Pregnancy Week by Week: Week 42

THIRD TRIMESTER

WEEK 42

Week 42 means your due date has come and gone and you have officially reached the end of pregnancy. Perhaps your original dates were a bit off, or perhaps baby just wants to hang about a little longer inside. But either way, in most pregnancies, natural labour starts by the 42^nd week, so your baby will be born very soon!

Your doctor will continue to monitor you and baby by conducting frequent biophysical profile tests, non-stress tests and ultrasounds to check on the well-being of baby, so even if you have not gone into labour, at least you know that you and your baby are being well looked after.

If you do not go into spontaneous labour soon, your healthcare provider will probably recommend that you have an induction, as the placenta, which up until now has been doing a sterling job, may not be able to provide as much oxygen and nourishment as it should.

Your baby’s endocrine system is kicking into gear, and research shows that it is possible that a hormone is transmitted to the placenta that triggers labour. Furthermore, stress hormones will be produced to help your baby cope with the strenuous task of childbirth, as well as to aid in the rapid adjustment to life outside the uterus and to stimulate survival instincts as your baby adjusts to life without the support of the placenta.

Before you start labour, you should discuss your pain relief options with your healthcare provider. In fact, this could have been a discussion you had long ago as most women want to know up front how painful childbirth might be, and if they will be able to cope, and what help is available to help them cope.

The first hurdle to overcome is your own fear, as this can have a negative effect on how your manage labour. Gaining as much knowledge and information as possible is key. Enlisting the emotional support of your partner or a birth partner will go a long towards giving you reassurance and confidence.

Explore alternative measures for comfort and pain relief during labour:

Different positions and movements

Try to keep mobile for as long as possible; walking, standing upright, kneeling, rocking, swaying can all help with managing pain. Lying on your back can prolong labour and make the contractions more painful.

Birthing pools and water birth

Water has long been known to have soothing properties, and you may have been enjoying relaxing baths and showers in the last few weeks of your pregnancy. This feeling of comfort can continue into labour and even birth if you opt for a birthing pool. The warm water keeps you buoyant which makes it easier to get into and maintain suitable positions. Some women report that giving birth in water, or at least going through labour in a birthing pool, offers pain relief and shortens the first stage of labour.

TENS (Transcutaneous Electrical Nerve Stimulation)

This is a machine which transmits mild electrical impulses to pads attached to your lower back, which you are able to control by way of a hand-held device. These little shocks cause a tingling sensation and are thought to block pain signals by stimulating nerves that connect to your spinal cord. Some experts are not quite convinced that TENS works, but it certainly gives the labouring mum-to-be a sense of being in control of her own pain, and therefore helps to reduce anxiety, which in turn can provide pain-relief.

Complementary therapies

These include practices like reflexology, aromatherapy, acupuncture, yoga, massage, and the like. A registered practitioner would need to be available to perform the therapies and research has not proven conclusively that the treatments are effective, although many women swear by them as a means of relaxation and distraction.

Sterile water injections

This involves injecting a small amount of water into the skin in the lower back area. There is no conclusive evidence to show that these work, but they may provide a positive psychological effect.

Gas and air

This is known as Entonox, and is a colourless, odourless gas made up of nitrous oxide and oxygen which is administered by mouth though a mouthpiece that you control. Entonox takes about 20 seconds to work effectively, is quick and simple to use, wears off quickly, but timing with contractions needs to be precise if you are to get maximum pain relief. Some women report feelings of nausea and light-headedness but happily there are no lasting adverse side effects for mum or baby.

Painkilling drugs

Pethidine, diamorphine and mepid are given by infection into the thigh. Remifentanil is given via drip that you can control yourself. This drug is not always available, and is a strong, short-acting painkiller.

Epidural

This is a common form of pain relief during labour. It is a local anaesthetic that is administered through a tube between two vertebra and is successful in that it removes all pain from the waist down. CSE (combined spinal epidural) is also available and is a low-dose drug that works more quickly than the epidural and some sensation remains. This may cause more discomfort, but it also enables you to participate more actively in labour. Epidurals need to be timed accurately as they are not recommended in very early or very late labour.

Helpful tips for during labour

• Labour at home for as long as possible.
• Create a positive picture before going into labour by imagining that birth is over, and you are holding your precious bundle in your arms.
• Keep moving about for as long as possible during labour. Leaning forwards and rocking will assist in the release of oxytocin and endorphins due to pressure of baby’s head on your cervix.
• Keep breathing calmly and rhythmically, focussing on the out breath during a contraction.
• Be noisy if it helps you!
• Apply heat and/or cold packs to your lower belly or back.
• Ask your birth partner to massage your lower back.
• Rest between contractions to conserve your energy.

Pushing stage

With cervical dilation at 10cm, you are ready for your baby to come out into the world, and you now need to get into the birthing position for pushing and delivery. Most women adopt the back-lying position, but this may not be the one most conducive to a quicker and less painful labour. Your healthcare provider will advise you as you go along and let you know if any particular position is putting strain on your baby or if you are likely to worsen the chances of bleeding or vaginal tearing.

Hands and knees

Back pain can be helped by the box position on all fours as you are able to do pelvic tilts and your birth partner can massage your back. If you become very tired, you can lean down on your forearms or rock back into ‘child’s pose’ as far as your tummy will allow.

Squatting

This position may be used more in late labour or during the actual delivery. The stance opens out the pelvis and gravity plays its part too. If you have had an epidural, it may not be possible to adopt the pose, and even if not, you may find your legs becoming very wobbly. Enlist the help of your birth partner or use a birthing bar or stool to lean on and take the weight off your legs.

Side lying

If you have had an epidural, or simply feel too tired from squatting or kneeling, side lying is a good option. Your birth partner will be able to massage your back, and this position may also reduce the risk of your vagina tearing.

Birthing stage

Your healthcare practitioner will guide you through the pushing stage by telling you when to push and when to pause as this needs to be co-ordinated with contractions.

When you have to give the final pushes, it may help to push as if you were having a bowel movement, tuck your chin in to your chest and stay focused. Trust in yourself and your doctor and give it all you’ve got!

Once the head has been born, mucus will be suctioned from nose and mouth, baby’s shoulders will be guided out as you give one more push, the umbilical cord will be clamped and cut, and your baby handed to you or placed on your chest or stomach. The final step will be to deliver the placenta, which should happen soon after baby’s delivery.

Your long journey from conception to delivery has been completed! Take things slow and give your baby as much skin-to-skin contact as you desire and spend time bonding with your new little family.