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Week 39
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How Big Is Your Baby?

Your baby weighs a little more than 7 pounds (3250g). By this point in your pregnancy, crown-to-rump length is about 14.4 inches (36cm). The baby's total length is 21.5 inches (48cm).

How Big Are You?

The illustration on page 327 shows a side view of a woman with a very large uterus and her baby inside it. As you can see, she's about as big as she can get. You probably are, too!

If you measure from the pubic symphysis to the top of the uterus, the distance is 14.4 to 16 inches (36 to 40cm). Measuring from the bellybutton, the distance is 6.4 to 8 inches (16 to 20cm).

You're almost at the end of your pregnancy. Your weight should not increase much from this point. It should remain between 25 and 35 pounds (11.4 and 15.9kg) until delivery.

How Your Baby Is Growing and Developing

The baby continues to gain weight, even up to the last week or two of pregnancy. It doesn't have much room to move inside your uterus.

At this point, all the organ systems are developed and in place. The last organ to mature is the lungs.

Changes in You

It would be unusual for you not to be uncomfortable and feel huge at this time. Your uterus has filled your pelvis and most of your abdomen. It has pushed everything else out of the way.

At this point in pregnancy, you may think you'll never want to be pregnant again because you're so uncomfortable. Or you may be sure your family is complete. At this point, some women consider permanent sterilization, such as tubal ligation.

Tubal Ligation after Delivery?

Some women choose to have a tubal ligation done while they are in the hospital after having their baby. Now is not the time to make the decision about having a tubal ligation if you haven't seriously considered it before.

Being sterilized following delivery of a baby has some advantages. You're in the hospital and won't need another hospitalization. However, there are disadvantages to having a sterilization at this time. Consider the procedure permanent and not reversible. If you have your tubes tied within a few hours or a day after having your baby, then change your mind, you may regret the tubal ligation.

If you have an epidural, it's possible to use the epidural as anesthesia for a tubal ligation. If you didn't have an epidural, it's necessary to put you to sleep. This is often done the morning after you've had your baby. This procedure does not usually lengthen the time you're in the hospital.

Different kinds of procedures are performed for permanent sterilization. Most common is a small incision underneath your bellybutton. The Fallopian tubes can be seen through this incision.

A piece of the tube can be removed, or a ring or clip can be placed on the tube to block it. This type of surgery usually requires about 30 to 45 minutes to perform.

If you have second thoughts or are unsure about having it done, don't have the surgery performed. Consider the procedure permanent. Tubal ligations can be reversed, but it's very expensive and requires a longer hospital stayù3 to 4 days. Reversals are about 50% effective, but pregnancy cannot be guaranteed.

How Your Actions Affect Your Baby's Development

This discussion of how your actions affect your baby's growth and development actually concerns your actions after your baby is born! I'm talking about your decision about breastfeeding your baby.

Is Breastfeeding Right for You and Your Baby?

Your decision about breastfeeding is a personal one. One of the more compelling reasons to breastfeed is the bonding that occurs between mother and baby. This close relationship can begin as soon as the baby is bornùsome women breastfeed on the delivery table. It helps stimulate uterine contractions, which can prevent hemorrhage.

Breastfeeding encourages the natural intimacy of a newborn baby with its mother and the mother with her baby. The opportunity to breastfeed may be a relaxing time for you. It may give you a chance to spend some wonderful time with your new baby. However, if it doesn't work out, it's all right to stop and switch to formula.

Benefits of Breastfeeding

Both you and your baby benefit if you breastfeed. Mother's milk is good for your baby because it contains all the nutrients your baby needs during the first months of life. Commercial formulas have good mixtures of vitamins, protein, sugar, fat and minerals, but none can match your breast milk.

Another advantage of breastfeeding is you pass protection against infection (through antibodies) to your baby in your breast milk. Many people believe a breastfed baby is less likely to get colds and infections than a bottlefed baby.

Breastfeeding is also good for the baby because the baby will probably have to nurse more vigorously than is necessary with some bottle nipples. This encourages good tooth and jaw development.

Advantages for you include decreased cost as compared to buying formula. It's convenient to breastfeed; you don't have to carry bottles and formula with you for the baby. Some women find breastfeeding makes it easier for them to regain their figure.

You may have noticed during pregnancy that your breasts got larger and were probably tender at times. This happens because increased hormonal activity makes the alveoli in the breasts get larger. Milk in the breast is stored in small sacs of these alveoli.

Laura called the office because she was concerned about a discharge from her nipplesùwas it an infection? I explained to her that late in pregnancy, a woman's breasts may begin to secrete colostrum. Colostrum is rich in antibodies that provide the baby with protection against various infections. I told her colostrum is normal and should not cause her concern.

The first milk that comes from the breasts usually arrives 2 or 3 days after delivery. Its arrival is initiated by stimulation from the baby suckling at your breast. The sucking sends a message to your brain to produce prolactin; this hormone stimulates milk production in the alveoli.

Some women have trouble breastfeeding because of inverted nipples. This happens when the nipple retracts inward instead of pointing outward. If you have inverted nipples, it is possible to breastfeed. Plastic breast shields are available to wear under clothing to help bring out an inverted nipple. Some doctors also recommend pulling on the nipple and rolling it between the thumb and index finger.

Some women find wearing a support bra very helpful in the last few weeks of pregnancy. A nursing bra is useful while nursing. Many doctors suggest wearing a nursing bra all the time, even when you sleep. You may be more comfortable.

There may be times when you are away from the baby, but you want to continue to breastfeed. You can do this by using a pump. You can pump your breasts with battery-operated pumps, electrical pumps, or manual pumps.

Learning to Breastfeed

You may want to learn how to breastfeed while you're in the hospital. Ask the nurses to show you some of the tricks they've learned to help your baby catch on to breastfeeding. Ask them any questions you have. What you learn may make the difference in keeping your baby happy with breastfeeding.

Breastfeeding requires a healthful nutrition plan for you, just as you consumed during pregnancy. You'll need at least 500 extra calories each day. Some doctors recommend you continue taking your prenatal vitamins after pregnancy while you are nursing.

Be careful about what you eat and drink because things you eat can pass into your breast milk. Certain foods may not ôsitö well with you or your baby. Spicy foods you eat may cause an upset stomach in your baby! Caffeine can also pass to your baby. Any alcohol you drink passes to your baby through your breast milk, so be careful about your consumption of alcoholic beverages. The longer you breastfeed, the more you'll realize what you can and cannot eat and drink.

Breastfeeding Problems

A common breastfeeding problem for some women is breast engorgement. The breasts become swollen, tender and filled with breast milk. The best cure is to drain the breasts, if possible, as by breastfeeding. Some women take a hot shower and empty their breasts in the warm water. Ice packs may also help.

Mild pain medicines, such as acetaminophen (Tylenol), are often useful in relieving the pain of engorgement. Acetaminophen is recommended by the American Academy of Pediatrics as safe to use while you're breastfeeding. You might need to use stronger medications, such as Tylenol with Codeine, a prescription medication. Call your doctor if engorgement is especially painful. He or she will decide on treatment.

One way to prevent breast engorgement is to feed your baby from both breasts each time you feed. Don't feed on only one side. When you're away from your baby, try to express some breast milk to keep your milk flowing and breast ducts open. You'll feel more comfortable.

Most nursing mothers have sore nipples at some point, particularly at first. Keep your breasts dry and clean. It may be helpful to use a lanolin lotion on the breasts to keep nipples from getting too dry. Before too longùa few days to a few weeksùyour breasts will become accustomed to breastfeeding.

It is possible to get an infection in your breast while breastfeeding. If you think you have an infection, call your doctor. An infection may cause pain in the breast, and the breast may turn red and become swollen. You may have streaks of red discoloration on the breast; you may also feel as though you have the flu.

You Should also Know

Pain Relief during Labor

Pain relief during labor is approached in many ways. When you take pain medication, remember there are two patients to considerùyou and your unborn baby. It is best to find out in advance what is available for pain control. Then see how labor goes for you before making a final decision.

A valuable part of your experience in labor and delivery is your preparation for it. This includes being aware of things that are happening to you, and why, and not being frightened by the pain you feel. You should have confidence in those taking care of you, including the staff at the hospital and your doctor.

When contractions are regular and the cervix is beginning to dilate, uterine contractions may be very uncomfortable. For pain in this early stage of labor, many hospitals use a mixture of a narcotic analgesic drug, such as meperidine (Demerol), and a tranquilizer, such as promethazine (Phenergen«). This decreases pain and causes some sleepiness or sedation. Medication may be given through an I.V. or by injection into a muscle.

Narcotic analgesics pass to your baby through the placenta and may decrease respiratory function in the newborn infant. It can also affect your baby's Apgar scores. These medications should not be given close to the time of delivery.

In many places, anesthesia for delivery is given by an injection of a particular medication to affect a particular area of the body. This is called a block, such as a pudendal block, an epidural block or a cervical block. Medication is similar to the type used to block pain when you have a tooth filled. The agents are xylocaine or xylocaine-like medications.

Very occasionally, it is necessary to use general anesthesia for delivery of a baby, usually for an emergency Cesarean section. A pediatrician attends the birth because it is possible the baby will be asleep following delivery.

What Is an Epidural Block?

The epidural block is a frequently used regional block. It provides relief from the pain of uterine contractions and delivery.

It should be administered only by someone trained and experienced in this type of anesthesia. Some obstetricians have this experience, but in most areas an anesthesiologist must administer it.

A continuous epidural block can be started when you are sitting up or lying on your side. An area of skin over your lower back in the middle of your spinal cord is numbed. A needle is introduced through the numbed area of the skin; anesthetic is placed around the spinal cord but not into the spinal canal. A plastic catheter is left in place.

Epidural pain medication may be given during labor with a pump. The anesthesiologist uses the pump to inject a small amount of medication at regular intervals or as needed. An epidural provides excellent relief from labor pain.

A problem with an epidural block is that it can make your blood pressure drop. Low blood pressure may affect blood flow to the baby. Fortunately, I.V. fluids administered with the epidural help reduce the risk of hypotension (low blood pressure). You may also have problems pushing during delivery.

Other Pain Blocks

Spinal anesthesia may be used for a Cesarean section. With this anesthesia, pain relief lasts long enough for the Cesarean section to be performed. Epidural anesthesia is used more often than spinal anesthesia for labor.

Other types of blocks used occasionally include a pudendal block. It is given through the vaginal canal and decreases pain in the birth canal itself. You still feel the contraction and tightening with pain in the uterus. Some hospitals use a paracervical block. It provides pain relief for the dilating cervix, but doesn't relieve the pain of contractions.

There is no perfect method for pain relief during labor and delivery. Discuss the possibilities with your doctor, and mention your concerns. Find out what types of anesthesia are available and the risks and benefits of each.

Anesthesia Complications

There are other possible complications from use of anesthesia. These include increased sedation of the baby with use of narcotics, such as Demerol. The newborn may have lower Apgar scores and depressed breathing. The baby may require resuscitation or it may need to receive another drug, such as naloxone (Narcan«), to reverse the effects of the first drug.

Increased sedation, slower respiration and a slower heartbeat may also be observed in a baby whose mother is given general anesthesia. The mother is usually ôoutö for more than an hour and is unable to see her newborn infant until later.

It may be impossible to determine before you go into labor which anesthesia will be best for you. But it's helpful to know what's available and what types of pain relief you might be able to count on during your labor and delivery.

Contraction of the Uterus after Delivery

After you deliver your baby, your uterus shrinks from about the size of a watermelon to the size of a volleyball. When this happens, the placenta detaches from the uterine wall. At this time, there may be a gush of blood from inside the uterus signaling delivery of the placenta.

After the placenta is delivered, you may be given oxytocin (Pitocin). This helps the uterus contract and clamp down so it won't bleed. Extremely heavy bleeding after vaginal delivery is called postpartum hemorrhage, which is bleeding more than 17 ounces (500ml). It can often be prevented by massaging the uterus and using medications to help the uterus contract.

The main reason a woman experiences heavy bleeding after delivering a baby is her uterus does not contract, called an atonic uterus. Your doctor or the nurse attending you may massage your uterus after delivery. They may tell you how to do it so your uterus will stay firm and contracted. This is important so you won't lose more blood and become anemic.

Cord-Blood Banking

Cord blood is blood left in the umbilical cord and placenta after a baby is born. In the past, the placenta and the umbilical cord were usually discarded following delivery. There is a great deal of interest now about saving cord blood after delivery. Cord-blood banking was called one of the top-10 medical advances of 1996 by the Harvard Health Letter.

Umbilical-cord blood can be used to treat cancer and genetic diseases that are now treated by bone-marrow transplants. Cord blood has been used successfully to treat childhood leukemia, some immune diseases and other blood diseases. At present research is being conducted in the United States and Europe to use cord blood for gene therapy in a number of diseases, including sickle-cell anemia, diabetes and AIDS.

Cord blood contains the same valuable cells that are found in bone marrow. These ôstem cellsö are the building blocks of the blood and immune systems. These special cells are undeveloped in cord blood. Because they are undeveloped, cord blood does not need to be matched as closely for a transplant as bone-marrow blood does. This feature can be especially important for members of ethnic minority groups or people with rare blood types. These groups traditionally have had more difficulty finding acceptable donor ômatches.ö

Before their baby's birth, parents may request that the baby's cord blood be collected and ôbankedö for future use. The blood can be used by the child from whom it was collected, his siblings and parents. You also may donate your baby's cord blood at no cost to you, similar to blood banking.

Blood is collected directly from the umbilical cord immediately after delivery. There is no risk or pain to the mother or baby. The blood is transported to a banking facility where it is frozen and cryogenically stored.

The cost of cord-blood banking includes an initial fee of about $1,000, with about a $100-a-year storage fee. As more is learned about blood banking and its use becomes more common, the cost may go down. Some health-insurance companies pay the fees for families at high risk of cancer or genetically based diseases. Also, cord-blood banking services themselves may waive fees for at-risk families who are unable to afford them.

For more information about cord-blood banking services, contact the International Cord Blood Foundation at (415) 635-1456.

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From Your Pregnancy Week by Week by Glade B. Curtis, M.D., OB/GYN. Copyright by Fisher Books. Electronic rights by Medical Data Exchange.

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