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Week 34 How Big Is Your Baby? Your baby weighs almost 5 pounds (2275g) by this week. Its crown-to-rump length is about 12.8 inches (32cm). Total length is 19.8 inches (44cm). How Big Are You? Measuring up from your bellybutton, it's about 5.6 inches (14cm) to the top of your uterus. From the pubic symphysis, you will measure about 13.6 inches (34cm). It's not important that your measurements match any of your friends' at similar points in their pregnancies. What's important is that you're growing appropriately and that your uterus grows and gets larger at an appropriate rate. These are signs of normal growth of your baby inside your uterus. How Your Baby Is Growing and Developing Testing Your Baby Before Birth? An ideal test done before delivery would determine if the fetus is healthy. It would be able to detect major fetal malformations or fetal stress, which could indicate an impending problem. Ultrasound accomplishes some of these goals by enabling doctors to observe the baby inside the uterus, as well as to evaluate the brain, heart and other organs of the fetal body. Along with ultrasound examinations, fetal monitoring has been done in the form of a nonstress test or a contraction stress test to indicate fetal well-being or problems. (This is described in Week 35.) Biophysical Profile A comprehensive test, called a biophysical profile, is used to examine the fetus while it is still in the uterus. The test helps determine fetal health and is done when there is concern about fetal well-being. It may also be done when a pregnancy passes the expected due date. A biophysical profile uses a particular scoring system. The first four of the five tests listed below are made with ultrasound; the fifth is done with external fetal monitors. A score is given to each area. The five areas of evaluation include: ò fetal breathing movements ò fetal body movements ò fetal tone ò amount of amniotic fluid ò reactive fetal heart rate During the test, doctors evaluate fetal ôbreathingöùthe movement or expansion of the baby's chest inside the uterus. This score is based on the amount of fetal breathing that occurs. Movement of the baby's body is noted. A normal score indicates normal body movements. An abnormal score is applied when there are few or no body movements during the allotted time period. Fetal tone is evaluated similarly. Movement, or lack of movement, of the arms and legs of the baby is noted. Amniotic-fluid volume evaluation requires experience in ultrasound examination. A normal pregnancy has adequate fluid around the baby. An abnormal test indicates no amniotic fluid or decreased amniotic fluid around the baby. Fetal heart-rate monitoring is done with external monitors. It evaluates changes in the fetal heart rate associated with movement of the baby. The amount of change and number of changes in the fetal heart rate differ, depending on who is doing the test and their definition of normal. A normal score is 2; an abnormal score is 0 for any of these tests. A score of 1 in any of the tests is a middle score. From these five scores, a total score is obtained by adding all the values together. Evaluation may vary depending on the sophistication of the equipment used and the expertise of the person doing the test. The higher the score, the better the baby's condition. A lower score may cause concern about the well-being of the fetus. If the score is low, a recommendation may be made to deliver the baby immediately. If the score is reassuring, the test may be repeated at weekly or twice-weekly intervals. If results fall between these two values, the test may be repeated the following day. It depends on the circumstances of your pregnancy and the biophysical-profile findings. Your doctor will evaluate all the information before making any decision. A biophysical profile may be valuable in evaluating an infant with IUGR, pregnancy of a diabetic mother, a pregnancy in which the baby doesn't move very much, high-risk pregnancies or overdue pregnancies. Because ultrasound is an important part of a biophysical profile, it may be useful in finding major congenital problems and evaluating the well-being of the infant inside the uterus. Changes in You How Much Does Your Baby Weigh? By this time, you have probably asked your doctor several times how big your baby is or how much your baby will weigh when it's born. Next to asking about the sex of a baby, this is the most frequently asked question I hear. Estimating the weight of the baby is extremely difficult. Many doctors will guess and give a range of 1 to 2 pounds in either direction. It's very difficult to determine how much a baby, placenta and amniotic fluid will weigh. A few of my estimates have been really off! Claudia asked me to tell her how much her baby would weigh at birth. I guessed over 8 pounds and was surprised when she delivered an 6-pound, 10-ounce baby! As you can see by the illustration on page 285, you're getting larger. The baby is growing, the placenta is growing and the amount of fluid around the baby is increasing. All these factors make estimating fetal weight more difficult. Using Ultrasound to Estimate Fetal Weight Ultrasound can be used to estimate fetal weight, but errors in weight estimates can and do occur. The accuracy of predicting fetal weight using ultrasound is improving. Making an accurate estimate can be valuable. Several measurements are used in a formula to estimate a baby's weight. These include diameter of the baby's head, circumference of the baby's head, circumference of the baby's abdomen, length of the femur of the baby's leg and, in some instances, other fetal measurements. Ultrasound is the method of choice to estimate fetal weight. But even with ultrasound, estimates may vary as much as half a pound (225g) in either direction. Will Your Baby Fit through the Birth Canal? Even with a fetal-weight estimate, whether by your doctor or by ultrasound, your doctor can't tell if the baby is too big for you or whether you'll need a C-section. Usually, it's necessary for you to labor to be able to see how the baby fits into your pelvis and if there is room for it to pass through the birth canal. In some women who appear to be average or better-than-average size, a 6- or 6.5-pound (2.7 to 2.9kg) baby won't fit through the pelvis. Experience has also shown women who may appear to be petite are sometimes able to deliver 7.5-pound (3.4kg) or larger babies without much difficulty. The best test or method of evaluating whether your baby will deliver through your pelvis is labor. How Your Actions Affect Your Baby's Development The end of your pregnancy begins with labor. One of the end results of labor is the birth of your baby. Some women are concerned (or hope!) that their actions can cause labor to begin. The old wives' tales about going for a ride over a bumpy road or taking a long walk to start labor aren't true. We do know intercourse and stimulation of the nipples may cause labor to start in some cases, but this isn't true for every woman. Going about your daily activities (unless your doctor has advised bed rest) will not cause labor to start before your baby is ready to be born. Understanding Labor It's important to know what to expect when labor occurs and what to do when it begins. What causes labor? Why does it happen? We don't have a good answer to this question. The factors that cause labor to begin are unknown. There are many theories; one is that hormones made by the mother and fetus trigger labor. It could be that a hormone produced by the fetus makes the uterus contract. Labor is the dilatation (stretching, expanding) of the cervix. This occurs because the uterus, which is a muscle, tightens to squeeze out its contents (the baby). As it pushes the baby out, the cervix stretches. It may be possible to feel tightening, contractions or cramps, but in the purest sense, it isn't labor until there is a change in the cervix. Three Stages of Labor Labor is divided into three stages. The first stage of labor begins with uterine contractions of great enough intensity, duration and frequency to cause thinning (effacement) and dilatation of the cervix. The first stage of labor ends when the cervix is fully dilated (usually 10cm) and sufficiently open to allow the baby's head to come through it. The second stage of labor begins when the cervix is completely dilated at 10cm. This stage ends with the delivery of the baby. The third stage of labor begins after delivery of the baby. It ends with delivery of the placenta and the membranes that have surrounded the fetus. Some doctors have even described a fourth stage of labor, referring to a time period after delivery of the placenta during which the uterus contracts. Contraction of the uterus is important in controlling bleeding that can occur after delivery of the baby and the placenta. Braxton-Hicks Contractions and False Labor Braxton-Hicks contractions are painless, nonrhythmical contractions you may be able to feel when you place your hand on your abdomen. These contractions often begin early in pregnancy and are felt at irregular intervals. They may increase in number and strength when the uterus is massaged. Like false labor, they are not positive signs of true labor. False labor often occurs before true labor begins. False labor contractions can be very painful and may appear to be real labor to you. In most instances, false-labor contractions are irregular. They are usually of short duration (less than 45 seconds). The discomfort of the contraction may occur in various parts of your body, such as the groin, lower abdomen or back. With true labor, uterine contractions produce pain that starts at the top of the uterus and radiates over the entire uterus, through the lower back into the pelvis. False labor is usually seen in late pregnancy. It seems to occur more often in women who have been pregnant and delivered more babies. It usually stops as quickly as it begins. There doesn't appear to be any danger to your baby. What Is a "Bloody Show"? Often following a vaginal examination or with the beginning of early labor and early contractions, you may bleed a small amount. This is called a bloody show; it can occur as the cervix stretches and dilates. You shouldn't lose a large amount of blood. If it causes you concern or appears to be a large amount of blood, call your doctor immediately. Along with a bloody show, you may pass a mucus plug at the beginning of labor. This is different from your bag of waters breaking (ruptured membranes). Passing this mucus plug doesn't necessarily mean you'll have your baby soon or even that you'll go into labor in the next few hours. It poses no danger to you or your baby. How Long Will Labor Last? The length of the first and second stages of labor, from the beginning of cervical dilatation to delivery of the baby, can last 14 to 15 hours or more in a first pregnancy. Women have had faster labors than this, but don't count on it. A woman who has already had one or two children will probably have a shorter labor, but don't count on that either! The average time for labor is usually decreased by a few hours for a second or third delivery. Everyone's heard of women who barely make it to the hospital or had labor lasting only 1 hour. For every one of those patients, there are many women who have labored 18, 20, 24 hours or longer. It's almost impossible to predict the amount of time that will be required for labor. You may ask your doctor about it, but his or her answer is only a guess. Timing Contractions Most women are instructed in prenatal classes or by their healthcare provider about how to time contractions during labor. To time how long a contraction lasts, begin timing when the contraction starts and end timing when the contraction lets up and goes away. It's also important to know how often contractions occur. There is much confusion about this. You can choose from two methods. With the first, the interval between contractions is noted as the time period between when a contraction starts to the time the next contraction starts. This is the most commonly used method and the most reliable. With the second method, the interval between contractions is noted by the time period from when a contraction ends to the time the next contraction starts. Ask your doctor which method he or she prefers. It's helpful for you and your partner or labor coach to time your contractions before calling your doctor or the hospital. Your doctor will probably want to know how often contractions occur and how long each contraction lasts. With this information, your doctor can decide when you should to go to the hospital. You Should also Know Will My Baby Drop? A few weeks before labor begins or at the beginning of labor, you may notice a change in your abdomen. When examined by your doctor, measurement from your bellybutton or the pubic symphysis to the top of the uterus may be smaller than what you noticed on a previous visit. This phenomenon occurs as the head of the baby enters the birth canal. It can also be a part of the decrease in amniotic fluid that may occur without rupture of membranes or loss of fluid. This change is often called lightening. Don't be concerned if you don't notice lightening or a drop of the fetus. This doesn't occur with every woman or with every pregnancy. It's very common for your baby to drop during labor or just before labor begins. With lightening, you may experience benefits and problems. One benefit may be more room in your upper abdomen. This gives you more room to breathe because there's more room for your lungs to expand. However, with the descent of the baby, you may notice more pressure in your pelvis, bladder and rectum, which can make you more uncomfortable. In some instances, your doctor may examine you and tell you your baby is ônot in the pelvisö or ôis high up.ö He or she is saying the baby has not yet descended into the birth canal. However, this situation can change very quickly. If your doctor says your baby is ôfloatingö or ôballotable,ö it means part of the baby is felt high in the birth canal. But the baby is not engaged (fixed) in the birth canal at this point. The baby may even bounce or move away from your doctor's fingers when you are examined. Uncomfortable Feelings You May Experience At this point in their pregnancies, some women have the uncomfortable feeling the baby is going to ôfall out.ö This feeling is related to pressure the baby exerts because it has moved lower in the birth canal. Some women describe the feeling as an increase in pressure. If you're concerned or worried about it, consult your doctor. It may be a reason to perform a pelvic exam to see how low the baby's head is. In almost all cases, the baby will not be coming out. But because it is at a lower position than what you're used to, the baby will exert more pressure than you noticed during recent weeks. Another feeling associated with increased pressure may occur around this week. Some pregnant women have described it as a ôpins-and-needlesö sensation. The feeling is tingling, pressure or numbness in the pelvis or pelvic region from the pressure of the baby. It is a common symptom and shouldn't concern you. These feelings may not be relieved until delivery occurs. You can lie on your side to help decrease pressure in your pelvis and on the nerves, vessels and arteries in the pelvic area. If the problem is severe, talk to your doctor about it. Don't try to move the baby or push the baby out of the way. It could be dangerous for both of you.
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