During your pregnancy journey, you will be seeing your doctor on a regular basis to ensure that everything is going smoothly. During a low-risk pregnancy, women will come into the office every month; at 28 weeks, they will be seen every other week. Then, around 36 weeks, pregnant women start to be seen weekly. Dr. Nathan Fox and Dr. Sara Kostant discuss some things pregnant patients should know about in these last few weeks of pregnancy.
Most likely, the last few weeks of pregnancy will be uneventful. More frequent visits are needed to monitor to keep an eye out for certain pregnancy complications. In addition, as you get closer to delivery, you may have more questions or concerns that can then be addressed more easily if you are seen weekly. One common condition to check for is preeclampsia, and illness that only affects pregnant women. Your blood pressure will be checked at every visit to make sure it is normal, and your urine tested for protein; high blood pressure and protein in the urine could be signs that a women is developing preeclampsia, which is more likely to happen in the last few weeks of pregnancy. The cure for preeclampsia is delivery, and if diagnosed early can lead to a safe, healthy outcome for mother and baby.
Doctors also like to follow fetal growth in low risk pregnancies with a “fundal height” measurement and will continue this in the last few weeks of the pregnancy. A tape measure is used to measure the distance from the pubic bone to the top of the uterus; the measurement in cm should roughly match the weeks of the pregnancy if a baby is growing appropriately. Some women will have ultrasounds to check the size of the baby every four weeks if they have certain medical issues or are on certain medications. In higher risk pregnancies, the baby’s movement will also be assessed weekly after 36 weeks with biophysical profile (BPP) ultrasound. This will be scheduled with your weekly visits if it is indicated. Seeing women weekly also gives doctors the chance to check the position of the baby (head down/head first, or breech (bottom/feet down). The baby needs to be head down for a woman to have a safe vaginal delivery.
“A lot of patients will ask also sometimes around 36, 37 weeks if I can predict, in advance when they will go into labor or if they will have any complications,” Explained Dr. Kostant. “And I can’t always, which is why we see patients once a week.” Usually, patients are advised to call their doctor and come to the hospital for labor when they have been contracting regularly, every 5 minutes for about 2 hours or when they feel any leakage of fluid. Depending on a patient’s history, she may be advised to come to the hospital for labor earlier. “ I always encourage patients to keep track of how they’re feeling, and give us a call if anything doesn’t seem right between visits, even if everything was fine at their last visit. I tell patients to trust their intuition.” Symptoms to look out for: any bleeding, even a small amount; a strong headache not relieved by Tylenol, any sudden vision changes, strong, constant abdominal pain, chest pain, or difficulty breathing; any decrease in fetal movement.
As patients near the end of their pregnancy, they may wonder how they will know they are in labor, especially if it’s their first pregnancy. “One common question is, ‘How do I know when to come to the hospital?’”, Dr. Kostant said. “And there are different variations of that. How do I know if my water broke? ‘How do I know when I’m going into labor?’ And so, I’ll go over the signs and symptoms of labor and ruptured membranes.”
One common phenomenon to be aware of are Braxton Hicks contractions, which may cause abdominal tightening that may radiate to the back and down the legs. This is one of the ways the uterus prepares for birth, but it is not considered labor. Unlike labor contractions, which are regular and do not go away after a couple of hours, Braxton Hicks contractions are irregular, mild, and usually do not last longer than a couple hours, though they may recur later in the day.
If a woman is having contractions or feels she is leaking fluid, a cervical exam and speculum exam may be recommended. Some women do want an exam at one of the visits in the last few weeks of pregnancy, even if they are not contracting, but it is not necessary for everyone and can be declined. “This is something I ask women, ‘Do you want an exam? If not, it’s ok’”, said Dr. Kostant. You may have heard of “stripping membranes”, which is when during an exam, the examiners finger sweeps around the cervix, possibly helping release chemicals that can increase contractions. Some women have noted that this helped them go into labor in prior pregnancies. “Women who have delivered before will sometimes just ask me to do this.” Said Dr. Kostant. Membrane stripping is not a routine part of a cervical exam and completely a patient’s choice.
Patients should also speak with their provider regarding what to have ready to bring to the hospital prior to labor. Having a bag packed at around 36 weeks can be helpful, as you never know when labor will occur. While most women will have plenty of time to get ready for the hospital, it can help to reduce anxiety levels, especially in first-time mothers. Basic things to pack include your wallet, ID, insurance card, slippers, comfy clothes, a toothbrush, an outfit for the baby to wear on the way home, and phone charger. Whatever you forget, the hospital will most likely have, so there is no need to stress!
Maternal Fetal Medicine blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!