starting to feel more pain in your back, your baby could be lying in a posterior position, which would put more pressure on your nerves. If you experience cramping, increasingly painful contractions or other signs of labor along with the back pain, call your doctor or midwife right away.
What's happening with your baby:
By now your baby weighs around 6 pounds and he's over a foot and a half (or 18 inches) from the crown of his head to his heel. He's lost most of his lanugo and he sports a thick coating of vernix caseosa to protect his skin from being damaged by the amniotic fluid. Space is tight, so he will turn now and then, but sporadic limb movements may come less frequently.
You're baby is almost at full term, so you can rest easy knowing that the odds are in his favor: if you were to deliver today, your little one would be able to survive with minimal medical intervention. The only organs that could use a couple more weeks are the lungs, which may still have some difficulty taking in air on their own. His motor skills are sharper, his digestive system is working and his brain is developing at an impressive pace. Your baby is almost ready for his life on the outside.
Things to do this week:
By now you're probably thinking of one thing and one thing only: your upcoming delivery. Preparing for labor can be tricky, especially if you haven't been through it before. Have you packed your hospital bag yet? Well, if you've put one big bag together, consider repacking the items into three smaller bags -- one for your labor, one for after delivery and one for your partner. This way you won't be fumbling with an array of unnecessary items after you deliver, and your partner will appreciate the ease of access to his own stuff.
When putting together the layette for the hospital (which will be Baby's first outfit), it's better to over-pack than under-pack. That doesn't mean you should include your baby's whole wardrobe, but rather the basic garments in a variety of sizes. Your doctor will be able to estimate your baby's size, but nobody knows for sure just how big he will be, and he could grow quite a bit in a matter of weeks: a newborn at 37 weeks could be a size smaller than one born at 40 weeks. Depending on the weather and temperature, you may need to include some specialized items, but start with onesies, undershirts, receiving blankets, socks and a soft hat to keep his head warm when you bring him home for the first time.
You'll probably be tested for a bacterial infection called group B streptococcus this week, and you'll need to be treated during labor if the test returns positive results. The infection rarely brings any symptoms in adult women, but it can have a deadly effect on babies that contract the condition during delivery.
Between 20% and 40% of pregnant women carry the group B strep bacteria in their vaginas, and while most babies born to infected mothers won't contract the infection, about 2% of these newborns will develop group B strep disease. Your doctor will want to take every precaution to avoid this outcome, so you'll have a virtually painless cervical swab (a procedure similar to a pap smear) to test for the bacteria, and there's a good chance you will need antibiotics during your labor to minimize your chances of passing along the disease. If you do test positive for the infection, it's a good idea to learn what to watch for in an infected newborn. Unlike adults, group B strep symptoms in babies can escalate quickly, leading to dangerous diseases like meningitis if not caught early enough.
Tips for your partner:
If you're going to be your partner's labor coach, refine your pain relief tactics before labor sets in. Try out different massage techniques and breathing patterns with your partner to see what feels natural and effective for both of you. Many childbirth preparation classes will teach you a variety of pain management techniques, but the nuances of labor pain are not universal so you can't expect that the most popular technique will necessarily be the best one for your partner.
Concentrating on your active role in the labor will also distract you from the scarier parts. While most partners won't faint or be sick at the sight of bodily fluid, it's the fear of this reaction that can interfere with your best intentions. Avoid the fear altogether by training in the weeks leading up to labor and focusing your efforts where they are most needed during delivery -- at face level, where you can encourage, calm and motivate your partner more effectively. Be comfortable with the birth plan and on good terms with the doula. Don't be afraid to express your concerns to your partner or some other trusted friends, and consider joining a forum for new dads to restore your confidence and calm your fears before the big day.
This week's FAQS:
How dangerous is a c section for me and my baby?
Although there will always be some risks involved with any surgery, a cesarean section is actually one of the safer procedures you could go through. If you aren't suffering from any major medical problem, your risk of dying from a cesarean birth is incredibly low -- less than one in 2,500, to be more precise -- and your baby also has a very low chance of being harmed during the procedure. However, your specific risk will depend on your health and unique circumstances so don't be afraid to ask your doctor how a c section is likely to affect you, not the "average" woman.
It's true that babies delivered by c section are more likely to have health issues, but in most cases, that's not the fault of the surgery: many cesareans are performed precisely because the baby isn't thriving or is expected to have trouble as labor progresses. However, because labor triggers the breathing response and completes lung function, babies that do not go through a vaginal delivery may have slight respiratory trouble after birth.
A growing concern among childbirth advocates is the high amount of cesareans that are conducted for low-risk pregnancies and labors, since vaginal childbirth ultimately carries a lower risk of complications, low birth weight babies and infection. This is another reason to discuss your options with your doctor. Is a c section absolutely necessary for your health and the health of the baby? If not, what exactly makes your doctor believe it's a better choice than a vaginal delivery? Don't let yourself get bullied into the decision; demand answers from your doctor and read up on both sides of the issue for your own clarity.
My doctor says that my amniotic fluid level is low. Should I be concerned about my baby's health?
Your amniotic fluid is measured with the help of an ultrasound, which displays four "pockets" of fluid in your uterus. Your amniotic fluid index (or AFI) is calculated by adding up the depths of each of these pockets: anything above 18 means you probably have too much amniotic fluid, and a score below 5 or 6 could indicate that the level is lower than normal. The technical name for this condition is oligohydramnios, but your doctor may refer to it simply as a low AFI.
Since the amniotic fluid is responsible for regulating your baby's body temperature, protecting his skin, conditioning his respiratory and digestive systems and cushioning his body, it's important that the fluid level is high enough to support your baby's growth and health. Inducing labor is quite possibly the easiest and safest solution, since delivery at 36 weeks carries little risk for you or your baby. Your doctor will monitor your baby closely, and depending on the fluid level and any signs of cord compression, she will decide if a vaginal delivery or a c section will be the best course of action.
Trying to decide if labor medication is right for you? One fact to consider is that studies have shown that women who have epidurals are nearly twice as likely to have major perineal tearing, and their use may also be linked to maternal fever during labor. While many women fear the pain of labor and wind up opting for strong pain relief to get through the experience, there are several types of pain relief available to you. Instead of going straight for the most powerful medication, read up on other types of medicine, devices and techniques designed to dissolve labor pain.