Pregnancy Week by Week: Week 41

THIRD TRIMESTER

WEEK 41

Well, you have passed your 40^th week, and you are still here, waiting for your baby to be born. Perhaps your dates were slightly off, and you are not actually late, or perhaps your baby just loves his snug and safe little nest and wants a bit more time inside! Either way, labour can’t be far off, and at least you know that when baby does make an appearance, your little one will be that much more alert and ready to face the world. Many first-time mums-to-be go past their due dates but are not considered to be overdue until 42 weeks of pregnancy.

Your baby will probably not grow any more in length but may possibly put on a few grams between now and birth. Fingernails, toenails, and hair continue to grow, and lungs can always do with a bit more development.

The amniotic fluid continues to shrink in volume – but the placenta is still doing its job by providing oxygen and nourishment. The creamy vernix coating that functioned as a barrier to protect baby’s skin has probably disappeared. This means that at birth, your baby’s skin could have dry or peeling patches from being immersed in the amniotic fluid. Some babies are born with some vernix clinging to their bodies.

Symptoms at week 40 and beyond

Your symptoms from the last few weeks continue into this week, and even the next if you have still not delivered!

Discomfort in the pelvic area may be greater now with pressure on the bladder and nerves, and the urge to pee frequently could be keeping you on the hop and preventing a good night’s sleep.

Pressure could also be causing swollen veins in the rectal area, resulting in painful haemorrhoids, which may get worse as you push and strain during delivery.

Your pregnancy weight gain will slow down or stop now that you have reached the end of the gestational period. This is a sign that your body is preparing for the big event by ridding itself of unnecessary fluids.

Leg cramps, Braxton Hicks contractions and backache may be more intense, and you could have a bloody show any time now as the mucus plug becomes dislodged.

Baby’s movements may change at this late stage of pregnancy as conditions become more cramped in the uterus, although you should still feel activity. If movement decreases dramatically or stops, let your healthcare provider know immediately.

What happens if labour does not start naturally

You can be sure that your ob/gyn or midwife is keeping a close eye on you and your baby. It is likely that an ultrasound, a non-stress test, and a biophysical profile test will be conducted, which will give you and your healthcare provider peace of mind that all is well with both you and your baby. It will check that baby has sufficient amniotic fluid, is moving and breathing appropriately and that the heart rate is on track.

But in the meantime, you must be feeling fed up and exhausted, as well as downright uncomfortable, and wondering if there is anything you can do to naturally bring on labour. Social media and old wives’ tales are full of ideas but beware of these myths as they can at best be useless and at worst pose a danger.

Hurrying labour along is usually not a good idea, and a better understanding of how, why, and when labour starts may put your mind at rest and highlight what you should and should not do.

Labour starts naturally when your brain receives a signal from your baby’s brain, which in turn stimulates the production of oxytocin, which causes uterine contractions, cervical changes, and ultimately, the onset of labour. Any artificial methods of starting labour means that nature does not run its normal course and, unless under the supervision of your healthcare provider, should be viewed with extreme caution.

Some labour self-inducing myths include having sex, stimulating nipples, eating spicy curries, and going for long walks. There is no medical basis to these methods, and they are not unreliable and not worth the effort.

Your healthcare provider will be closely monitoring your health and progress and that of your baby and will advise you if he thinks steps need to be taken to induce labour. Most women go into spontaneous labour by 42 weeks, and as long as there is no reason to induce you, like foetal distress, it is best to allow nature to take its course.

Induction is commonly considered in certain situations:

• You have concluded your 41^st week of pregnancy
• You develop pre-eclampsia
• Baby is in distress
• Your waters have broken but contractions have not started
• Labour is progressing too slowly

Your doctor will no doubt discuss the pros and cons of an induction and give you the opportunity to bring up any fears, concerns or queries you may have.

What to expect with an induction

Firstly, an induction will take place in hospital, and usually starts off with your doctor or midwife doing a vaginal examination to determine whether your cervix is ready for labour, after which one of various forms of induction will be decided upon:

• Membrane sweep

This is a drug-free method and consists of the midwife or doctor inserting a finger into the cervix and ‘sweeping’ it around in a circular movement to separate the sac from the cervix, which can trigger labour. This procedure feels like an internal examination and can be a little uncomfortable.

• Artificial rupture of membranes

This is where a small, hooked instrument is used to make a hole in the membrane of the sac, thereby causing the waters to break, in the hope of triggering labour.

• Cervical ripening balloon catheter

A tube attached to a balloon filled with a saline solution is inserted into the cervix and remains there for up to 15 hours, putting pressure on the cervix, which should then soften and ripen.

• Prostaglandin

This is a gel-like synthetic hormone that is inserted into the cervix that should soften and ripen the cervix in preparation for labour.

• Oxytocin

A natural hormone that stimulates contractions for labour and the let-down reflex when breast feeding.

Some pregnant women feel at peace with being induced, while others may be disappointed or sad that labour did not begin naturally. Whatever your feelings are, talking about them with your partner and/or family and friends can be extremely beneficial. Ultimately, your goal is a safe labour resulting in a healthy baby, and if an induction is the way this can be achieved, well and good.