Month 9

What's Happening to Me?

This final month of your pregnancy brings many physical and emotional changes. As your body prepares for birth, your metabolism picks up speed. Your heart adapts to the additional workload of this change, as well as to the increase in your weight and the baby's growth, by becoming slightly enlarged and adding an additional ten beats per minute. Again, you can expect to gain approximately three to four pounds during this last month. Your uterus now weighs almost two pounds, and extends to just under your rib cage.

If your baby has not "dropped," he or she soon will. While this may exert additional pressure on your bladder and rectum, you should be able to breathe a bit easier. Baby's movements decrease because he or she has less space in the uterus, but strong jabs from hands and feet can still be felt.

Emotionally, you are probably very anxious for your pregnancy to be over, yet you may also be having last-minute concerns and fears. How is being a mom going to change my life? Will my baby be healthy? You may also be increasingly dependent upon your partner, family, and friends. Take some comfort in knowing that every mother before you has had these same fears, thoughts, and concerns. Remember, you're not going into labor alone. You'll have a team of qualified healthcare specialists there to help you every step of the way.

NEWSLETTER
Table of Contents

Baby's Development

Overdue?

Am I In Labor?

Mommy's Notes

The Delivery

Twins

Cesarean Delivery

Anesthesia and You

Tips for the Labor Coach

Umbilical Cord Care

Baby Business

Prenatal visits with your physician will be weekly now as your delivery date approaches. Take these opportunities to address any questions or concerns that you may have.

Baby's Development

By now, your baby is fully developed, approximately 20 inches long, and weighs five to nine pounds. Brain cells are developing at the most rapid rate during the pregnancy. Baby's inner ear is formed. Nails have grown beyond the tips of the fingers and toes. The bones of the head are well developed, and the head and shoulders measure the same circumference. When he or she is awake, baby's eyes are open and can discern light.

Baby will move downward and usually turn head down, ready to be born. The baby's lungs are mature, and the baby continues to practice breathing in preparation for its first breath of air. The placenta has grown to about seven inches in diameter and weighs about one to two pounds. Maternal antibodies are passed onto baby through the placenta, offering some temporary immunity to some of the diseases you have had or have been immunized against.

Overdue?
	If you go past your due date, don't despair -- you are not alone; very few women deliver their babies on time. Most women, especially first-time moms, deliver after their anticipated due date. If you are overdue, your physician will watch you closely and may order tests to make sure baby is doing okay.

Am I in labor?
	False labor is very common and may seem like the real thing. To distinguish between the two, false labor is felt mainly in the abdomen but not in the lower back area. Contractions are irregular and may disappear with a change in activity or position. False labor contractions also do not increase in strength or length. To ease your anxiety, it is helpful to understand the three basic signs of true labor: Water leakage or breakage. This may be characterized by a small trickle or a large rush of watery fluid. Call your doctor when this happens -- don't wait!	Regular contractions felt in the lower back, as well as in the front of the abdomen. These contractions come at regular intervals, beginning 15 to 20 minutes apart and lasting 30 to 45 seconds. I Pink or bloody discharge, signifying that the baby has begun to push against the cervix. When you think you are in labor, call your doctor. Stop eating, to reduce the chances of nausea during labor. Your doctor will tell you if it's time to go to the Hospital. And relax. Feel confident that you are packed and ready to go.

The Delivery

It's time! Here's some information to help refresh your memory about what you've already learned from your BEGINNINGS Childbirth Education classes. Labor, in its three stages, is the process by which your baby advances from the uterus to the outside world. Most women experience labor in the 38th to 42nd week of pregnancy.

Labor for the first-time mother usually lasts about 14 hours, while labor for additional children is usually shorter, lasting approximately 8 to 10 hours.

Before birth can take place, the cervix, or mouth of the uterus, must be effaced (become shorter and thinner) and dilated (open to approximately 10 centimeters in width) to allow the baby to pass through.

Labor - Stage One

Phase One
The early or "inactive" phase of labor is signaled by the first real contractions and lasts until the cervix has dilated to approximately four centimeters. This will probably be the longest part of your labor but will also be the least painful.

Constrictions are felt in the lower back as well as in the front of the abdomen. They come at regular intervals, beginning 15 to 20 minutes apart, and normally last 30 to 45 seconds. In the beginning, these contractions feel like a menstrual cramp or gas-like discomfort. During this phase you may be most comfortable in your own home, and walking can help ease your discomfort. If your water breaks, call your doctor first, then proceed directly to the Hospital.

Phase Two
Phase Two is the "active" phase of labor. By now you should be at the Hospital, where you will be taken to an LDR (labor, delivery, recovery) suite. Contractions have intensified, occurring every three to five minutes and lasting 45 to 60 seconds. During Phase Two, your cervix will dilate from four to eight centimeters.

Your labor and delivery nurse will monitor the baby's heart rate with a fetal monitor. Your temperature, pulse, respiration, and blood pressure will also be monitored. Your doctor or nurse will also periodically check the progress of your dilation.

The relaxation breathing techniques you learned in your BEGINNINGS childbirth classes can be very helpful during this phase. Changing your position may make you more comfortable. In addition, your partner can massage your back. Phase Two is shorter in time than Phase One.

Phase Three
Phase Three is known as "transition" labor, when your cervix will dilate from eight to ten centimeters. This is the most demanding part of labor and, thank goodness, the shortest. Your contractions are now very intense, occurring approximately every two minutes and lasting 60 seconds. Relaxation is difficult, and you may experience cold spells and trembling. You may also feel sleepy between contractions, as the uterus is requiring much of your blood sugar supply. Your backaches are worsening as the baby advances further into your pelvic region. The completion of this stage of labor comes when the baby has descended into the birth canal. You may have the urge to bear down and push. It is necessary to try to control this urge through breathing techniques (such as panting) until your cervix is fully dilated. Early pushing will increase your fatigue and may actually slow down labor.

Labor - Stage Two

Stage Two begins when your cervix is fully dilated and lasts one-half to two hours, until the baby is delivered. Contractions are further apart and less intense, occurring every three to five minutes and lasting 60 to 90 seconds.

When the baby's final journey begins, the cervix temporarily merges with the uterus to clear the way through the birth canal. Next, your baby's head will rotate, and he or she will slowly move past the bend of the birth canal to the vaginal opening. When your baby's head appears or "crowns," the doctor may perform an episiotomy to prevent irregular tearing of the vagina. First, baby's head emerges, next the shoulders, and then the rest of the body. Congratulations! Your baby has just been born!

Labor - Stage Three

This stage begins with your baby's birth and concludes when the placenta and membrane that held your baby are expelled. Only a few mild contractions are needed for this stage. The doctor will examine the placenta for any irregularities.

It's amazing how fast your body begins to repair itself. Hormones and contractions squeeze shut and seal off the open blood vessels left behind by the placenta. Your body's circulation is assisted by rerouting your blood away from the uterus to other parts of your body. You probably won't even notice this stage. If there are no complications, you and your baby will be united to see one another face to face for the first time.

Immediately after baby is born, his or her nose and throat will be cleared of mucous or fluid, if necessary, and then the umbilical cord will be clamped and cut. The baby is quickly dried off, wrapped in a blanket to keep warm, and may be placed on your stomach so you can enjoy the moment. At one minute and at five minutes after the birth, your baby will be assessed as to how well he or she has made the change from your uterus to the outside world. All newborns are required by law to be tested or screened for certain rare inherited diseases. For the screening, a few drops of blood are usually taken from the baby's heel.

Twins

Labor is no more painful with a twin delivery than with a single baby. There is only one first stage of labor if you hare having twins. Once the cervix is fully dilated and you are able to push, both babies are pushed out one after the other. There are two second stages, though the second one will be short, especially if the second baby is smaller than the first. The majority of second babies are born within 10 to 30 minutes of the first.

Emotionally, a twin birth is different from a single birth. After the euphoria of the first baby, the delivery of the second baby only adds to the triumph and joy. The physician will examine you to see that the second baby is lying correctly. The contractions will begin again after a few minutes, and the membrane will be artificially ruptured.

Cesarean Delivery

A cesarean section is a major abdominal operation that should never be undertaken lightly. There are slight risks associated with it, similar to any major surgery. There is also the disadvantage of being left with a scar on the uterus which may weaken it.

You may know you are to have a cesarean section weeks or perhaps only days in advance. This is known as a planned cesarean section. Unless your cesarean is a dramatic emergency, it can be done under an epidural anesthetic, which means you can be conscious throughout to see your baby the moment he or she is born.

The cesarean section usually takes about 45 minutes, but the baby is delivered within the first five to ten minutes. The remaining time is for stitching the uterine wall and the abdomen.

The anesthesia will be set up, an intravenous drip inserted into your arm so that fluids can be fed directly into your bloodstream, and a catheter inserted into your bladder. A screen will probably be placed in front of your face, and your birth partner may prefer to stand behind it at your head if he doesn't want to see the surgical procedure. The incision is usually horizontal, and the amniotic fluid is then drained off by suction. The baby is then gently lifted out. You will then be given an injection to make the uterus contract and stop the bleeding. You and your birth partner can hold the baby while the third stage is completed. Depending on the reasons for the operation, your baby may be taken to special care for observation. If everything is all right, you can start nursing the baby as soon as possible.

Reasons for a cesarean section include:

Prolapsed umbilical cord through the cervix
Placenta previa
Detachment of the placenta from the uterine wall
Induction and labor are considered an unnecessary risk to baby or mother
Multiple gestation, abnormal position
Fetus is extremely large or baby's head is larger than the pelvic cavity
Baby fails to descend
Fetal distress
Previous uterine surgery
Cervix fails to dilate
Cervical herpes (active)

Some of these conditions may not be apparent until labor has begun. This can result in an emergency cesarean section. If you have concerns or questions, discuss them with your physician.

If you and your physician are planning a cesarean section, the Childbirth Education series will discuss what to expect and prepare you for a positive experience.

Anesthesia and You

Each woman's labor is unique to her. The degree of labor pain which you feel differs from that felt by other women in labor, influenced by factors such as the level of pain tolerance, size and position of the baby, strengths of uterine contractions, and prior birth experiences. So, decisions regarding control of your labor pain must be made specifically for you. Some women achieve adequate pain control with the breathing and relaxation techniques learned at childbirth classes. Others may find them inadequate.

Today's mothers are reconsidering the idea that childbirth is "natural" only without medication, and they are choosing to have pain relief during labor and delivery to help them experience a more comfortable childbirth. This is a decision that should be discussed with your doctor beforehand so you understand all the options available to you.

Your wishes and your medical condition will be considered for the type and extent of pain relief administered. Your physicians will prescribe or administer medications only in the amounts and during those stages of labor that are best for the well-being of your baby.

Analgesics
Pain-relieving medications injected into the vein or muscle are called analgesics and will help dull pain, although they may not eliminate it completely. These are prescribed by your obstetrician. Because they sometimes make both you and your baby sleepy, they mainly are used during early labor when it is important that you reserve your energy.

Local Anesthesia
Other pain-relieving medications may be injected in the vaginal and rectal areas by your obstetrician at the time of delivery. These medications are called local anesthetics, and they provide a numbness or loss of sensation in a small area. Local anesthesia often is used to ease the pain of childbirth or when an episiotomy incision is done to assist the delivery. It does not relieve the pain of contractions.

Regional Anesthesia
Regional anesthesia refers to epidural and spinal blocks which are administered in the lower back, usually by an anesthesiologist. Certain local anesthetics and other drugs are used for these blocks, which reduce or block pain and other sensations in a wider region of the body. An epidural block may be used for labor and vaginal or cesarean delivery. A spinal block may be used for a cesarean delivery, but is seldom used during labor.

General Anesthesia
General anesthesia is used when a block anesthetic is not possible or is not the best choice for medical or other reasons. It can be started quickly, with a rapid loss of consciousness; thus, it is commonly used when an urgent cesarean delivery is required, such as in rare instances of problems with the baby or vaginal bleeding. In these circumstances, general anesthesia is quite safe for the baby.

One of the most significant hazards during general anesthesia is caused by food or liquids in the mother's stomach. Labor usually causes undigested food and acids to stay in the stomach. During unconsciousness, these could come back into the mouth and go into the lungs where they can cause damage. Your anesthesiologist, therefore, takes extra precautions to protect your lungs, such as placing a breathing tube into your mouth and windpipe after you are asleep. You also may be given an antacid to neutralize stomach acids before your cesarean delivery.

It is best to remember, though, that you should not eat or drink anything after labor pains begin regardless of your plans for delivery or pain control. Sometimes during labor, small sips of water or ice chips are permissible with your physician's consent.

Modern anesthesiology offers a variety of safe choices for a more relaxing childbirth. It is the goal of your anesthesiologist to make your labor and delivery as comfortable and safe as possible for you and your baby.

Tips for the Labor Coach

Although your labor coach has most likely attended the childbirth education classes with you, during the intense time of labor things change. Although your coach may try to be supportive and helpful using massage and relaxation techniques learned in class, you may shout, "Don't touch me!" and "Leave me alone!" during one contraction and "Rub harder!" or "Don't leave me!" during another. It can be difficult for your coach to know when to lead and when to follow. This article is designed for your labor coach.

The important thing is to see labor through. Your presence is what counts.

Encourage and praise her.
Accept her irritability without taking it personally.

Remind her to:

relax between contractions and to take one contraction at a time. Use descriptions such as "Let your muscles go limp," "Loosen up your hands, jaw," and "Allow your body to melt between contractions."
empty her bladder every one to two hours
change positions frequently. Discourage her from lying flat on her back.

Provide:

a calm, quiet environment
lip balm for dry lips
ice chips
cold washcloth for face, arms, legs, back
socks for cold feet
small paper bag, as needed, for hyperventilation
touch relaxation for relief of tension, massage, and back rubs, as needed. (Use counterpressure with the heel of hand or tennis balls for back labor.)

During transition
Transition is not only the hardest time for the mother, but also the greatest challenge for the labor coach. Contractions are relentless, and your presence is of utmost importance despite what she may say or how she may act. Breathing with her, helping her focus, and giving her constant reassurance that she is doing a good job will help you through this time of transition. Keep in mind though, that the most important role (as it is in early labor) is your physical presence.

Remind her that this is the shortest part of labor and to take one contraction at a time.
Ask what you can do to help. Never criticize.
If she is having difficulty staying focused, try taking her face in your hands and making direct eye contact. If necessary, tell her to open her eyes and to look at you.
Breathe with her, maintaining eye contact.
Talk to her between contractions; tell her she's doing a good job.
If she tells you to leave her alone, respect her wishes, but stay close by.
Don't take everything she says personally. She is likely to say things she doesn't mean and won't even remember later on.
Try distractions such as massage or music, but don't be surprised if she rejects them. The same things that may be of help to her at one moment may irritate her at another.
Suggest a position change.
Don't give up on her. Your confidence and strength will give her confidence and strength.

Pushing
Fathers or partners are sometimes discouraged at this point, and often a little fearful. You can't seem to do anything to help because only the mother can push the baby out. But you can be encouraging as a coach.

Count during the pushes, giving enthusiastic feedback about how well she is doing.
Hold her hand.
Give her a cool washcloth for her forehead.
Support her legs or back during the pushes.
Most importantly, you are with her, going through this incredible experience together.

Umbilical Cord Care
	The last remnant of the baby's close attachment to its mother in the uterus is the stump of the umbilical cord. It will turn black a few days after birth and can be expected to drop off between one and four weeks later. You can hasten the healing and prevent infection by keeping the area dry and exposed to air. The following will help accomplish this:	Skip tub baths and avoid wetting the navel when sponging until the cord falls off. Fold the front of baby's diaper to fit below the navel to keep urine off and let air in. Fold the shirt up. Dab the stump with alcohol (on sterile absorbent cotton balls, sterile gauze squares, or alcohol pads) to help keep the site clean and hasten drying. If the area around the navel turns red, or the site oozes, call the doctor.

Baby Business

There are two very important documents that your baby will need periodically throughout life. One is a birth certificate, which will be needed when registering for school, applying for a driver's license, passport, marriage license, or Social Security benefits. The other is a Social Security card. A birth certificate registrar will vist you in the Hospital to register your baby's birth. The completed forms will be verified by you and mailed to the State, which will mail you your baby's birth certificate and Social Security card.