Pregnancy Week by Week: Week 40

THIRD TRIMESTER

WEEK 40

Well, you’ve made it! You have reached week 40 of pregnancy, and it is almost time to meet your precious little baby, who could be measuring up to 56cm and weighing about 4.1kg.

Birth weight varies greatly from baby to baby, so you may end up with a dainty little bundle, or the ward whopper! Baby is probably about as big as a watermelon and you sure can believe it as you battle to walk with this huge bump in front of you! Research shows that a 40-week foetus has grown seven times in length since it was 12 weeks and is about 200 times heavier. No wonder you are feeling exhausted!

But even though you think you may have reached the finishing mark your baby might have other ideas! Remember that due date is at best an estimate, and baby will make an appearance when he is good and ready! Many first-time mums end up waiting two weeks or so after their expected delivery date.

At 40 weeks pregnant baby is fully formed, with all organs, systems, and reflexes ready for life outside the uterus. Hair and nails continue to grow, lung development is still happening, and baby will continue to pack on stores of fat until the last moment.

If you reach this critical week and don’t go into spontaneous labour, your healthcare provider will probably request a biophysical profile test to evaluate your baby’s wellbeing. This consists of a non-stress test to assess baby’s muscle tone, heart rate, breathing and body movements, as well as the amount of amniotic fluid. If you are overdue or have an at-risk pregnancy, this test may be repeated a few times a week until you go into labour.

Pregnancy symptoms during week 40

During these last couple of weeks the symptoms that you have been experiencing previously will continue:

Swelling

Legs, feet, ankles and fingers often become more swollen in the later stages of pregnancy.

Try to:

• Wear comfortable shoes
• Avoid standing for long periods
• Take frequent rests with feet up
• Drink plenty of water to flush your system
• Take regular walks or gentle swims

Baby’s movements

Your baby's movements should remain consistent and strong despite the cramped conditions inside the uterus, even if at this late stage of pregnancy the pattern of movements has slowed or changed. You can feel the little head turning and will be relieved that the feet can no longer kick you in the ribs. You should notice at least 10 movements an hour that could feel like rolling, fluttering or squirming. If you notice any significant changes in your baby's movements, such as a reduction or lack of movement, or if you are concerned in any way, contact your healthcare provider without delay. Do not leave it to the next day in the hopes that the condition will improve or settle.

Pelvic pain

Now that your baby’s head has dropped into your pelvis, it could be pressing on nerves and on your bladder. Up to 80% of mums-to-be say this is one of the most uncomfortable symptoms in the last few weeks of pregnancy. Groin pain, which is also called ‘lightning’, and leg cramps also occur because of pressure on nerves. Pelvic pressure is different from the pain described above and is caused by cervical effacement and dilation – which is actual labour.

To relieve pelvic pain here are some tips to try:

• Pelvic exercises
• Warm bath
• Heat pad on lower back for 20 minutes at a time
• Belly sling or belt
• Pre-natal massage from a maternity specialist

Nesting instinct

You may find that you have boundless energy this week, and then suddenly all you want to do is flop down on your bed and nap. It is typical at this stage to toggle between the two. Just take care not to exhaust yourself as you need to conserve energy for the arduous task of giving birth. You also would not want to start any large project that you may not be able to finish.

Frustration

Perhaps the worst symptom now is frustration! You have been gearing up for this milestone week, and all expectations were set for delivery now. Feeling frustrated is extremely common but bear in mind that you may not even be late yet. Due date calculation is not a definite study, and it sometimes happens that the original information regarding the last period was slightly off. Statistics show that about half of all newborn babies arrive a little late, with only about 7% being overdue in the true sense of the word.

So as tedious as it is, just hang in there, as labour is sure to start soon!

What to expect during labour

By week 40, labour can start at any time. Brush up on signs and signals of labour, and in particular, pay special attention to any watery trickle or gush from your vagina, as your waters could have broken. If your contractions feel stronger or more regular than Braxton Hicks and are even slightly more uncomfortable, let your healthcare provider know, as this could be the moment you have been waiting for!

If you have been attending prenatal classes, or doing your own research, perhaps you already know that childbirth is made up of three different stages.

Stage 1 – Labour

This is the longest stage and if it is your first baby, labour could take 12-19 hours, and up to 14 hours if it is a subsequent pregnancy. Strong and regular contractions will cause the cervix to dilate and thin out, which enables baby to move further down the pelvis and into the birth canal.

This first stage is further divided into three parts, namely:

• Early labour, which is characterised by mild contractions and a possible bloody show.
• Active labour is when contractions become stronger and longer; you may feel pain or pressure in lower back; you could have the urge to push; waters could break; you could be fully dilated. You would need to go to hospital at this stage.
• Transition to Stage. This is the hardest and most painful part of childbirth and can last anywhere from 10 minutes to an hour. Your cervix will be fully dilated, contractions come closer together and you will have an almost unstoppable urge to bear down and push.

Stage 2 – Pushing and birth.

Your contractions could slow down. At this stage, if it seems necessary your doctor will perform an episiotomy, which is a small snip at the opening of the vagina. Sometimes aids like forceps or suction are necessary to help get baby out of the vagina. Once baby is born, the umbilical cord is cut.

Stage 3 – Delivery of the placenta.

This stage is the shortest, starting soon after birth and lasting about 20 minutes. You will continue to have contractions, which will help to part the placenta from the uterus and move it down the birth canal. If necessary, you will have the site of the episiotomy stitched now.

Our best advice to you during labour is to try and stay comfortable and relaxed throughout. Move around and try different positions to see what works best for you. Enlist the help of your doula or birth partner in this.