CHANGES TO MUM
As your due date grows closer and closer at week 39 of your pregnancy you may be quite emotional and feeling anxious about labour.
The stages of labour were discussed in week 38 of the Pregnancy Baby Child week by week pregnancy guide, however labour and the birth doesn’t always go according to plan.
Ensuring you are well informed about the possible common difficulties during birth can help you to understand what might need to be done in an emergency situation.
The more informed you are about the process and different emergency interventions that the obstetrician may suggest will help you to be better prepared at the time of birth.
An episiotomy may be required to speed up the birth and for assisted births such as vacuum. It can also help to prevent perineal tearing by making a cut in the perineum just as the baby’s head appears.
A local anaesthetic is generally given prior to an episiotomy and will be repaired with stitches after the birth of your baby.
During the second stage of labour forceps may be required to assist the baby out of the vagina.
This can be required particularly necessary if there is fetal distress, slow progress, pelvis a tight fit for the baby, unable to push either due to exhaustion, unable to feel contractions or severe high blood pressure.
For the use of forceps, the cervix must be fully dilated and your bladder empty (a catheter may be used for this purpose). Stirrups may be used and a local anaesthetic to numb the lower third of the vagina and perineum.
The forceps are used one at a time around the baby’s head, locked into position and the baby is rotated into the correct position. Once the baby is in the correct position they often can then be delivered with no further assistance.
The forceps are used further if there is still trouble with the delivery, but are then removed once the baby’s head is delivered.
Like the forceps the vacuum is used for many of the same reasons, however it cannot be used to rotate the baby.
A suction cap is attached to the baby’s head during the second stage of labour and is used to assist while you push during a contraction.
The cap is removed once the baby’s head is born, with the body being born normally.
In very rare cases the placenta can become retained and unable to be delivered. If this is a problem the placenta is removed under anaesthetic in an operating theatre.
There are many reasons that an emergency caesarean may be required during labour. Some of these include:
- Breech presentation
- Abnormal fetal heart trace
- Failed induction of labour
- Severe high blood pressure
- Cephalo-pelvic disproportion (CPD – where the baby is too large to fit through the birth canal/pelvis)
- Placenta praevia (where the placenta grows low and possibly covers the outlet of the cervix as a result)
- Placental abruption (where the placenta breaks away from the uterine wall before birth of your baby)
- Unstable diabetes that has caused the baby to grow too large
- Cord prolapse/cord presentation
- Multiple pregnancy
- Previous lower segment caesarean section (LUSCS) – generally in this case a cesarean is planned ahead; an elective caesarean.
If an emergency caesarean is required a general anaesthetic will be administered. Usually in an emergency situation your support person will not be permitted in the operating theatre.
A catheter is used to empty the bladder and stays in until the morning after.
After the anaesthetic has taken effect a 15cm abdominal incision is made at the bikini line, the bladder is moved out of the way and the uterus is opened. Amniotic fluid is removed and the baby is delivered through the incision.
The baby is examined and if there are no concerns you will be given your baby. The incision is sutured in layers and then transferred to the postnatal ward for recovery.
Following a caesarean section your hospital stay will generally be longer than that of a natural delivery as a longer recovery time is required.
CHANGES TO BUB
At 39 weeks of pregnancy it is all about size!! As room to move is now minimal in your womb, you may find that your baby is moving less and less. While your baby continues to build up fat to be able to maintain body temperature in the outside world with the average baby weighing approximately 3.4kgs at birth.
As we all know babies can range in size significantly, a health weight range at birth for a newborn baby is anywhere between 2.5 and 3.8kgs.
At 39 weeks of pregnancy a baby is usually just over 3.2kgs or 7 pounds in the old measurements.
The average length of a baby is around 51cms from head to toe, but once again can vary greatly from baby to baby.
All of your baby’s organs systems have developed, with the lungs the last to fully mature. Your placenta continues to help protect your baby against infections from bacteria and viruses through the supply of antibodies.
Amazingly these antibodies will boost your baby’s immune system for the first six months of life, while breastfeeding your baby will further increase your baby’s immune system against a range of possible infections outside the womb.