Week 39: Labor Signs

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This is your Pea in the Podcast for week 39 of your pregnancy. I'm Bonnie Petrie joined by Dr. Laurie Swaim, an obstetrician with Houston Women's Care Associates in Houston, Texas.

At 39 weeks you could go into labor today or you could go into labor three weeks from now but you should have your doctor's number close by. In any case you should have your doctor's number close by. "These are the things that we tell people to call us for anytime day or night: any bleeding, period; if you break your bag of water or you think you do and people are constantly like 'how will I know?' Believe me, you'll know. If there's clear fluid running down your legs you'll know. If the baby's not moving as much as usual and the hardest one for people to grasp: regular painful, painful contractions that are every five minutes we usually have them call us after an hour of that. It needs to be repetative and painful. Now it is true that more women really think they're in labor than really are. We're happy to see them any time and they're sort of a little annoyed with us when I tell them it's not time because after all what they're feeling hurts. But what they don't know is real labor hurts a lot more, sort of hard to tell people. But anyway that's what we're looking for."

Now we've all see the images of women on TV whose water breaks in a large gush; that does not always happen. In fact some sources say only 10% of labors begin with ruptured membranes at all. Most times your water will break when you're in labor in the delivery room, still if you suspect that trickle of liquid wetting your pants could be amniotic fluid, do call your doctor. "That's right, if there's any concern that your water is broken we need to hear about that, we need to look, it's easy to do and you don't want to miss it." Your amniotic fluid is usually clear, though it can be bloody or yellow or green tinged. It may smell sweet. Your doctor will check to see if the fluid is indeed amniotic fluid by putting it on a strip of paper, the paper's color changes to reflect the pH of the fluid. Now if you have ruptured membranes you may in fact be meeting your baby soon, if you don't go into labor on your own your doctor may decide that that's the cue to start labor artificially. That's called labor induction and there are a couple of reasons your doctor might consider inducing you, "One is elective and one is for medical reasons. As far as I'm concerned a woman who's pregnant with her first baby should never have an elective induction. The reason for that is there are studies, after studies, after studies showing a marked increase risk of cesarean deliveries, period. With second and subsequent babies, if the cervix is favorable, and she's 39 weeks then I think there's nothing wrong with an elective induction. Then there's medical reasons and that list is really long but some of those things we sort of talked about: preecalmpsia, inter-uterine growth restrictions, diabetes, other types of hypertension, hypertensive disorders, chronic medical diseases, heart, lung, lupus, kidney, those are just some examples. Ruptured membranes is an indication for induction after 34 weeks, poor fetal testing. If mom's not feeling the baby move we look on the ultrasound, if it doesn't meet the criteria that we're looking for on a certain ultrasound examination, then it would be delivered for that, not enough fluid, hydremia, yeah the list is long."

Now the decision to induce or not to induce is one you're talk over with your doctor. Some things to be aware of, induction requires the use of monitors and most often the use of an IV is required and that may limit freedom of movement. Now many women rely on the freedom of movement to manage their discomfort and keep their labor moving so this can be a concern. As Dr. Swaim says research does show that induction can lead to a higher incidence of cesarean section.

Now some women have scheduled a C-section with their doctor for this week. A higher order multiples, all of them get sections in the United States, although triplets get delivered vaginally in Australia, I think. Some people will section twins although it's not necessarily an indication for section but some people will. If you feel comfortable delivering vaginally then you should deliver vaginally, if they're in the right position. Placenta previa or vasia previa, fetal macrophomina, if the baby is thought bigger than 4500 grams." Again these may be some of the reasons your doctor might consider scheduling a C-section for you. And there are many other medical reasons that might warrant surgical intervention. This is another decision that is just between you and your doctor. Now other women may face a C-section delivery after they're already in labor. "So in labor the general categories could be the baby can't tolerate labor, and it's at a point where we're afraid oxygenation is not normal or it's not going to be normal or the baby's head just basically won't come out. Those are what we call arrest disorders and they can happen either with what we call arrested dilation where the cervix is not dilating after a number of hours. There's a lot of nuance that goes with this, there's a lot of science that goes with this too. It also depends on how far someone is dilated and how much pitocin they got, etc. There's something called arrested descent which is after a certain amount of time of pushing the baby is supposed to come down a certain amount and when those things don't happen then that's the most basic of putting it, but those two things can cause the need for a cesarean delivery." Don't let any of the information of this podcast scare you. I tell you all this just to prepare you unless your doctor has told you otherwise there is absolutely every reason to believe you will have an uncomplicated vaginal delivery and very soon too. I know you're hoping it's very soon; you're pretty comfortable by now. "You might have bad varicose veins and sometimes they're not just on your legs but on the labia. You have some swelling maybe and you're pretty darn uncomfortable. You can't see to wipe yourself, there's all kinds of stuff you can't do but I always tell patients at this stage this is when you need to get manicures and pedicures and buy things that don't come in sizes like jewelry." It might also be the perfect time to sign up for a full body pregnancy massage, they are amazing. Warning though you may fall asleep on the table and start snoring, I did. The therapist didn't mind though, I think she's probably used to it.

Your baby this week is just about ready to meet you, he is about seven and a half pounds, although there is a pretty wide range in newborn baby birth weight, and is likely around 20 inches long. You're 39 weeks pregnant. You have just one week to go until week 40.

That's your Pea in the Podcast for week 39 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.