What to expect when you're expecting (137 page)

“If I’m past my 38th week and haven’t dropped, does it mean I’m going to be late?”

Just because your baby doesn’t seem to be making his or her way toward the exit doesn’t mean that exit will be late. “Dropping,” also called “lightening,” is what happens when a baby descends into mom’s pelvic cavity, a sign that the presenting part (first part out, usually the head) is engaged in the upper portion of the bony pelvis. In first pregnancies, dropping generally takes place two to four weeks before delivery. In women who have had children previously, it usually doesn’t happen until they go into labor. But as with almost every aspect of pregnancy, exceptions to the rule are the rule. You can drop four weeks before your due date and deliver two weeks late, or you can go into labor without having dropped at all. You can even drop and then undrop. Your baby’s head can appear to settle in and then float up again (meaning it’s not really fixed in place yet).

Often, dropping is obvious. You might not only see the difference (your belly seems lower—perhaps a lot lower—and tilted farther forward), you might feel the difference, too. As the upward pressure of the uterus on your diaphragm is relieved, you can breathe more easily, literally. With your stomach less crowded, you can eat more easily, too—and finish up your meals without a side of heartburn and indigestion. Of course, these welcome changes are often offset by a new set of discomforts, including pressure on the bladder (which will send you to the bathroom more frequently, again), the pelvic joints (which will make it harder to walk … or waddle), and the perineal area (sometimes causing pain); sharp little shocks or twinges on the pelvic floor (thanks to baby’s head pressing hard on it); and a sense of being off-balance (because your center of gravity has shifted once more).

It is possible, however, for baby to drop unnoticed. For instance, if you were carrying low to begin with, your pregnant profile might not change noticeably after dropping. Or if you never experience difficulty breathing or getting a full meal down, or if you always urinate frequently, you might not detect any obvious difference.

Your practitioner will rely on two more indicators to figure out whether or not your baby’s head is engaged: First, he or she will do an internal exam to see whether the presenting part—ideally the head—is in the pelvis; second, he or she will feel that part externally (by pressing on your belly) to determine whether it is fixed in position or still “floating” free.

How far the presenting part has progressed through the pelvis is measured in “stations,” each a centimeter long. A fully engaged baby is said to be at “zero station”; that is, the fetal head has descended to the level of the prominent bony landmarks on either side of the midpelvis. A baby who has just begun to descend may be at –4 or –5 station. Once delivery begins, the head continues on through the pelvis past 0 to +1, +2, and so on, until it begins to “crown” at the external vaginal opening at +5. Though a woman who goes into labor at 0 station probably has less pushing ahead than the woman at –3, this isn’t invariably true, since station isn’t the only factor affecting the progression of labor.

Though the engagement of the fetal head strongly suggests that the baby can get through the pelvis without difficulty, it’s no guarantee. Conversely, a fetus that is still free floating going into labor isn’t necessarily going to have trouble negotiating the exit. And in fact, the majority of fetuses that haven’t yet engaged when labor begins come through the pelvis smoothly. This is particularly true in moms who have already delivered one or more babies.

“My baby used to kick so vigorously, and I can still feel him moving, but he seems less active now.”

When you first heard from your baby, way back in the fifth month or so, there was ample room in the uterus for acrobatics, kickboxing, and punching. Now that conditions are getting a little cramped, his gymnastics are curtailed. In this uterine straitjacket, there is little room for anything more than turning, twisting, and wiggling—which is probably what you’ve been feeling. And once your baby’s head is firmly engaged in your pelvis, he will be even less mobile. But this late in the game, it’s not important what kind of fetal
movement you feel (or even if it’s only on one side), as long as you feel some every day. If, however, you feel no activity (see next question) or a sudden spurt of very panicky, frantic, jerky, or violent activity, check with your practitioner.

Going Down?

You may be in for a surprise—and a treat—at one of this month’s weigh-ins. Most expectant moms who reach the end of pregnancy also reach the end of pregnancy weight gain. Instead of watching the numbers on the scale go up (and up), you may start seeing those numbers go nowhere—or even go down—over the last few weeks. What’s up (or rather, down) with that? After all, your baby isn’t losing weight—and your ankles (not to mention your hips) are still plenty puffy, thank you very much. What’s happening, actually, is perfectly normal. In fact, this weight gain standstill (or downward trend) is one way that your body gets ready for labor. Amniotic fluid starts to decrease (less water equals less weight), and loose bowels (common as labor approaches) can also send the numbers down, as can all that sweating you’re doing (especially if you’ve been nesting overtime). And if you think this weight loss is exciting, wait until delivery day. That’s when you’ll experience your biggest one-day weight-loss total ever!

“I’ve hardly felt the baby kick at all this afternoon. What does that mean?”

Chances are your baby has settled down for a nap (older fetuses, like newborns, have periodic interludes of deep sleep) or that you’ve been too busy or too active to notice any movements. For reassurance, check for activity using the test on
page 289
. You may want to repeat this test routinely twice a day throughout the last trimester. Ten or more movements during each test period mean that your baby’s activity level is normal. Fewer suggest that medical evaluation might be necessary to determine the cause of the inactivity, so contact your practitioner if that’s the case. Though a baby who is relatively inactive in the womb can be perfectly healthy, inactivity at this point sometimes indicates fetal distress. Picking up this distress early and taking steps to intervene can often prevent serious consequences.

“I’ve read that fetal movements are supposed to slow down as delivery approaches. My baby seems as active as ever.”

Every baby’s different, even before he or she is born—especially when it comes to activity levels, and particularly as delivery day approaches. While some babies move a bit less as they get ready to arrive, others keep up an energetic pace right until it’s time for that first face-to-face. In late pregnancy, there is generally a gradual decline in the number of movements, probably related to tighter quarters, a decrease in amniotic fluid, and improved fetal coordination. But unless you’re counting every single movement, you’re not likely to notice a big difference.

“I’ve heard about the nesting instinct. Is it pregnancy legend, or is it for real?”

The need to nest can be as real and as powerful an instinct for some
humans as it is for our feathered and four-legged friends. If you’ve ever witnessed the birth of puppies or kittens, you’ve probably noticed how restless the laboring mother becomes just before delivery—frantically running back and forth, furiously shredding papers in a corner, and finally, when she feels all is in order, settling into the spot where she will give birth. Many expectant mothers do experience the uncontrollable urge to ready their nests, too, just prior to childbirth. For some it’s subtle. All of a sudden, it becomes vitally important to clean out and restock the refrigerator and make sure there’s a six-month supply of toilet paper in the house. For others, this unusual burst of manic energy plays itself out in behavior that is dramatic, sometimes irrational, and often funny (at least, to those watching it)—cleaning every crevice of the nursery with a toothbrush, rearranging the contents of the kitchen cabinets alphabetically, washing everything that isn’t tied down or being worn, or folding and refolding baby’s clothes for hours on end.

Though it isn’t a reliable predictor of when labor will begin, nesting usually intensifies as the big moment approaches—perhaps as a response to increased adrenaline circulating in an expectant mom’s system. Keep in mind, however, that not all women experience the nesting instinct, and that those who don’t are just as successful in bearing and caring for their nestlings as those who do. The urge to slump in front of the television during the last few weeks of pregnancy is as common as the urge to clean out closets, and just as understandable. Make that more understandable.

If a nesting urge does strike, make sure it’s tempered by common sense. Suppress that overwhelming urge to paint the baby’s nursery yourself; let someone else climb the ladder with the bucket and roller while you oversee
from a comfy chair. Don’t let overzealous home cleaning exhaust you, either—you’ll need energy reserves for both labor and a new baby. Most important of all, keep the limitations of your species in mind. Although you may share this nesting instinct with members of the animal kingdom, you are still only human—and you can’t expect to get everything done before that little bundle of joy arrives at your nest.

Getting Ready

These days, it almost goes without saying that becoming educated about childbirth is one of the best ways to prepare for this momentous experience. So by all means make sure you and your coach are as educated as you can be: Read the next chapter, along with any other materials on labor and delivery you can get your hands on; watch DVDs; take a childbirth class together. But don’t let your preparedness stop there. Be as prepared for matters practical and aesthetic, and plan, too, for your entertainment. Consider, for example: Are you interested in having the event videotaped (if that’s allowed where you’re delivering), or will a few photos suffice? Will music soothe your soul when your soul needs it most, or will you prefer some peace and quiet? What will distract you best between contractions—playing poker with your partner or solitaire on your cell phone, checking e-mail on your laptop, or watching reruns of your favorite sitcoms on TV? (Of course, also be prepared for the possibility that once those contractions begin, you may have little patience for distractions.) Don’t forget to include the materials you’ll need for the activities you’ve planned (including batteries for that camera, plus your phone charger) in the suitcase you’ll be taking to the hospital or birthing center (see
page 356
for a complete packing list).

How Is Baby Doing?

As your pregnancy nears its end (yes, it
will
end), your practitioner will be keeping a closer eye on your health and that of your baby—especially once you pass the 40-week mark. That’s because 40 weeks is the optimum uterine stay for babies; those who stick around much longer can face potential challenges (becoming too big to arrive vaginally, experiencing a decline in their placenta’s function, or a dip in amniotic fluid levels). Luckily, your practitioner can tap into plenty of tests and assessments of fetal well-being to make sure all’s well and will end well:

Kick counts.
Your record of fetal movements (see
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), though not foolproof, can provide some indication of how your baby is doing. Ten movements an hour is usually reassuring. If you don’t notice enough activity, other tests are then performed.

The nonstress test (NST)
. You’ll be hooked up to a fetal monitor (the same kind that’s used during labor) in your practitioner’s office to measure the baby’s heart rate and response to movement. You will be holding a clicker contraption (like a buzzer on a game show), and each time you feel the baby move, you’ll click it. The monitoring goes on for 20 to 40 minutes and is able to detect if the fetus is under any stress.

Fetal acoustical stimulation (FAS) or vibroacoustic stimulation (VAS)
. This nonstress test, in which a sound-and-vibration-producing instrument is placed on the mother’s abdomen to determine the fetus’s response to sound or vibrations, is useful if there’s a question about how to interpret a standard NST.

The contraction stress test (CST) or oxytocin challenge test (OCT).
If the results of a nonstress test are unclear, your practitioner may order a stress test. This test, done at a hospital, tests how the baby responds to the “stress” of uterine contractions to get some idea of how the baby will handle full-blown labor. In this somewhat more complex and time-consuming test (it may take a number of hours), you’re hooked up to a fetal monitor. If contractions are not occurring on their own, you’ll be given a low-dose IV of oxytocin (or you’ll be asked to stimulate your nipples) to jump-start the contractions. How the fetus responds to contractions indicates its probable condition and that of the placenta. This rough simulation of the conditions of labor can, if the results are unequivocal, allow a prediction to be made about whether or not the fetus can safely remain in the uterus and whether it can meet the strenuous demands of true labor.

A biophysical profile (BPP).
A BPP generally evaluates, through the use of ultrasound, four aspects of life in the uterus: fetal breathing, fetal movement, fetal tone (the ability of your baby to flex a finger or toe), and amniotic fluid volume. When all these are normal, the baby is probably doing fine. If any of these are unclear, further testing (such as a CST or a VAS) will be given to provide a more accurate picture of the baby’s condition.

The “modified” biophysical profile
. The “modified” biophysical profile combines the NST with an evaluation of the quantity of amniotic fluid. A low level of amniotic fluid may indicate that the fetus is not producing enough urine and the placenta may not be functioning up to par. If the fetus reacts appropriately to the nonstress test and levels of amniotic fluid are adequate, it’s likely that all is well.