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You’re now at 32 weeks!
It’s been about four weeks since you last heard from us and by now you will probably have had or be about to have your 32-week appointment. This week we have a few reminders and some information about things affecting your pregnancy now. We also explain the labour process and include a video tour of our Birth Centre.
Part 1: Reminders and recap
In these last few weeks, you’ll probably be thinking more about what will happen when your labour starts. You will find advice on what signs to look out for in our fact sheet When to call the hospital: Advice in late pregnancy
The Women’s recognises that family violence and sexual assault are unacceptable and illegal. We believe that women have the right to live a life free from violence and can make decisions about what is best for their lives.
If you are experiencing family violence you can speak to a midwife or doctor at the Women’s or call: Safe Steps Family Violence Response Centre on 1800 015 188. In an emergency or if you are in danger RIGHT NOW: Call Emergency Services on 000.
Regular and healthy movements are a good sign of wellbeing. It is a myth that babies’ movements slow down or become weaker towards the end of pregnancy.
If at any point you are concerned about your baby’s movements, please contact your doctor or midwife. To speak with a midwife about any of these concerns, call (03) 8345 3635.
For more information about your baby’s movements see CRE - Movements matter and Reducing the risk of stillbirth.
Everyone should exercise their pelvic floor muscles everyday throughout life, to prevent weakness and improve strength. This is particularly important in pregnancy and after the birth as well. You can generally restart pelvic exercises a few days after birth.
Two common signs of pelvic floor problems are leakage of urine and vaginal heaviness. Other less obvious signs that could be connected to pelvic floor problems are constipation, lower back pain, pain during sexual intercourse and pain around the pelvic bones.
You can read more information on Your health after birth: Exercise and refer to week 22 where this topic was discussed in more detail
During pregnancy the long muscles of the abdomen may separate. This is a normal safety mechanism to avoid the muscles tearing as your baby grows. It only becomes a problem if the muscles stay separated after your baby is born. Stretched and separated muscles do not provide full support for your back and may increase the incidence of back pain.
For more information on this topics and tips on what can be done to help see our fact sheet Abdominal muscle separation.
Your midwife or doctor can refer you to our Physiotherapy Department for review and advice if needed.
Part 2: Things affecting your pregnancy now
The Women’s recommends you have a Group B Streptococcus (GBS) screening test around 36 weeks of your pregnancy (unless you are having a planned caesarean). GBS is a bug that commonly lives in the bowel and one in four women carry it in their vagina. Being a carrier is not harmful to you, but it can cause infection in your newborn baby. GBS is not sexually transmitted.
If you are found to carry GBS you can be treated with antibiotics during your labour. This reduces the risk of your baby developing a serious infection which may make your baby very sick.
The GBS bug does not live in the vagina all the time. The test can only detect GBS if the bug is present at the time of the swab and screening may not detect GBS in approximately five per cent (5 in every 100) of GBS positive women.
See our fact sheet Group B Streptococcus (GBS) screening test for more information.
Your posture and positions can influence your baby’s position during pregnancy and labour and assist your baby to be in an ‘optimal’ position (head down & flexed, facing your spine) ready for birth.
Staying healthy in pregnancy, using upright forward-leaning positions, and exercising your pelvic floor can help your baby to find an optimal position.
At this stage in your pregnancy, there will be times when a midwife or doctor may ask for your consent to perform a vaginal examination. With a gloved hand they will insert two fingers into your vagina to measure cervical changes and progress in labour. This may feel anything from uncomfortable to mildly painful.
Part 3: Things to consider
A birth plan or birth map is a tool to communicate your preferences and goals for your labour and birth to anyone supporting you in labour. It can provide clarity for yourself, your support team and care providers.
Labour and birth are unique to each parent and baby so your birth plan will work better if it is flexible. There may be times when changes or an intervention is recommended to keep you and your baby safe; however, we work in partnership with you and support informed decision-making.
To access the Women’s birth plan template please click on the link:
Understanding the process of labour
When your body and baby are ready, spontaneous labour will usually start around 37-41 weeks.
The uterus is an organ made of muscle that sits in the lower pelvis. The lower end of the uterus is the cervix. During your pregnancy, the cervix remains long and closed so that the baby is kept safely inside. During labour as the uterine muscle contracts, the cervix becomes softer, thinner, shorter, and more open over time.
Labour is made up of three stages:
- Stage one – has three phases
- Latent labour
- Active labour
- Transition labour
- Stage two – pushing and birth
- Stage three – passing the placenta
Stage one:
At the beginning of labour (especially if this is your first birth) contractions are often spaced apart and irregular. There isn’t yet a set pattern to how often and how long your contractions will last.
The contractions in this early stage may be short in length (approx. 10-20 seconds) and may feel like heavy period pain, or intermittent back pain. At this stage, the cervix is thinning and shortening before it begins to dilate and open.
If it’s your first baby, labour may last many hours. We encourage you to rest as much as possible and call the hospital for advice.
Naps, baths, showers, and a heat pack on your belly or lower back are great options for this stage. Home is a good place to stay when:
- you have a low-risk pregnancy
- your baby’s movements are still being felt regularly
- your waters have not broken.
We know that the early stages of labour can work very well when you feel comfortable and safe. In most cases, early labour is best spent at home.
If you who have laboured before, often this phase of labour may be very short or you may not notice it as much if you are busy with your other child or children. It may appear to you that you have gone very quickly into the next, active, stage of labour
For more information review the following fact sheet and videos:
- Our factsheet: When to call the hospital: Advice in late pregnancy
- Our When to come to the Women’s video
- Our Where to go when you come to hospital video
Active labour is when contractions are generally 3-4 minutes apart and lasting 50-60 secs or 3 contractions in a 10-minute period. Once this pattern establishes, it is a good time to come to the hospital.
As your uterus continues to contract, your cervix will continue to open.
If you have laboured before, you may think the contractions are stronger than your last labour. This perception is because your body has done this work before and, most often, will quickly and efficiently progress with labour.
For more information about what our Birth Centre will look like when you come into hospital in labour:
During labour, you may feel like you can’t do it anymore. This can happen at any time in labour but is often more obvious around this time of labour. At this point, you may feel some pressure in your bottom as your baby moves down lower in the pelvis and pushes on the bowel. This pressure will intensify with each contraction until an involuntary urge to push may come with the contractions. The contractions are often closer together, lasting longer and stronger.
Stage two: pushing and birth
Your cervix is now fully open, and your baby’s head is usually well down in the pelvis.
If you are in an ‘upright position’ - this could be standing, bending forward, kneeling or on all fours (on your hands and knees) - it provides more space for your baby to pass through your pelvis and assists birth. Working with the pressure sensations, breathing deeply, focusing on releasing, and altering positions will help birth your baby.
Towards the end of the second stage, the midwife will offer guidance with pushing as needed; aiming for a slow, calm birth of your baby’s head and body.
If this is your first labour, this pushing stage may last 30 minutes or more.
If you have laboured before you may find this stage can be as short as five minutes.
It is standard practice for the midwife to ask if they can apply warm compresses to your perineum to help minimise perineal trauma (see below).
Stage three: passing the placenta
After the birth, while you and your baby have skin-to-skin contact, your uterus will contract to loosen and push out the placenta and membranes through your vagina.
You may also need to give a small push to help the placenta pass. This may occur between 5-30 minutes after the birth of your baby.
The muscles of your uterus will then continue to contract to stop the bleeding and help the uterus involute (begin the process of returning to its pre-pregnancy size). The birth of the placenta involves moderate blood loss. This stage is monitored closely to reduce the risk of excessive bleeding (postpartum haemorrhage).
At the Women’s, we practice delayed cord clamping. This means waiting for a short period of time before clamping the umbilical cord. Research shows that delayed cord clamping allows your baby to benefit from placental blood even after birth has occurred. Immediate clamping may be necessary if you or baby need immediate medical attention or when blood is required from the cord.
There are two ways to birth the placenta:
- Physiological birth of the placenta
This means you wait for the placenta to be birthed naturally. Your uterus will contract assisting the placenta to separate from your uterus and move into your vagina for you to push out.
- Active management
This is when you are given an injection after the baby’s birth, usually because there have been complications during your pregnancy, labour, or birth. The injection helps to reduce the risk of heavy bleeding after the birth of your baby.
The midwife or doctor will ask to give you an injection of synthetic oxytocin. This will make the uterus contract, assisting the placenta to separate from your uterus and move into your vagina. It usually takes between 5-15 minutes. The midwife or doctor will guide the placenta through your vagina by gently pulling on the cord. Delayed cord clamping as described above will happen if possible.
After giving birth, either vaginally or by caesarean section, it is normal to have some vaginal bleeding. This bleeding usually comes from where the placenta was attached to the uterus. It can also come from an episiotomy or tears that occur during a vaginal birth. Bleeding is usually heaviest just after birth and gradually becomes less over the next few hours, days, and weeks.
It is common to lose up to 500 mL of blood during the birth of a baby and placenta. Sometimes, about 25 in 100 births, there is more bleeding. This is called a postpartum haemorrhage or PPH. If you have a postpartum haemorrhage, you will be treated while you are in hospital.
Postpartum haemorrhage can also occur up to 6 weeks after the birth. This is called a secondary PPH and affects fewer than 2 in 100 women. If this happens to you, call 000 for an ambulance or go to your nearest Emergency Department.
It’s important to remember that the in most cases, postpartum haemorrhage does not occur.
Your perineum is the diamond-shaped area between the vagina and anus that stretches to allow your baby through during birth. This area gets stretched as the head is being born.
Sometimes the perineum is grazed or tears during the birth. Sometimes you may need an episiotomy. This is when a midwife or doctor makes an incision (cut) into the perineum to make the vaginal opening larger during birth. The incision is stitched following the birth.
Episiotomies are not routinely performed for each birth but may be advised in certain circumstances, such as an assisted birth, if the perineum is rigid and not stretching, or when there is the likelihood of significant perineal trauma.
Talk with your midwife or doctor if you have any preferences or would like to know more.
3rd and 4th degree tears
About 8 in 10 women who have a vaginal birth will have a vaginal or perineal tear. Most of these need stitches but heal well without any problems. A small number of women, about 3 in 100, will have a more severe tear that affects the muscle around your bottom. This type of tear is called a 3rd or 4th degree tear.
It’s not possible to tell whether you will have a 3rd or 4th degree tear, but we do know that there are some common risk factors. These include a first vaginal birth, delivering a bigger baby or if you are from an Asian background.
Your midwife will offer some suggestions during the birth to reduce your risk of a vaginal tear.
There are also things you can do to prepare your body for birth. These include perineal massage and other ways to reduce damage.
Protecting the perineum
Things that can help protect the perineum include:
- warm compresses during the birth of baby’s head
- perineal massage from 35 weeks of pregnancy
- a slow controlled birth of baby’s head.
Perineal massage
Perineal massage is the method used to help stretch the skin and prepare you for the sensations of tingling, burning, or stinging as your baby’s head is born. Performing perineal massage on yourself towards the end of your pregnancy can help prevent perineal trauma.
For more information see the What is perineal massage video.
Your relationship and experience with pain will affect the way you deal with pain in labour.
Many people fear pain. This is usually because in the past they have experienced pain from surgery, accidents, illness, overuse of their body, etc. We tend to want to fix this pain and make it go away. This is often called pathological pain.
However, in labour, the pain surges or waves that you experience are physiological. They are a sign that your labour is progressing, and your body is getting ready to birth your baby. Each wave or surge helps the cervix to become softer, shorter, and to open.
Understanding the pain of labour may support you to work with the labour rather than fight against the pain.
Hormones of labour
There are three main hormones that greatly enhance labour:
- oxytocin
- endorphins
- melatonin.
Promoting the release of these hormones can greatly assist the birthing process.
There is one hormone which can negatively affect your labour and potentially decrease the good effects of the positive hormones. That hormone is adrenaline
This hormone is often referred to as the ‘love and bonding’ hormone due to its connection with falling in love, sexual activity, birth, breastfeeding, and bonding.
Oxytocin builds in labour making your uterus contract more frequently, effectively and with more intensity. Oxytocin can provide a sense of purpose, empowerment, and acceptance of the labour process.
Endorphins are your body’s built-in ability to cope with pain. They are released through movement, massage, and in response to pain or strong sensations, such as contractions.
They reduce your perception of pain and provide a sense of strength, motivation, and euphoria.
Melatonin is a hormone that works best in the dark and aids oxytocin production. Keep lights turned low at home and in the birthing room. Rest in early labour, especially at night. Bright lights can negatively impact the labour process.
Adrenaline is produced by your body as part of the fight, flight or freeze reaction in response to stress, fear, and anxiety. High levels in labour can inhibit oxytocin, slow the progress of labour, and increase your perception of pain. It is important to try and keep adrenaline levels low. Adrenaline can increase during the pushing stage to provide energy. However, it’s still important to maintain a calm, safe environment.
Ideas for assisting the labour process
Creating a comfortable, familiar, and safe environment may include the use of:
- dim lighting, an essential oil diffuser and listening to music
- massage and heat packs
- distraction techniques
- mindfulness techniques like affirmations and visualisations
- deep breathing.
Reminder: relaxation techniques can help to activate the body’s relaxation response and aid to reduce the body’s stress response. It can, therefore, be beneficial to practice relaxation techniques in pregnancy and labour. Refer to Week 22 for more information.
Staying active and upright assists the descent of the baby, for example sitting on a fit ball, standing, walking, kneeling, and squatting.
Movement also helps the labour and birth process and can decrease potential ‘pain’. Try slow dancing, walking, using a fit ball, swaying, and rocking,
For more information see the fact sheet Active birth.
At the Women’s Hospital, you can choose to labour and birth in water, when it is considered safe for you and your baby. Using water from the shower or the bath in labour & birthing has many potential benefits.
You can use the following information to have a discussion with your doctor or midwife at your next clinic appointment: Water birth at the Women’s.
Additional things to consider
If you are expecting two or more babies, your health care team will talk to you about your options for spontaneous labour, induction, or caesarean section birth.
Get to know the Women’s and our birth suites by taking a virtual hospital tour of the Women’s Parkville campus.
After the birth, the Women’s will provide you with information about registering your baby’s birth, applying for a birth certificate, and Centrelink requirements.
You don't automatically get a birth certificate when you register the birth. You can order a certificate at the time of registration or order one separately later.
Visit Birth, Deaths, and Marriages Victoria for more information about registering your baby.
For information on Centrelink payments, eligibility, application process and Medicare go to Services Australia – Before the birth of your baby.
We hope you have found this information helpful.
Remember you can go back to previous weeks.
If you have any health concerns, please talk to one of your health care professionals – midwife, General Practitioner (GP), hospital doctor, etc.
There will be more to read and learn next month in week 36. Stay safe and well.