Stages of Pregnancy - Weeks 28-40

You are in the home stretch. Just one trimester (roughly 13 weeks) left to go until the big day. Even while both of you grow at a more rapid rate, the last few weeks may feel endless. Use this time of anticipation to prepare yourself and your home to welcome your baby.

Development

Weeks 26-29: Your baby's eyes can now open and close. Hair is on the head and body. Skin is less wrinkled because of added fat and weight. By the end of this period, your baby weighs about 3 pounds and is 15 inches long. As lungs and nervous system mature, your baby will be ready to breathe and maintain body temperature without help from you. A baby born during these weeks is premature but still very likely to survive.

Weeks 30-34: You may notice that your baby moves slower now. There is no need for concern. At about 5 pounds and 18 inches, he or she has simply used up most of the space in your uterus. You can feel stronger kicks and you may see a heel or elbow move across your belly. The bones of the head are soft and flexible.

Weeks 35-38: The baby is filling out and gaining as much as a half pound a week. Growth in length is slowing down. If your baby is a boy, his testes are in his scrotum. The lanugo (fine body hair) is gone. Bones of the head stay soft and flexible. Your baby has most likely moved into position for birth.

Week 39 - birth: Your baby could arrive at any time. When labor begins is based on many factors. Most babies born at Gundersen weigh 7-9 pounds and measure 19-22 inches in length.

Changes in you

During weeks 29-34, your uterus will grow until it is under your ribs. From week 36 on, your weight may cause discomfort. You may be able to identify your baby's knees, elbows, back and head in your abdomen. By week 39, 97 percent of all babies have moved into head-down position.

Your breasts will enlarge. You may notice a white or clear discharge from your nipples. This is colostrum, the early pre-milk your breasts produce before delivery. If you leak, apply pressure to your breasts to stop the flow. You may want to put disposable breast pads in your bra.

Extra weight and pressure will make you pass urine more often. Sometimes your active baby will make you leak urine. This problem is out of your control but should not last after your baby is born.

The growth of your abdomen and breasts can stretch your skin and may cause stretch marks, pink or reddish streaks. These marks generally fade after your baby is born. Developing stretch marks is not preventable; however, some women never get them.

You are still gaining about a pound a week. By the end of pregnancy, average weight gain for most women is 25-35 pounds.

Activities & Nutrition

Activities: Follow your normal routine unless your doctor or nurse midwife tells you to take it easy. Extra weight may slow you down. Listen to your body. Fatigue or discomfort may tell you to do less and rest more.

Nutrition: You may no longer be able to eat large meals. Proper diet is still important during the last trimester. Try to eat smaller meals more often. Talk with your doctor or midwife if you have heartburn or indigestion. You may need to avoid certain foods, take antacids or lie in a different way when you rest or sleep.

Screenings

Ultrasound: An ultrasound may be needed during the last 3 months if:

  • Your baby seems to be too small.
  • You are past your due date.
  • The doctor needs to be sure of your baby's position.

Biophysical profile/non-stress test: These ultrasound tests assess amniotic fluid volume, fetal breathing, muscle tone and movement. A non-stress test may also be done. The doctor or nurse midwife may also request a non-stress test if you are 7-10 days past your due date. A special device on a band around your belly will transmit your baby's heartbeat and movements. This helps your doctor or nurse midwife know how your baby is doing.

Problems of the final 3 months

As your baby gains weight and takes up more space, you may have these symptoms:

  • Shortness of breath
  • Varicose veins (enlarged veins in your legs or pubic area)
  • Hemorrhoids (enlarged and tender veins in your rectum)
  • Swollen hands and feet
  • Feeling lightheaded or dizzy 
  • There is some risk of more serious problems during the last 3 months. If you have signs of any of these, call your provider right away:
    • Pre-eclampsia with high blood pressure, excess swelling and protein in urine
    • Vaginal bleeding
    • Leaking amniotic fluid
    • Pre-term labor

What if I go overdue?

In medical terms, your baby is not overdue until 2 weeks after your due date.

Staying pregnant beyond the due date may be stressful for many women. Your care team is just as eager for labor to start, but they want you to have the best possible experience. You may want to do daily kick counts to make sure your baby is moving about the same amount. Ten movements a day are normal. If movement has decreased a great deal, call your provider.

Options when you are overdue

Because of slight but slowly rising risks for your baby after 41 weeks, you are offered these options:

  • Watchful waiting with biophysical profile and/or non-stress test twice a week
  • Have labor induced

Waiting is more likely to result in labor starting on its own. Most women find this a more satisfying and successful birth experience. But, stress on your mind and body can make waiting more than you can stand. At 42 weeks, risks to the baby increase even more. Induced labor is then suggested but not required.

Induced labor is more likely to work if the cervix has begun to ripen. (The muscle band at the bottom of the uterus becomes thinner, softer and wider.) It can be a relief to know your baby will be born for sure on or soon after a certain day. Here is the downside: Induced labors are often more painful than those begun by nature. There is a slightly higher need for using forceps or cesarean delivery.

After the cervix has ripened, labor can be induced with:

  • Amniotomy (breaking the “bag of waters”) – If active labor does not begin, some other method will be used within 24 hours.
  • Pitocin – This drug is given through an intravenous (IV) line attached to a small pump. "Pit" makes your uterus contract. The dose can be increased as needed to shorten time between contractions.

Why ripen the cervix? Induction takes a long time or may fail if the cervix is "unripe." This is not a good idea unless there is a strong medical need for the baby to be born. Simply wanting to end your discomfort must be weighed against the risks for you and your baby. Two common methods are used to ripen the cervix:

  • Place prostaglandin gel or misoprostol (Cytotec®) tablets in the vagina. 
  • Put laminaria (seaweed which absorbs water and swells) or a catheter (tube) into the cervix.

You will be observed in Labor & Delivery while these take effect. More than one dose may be required. Within the next 24 hours, contractions will help the cervix soften and thin. Labor may even begin without being induced.

Love + Medicine

Every day, Gundersen Health System delivers great medicine plus a little something extra—we call it Love + Medicine.

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