Pregnancy care

Did you know that babies get the best possible start in life when they've had a full 39 weeks or more to develop before they are born?

And that labor tends to be shorter and goes more smoothly for mothers, if it starts on its own, naturally?

That is, if delivery is NOT scheduled or induced.

Maybe, you've already begun thinking about labor and birth. Or …maybe not...

"So I am pretty sure how this baby got in here but I'm not exactly clear on how it's going to get out."

Wherever you are in your planning for birth, this video is for you.

You'll hear from mothers who've had their babies and women who are still waiting. They have great advice for handling the last months of pregnancy and birth. What they have to say may help while you are …

"Waiting for Baby"

If you are like most women, you're learning about childbirth in lots of ways: from friends, health care providers, the Internet and mass media. Making sense of all the information that's available today isn't easy. And, if you feel confused sometimes, you aren't alone.

" You look up one thing and you get 100 different answers about what it might be and, for me, at least, my wheels just start spinning and it worries me.

That's one reason we're bringing you the most recent scientific evidence about how and when it is best for babies to be born.

" …that's why you come to childbirth education classes …"

With the limited time available in prenatal visits, its helpful to have access to an expert who can help you make decisions about birth based on what is proven to be best for mothers and babies.

"When we started to learn about the way my body's gonna work together and all of the parts are going to do their thing, it helped to make me feel a lot more confident about the labor and delivery and that everything knows what it is supposed to be doing."

Of course, using your appointments with your doctor or midwife to get good information and reassurance also helps to build confidence in yourself and your body as you prepare for birth.

"so it's getting really close to birth time and I am a little nervous. I still don't know exactly what to expect." " For centuries, you know, women have been pregnant and they deliver their babies and the majority of babies are born naturally, um, so your body is well prepared for continuing this pregnancy and for the delivery.

It's normal to feel anxiety about something you've never done before.

And because each birth experience is unique, it isn't possible to predict everything that will happen during your baby's arrival.

That's why learning about choices you can make to give your baby the healthiest possible start in life, will help you approach birth with confidence.

"I mean, it was hard but it was not as bad as I expected. I really didn't think it was gonna be that easy and I'm not saying it's easy. It's just I thought I was gonna probably feel like I was gonna die 'cause I was watching all those, uh, TLC shows and I thought, I was like oh man, I'm in for something awful. [Laughter] It'…the pain is so worth it. It is one of those things that hurts so great."

You may find it helpful to know that…

If the female reproductive system was a building, it would definitely win a prize for best architecture. Your body contains everything it takes to grow and give birth to another human being.

Second to your heart, your uterus is the strongest muscle in your body.

When your baby is ready to be born, the uterus begins to contract, that is - squeeze in and out, at first gently and for only a few seconds, and many minutes apart.

"When I relaxed and list.. and started listening to my body and just you know going through the contractions breathing through them, not thinking about the end result, just thinking about minute to minute how I was gonna get through, um, I think was a really key factor for me.

Unlike a marathon runner who sets out to reach her destination without stopping, a woman in labor has regular rest points that last several minutes while her uterus is not in a contraction.

"I remember when I had the 1st contraction that I could tell for sure, OK I am in labor. And the 1st, it wasn't super painful but it was uncomfortable but at that moment I was very excited because then you can tell oh it's really happening

As labor progresses, stronger contractions move your baby through the birth canal.

They may be uncomfortable for mothers, but to your baby, contractions probably feel like gentle hugs.

The cervix is the opening at the bottom of the uterus. It stays tightly closed during the nine months your baby is developing.

At the end of pregnancy, even before labor officially begins, your baby will drop into your pelvis. And at the same time, hormones signal the cervix to start to open, or 'dilate'.

Then, during labor, the rim of the cervix thins out, or effaces, as contractions gradually cause the opening to grow larger. When the cervix is wide enough, it will be time for you to push your baby into the birth canal,

And then, finally, into your arms.

"What a big baby!"

This amazing process of childbirth is something that normally begins all on its own when your baby's lungs, brain and other organs are fully mature.

"Aren't you just a beautiful babe."

"We can estimate when your due date is but we don't know exactly the day. So we want babies to deliver after 39 weeks and we actually wait for even a week or two after that for your body to decide when to deliver. And the reason is that babies are continuing to grow and they are continuing to mature.

The brain is developing, the lungs are still developing, the liver is still developing and your baby is being nourished by you and your body. And it is so much better to stay inside of you than us making a decision when this baby should be born. "Ok"

" The wafer is just that little thin thing on the bottom."

You may have heard about women who had their labor induced - that is started artificially before their bodies began to labor on their own.

Lately, though, concern about the number of inductions is growing because there is evidence that they often lead to unintended complications.

The fact is even ultrasound readings can't be 100% accurate about a due date. Some may be off by as much as two weeks.

That is why unless there is a medical reason to induce, it is best for babies' development if labor begins naturally after at least a full 39 weeks of pregnancy. "And, I am really glad you are not asking for a particular date to be induced just because your mother is here and patients do ask that question but we really want your body to and your baby to decide when the birth day is.

Babies who have the benefit of a full term pregnancy and a birth that begins naturally on its own, tend to have an easier time getting used to life outside the womb.

"My children that came on time just tended to eat better and they slept better and they cried less than my little guy that came early.

" I thought that with all of the modern miracles of science that a little, a little bit premature baby is not a big deal anymore.

Actually, babies born between the 36th and 38th weeks of pregnancy have twice as many health complications as those that arrive after at full 39 weeks in the womb .

It really is amazing how much development happens in the last part of pregnancy. For instance,

A lot of lung and liver growth is still taking place.

Also, at 35 weeks, a baby's brain weighs only two-thirds of what it will weigh at 39 weeks.

And white matter - which helps different parts of the brain communicate with each other - increases dramatically in the same time period.

All throughout the last weeks of pregnancy, the brain is rapidly building connections that influence how a newborn is able to move, see and learn.

The same brain development happens for infants born prematurely but it has to take place more slowly. That's because once out of the uterus, a baby needs to direct a lot of energy to keeping warm, learning to feed and facing other ordinary challenges of life as a newborn.

Some early births are unavoidable and medically necessary

But we now know that every single day in the womb gives your baby an advantage.

"So, the last month of pregnancy I have learned is slightly uncomfortable…"

It's true: Every woman will tell you, the last part of pregnancy has challenges and it is normal to feel cranky or even fed up sometimes. Putting up with up with the inconveniences of late pregnancy, though, has advantages for YOU as well as your baby.

"Like what, for instance?"

Well, when labor begins on its own, it tends to be shorter and less complicated than if it is artificially induced.

That's because pitocin, a medicine used to induce labor can make contractions harder to manage, partly because the cervix may not be quite ready to start opening.

Also, sometimes inductions don't work and when that happens, it often leads to more interventions.

Like Cesarean birth - also known as "C-section".

Research shows that inducing labor can double the chance of having a C-section.

Many women aren't aware that a cesarean birth is major abdominal surgery which brings risks for

• Internal bleeding
• Blood clots
• Infection
• Increased chance that future births will require a C-section
• And longer hospital stays and longer recovery time

"I guess I had always heard about C-sections in the media. Like so-and-so went in, had their baby, two weeks later they were back at work everything's fine. It seemed like this kind of easy, new approach to having a baby. You don't have a vaginal birth you have a C-section and a little stitch and you're back and everything's fine. And maybe some people even get a tummy tuck at the same time. I mean that's the stuff I read about all the time in fashion magazines.

And I think there's a lot of things that are associated with C-sections that we don't realize like you can't get back in shape as fast because you're recovering from abdominal surgery. You can't exercise as quickly as you'd want to you have to stay away from everything for at least six weeks. You know it's so involved and nobody told me anything about that

For reasons researchers are still investigating, the number of C-sections has been on the rise. However, noticeable improvements in mothers and babies health haven't come along with the high Cesarean rate.

So while trends in childbirth change with time, the steep rise in potentially avoidable C-sections is one trend that didn't serve babies or mothers very well.

"We really want you to have this baby vaginally. In some situations, and they are very rare, less than 15%, and in your situation it will probably be even less than that, there might be a case where we'll have to end up having to do a Cesarean section

Cesarean surgery happens when there are conditions that make a normal delivery dangerous to you or your baby. These include:

• bleeding problems with the placenta
• abnormal positioning of the baby in the uterus
• Active infections that could harm the baby or
• an unusually long labor with medical indications that vaginal birth will be difficult.

The good news is that your doctor or midwife is trained to recognize these conditions, which do not affect the vast majority of pregnancies.

"Is there anything I can do to on my part to make sure that I am doing everything I can to have it naturally?"

"I think you are doing great. You baby is growing appropriately. Your weight is right on the curve that we want. And, that you are actually walking everyday and being very healthy so there is nothing in your situation that would make me feel that you are going end up with a c-section."

The last weeks of pregnancy will be a whole lot easier to handle if you stay active and healthy. It's also a good time to remind yourself that by reaching term and letting labor start on its own, your newborn is less likely to have:

• Difficulties with breathing
• Jaundice
• Infection
• Problems learning to breastfeed
• Trouble staying warm
• Low blood sugar
• Vision and hearing problems
• A stay in the neonatal intensive care unit
• and other complications from early birth

It's good to remember the benefits that a full term, forty week pregnancy has for babies -and mothers too, as you move through your last trimester and get ready for birth.

"Yes, right now you're wobbling like a penguin but you know what? That mean you're close."

"Do anything you can to make yourself feel a little bit better. Eat all the watermelon you can. Eat all the bon-bons. Sit it in a bath of cold water. Whatever it's going to take just to let that baby cook.

"Just waiting those last few extra days or minutes or even weeks, uhm, can be really tough but you saying, okay, I'm not going to put this on my schedule; I'm going to focus on what's best for the baby. And, uhm, that timing when they choose to come out, I think, is important.

You are going to feel much more at ease about labor and birth if you don't have to deal with misinformation.

"Well, I heard the bigger the baby's gonna get, the harder the labor gonna be."

Actually, a baby's weight is not a good predictor of how difficult or easy birth will be. And babies born at healthy weights have the advantage of being able to keep themselves warmer than babies born too small.

"See, I'm, I'm really small and I am worried that my baby will get stuck."

Regardless of how tall or thin they are, most women have pelvises that are naturally large and flexible enough to accommodate average and above average weight babies, without the need for medical intervention.

And you can rely on nurses to help you gradually guide your baby through the birth canal during labor.

"Well, this is kind of a little embarrassing but I was thinking that having a cesarean would, um, give me the ability to enjoy sex as much as I did before being pregnant, um, after."

You may be reassured to know that after a normal delivery, the muscle tone and elasticity of the vagina and surrounding tissue returns to normal within about three months.

"I am a person who likes control in my life. I like to control everything that happens to me and the idea that the labor is going to be something I won't be able to control is very scary for me."

"I will honestly say the single hardest thing for me in this pregnancy has been letting go of the control"

Letting your body and your baby's development determine the best time to give birth does involve dealing with uncertainty. And for some women, that is hard. If you can let yourself get comfortable with the element of surprise, it helps.

"Children for the rest of our lives they'll surprise us and it starts with labor. They will surprise us. They know when they're ready. It's such a great feeling to be surprised by your own child that you made. It's like a gift."

The reality is: there is not much about children in general that is perfectly predictable.

Your baby will eventually smile and sit and walk, but you'll never know exactly when.

It's good to think about the timing of your labor and birth the same way – with flexible expectations.

The changes pregnancy and birth bring do require adjustments in life, but before you know it, the many rewards a new baby brings will convince you that all your patience was worth it.