Week 33: Preparing For a Preemie

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This is your Pea in the Podcast for week 33 of your pregnancy. I'm Bonnie Petrie joined by Dr. Laurie Swaim, an obstetrician with Houston Women's Care Associates in Houston, Texas.

Now when most people think about amniocentesis they think about the prenatal test with the long needle that you have in the second trimester to look for disorders like Down syndrome. But, some moms-to-be have to reconsider the test in the third trimester. "The amniocentesis is performed when we're delivering a baby less than 39 weeks either for elective reasons, which would be stupid, I mean I don't know anyone who would really do that, or for example let's say you have a woman who is pregnant with twins and her cervix is four centimeters dilated and she's 34 or 35 weeks and she's got multiple visits, in and out of the hospital for all of these contractions and you want to know if you could just deliver these babies. You can do an amnio and if they're mature deliver the babies." Now it is around this time that an amnio will begin to be considered to detect fetal lung maturity because doctors safely assume your baby's lungs will not be mature before now. As Dr. Swaim said, amnio may be done all the way up to week 39 particularly for diabetic women because poorly controlled diabetes may delay fetal lung maturity even though those same babies may be larger than average. There are some risks with third trimester amnio, "There is a risk of ruptured membranes, there's a risk of infection, there's a risk of poking the baby although the second it's born we give it a shot anyway, there's a risk of bleeding, there's a risk of going into labor, there is a risk of discomfort but there are not that many risks."

So what happens during the third trimester amnio? The baby's heart rate is checked before and after the test, your abdomen is cleaned with an antiseptic and you'll likely get a topical anesthetic. Ultrasound helps the person doing the test guide the needle through your abdomen into your uterus, away from the baby and to the area where the most amniotic fluid is. It may hurt a little when the needle is inserted and when it goes through your abdominal muscle. A small amount of fluid is withdrawn, sent the lab and tested for a few substances including one called surfactant. Now the results help the doctor predict whether your baby's lungs are developed enough for delivery to be safe. Now why is surfactant so important? Well it's the stuff that lubricates the lining of the air sacks within the lungs and allows them to expand. Without it is breathing is a struggle and a baby might suffer with a syndrome, a dangerous syndrome called RDS, Respiratory Distress Syndrome. If the amnio shows your baby's lungs are not ready but delivery still seems imminent, within one or seven days, your doctor may help the lungs along by giving you steroid shots, "That's to enhance the baby's lung maturity, to decrease their need for ventilatory support and the medications that are used by the neonatologist to make their lungs more compliant." Now you might get two shots of a steroid called betamethasone or four shots of dexamethasone. The steroids kick up the production of the surfactant a notch and may help a preemie breath with less distress.

But I'm hoping amnios and steroid shots are the furthest thing from your mind right now as you settle into the final months of your pregnancy. Your uterus right now is a little over five inches above your belly button and you may have gained around 28 pounds. Has your belly button popped yet? Don't worry if it hasn't, it may not pop at all but many women do have outies by this point in their pregnancy. You may be starting to feel very tired and this is probably normal but if it's really slowing you down, do mention it to your doctor, there's always that risk for anemia. Braxton Hicks contractions and pelvic aches are probably plaguing you although some women never feel a single Braxton Hicks contraction; they may be having them just not feeling them. Those vivid dreams may still be keeping your attention while you sleep but even if they're super sexy dreams they may not make you feel frisky at all. Many women report their libido takes a big ol' nose dive around this time. Now if you're getting impatient you can pass the time by making your plans for 'labor day'. Many moms-to-be find writing a birth plan helps them focus positively on what's to come and helps them to learn more about their options, it also gives you some points to ponder that you can talk through with your partner and with your doctor or midwife. Dr. Swaim says, yes talk to your doctor, birth plans are fine but don't spring it on your doctor at the last minute. "I think that if you're going to have a birth plan that you shouldn't surprise your obstetrician with it when you come in in labor and that most women will find that they want the same things that their obstetrician wants. It's funny because some women are like 'I don't want a cesarean', well no kidding. No one wants that to happen, I don't want for that to happen. We don't plan on doing forceps on everyone although these are things that need to be discussed. 'I don't want IV fluids', well fine we can compromise, you can have a heplock, you don't have to have IV fluids if you don't want it. 'I don't want pain medicine', we're not going to give you pain medicine unless you ask for it. There is stuff where everyone is on the same page. 'I don't want an episiotomy'; well you know what, episiotomies pretty much shouldn't be cut anymore anyway and in the rare instances that they are there is communication between the patient and the doctor. I think that it should be reviewed beforehand." Dr. Swaim says discussing what you want and what you don't want with your doctor can help demystify those various interventions that may come up during labor and delivery. "I don't want cesarean or forceps, well sometimes forceps can save you a cesarean. So let's talk about this, why is it that you don't want this. And once there's a discussion then usually the patient feels better." You can find a link that will help you get started on your birth plan at peainthepodcast.com.

This week you can also start to write down what you want to include your hospital bag, that may include things like music for delivery, a tennis ball or something like that for massages, your camera, comfortable loose fitting clothes and not in your pre-pregnancy size, sorry to say, your own pajamas may make you feel more comfortable in the hospital, a nursing pillow is handy, a going home outfit for the baby, the list goes on and on and it may be long so you may want to add things over the next couple of weeks so keep it handy. Also having your doctor's phone numbers available to you and if you have to mapquest the hospital and know your route in advance will ease your mind for sure. Now is also a good time to pre-register at the hospital, if you're delivering at home by the way you don't get out of this task, you'll need to prepare the birthing room and the list will help you get all that done.

Now your baby continues to fill out this week, adding fat. If you saw this baby had a little bit of hair during that 20 week ultrasound they may have a full glorious head of it now. Your baby can listen and feel and see; it weighs a little over four pounds and may be just over 19 inches. You are 33 weeks pregnant; you have just seven weeks to go now until week 40.

That's your Pea in the Podcast for week 33 of your pregnancy. Dr. Swaim and I look forward to talking to you again next week. Enjoy this week. For a transcript of any of our Pea in the Podcasts go to our website peainthepodcast.com. For Pea in the Podcast, I'm Bonnie Petrie, thanks for listening.