What to expect when you're expecting (138 page)

Umbilical artery Doppler velocimetry
. This test uses ultrasound to look at the flow of blood through the umbilical artery. A weak, absent, or reverse flow indicates the fetus is not getting adequate nourishment and probably not growing well.

Other tests of fetal well-being
. These include regular ultrasound exams to document fetal growth; amniotic fluid sampling (through amniocentesis); fetal electrocardiography or other tests (to assess the fetal heart); and fetal scalp stimulation (which tests how a fetus reacts to pressure on, or pinching of, the scalp).

Most of the time, fetuses pass these tests with flying colors, which means they can continue to stay put until they’re good and ready to make their debuts. Rarely, the test results can be labeled “nonreasurring,” which really isn’t as unreassuring as it sounds. Because these tests yield plenty of false positives, a nonreassuring result doesn’t definitely diagnose distress, but it will mean that your practitioner will continue to test your baby, and if it turns out that there’s any indication of fetal distress, will induce your labor. (For information on labor induction, see
page 368
.)

“I just had an internal exam and the doctor said I’ll probably be going into labor very soon. Can she really tell exactly how close I am?”

Your practitioner can make a prediction about when you’ll give birth, but it’s still just an educated guess—just as your original due date was. There are clues that labor is getting closer, which
a practitioner looks for beginning in the ninth month, both by palpating the abdomen and doing an internal exam. Has lightening or engagement taken place? What level, or station, has the baby’s presenting part descended to? Have effacement (thinning of the cervix) and dilation (opening of the cervix) begun? Has the cervix begun to soften and move to the front of the vagina (another indicator that labor is getting closer) or is it still firm and positioned to the back?

But “soon” can mean anywhere from an hour to three weeks or more. A practitioner’s prediction of “you’ll be in labor by this evening” could segue into a half month more of pregnancy, whereas a forecast of “labor’s weeks away” could be followed hours later by birth. The fact is that engagement, effacement, and dilation can occur gradually, over a period of weeks or even a month or more in some women—and overnight in others. Which means that these clues
are far from sure bets when it comes to pinpointing the start of labor.

Do-It-Yourself Labor Induction?

So what happens if you’re overdue, and still as pregnant as ever (make that more pregnant than ever), with your baby showing no signs of budging? Should you just let nature take its course, no matter how long that course takes? Or should you take matters into your own hands, and try some do-it-yourself labor induction techniques? And if you do take matters into your own hands, will it even work? While there are plenty of natural methods you can use to try to bring on labor (and plenty of old wives’ tales to go along with them), it’s hard to prove that any of them will do the trick. Some women swear by them, but none of the homegrown methods passed from mom-to-be to mom-to-be has been documented as consistently effective. That’s probably at least partly due to the fact that when they do appear to work, it’s difficult to establish whether they actually worked—or whether labor, coincidentally, started on its own at the same time.

Still, if you’re at the end of your rope (and who isn’t by 40 weeks?), you might want to give these a try:

Walking.
It has been suggested that walking can help ease the baby into the pelvis, thanks perhaps to the force of gravity or the swaying (or waddling) of your hips. Once your baby puts pressure on the cervix—literally—labor just might get going. If it turns out that your stroll doesn’t jump-start labor, you’ll be no worse for the wear. In fact, you might be in better shape for labor, whenever it actually does begin.

Sex
. Sure you’re the size of a small hippo, but hopping (make that hoisting yourself) into bed with your partner may be an effective way to mix business with pleasure. Or not. Some research shows that semen (which contains prostaglandins) can stimulate contractions, while other research has found that women who continue to have sex late in pregnancy might carry their babies even longer than those who abstain. The bottom line? Go for your bottom lines, if you’re game to try (and get a good laugh while you’re at it). After all, it may be the last time in a long time that you’ll actually be able (or willing) to have sex. If getting busy brings on labor, great—if it doesn’t, still great.

Other natural methods have potential drawbacks (even though they’ve been passed down from midwives to old wives to new doctors). So before you try these at home, discuss them with your practitioner first:

Nipple stimulation.
Interested in some nipple tweaking (ouch)? How about some nipple twisting (double ouch)? Stimulating your nipples for a few hours a day (yes, hours) can release your own natural oxytocin and bring on contractions. But here’s the caveat: Nipple stimulation—as enticing as hours of it may sound (or not)—can lead to painfully long and strong uterine contractions. So unless your practitioner advises it and is monitoring your progress, you may want to think four times—twice for each nipple—before you or your spouse attempt nipple stimulation.

Castor oil
. Hoping to sip your way into labor with a castor oil cocktail? Women have been passing down this yucky-tasting tradition for generations on the theory that this powerful laxative will stimulate your bowels, which in turn will stimulate your uterus into contracting. The caveat for this one: Castor oil (even mixed with a more appetizing drink) can cause diarrhea, severe cramping, and even vomiting. Before you chug-a-lug, be sure you’re game to begin labor that way.

Herbal teas and remedies
. Raspberry leaf tea, black cohosh—these herbal remedies might be just what your grandmother orders to bring on labor, but since no studies have been done to establish the safety of any herbal treatments as labor inducers, don’t use any without getting the green light from your practitioner first.

And while you’re pondering the effectiveness of the do-it-yourself methods, remind yourself that you
will
go into labor—either on your own or with a little help from your practitioner—in a week or two.

So feel free to pack your bags, but don’t keep the car running. Like every pregnant woman who preceded you into the birthing room, you will still have to play the waiting game, knowing for certain only that your day, or night, will come—sometime.

“I’m a week overdue. Is it possible that I might never go into labor on my own?”

The magic date is circled in red on the calendar; every day of the 40 weeks that precede it is crossed off with great anticipation. Then, at long last, the big day arrives—and, as in about half of all pregnancies, the baby doesn’t. Anticipation dissolves into discouragement. The stroller and crib sit empty for yet another day. And then a week. And then, in about 10 percent of pregnancies, most often those of first-time mothers, two weeks. Will this pregnancy never end?

Though women who have reached the 42nd week might find it hard to believe, no pregnancy on record ever went on forever, even before the advent
of labor induction. Studies show that about 70 percent of apparent post-term pregnancies aren’t post-term at all. They are only believed to be late because of a miscalculation of the time of conception, usually thanks to irregular ovulation or a woman’s uncertainty about the exact date of her last period. And in fact, when early ultrasound examination is used to confirm the due date, diagnoses of postterm pregnancy drop dramatically from the long-held estimate of 10 percent to about 2 percent.

Even if you do end up among those 2 percent of women who are truly overdue, your practitioner won’t let your pregnancy pass the 42-week mark. In fact, most practitioners won’t even let a pregnancy continue that long, choosing instead to induce by the time your baby has clocked in 41 uterine weeks. And, of course, if at any point test results show that the placenta is no longer doing its job well or that the amniotic fluid levels have dipped too low—or if there are any other signs that baby might not be thriving—your practitioner will take action, and depending on the situation, either induce labor or perform a cesarean delivery. Which means that even if you don’t end up going into labor on your own, you won’t be pregnant forever.

“I’ve heard that overdue babies don’t continue to thrive. I just passed my 40th week—does that mean my baby should be delivered?”

Just because your pregnancy has exceeded those 40 allotted weeks doesn’t necessarily mean that your baby has worn out his or her uterine welcome—or that a speedy exit is called for. Many babies actually continue to grow and thrive well into the tenth month. But when a pregnancy goes post-term (technically, at the 42-week mark), the once ideal environment in a womb can become less hospitable. The aging placenta can fail to supply enough nutrition and oxygen, and production of amniotic fluid can drop off.

Babies born after spending time in such an inhospitable environment are called postmature. Their skin is dry, cracked, peeling, loose, and wrinkled, having already shed the cheesy vernix coating that previously protected it. Being “older” than other new arrivals, they have longer nails and more hair, and are generally open-eyed and alert. Because they are usually larger than term babies, with wider head circumferences, and because they may sometimes be in distress, postmature babies are more likely to be delivered by cesarean. They may also need some special care in the neonatal intensive care nursery for a short time after birth. So, though the majority of post-term babies arrive home a little later than scheduled, they arrive completely healthy.

To prevent postmaturity, many practitioners choose to induce labor
when it’s certain that a pregnancy is past 41 weeks and the cervix is found to be ripe (soft and ready to dilate) or sooner if there are complications of any kind. Other practitioners may choose to wait it out a bit longer, performing one or more assessment tests (see box,
page 348
) to see if the baby is still doing well in the uterus, and repeating these tests once or twice a week until labor begins. Ask your practitioner what game plan he or she usually goes with when a baby’s late.

Massage It, Mama

Got nothing but time on your hands as you wait for baby’s arrival? Put your hands (or a special someone else’s hands) to good use—and give yourself a rub. Perineal massage can help gently stretch a first timer’s perineum (that area of skin between your vagina and rectum), which in turn can minimize the “stinging” that occurs when baby’s head crowns during childbirth. And here’s another plus you’ll appreciate: It may also help you avoid an episiotomy and tearing, according to some experts.

Here’s how to give your perineum the right rub: With clean hands (and short nails) insert your thumbs or index fingers (lubricated with a little K-Y jelly if you’d like) inside your vagina. Press down (toward your rectum) and slide your fingers across the bottom and sides of your perineum. Repeat daily during the last weeks of pregnancy, five minutes (or longer) each time. Not in the mood for a perineal massage? It’s certainly not something you have to do. Don’t bother if you don’t feel comfortable with the concept, it seems too weird, or you just don’t have the time. Though anecdotal evidence has long supported its effectiveness, clinical research has not yet backed it up. Even without the rubbing, your body will still stretch when the time comes. And don’t bother with perineal massage if you’ve already popped out a baby or two. Your perineum doesn’t need, and probably won’t benefit from, the extra stretching.

One word to the wise: If you do go the massage route, proceed gently. The last thing you want to do right before labor is to pull too hard, scratch yourself, or irritate the sensitive skin down there. Bottom line: Massage with care.

Of course, chances are good your baby will decide to check out of your womb sooner than later—and without any prompting.

“I’m really excited about having my baby and I want to share the experience with my sisters and best friends—and, of course, my mom. Would it be weird to have them all in the birthing room with me and my husband?”

Someone’s having a birth day party (your baby, in fact), and if you’re like more and more moms-to-be, the guest list is getting longer and longer. There’s definitely nothing weird about wanting to have those who are closest to you by your side on the big day—and, in fact, it’s a trend that’s gaining popularity in birthing circles.

Why is more merrier for some women on labor day? For one, the widespread use of epidurals has made labor less laborious for many. With little or no pain to deal with—or breathe through—there’s more opportunity to socialize (plus, it’s a lot easier to be in a party mood if you’re not groaning and panting). For another, hospitals and birthing centers are also enabling the maternity mob, making some birthing rooms bigger (more equipped to handle the overflow of guests) and more comfortable (complete with sofas and extra chairs for visitors to plop down on while they’re waiting for the headliner to make his or her debut). Some even have Internet access to keep guests busy when there’s a break in the action. Policies have become more lenient, too—and at some hospitals and birthing centers, even open door (for as many as can fit in the door, that is). And having a gaggle of girlfriends and relatives may be just what the doctor—
or midwife—ordered, too. Many practitioners reason that having more distraction, support, and back-rubbing hands makes a mom-to-be happier and more relaxed during labor—always a good thing, whether it’s a medicated birth or not.