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Week 36 How Big Is Your Baby? By this week, your baby weighs about 6 pounds (2750g). Its crown-to-rump length is over 13.5 inches (34cm), and total length is 20.7 inches (46cm). How Big Are You? Measuring from the pubic symphysis, it's about 14.5 inches (36cm) to the top of your uterus. If you measure from your bellybutton, it's more than 5.5 inches (14cm) to the top of your uterus. You may feel as though you've run out of room! Your uterus has grown bigger in the past few weeks as the baby has grown inside of it. Now the uterus is probably up under your ribs. How Your Baby Is Growing and Developing What Is a Cesarean Delivery? Most women plan on a normal vaginal birth, but a Cesarean delivery is always a possibility. With a Cesarean, the baby is delivered through an incision made in the mother's abdominal wall and uterus. The illustration on page 301 shows a Cesarean delivery. Common names for this type of surgery are C-section, Cesarean section and Cesarean delivery. C-sections are done for many reasons. The most common reason for having a C-section is a previous Cesarean delivery. However, some women who have had C-sections can have a vaginal delivery with later pregnancies; this is called vaginal birth after Cesarean (VBAC). See the discussion on page 303. Discuss the matter with your doctor if you've had a C-section and would like to attempt a vaginal delivery this time. There is some risk that the surgical scar from an earlier C-section could stretch and pull apart during subsequent labor and delivery, with serious consequences. In this case, a repeat C-section may be advised to avoid rupture of the uterus. However, if pregnancy and labor are closely monitored, a woman may be able to have a normal vaginal delivery (VBAC). A Cesarean delivery may be necessary if your baby is too big to fit through the birth canal. This condition is called cephalo-pelvic disproportion (CPD). CPD may be suspected during pregnancy but usually labor must begin before it can be confirmed. Fetal distress is another reason for a Cesarean section. Doctors use fetal monitors during labor to watch the fetal heartbeat and its response to labor. If the heartbeat indicates the baby is having trouble with labor contractions, a C-section may be necessary for the baby's well-being. If the umbilical cord is compressed, a C-section may be necessary. The cord may come into the vagina ahead of the baby's head or the baby can press on part of the cord. This is a dangerous situation because a compressed umbilical cord can cut off the blood supply to the baby. A C-section is necessary if the baby is in a breech presentation, which means the baby's feet or buttocks enter the birth canal first. Delivering the shoulders and the head after the baby's body may damage the baby's head or neck, especially with a first baby. Placental abruption or placenta previa are also reasons to have a Cesarean delivery. If the placenta separates from the uterus before delivery (placental abruption), the baby loses its supply of oxygen and nutrients. This is usually diagnosed when a woman has heavy vaginal bleeding. If the placenta blocks the birth canal (placenta previa), the baby cannot be delivered any other way. Rising Rate of Cesarean Deliveries In 1965, only 4% of all deliveries were by C-section. Today, in the United States, Cesarean deliveries account for 20% of all deliveries. In some areas this percentage is even higher. In Canada, Cesarean deliveries account for almost 18% of all deliveries. This increase is related in part to more stringent monitoring during labor and safer procedures for C-sections. Another reason for more Cesarean deliveries is bigger babies. With bigger babies, a C-section is sometimes the only way to deliver. (Researchers believe this increase in the size of babies is due to pregnant women eating a better diet and not smoking during pregnancy.) The rising rate may also be related to the pressure on doctors to deliver a baby safely. How Is a C-Section Performed? You may be awake when a C-section is done. An anesthesiologist usually gives you an epidural or spinal anesthetic. (Types of anesthesia are discussed in Week 39.) If you're awake for the procedure, you may be able to see your baby immediately after delivery! With a C-section, an incision is made through the skin of the abdominal wall to the uterus. The wall of the uterus is cut, then the amniotic sac containing the baby and placenta is cut. The baby is removed through the incision. Next, the placenta is removed. The uterus is closed in layers with sutures that absorb and do not have to be removed. The remainder of the abdomen is sewn together with absorbable sutures. Most Cesarean deliveries done today are low-cervical Cesareans or low-transverse Cesareans. This means the incision is made low in the uterus. In the past, a Cesarean was often done with a classical incision, in which the uterus is cut down the midline. This incision doesn't heal as well as a low-cervical incision. Because the incision is made in the muscular part of the uterus, it is more likely to pull apart with contractions (as in a vaginal birth after Cesarean). This can cause heavy bleeding and injure the baby. If you have had a classical Cesarean section in the past, you must have a C-section every time you have a baby. A T-incision is another type of C-section incision. This incision goes across and up the uterus in the shape of an inverted T. It provides more room to get the baby out. If you have had this type of incision, you will need to have a Cesarean delivery with all subsequent pregnancies. It too is more likely to rupture than other types of incisions. Advantages and Disadvantages of Having a C-Section There are advantages to having a C-section. The most important advantage is delivery of a healthy infant. The baby you are carrying may be too large to fit through your pelvis. The only safe method of delivery might be a C-section. Usually a woman needs to experience labor before her doctor will know if the baby will fit. It may be impossible to predict ahead of time. The disadvantage is that a Cesarean section is a major operation and carries with it all the risks of surgery. Risks include infection, bleeding, shock due to blood loss, the possibility of blood clots and injury to other organs, such as the bladder or rectum. You will probably stay in the hospital an extra couple of days. Recovery at home from a Cesarean section takes longer than recovery from a regular delivery. The normal time for full recovery from a C-section is usually 4 to 6 weeks. In most areas, an obstetrician performs a C-section. In small communities, C-sections may be performed by a general surgeon or a general practitioner. Will You Need a Cesarean? It would be nice to know you're going to need a C-section before delivery so you wouldn't have to go through labor. Unfortunately, it's usually necessary to wait for labor contractions for a couple of reasons. You won't know ahead of time if your baby is stressed by labor contractions. And it is often hard to predict if the baby will fit through your birth canal. I've had women tell me that if they have a Cesarean, τit won't be like having a baby.φ They falsely believe they won't experience the entire birth process. That's not true. If you deliver by C-section, try not to feel this way. You haven't failed in any way! Remember, having a baby has taken 9 long months. Even with a C-section, you have accomplished an amazing thing. After a C-section, you can hold the baby and perhaps even nurse. Changes in You You only have 4 to 5 weeks to go until your due date. It's easy to get anxious for your baby to be delivered. However, don't ask your doctor to induce labor at this point. You may have gained 25 to 30 pounds (11.25 to 13.5kg), and you still have a month to go. It isn't unusual for your weight to stay the same at each of your weekly visits after this point. The maximum amount of amniotic fluid surrounds the baby now. In the weeks to come, the baby continues to grow. However, some amniotic fluid is reabsorbed by your body, which decreases the amount of fluid around the baby and decreases the amount of room in which the baby has to move. You may notice a difference in sensation of fetal movements. For some women, it feels as if the baby is not moving as much as it had been. How Your Actions Affect Your Baby's Development Vaginal Birth after Cesarean Should you attempt a vaginal delivery after having had a previous C-section? Vaginal birth after Cesarean (VBAC) is becoming more common. Medically speaking, the method of delivery is not as important as the well-being of you and your baby! Before you and your doctor make a final decision, you need to weigh the risks and the benefits to you and your baby with both types of delivery. In some cases, you won't have any choice in the matter. In other cases, you and your doctor may decide to let you labor for a while to see if you can deliver vaginally. Some women like having a repeat Cesarean section. They request one because they don't want to go through labor only to end up with a Cesarean delivery anyway. Advantages and Risks of VBAC Advantages of a vaginal delivery include a decreased risk of problems associated with major surgery, which Cesarean birth is. Recovery after a vaginal delivery is shorter. You can be up and about in the hospital and at home in a much shorter amount of time. The type of incision previously performed on the uterus dictates if labor can be attempted. One of my new patients, Carol, wanted a VBAC but didn't know what kind of uterine incision she'd had previously. When I got her records from Rhode Island, I discovered she'd had a classical incision. Labor is not permitted after a classical incision that goes high up on the uterus. (You can't see this incision; your doctor can provide you with this information.) Carol was disappointed she couldn't try a vaginal birth, but she understood the reason for another C-section. If you are small and the baby is large, you may need a C-section. Multiple fetuses may also make vaginal delivery difficult or impossible without danger to the babies. Medical complications, such as high blood pressure or diabetes, may require a repeat Cesarean section. If you want to attempt VBAC, discuss it with your doctor in advance so plans can be made. During labor, you will probably be monitored more closely with fetal monitors. You may be attached to I.V.s in case a Cesarean section becomes necessary. Consider the benefits and risks in deciding whether to attempt a vaginal delivery after a previous Cesarean section. Discuss advantages and disadvantages at length with your doctor and your partner before making a final decision. Don't be afraid to ask your doctor his or her opinion of your chances of a successful vaginal delivery. He or she knows your health and pregnancy history.
You Should also Know Group-B Streptococcus Infection Group-B streptococcus (GBS) infection in a mother-to-be can cause problems for her baby. GBS rarely causes problems in adults but can cause life-threatening infections in newborns. GBS is often transmitted from person to person by sexual contact. In women, GBS is most often found in the vagina or rectum. It is possible to have GBS in your system and not be sick or have any symptoms. The Centers for Disease Control, the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics have developed recommendations aimed at preventing this infection in newborns. One recommendation is that all women who have risk factors be treated for GBS. Risk factors include a previous infant with GBS infection, preterm labor, ruptured membranes for more than 18 hours or a temperature of 100.4 (38C) immediately before or during childbirth. The second recommendation is a GBS culture should be taken from the rectal and vaginal areas of all pregnant women at 35 to 37 weeks gestation. Penicillin is then used to treat women with positive results. Your Baby's Apgar Score After a baby is born, it is examined and evaluated at 1 minute and 5 minutes after delivery. The system of evaluation is called the Apgar score. This scoring system is a method of evaluating the overall well-being of the newborn infant. In general, the higher the score, the better the infant's condition. The baby is scored in five areas. Each area is scored 0, 1 or 2; 2 points is the highest score for each category. The top total score is 10. Areas scored include: Heart rate of the baby. If the heart rate is absent, a score of 0 is given. If it is slow, less than 100 beats per minute (bpm), a score of 1 is given. If it's over 100 bpm, 2 points are scored. Respiratory effort of the baby. Respiratory effort indicates the newborn's attempts at breathing. If the baby isn't breathing, the score is 0. If breathing is slow and irregular, the score is 1. If the baby is crying and breathing well, the score is 2. Baby's muscle tone. Muscle tone evaluates how well the baby moves. If arms and legs are limp and flabby, the score is 0. If some movement is observed and the arms and legs bend a little, the score is 1. If the baby is active and moving, the score is 2. Reflex irritability of the baby. Reflex irritability is scored 0 if the baby doesn't respond to stimulus, such as rubbing his or her back or arms. If there is a small movement or a grimace when the baby is stimulated, the score is 1. A baby who responds vigorously is scored with 2 points. Baby's color. The baby's color is rated 0 if the baby is blue or pale. A score of 1 is given if the baby's body is pink, and arms and legs are blue. A completely pink baby is scored at 2. A perfect score of 10 is unusual. Most babies receive scores of 7, 8 or 9 in a normal, healthy delivery. A baby with a low 1-minute Apgar may need to be resuscitated. This means a pediatrician or nurse must help stimulate the baby to breathe and to recover from the delivery. In most cases, the 5-minute Apgar is higher than the 1-minute score because the baby becomes more active and more accustomed to being outside the uterus. Previous Week > Contents > Next
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