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40 Weeks Pregnant

40-weeks-baby

Image: Fetal Development At 40 Weeks

You must be so excited now – by the end of this week you may have given birth! Although don’t worry if you’re still waiting – in reality most babies don’t arrive bang on the due date. You’ve got more time now you’re off on maternity leave so why not distract yourself from the anticipation with some movies or a treat?

Your baby could be up to 50cm long by now! She’s still shedding that greasy white protective vernix, turning the amniotic fluid from clear to milky. Outer layers of skin are also being shed as new skin forms. Your baby’s fingernails may even extend past her fingertips and might look long at birth.

Throughout pregnancy time flies but most women say the last few days feel the longest! If you want to move things along, you and your partner might want to enjoy a bit of lovemaking – it’s been known to help get labour started!

What if my baby is late?
You’ve been waiting all this time to give birth and if your due date comes and goes with no baby, you might feel a little nervous or disappointed – not to mention physically tired.

To top that, you’ve probably got friends and family texting or calling you all the time to ask if it’s happened yet. Some women don’t mind this and others feel pressured and fussed over. If you do, it’s perfectly fine to tell your loved ones that you’ll get in touch as soon as there’s any news.

Most midwives or doctors will wait 10-14 days after your due date to induce you, by which time you’ll probably be feeling very hot and bothered! So we’ve listed a few things you can try at home to help things get started.

Self-help techniques to try at home to help get labour started:

  • Acupuncture involves the stimulation of energy in your body through the insertion of needles at specific points. Some women have found this helpful in a late pregnancy. Make sure you consult a properly trained practitioner who is experienced in working with pregnant women though.
  • Curry is thought to help speed things along for the same reasons. Phew!

  • Pineapple contains bromelain, an enzyme which is thought to help bring on labour by softening your cervix. Furthermore eating a lot of pineapple is also likely to stimulate your tummy, which might also stimulate your womb.
  • Herbal remedies like black cohosh and blue cohosh are a lot more potent than homeopathic remedies and you should seek professional guidance if considering using them. In particular blue cohosh has been linked to birth complications so be very careful.
  • Homeopathic remedies like pulsatilla are often tried to help bring on labour and lots of mums swear by them. But always talk to your midwife or doctor before using them.
  • Raspberry leaf can be taken either in tablet form or simply drunk as a tea. It is believed to stimulate your womb and encourage labour. Although be careful not to drink it before 30 weeks.
  • Sex can seem a bit problematic when your bump is so big and you’re exhausted! But it might trigger a release of oxytocin, a hormone which brings contractions on. Also, orgasm could stimulate your uterus and help kick start things.
  • Going for a walk could help get things going. The weight of your baby’s head against your cervix causes pressure which can trigger the release of oxytocin, a hormone which brings on contractions. Upright positions also encourage your little one to snuggle down into your cervix.



What does it mean to have labour induced?
Most labours start naturally and even if the baby is a few days late, it’s usually best to relax and let things follow their natural course. Having said that, there are times when the process needs speeding along a bit. To induce labour means to kick start it artificially. Induction is offered when the risks of continuing pregnancy outweigh the risks of giving birth right away.

Why might my labour be induced?
You can expect to be offered an induction if:

  • You are more than 41 weeks pregnant and considered overdue. Often, your induction will be offered between 41 and 42 weeks.
  • Your waters have broken but labour hasn’t begun. It’s expected that a woman will go into labour within 24 of her waters breaking. If this doesn’t happen, there’s a risk of the mother or baby developing an infection so an induction will be offered.
  • You are diabetic – in which case assuming your baby is growing normally, inductions are usually offered after 38 weeks.
  • You have a condition (either chronic or acute) such as kidney disease or pre-eclampsia, which is hazardous to the health or wellbeing of your little one.

Some women ask for an induction for personal reasons. For example if their partner is going to be posted abroad with the armed forces and they will miss the birth. Or others may ask to be induced because of worry about prior stillbirth or current pregnancy complications. Requests like these are considered individually.

Planning your induction
If your baby is overdue, have a good chat with your midwife or doctor. You have choices about whether you want an induction and about what methods are used. Different methods might be appropriate according to how soft and prepared for labour your cervix is.

Cervical ripeness is measured using something called the Bishop Score, which marks your cervix out of 10. A score of 8 or higher denotes that your cervix is ready for labour. Midwives rate you on the Bishop Score before beginning induction and to assess the effectiveness of various induction methods used.

Around 15% of inductions that begin with an unripe cervix are unsuccessful. If this is the case, your doctor will talk to you about whether to try stronger interventions, or wait and then try again, or have a caesarean. Have a think about what works best for you. Also think about your preferred methods of pain relief; if induction is successful then your contractions may be stronger.

What is a membrane sweep?
A membrane sweep is conducted by your doctor or midwife. Whilst examining you internally he/she will “sweep” their finger around your cervix. The idea is to separate the membranes around your baby from your cervix which can release hormones called prostaglandins, which can help to get labour going.

When might I be offered a membrane sweep?
If home methods aren’t effective, your midwife may suggest a membrane sweep. This will be offered before other induction techniques are suggested.

As a general recommendation, first-time mothers are offered a membrane sweep at their 40 weeks antenatal appointment, and then again at the next week’s appointment. For women who’ve had babies before, membrane sweeps are offered at 41 weeks.

What are the benefits and potential drawbacks of a membrane sweep?
A membrane sweep increases your chance of beginning labour within 48 hours. It is more likely to work if your cervix is already beginning to soften and prepare for labour. Don’t worry; it doesn’t increase the risk of infection to you or your little one.

The drawback is that a membrane sweep can be a bit uncomfortable, or even painful. This is because the cervix is often tricky to reach before labour. You might want to use this as an opportunity to practice your birth breathing techniques to help you relax. You might also experience a bit of blood ‘spotting’ or irregular contractions straight afterwards.

You may be given two or three membrane sweeps before trying other methods. Try to bear with it; soon you’ll have your little bundle of joy in your arms!

What is prostaglandin?
Prostaglandin is a hormone-like substance which assists with the stimulation of contractions.

What happens if I’m given prostaglandin?
Prostaglandin will be inserted by your doctor or midwife as a pessary, tablet or gel into your vagina to ripen your cervix.

If labour hasn’t begun after six hours you may be given a second dose of the gel or tablet. With pessaries only one dose is needed and the prostaglandin is released gradually over 24 hours.


Are there any risks to using prostaglandin?
Vaginal prostaglandin is the most commonly recommended labour induction method because it tends to carry the least risks and is easy to administer. Having said that, there is a very small risk that it could cause over-stimulation or hyper-stimulation of the uterus. This drastically reduces your baby’s oxygen supply, in which case drugs can be administered to slow down or stop the contractions.

In a worst-case scenario, hyper-stimulation can cause rupturing (tearing) of the uterus. There is an increased risk of this if you are having a ‘trial of labour’ after a prior caesarean section – this is why doctors are reluctant to induce labour after a prior caesarean section.

What does it mean to ‘artificially rupture the membranes’ (ARM)?
Also sometimes called ‘breaking the waters’, ARM is no longer a recommended induction method (unless vaginal prostaglandins can’t be used for any reason). However sometimes midwives or doctors may use it to speed up labour if it’s not moving along.

What is involved in having my waters broken?
This procedure is sometimes conducted during an internal examination. A doctor or midwife makes a break in the membranes surrounding your baby using an amnicot (a medical glove with a pricked end) or an amniohook (a thin, long probe resembling a fine crochet hook). This procedure is most effective when the cervix is already softening and ready for the start of labour.

Are there any risks to having my waters broken?
An ARM (artificial rupture of the membranes) isn’t always effective and your baby could be at risk of infection once your waters have broken. This is the reason ARM is not recommended as a sole method of induction any more. You will be given antibiotics if your doctor or midwife suspects infection.

What is syntocinon?
Syntocinon is a drug which mimics the function of the hormone oxytocin. Synctocinon is only offered after unsuccessful membranes sweeps or prostaglandin, or in a case of ineffective contractions. This is because it has a number of drawbacks. Some women even have caesarean as opposed to syntocinon.

What happens if I’m given Syntocinon?
Syntocinon is administered through an intravenous drip straight into your veins. After contractions have begun, the speed of the drip can be adjusted in order to manage the flow of contractions.

Are there risks to Syntocinon?
Yes. This drug can bring on strong contractions, putting your baby under stress. There is also a very small risk of over-stimulation or hyper-stimulation of the womb through the use of Syntocinon. Therefore women given Syntocinon are monitored carefully.

Some mums have also said that Syntocinon-induced contractions are worse than natural ones, so some women choose to have an epidural to relieve the pain.

There has been some evidence to suggest that any an induction (whatever the method) is associated with the greater likelihood of needing to use instruments like forceps or ventouse to help with delivery. But this could either be caused by pre-induction pregnancy complications or the induction itself.

Possible Scan at Week 40
The purpose of a Well-being Scan is to check that the baby is growing well and that the pregnancy is developing normally. You may want to have this scan if your baby has been moving less, if you have had unusual tummy pains, light bleeding or if you have had some kind of accident (for example on the road or in a fall).

A Wellbeing Scan is particularly important if you have had pregnancy complications or problems in a previous pregnancy. This scan is usually only offered by the NHS if there is a complication with the pregnancy.