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You are now at 36 weeks!
By now, you will probably have had - or be about to have - your 36 week appointment.
This information will be presented in a three-part format. You will receive your next update from us when you are at 40 weeks.
Part 1: Reminders
Have you considered writing a birth plan or map? Now is the time to discuss your plan with your support person and write your ideas down.
To access the Women’s birth plan template please click on the link:
Rest and exercise are so important, especially now that baby is growing much bigger. Back care, rest, and gentle exercise will improve your stamina in labour and support a good recovery after the birth. Refer to Week 22 for more information.
Relaxation is best practiced on a regular basis. If you haven’t found a form of relaxation that works for you, now’s the time to seek out options and then practice them daily if possible. Week 22 has more information for you.
Congratulations if you have been doing your pelvic floor exercises regularly. If not, here is a reminder of how to do them – Pelvic floor exercises.
If at any point you are concerned about your baby’s movements, please contact your doctor or midwife at the Women’s on (03) 8345 3635.
More information is available at: CRE - Movements matter.
Before going into hospital, you will need to consider what you may need in labour and what you and your baby will need after the birth.
It may be helpful for you to gather all you need but let your partner or support person pack the bag.
This way they will know where everything is and will be able to easily gather something, if you need it during your labour.
See our fact sheet Things to bring into hospital for suggestions. This fact sheet is available in many languages.
Some information was provided in Week 28 about siblings or older children. If you haven’t done so already, start to make plans of who can care for your child/children when you go into labour.
You may need to consider two or three plans, depending upon the time of day (or night) you go into labour. Remember to have back-ups in case anyone gets COVID-19. Making additional plans can decrease any potential added stress on the day.
If you need an interpreter at any time, please let your midwife or health professional know. They can usually arrange for someone to assist, either in person or via telephone.
The Women’s recognises that family violence and sexual assault are unacceptable and illegal. We believe that you have the right to live a life free from violence, and make decisions about what is best for you.
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 NOW: Call Emergency Services on 000.
A list of support services is available from back in Week 28.
Part 2: Things related to pregnancy now
By now, you have been told about - or already done - your Group B Streptococci (GBS) test. The test for GBS involves a swab of the vagina and anus, which you can easily do yourself. You will be given instructions on how to do this.
If you do have GBS you will be offered antibiotics when you are in labour to decrease the risk of infection to your baby.
See our fact sheet for more information about the Group B Streptococcus (GBS) screening test.
The amniotic bag surrounding your baby will usually break once labour has started. Sometimes, the amniotic bag may break - and fluid may leak - before labour begins.
If you think the bag has broken, please ring the hospital (03) 8345 3635. You will usually be asked to come into the hospital for assessment.
If the bag has broken, our recommendations for your treatment will depend upon how many weeks pregnant you are, and your baby’s health.
Part 3: Things to consider
It is important that you:
- can ask questions
- get answers to your questions, and
- feel heard about what your concerns or wishes are.
Remember that using the BRAINS tool can help you ask questions that are relevant to your situation.
|
B |
What are the potential benefits to me or my baby of this procedure, care, or medication? |
|
R |
What are the potential risks to me or my baby of this procedure, care, or medication? |
|
A |
Are there any alternatives to this procedure, care, or medication? |
|
I |
What does my intuition or instinct tell me about this decision? |
|
N |
What happens if I do nothing? Does this need to happen now? |
|
S |
Ask for support in gathering more information. Ask for space and privacy to discuss this with your partner. |
In Week 32 we focused on labour and natural ways of working with the contractions and the roles that hormones play during labour.
There may be times when you choose medical methods to reduce your pain sensation.
Below you will find information about TENS which is a machine to help with pain relief (you will need to hire or buy this) and the options for medical pain relief available at the Women’s.
Medical pain management
TENS (Transcutaneous Electrical Nerve Stimulation)
TENS is a small portable device that has two to four electrodes attached. These electrodes are placed on your lower back. The device then sends electrical impulses (signals) into your body via the electrodes, creating a 'pins and needles' type sensation.
The electrical impulses help to block pain messages from reaching your brain. The TENS machine also promotes the release of endorphin hormones which help reduce pain. It is used to potentially relieve lower back pain and cervical contraction pain.
The TENS machine is most beneficial during the first stage of labour. It works well if used early in the labour - it can be used for many hours and can be used at home.
If you would like to use this option, you will need to hire or buy a TENS Machine before your labour starts.
Sterile water injections
A midwife may inject four tiny amounts of sterile water just under the surface of the skin, on your lower back, forming four small ‘pockets’ of water. The injections can feel like a bee sting.
These pockets can offer relief from back pain by blocking the pain messages from your lower back and by aiding the release of endorphins. The injections are usually given during the first stage of labour. They may provide relief for one-to-four hours and can be repeated. They are used to potentially relieve lower back pain, not contraction pain.
Gas (nitrous oxide and oxygen)
This is a mixture of nitrous oxide and oxygen – often called ‘laughing gas’ or Entonox. The gas comes from a machine in the hospital birth room. A long length of tubing attaches the machine to a mouthpiece.
You breathe the gas in and out through the mouthpiece, during a contraction, using regular deep breaths. You then breathe air after each contraction which eliminates the gas from your lungs. The pain relief effect is temporary.
It is most beneficial during the first stage of labour and reduces pain in your body by blocking pain messages and reducing adrenaline. It can help relieve the intensity at the peak of a contraction.
Narcotics (morphine)
Morphine is a pain medication of the opiate family. During labour, it is normally given as an injection into the thigh or buttock.
Morphine is a strong drug that works in the body by imitating endorphins and assisting in blocking pain sensations. It may also aid relaxation and rest. It is most beneficial in the first stage of labour.
Morphine circulates within the whole body, as well as the placenta, and may affect your baby’s responses at birth. A vaginal examination is recommended before having a morphine injection. This can help to estimate the baby’s time of birth and therefore reduce any potential impacts the drug may have on your baby.
Morphine can become effective within 15-40 minutes and may last for two-four hours as a pain reliever. It can have a different effect on each woman.
When possible, it would be given at least two-three hours before birth. There is a maximum of two consecutive doses in labour.
In maternity care, epidural anaesthetics are used to potentially remove pain sensations from the waist down to the toes. An epidural is a regional anaesthetic (because it affects a certain part of the body – not all the body) and is administered by an anaesthetist.
The anaesthetic medication is given through a needle and fine tubing and is inserted into the epidural space between the bones in your spine. The procedure may take 10-20 minutes to perform, and the medication may take another 15-25 minutes to be effective. The medication will usually be given using a computerised pump.
You will also have:
- an intravenous (IV) drip inserted in your arm to give you fluids and/or drugs, and
- a urinary catheter to help keep your bladder empty.
A CTG (contraction and baby monitor) is used to monitor your baby’s well-being.
Epidural anaesthetic
If you have an epidural, you will not be able to move around and will have to stay in bed. It is effective for pain relief about 85 per cent of the time. The pushing sensation during contractions may be absent or reduced.
Because of the length of the procedure, the medication used, and how it may reduce your pushing sensations, it is recommended to have a vaginal examination before having an epidural to help estimate the time of birth.
Once the epidural is removed or turned off, it will take between 30 minutes - 3 hours for you to recover physical sensation.
For more information see our fact sheets:
Medical intervention during labour
Sometimes a vaginal birth without medical intervention is not possible. Below, we discuss some of the procedures that may be used to help you birth your baby. Your doctor or midwife will explain these procedures to you when they think you may need these procedures. Your consent will be sought before these procedures occur.
Sweeping of the membranes
Sweeping the membranes - also known as ‘a stretch and sweep’ or ‘stripping the membranes’ - is a technique that helps to start labour when you are at, or near, term.
During a vaginal examination, your doctor or midwife will attempt to detach the membranes around your baby from the cervix. Approximately half of the time, this results in prostaglandins (a hormone that softens the cervix) being released which may promote the onset of labour in the next 48 hours.
You may find this procedure uncomfortable and painful and may have some vaginal bleeding or contractions in the 24-hour period after it is done.
It may be offered to you at around 40 weeks of pregnancy before attempting a formal induction of labour.
This is when your labour is medically started because you have certain risk factors such as diabetes, your baby's bag of waters breaks and labour does not begin, or your pregnancy goes for more than 41 weeks.
Induction of labour
Induction of labour is usually done in two steps.
- Step 1: Cervical ripening or softening
This is done in the hospital. The cervix is made softer and shorter by inserting either synthetic hormone gel or a balloon catheter into the vagina. It may take several hours or days for the cervix to ripen. Sometimes you will be able to go home between the first and second stage. - Step 2: Induction of labour
Inducing labour begins in the Birth Centre with breaking the baby’s bag of waters. If the baby responds well to this, then an intravenous drip containing synthetic oxytocin will be attached to your arm. The amount of synthetic oxytocin given via the drip will be increased over time to make your contractions begin. Usually, this process makes the labour start more quickly and become more intense.
Synthetic oxytocin does not have the same benefits to you or your baby as natural oxytocin. Your baby will require continuous monitoring during the labour. This procedure may restrict your freedom of movement and your option for a water birth.
If your pregnancy is induced, you are more likely to use medical pain relief options, and require assistance at birth with either vacuum or forceps.
For more information watch our Induction of labour video:
We also have a fact sheet on Induction of Labour that you may like to read through. This fact sheet is available in many languages.
Augmentation of labour
If you have gone into labour spontaneously but the labour has slowed down, then this process will help your labour to progress.
Augmentation of labour is done by breaking the baby’s bag of waters and/or giving you synthetic oxytocin via an intravenous drip as described in the Inducation of labour section above.
If your labour is not progressing or you or your baby are showing signs of distress, you may need help to birth your baby.
Depending on the reason and at what stage of labour you are in, an obstetric doctor will talk to you about the options available to you.
Note: you may wish to use the tool BRAINS (see Decision making) to gather more information and help you decide what to do.
We have outlined the options below and there is more information available on the following webpage – Assisted birth.
Vacuum birth
A vacuum birth can only happen when your cervix is fully dilated, your baby’s head can be seen, and you are contracting.
During a vacuum birth an obstetric doctor will do a vaginal examination so that they can apply a small vacuum cap to your baby’s head. During a contraction and while you are pushing, the doctor will use the vacuum/suction to support your baby’s head to be birthed. You may require an episiotomy, as described in week 32.
Vacuum birth and forceps birth are more likely when epidural anaesthetic is used.
Forceps birth
A forceps birth can only happen when your cervix is fully dilated, your baby’s head can be seen, and you are contracting. When your cervix is fully dilated, an obstetric doctor will do a vaginal examination so that they can apply two forceps, one either side of the baby’s head. These forceps then lock into position to support your baby’s bony skull.
During a contraction, and when you are pushing, the doctor uses a guiding motion to support your baby’s head to be birthed. Most babies will develop temporary red marks or bruises on their face or head from the forceps, An episiotomy is usually required. For more about an episiotomy see week 32.
Vacuum birth and forceps birth are more likely when epidural anaesthetic is used.
Caesarean section birth
A caesarean section birth is a major surgical operation performed in an operating room, to birth your baby via a cut into your lower abdomen and uterus.
During your pregnancy, a caesarean section birth may be planned or arranged, because of known reasons. This means a date and time will be organised for the birth. This is known as an elective caesarean section birth.
On other occasions, women undergoing labour require emergency caesarean section births. This happens when women develop complications quickly, or labour has started and your baby needs to be born and the cervix has not yet reached full dilatation of 10cm.
An obstetric doctor and team will perform the operation often using a regional anaesthetic, like an epidural or spinal anaesthetic. This allows you to be awake and for your support person to be present for the birth. You will also need an intravenous drip and urinary catheter to be inserted. A screen is used so the surgery is not visible, and this may be lowered for the actual birth.
It may take 10 minutes from the beginning of surgery until your baby is born. Whenever possible, your baby will be placed with you so that skin-to-skin contact can occur immediately after the birth. The actual surgery including birth of your baby and placenta, and stitching each internal layer, may take about an hour.
There will be another 30-plus minutes in recovery after the surgery is completed. Where possible a midwife will stay in recovery to help you with skin-to-skin contact with your baby and/or their first breastfeed.
For more information see:
There are several things that your health care provider will do to monitor you and your baby’s health and the progress of your labour while you are in hospital.
Some or all of the following may happen during your labour:
- feeling your abdomen – this can tell us the position of your baby
- listening to your baby’s heart rate
- monitoring your baby’s heart rate and response to labour, using external CTG monitors
- monitoring your baby’s heart rate and response to labour, with an internal CTG probe (vaginal)
- monitoring your contractions with an external CTG machine
- observing and feeling the contractions as they occur
- if the membranes have broken, we can see what colour the fluid is, and this can help tell us if baby is coping well or not
- observing and listening to your reaction to labour
- performing a vaginal examination that may give us information on changes to your cervix, the baby’s position, etc.
- taking your pulse, temperature, and blood pressure at various times during the labour.
Cardiotocography (CTG) is a technique used to monitor your baby’s heartbeat and the uterine contractions during pregnancy and labour. The machine used to perform the monitoring is called a cardiotocograph.
This recording is taken by using external straps around your abdomen or occasionally an internal (vaginal) probe that secures to the baby’s scalp.
In the hospital after the birth of your baby, the midwife or doctor will examine you and your baby to make sure you are both well. You will both be transferred to the postnatal ward.
There, the midwives will care for you by checking:
- your temperature, pulse, etc
- your vaginal blood loss
- the position of your uterus
- the condition of your breasts
- how you are breastfeeding
- how you are feeling emotionally and giving you the opportunity to raise any concerns.
Your baby will be checked for:
- their weight
- how often they feed
- how often they wee and poo
- their skin colour.
You and your baby will stay together during your hospital stay. Room sharing is known to reduce the risk of Sudden Unexpected Death in Infants (SUDI). It will also help you to recognise when your baby is hungry, tired, or in need of a cuddle.
It is important to provide a safe sleep environment for your baby night and day. More information about safe sleeping was provided in Week 28.
Before going home
You will be given your legal documents for Registration and Centrelink as well as Baby’s Health Record Book.
Going home from hospital after your baby is born can be exciting, but it is busy and demanding too.
Even after you go home, you will still have 1-2 visits at home by a hospital midwife as part of our Postnatal Care in the Home program.
Then, from about 7-10 days after the birth, the free Maternal & Child Health Service (managed by the Department of Health) will support your transition to parenting.
See Maternal and Child Health Service for more details about their clinics, services and telephone helpline.
Length of stay
Your length of stay will depend upon the type of birth you have had, your baby’s age, and their needs.
Visiting hours
Visiting hours will be dependent upon any social or health restrictions that are in place at the time. Please refer to our COVID-19 Information Hub for up-to-date information.
About Special Care and our Newborn Intensive Care Unit
Sometimes if a baby is premature, sick or requires additional care, they may be admitted to our Special Care or Newborn Intensive Care Unit.
In these cases, you will be able to visit your baby at any time. Sometimes, your baby is required to stay in hospital even when you go home.
There will be many ways that you can be involved with your baby’s care, such as talking, reading, and singing to them; nappy changing; and skin-to-skin contact and holding them, when possible. Breastfeeding may or may not be possible in the beginning – our midwives will help you with expressing milk and feeding your baby.
Here are a few tips for while baby is in hospital:
- take lots of photos
- keep a diary and record milestones
- collect cards and other mementos
- if you can’t be there – telephone staff, leave a camera for staff to take photos
- ask siblings, family, or friends to make cards.
Going home from hospital
It’s normal to feel overwhelmed sometimes but there are many things you can do to help you and your family enjoy the early weeks at home.
We have areas on our website packed with information to help you:
Pre-planning or creating a postnatal plan can help you to transition into your new role and recovery after birth.
Some simple things to include in this planning are:
- managing a well-balanced diet and having sufficient fluids
- pre-making nutritious meals and snacks
- managing changes to sleep patterns and making time for rest
- recognising that relationships with other family members may change - talk about ways that you can support each other.
- “It takes a village to raise a child.” Gather support from others - family, friends, community groups
- including gentle exercise into your daily activities, aiming for about 30 minutes every day
- restarting your pelvic floor exercises, from a few days after birth
- making your recovery after birth and self-care important
- use our Women’s Health Information for information on recovery after birth and breastfeeding guidance
- asking for help and accepting help
- prioritising things that need to be done
- acknowledging that relationships change, and that changing emotions, tiredness and responsibility can affect how you adjust to new roles and family dynamics
- understanding the physical and hormonal changes that are occurring after the birth and allowing time for these to resettle.
Most new parents go through an adjustment period after baby is born. During this time there may be moments of tiredness or fatigue and eating habits may change.
However, if these feelings become persistent, they may indicate that you are suffering from postnatal depression. Postnatal depression can affect both parents.
Potential signs and symptoms to look out for include:
- persistent sadness
- sleep disruption
- compulsive behaviours
- worried/anxious thoughts more than usual
- panic attacks
- feeling overwhelmed
- significant changes to your eating habits
- feelings of disconnect
- abrupt mood swings.
If you have thoughts of self-harm or harming others, please seek immediate help.
If you need information and help, contact the following support services:
- PANDA (Perinatal Anxiety & Depression Australia)
T: 1300 726 306 (Mon to Fri, 9am – 7.30pm)
Visit the website for a range of online resources. Information is also available for LGBTIQ families.
- Beyond Blue
T: 1300 224 636 (24/7)
For online information visit Healthy families
- Relationships Australia
T: 1300 364 277
- Maternal & Child Health 24-hour Help Line (Victoria):
T: 13 22 29
- COPE (Centre of Perinatal Excellence)
For useful information about adjusting to the changes and challenges of new parenthood.
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. Stay safe and well.