What's Happening to Me

• You may be tired of being pregnant and ready for delivery. You tire easily and often feel drowsy.
• Your abdomen is getting bigger. It may look lopsided when the baby moves.
• Your uterus lowers as the baby drops toward the birth canal. This is called "lightening." Because your baby has "dropped," you may again have the urge to urinate frequently. However, you'll find breathing is easier.
• Your hands and feet may swell.
• You may feel pressure low in your pelvis as the baby settles into position for birth.
• Braxton Hicks contractions are more frequent. If you have four or more contractions in 1 hour, call your health care provider.
• Getting up from a sitting position can be a real chore. Try sitting in a straight-back chair. If one is not available, be sure that the chair you do sit in has arms.
• You are well on your way in the parenting journey. Do not hesitate to call your health care professionals if you have questions. They are ready to reassure, help, and support you.

What's Happening to My Baby

• By the end of this month, your baby will be fully developed.
• The bones of his head will be soft and flexible for delivery. In most cases, babies ready to be born will turn head-down toward the cervical opening, with their feet up under mom's ribs.
• His eye color is dark gray. This may change after birth.
• His fingernails become complete and may grow long.
• He may seem quieter because there is less space to move.
• There are periods of sleep and activity.
• His organs are maturing so the baby will be ready to breathe and grow on his own after birth.
• About 1 quart of amniotic fluid surrounds him.
• He'll have smooth skin, be 50 to 55 cm (20 to 22 inches) long and weigh between 3 - 3.5 kg (6½ - 7½ pounds).

Things I Need to Do

• Get a prenatal checkup as recommended.
• Eat smaller meals more often.
• Continue to exercise and practice for childbirth.
• Limit out-of-area travel.
• Plan for a birth-control method.
• Cover your mattress and your chair with plastic in case your "bag of waters" breaks.
• List phone numbers of people to call when labor begins.
• Pack your suitcase. Put in clothes and other items to use at the hospital and what you and your baby will wear home.
• Get the baby's car seat ready and learn how to install it correctly (before going to the hospital).
• Treat yourself and your partner to something special.

Labor and Delivery

Every woman is different. Every labor is different. That can make it difficult to know if you are really going into true labor, or if it is something else.

As your due date approaches, you may experience false labor (irregular contractions that may feel like your uterine muscles are knotting up). These cramps are called Braxton Hicks contractions. They are normal, even though they sometimes can be painful. Braxton Hicks contractions are most common in the afternoon or evening, when you are tired or after physical activity.

Signs of True Labor

To help you decide if you are beginning true labor, monitor your contractions. Time them from the start of one contraction to the start of the next one and use the following tips:

Contractions in true labor:

• Come at regular intervals (usually 5 minutes apart or closer).
• Get closer together and stronger as time goes on.
• Continue, even after you move around.
• Are usually felt in the back first, then in the front.
• Feel stronger when you walk.
• Last about 30 to 70 seconds each.

Contractions in false labor, or Braxton Hicks contractions:

• Are irregular and do not consistently get closer together.
• May stop when you walk or rest, or may even stop if you change positions.
• Are often felt only in the abdomen.
• Are usually weak and do not get much stronger; some are strong, then weak.

It's not always easy to tell the difference between the two. False labor, for example, can occur when real labor is expected to start. Sometimes the difference between true and false labor can only be determined by a vaginal exam. Call your health care professional about any contractions you are concerned about or those that don't fade away quickly. Do not feel embarrassed if it is determined that you're not in labor.

Tip: Talk with your health care professional about how to time your contractions to help you tell the difference between true and false labor. Also, ask whether you should call the office first or go directly to the hospital when labor starts. If you feel you're going into labor, don't wait too long to call or go to the hospital. Labor can occur earlier and proceed more quickly than expected if you have had a baby before.

Call your health care provider right away if your water breaks (membranes rupture), you bleed from the vagina or have constant, severe pain with no relief between contractions.

The Three Stages of Labor

The process of labor can be long, hard work for the mother as the baby moves from the uterus through the birth canal.

The first stage. Initially, the contractions often are short and mild, occurring at 5- to 10-minute intervals. During this time, you probably are free to be in any position you want or to move around. When the contractions come 3 to 5 minutes apart and are more intense, lasting 40 to 50 seconds, you are in active labor.

During this stage, your uterus contracts to push the opening of the cervix wider and wider. When you arrive at the hospital, your cervix will be examined to see how much it has opened, or dilated, and thinned (called effacement). Your temperature, pulse, respiration, and blood pressure and also the heart rate, position, and condition of your baby will be monitored.

The time between your contractions continues to shorten to about 2 minutes; at this point contractions are more intense and last about a minute. Your labor coach and the staff are important in keeping you comfortable and motivated during this stage. The completion of this stage of labor comes when your cervix is fully dilated (about 10 centimeters or 4 inches).

The second stage. This stage may last up to 2 hours or more and ends with the birth of your baby. Find a position for pushing that is comfortable and push only when asked.

When your baby's head appears, or crowns, a doctor makes the episiotomy, if one is needed. Then, as you pant or blow to prevent further pushing (you may be watching in the mirror), your baby's head is gradually delivered. Next the shoulders appear, and then the rest of the body.

The third stage. This short stage ends when the placenta and the membranes that held your baby are out. The staff will clean you and provide fresh bedding.

Your baby. Immediately after your baby is born, the staff will clear your baby's nose and throat of mucus or fluid, if necessary, and then clamp and cut the umbilical cord. Drops or ointment will be put into your baby's eyes to prevent infection, and he will be given vitamin K to prevent problems with blood clotting. The baby is quickly dried off, wrapped in a blanket to keep warm and may be placed on your stomach so you can enjoy the moment.

At 1 minute and at 5 minutes after the birth, the staff assesses how well your baby has made the transition from your uterus to life outside you and assigns the Apgar scores. Then, perhaps all three of you—mother, father and baby—can have some quiet time together. The baby may be able to be put to the breast if you have decided to breastfeed.

The Cesarean Birth

Cesarean birth (C-section) is the delivery of a baby through an incision in the abdomen and uterus. If you have been told there's a possibility you may have a cesarean birth, don't worry. Keep these facts in mind:

• As with a vaginal delivery, the goal of a cesarean birth is to deliver a healthy baby and assure your well-being. Dad-to-be or another support person can usually be present during a cesarean birth.
• Women who have had a cesarean birth usually spend at least 1 day longer in the hospital to recover than women who have a vaginal birth.
• Some women who have had a cesarean birth are interested in having a vaginal delivery with later pregnancies. Women who are considering this option should discuss it with their health care provider.

What I Should Take to the Hospital

When it's time to go to the hospital, it's best to have already packed. Here's a handy checklist for packing your stay-over bags.

For Mom's Bag:

• Robe and a couple of nightgowns that button in the front or nursing gowns, if you plan to breastfeed
• Warm socks, in case your feet get cold during labor
• Comfortable slippers
• Bras or nursing bras
• Toiletries, like toothbrush, toothpaste, lotion, hairbrush, deodorant, shampoo, hair conditioner or rinse, hair dryer, makeup, a bar of soap and soap case and other personal essentials that make you feel good
• Glasses and reading material
• An item to use as a focal point or concentration aid during labor
• Change to buy small items
• Your own pillow from home, if desired
• A comfortable, going-home outfit
• Kleenex boxes, napkins, etc. may be required. Check with your hospital
• 6 x 120 mL glass bottles Similac Advance Ready-to-Use formula

For Labor Coach's Bag:

• Digital watch or one with a second hand for timing contractions
• Insurance card
• Labor aids, such as a tennis ball in a sock for a lower-back massage
• List of phone numbers of friends and family to call when the baby is born
• Lots of change for phone calls and snack machines
• Camera with flash, film, CD player, or video equipment. Check to see what type of equipment the hospital allows
• An item to use as a focal point or concentration aid, during labor—maybe a picture for the wall or baby's first toy

For Baby's Bag:

• Diapers (two diaper pins for cloth diapers)
• Undershirt
• Nightgown and socks or booties
• Cap
• Receiving blanket
• Going-home outfit
• Blankets or outerwear, depending on the weather

Baby Safety Tip:

Now's the time to buy an infant car seat—required by law in every province—if you don't have one already. Install the seat according to the manufacturer's instructions—before the trip to the hospital so your baby is protected on that first trip home. Always place your baby in the rear-facing car seat when he or she is riding in the car.

Newborn Screening

All newborn babies are required by law to be tested, or screened, for certain rare inherited diseases. These diseases, if untreated, can seriously interfere with a baby's development.

For screening, a few drops of blood usually are taken from the baby's heel. Although all babies are screened in the hospital, sometimes babies have to be screened again after they have gone home. In certain situations, the screening may not detect the disorder the first time. Check with your baby's health care provider at an early visit to be sure that your baby has been properly screened for these rare but serious diseases.

What I Should Know Before I Leave the Hospital

Whatever the length of your hospital stay, it's important to learn how to care for your baby before you're discharged. Before you leave the hospital, be sure to discuss these topics:

• How to bathe, diaper, and feed your baby; care for the umbilical cord and the circumcision site, if applicable; and take your baby's temperature.
• What to expect of normal sleep, awake, and feeding patterns; stool and urination patterns; and spitting up.
• Which sleeping position is safest.
• What conditions should prompt you to call your baby's health care provider, such as signs of jaundice.
• How to reach the health care provider after office hours.
• The schedule for immunizations. Your baby needs most immunizations by age 2 years, with the first immunization due between birth and age 2 months.

Now's a good time to arrange support from dad, family and friends for your first week home. Once you're home, try to get the extra rest you'll need. Depending on your baby's or your needs after discharge, it may be recommended that a home health care nurse visit you and your baby at home or that you make an early visit to the office.

The Circumcision Choice

Circumcision is the surgical removal of the layer of skin (foreskin) covering the tip of the penis, and may commonly be done for hygiene or religious reasons. You choose whether or not to circumcise your son—no laws or hospitals require it. Your baby's health care provider can explain the possible benefits and risks of either decision.

A portion of the information contained within this page has been taken from patient education material from www.medicalcenter.osu.edu. © the Ohio State University Medical Center, Columbus, Ohio. All rights reserved.

The information contained in the www.medicalcenter.osu.edu Web site is provided as a public service by The Ohio State University Medical Center. It is posted for informational and educational purposes only. This information should not be construed as personal medical advice. Because each person’s health needs are different, a physician should be consulted before acting on any information provided in these materials. Although every effort is made to ensure that this material is accurate and up-to-date, it is provided for the convenience of the user and should not be considered definitive.