Friday, January 31, 2014

Surviving the Last Weeks of Pregnancy

1.  Reframe the idea of a “due date.”  Your due date marks 40 weeks from your estimated last period; it doesn’t necessarily mark the end of pregnancy.

Key Points to Remember:
·       Normal gestation ranges from 37-42 weeks (and in some cases longer).
·       Average gestation for first-time mothers is 40 weeks + 5 days.
·       Babies are not considered post-term (overdue) until after 42 weeks, not at 40 weeks.
·       Due dates can be off by several weeks, even with early ultrasound estimates.
·       Women are mammals, not machines or textbooks. Variation is natural and
normal, and there is no magic timer to indicate when your bun is done cooking!

Strategies to Help You Deal:
·       Rather than a due date, think of it is your “due month.” Let people know you’re due “towards the end of April” rather than April 17.
·       Expect to be pregnant until at least 41 weeks. That way if baby comes earlier, it will be a pleasant surprise, and you won’t be phased if your due date comes and goes and you’re still pregnant.
·       Read/listen to daily affirmations that recognize your baby’s and your body’s wisdom, knowing that baby will come when the time is right.
·       Read positive birth stories of other women who had longer gestations. 
·       Come up with a list of projects to do to distract yourself during those last weeks.
·       Give yourself permission to turn off your phone and ignore emails and Facebook if you start getting the “You’re still pregnant????” messages. Or refer friends and family to
·       Schedule a date with your partner or a pampering day of massage for yourself near or even after your due date. (Babies love to interrupt that kind of thing!)

2.   Do what you can to stay comfortable. Trouble sleeping? Check. Waddling? Check. Braxton-Hicks contractions? Check. Welcome to the end of pregnancy!

Strategies to Help You Deal:

·       Fatigue:
o   If night waking is bothering you, try alternate nostril breathing, meditating, or listening to relaxing music to help you go back to sleep. Take naps in the day if possible.
o   Try not to stress about whether or not you’ll have energy for the big day. Know that your body will provide all the hormones needed to get you through it!
o   Think of this as excellent preparation for caring for a newborn. Your little one will likely wake every 2-3 hours to eat during the first weeks (or longer). You will be ready!

·       Aches and Pains:
o   Keep your body moving! This will not only help ease the discomforts of pregnancy, but will also help prepare your body for birth. Choose a couple of the following easy activities to do every day:
§   Walking. Even 15 minutes a day, twice a day, makes a difference!
§   Do hip circles while you brush your teeth. Bend your knees slightly, and place your feet hip-width apart. Move your hips around in a circle or figure 8 as slowly or quickly as you like, being mindful to go both directions.
§   Trade in your chair for a birth ball. Use it while watching TV, at the dinner table, even at your desk. You can bounce on it and do hip circles if you like, but even just sitting on it gently exercises your core muscles and promotes good posture, which helps your baby position herself for birth.
§   Spend time on your hands and knees every day. Practice the cat-cow yoga movement before bed (more throughout the day if you like!), scrub the floors, crawl after a toddler, etc.
§   Do a few squats each time you shower, and get in the habit of squatting throughout your day instead of bending over when you pick things up*.
§   If you are motivated and able, activities like prenatal yoga, swimming, and bellydance are also excellent ways to help prepare you physically for birth.

o  Consider visiting a chiropractor if you have any of the following:
§   Persistent back, leg, or pelvic pain. (Note: Lower backache is very common, and often alleviated by cat-cow).
§   You feel that when you walk, one leg moves much differently than the other (such as a limp or another awkward movement).
§   You have had a prior Cesarean due to baby’s position (breech, posterior, asynclitic) or failure to progress.
§   You have previously injured your pelvis.

·       Frequent Braxton-Hicks contractions:
o   Be sure to stay hydrated. Drinking water and lying on your left side will sometimes slow or halt these contractions.
o   Take a warm bath. This can also slow things down. If it’s the real thing, labor might speed up!
o   Use Braxton-Hicks as a way to practice your coping techniques, such as deep breathing, position changes, visualizations, etc. One simple practice is to relax your jaw by making the “haaaa” sound (like a deep sigh), visualize your cervix opening, and repeat a mantra in your mind like “open” or “welcome baby” or “relax” each time you have a contraction.
o   Erase the words “false labor” from your vocabulary—there’s nothing false about it! Know that these practice contractions are getting work done, whether by strengthening your uterus, changing the position or consistency of your cervix, or bringing baby into a better position. The more work your body can get done before labor, the better!
o   If contractions are not letting up and lasting over several days but not leading to dilation (prodromal labor), consider that baby’s position or cervical scarring might be an issue (see below).

3. Address any emotional or physical barriers to birth. While there are many natural “induction” methods, these often do not lead to labor unless baby is ready to be born. But occasionally, a baby that is ready to be born might be held up by emotional or physical barriers that you can address.

Strategies to Help You Deal:
·       Scan your emotional/psychological state. Do you have any nagging fears or concerns? These may not even be directly related to the birth, but might be about your financial situation or worries about motherhood, for instance. Stress hormones hinder the process of labor, as your primal brain needs to feel safe and secure to do its job. To address this:
o   Do a fear release exercise, alone or with your partner.
o   Air out any submerged relationship issues with your partner that are sources of insecurity or doubt.  
o   If there are issues with other family members (such your sister feeling uncomfortable with your birth choices, for example), you will have to decide whether or not it will be productive and healing to talk with them, or if it will cause you more stress and be unlikely to change anything anyway. In that instance, writing a letter can be cathartic (whether or not you send it). Doulas are also great listeners – talk to us!
o   Crying and laughter are both great emotional and cleansing releases – give yourself the chance to do both.
o   Surround yourself with women who support and share your desires for your birth (whether physically, virtually, or through the pages of a book).
o   Do whatever works for you to keep you feeling calm and confident, whether listening to affirmations, meditating, practicing yoga, praying, or talking to a trusted friend.
o   Talk to your baby daily out loud or in your mind, letting her know that she is loved, welcome, and that you are ready for her. If this feels awkward at first, it will likely become easier with practice.

·       Address any position-related issues that might prevent labor from starting on its own. Sometimes even a subtle misalignment prevents baby’s head from putting adequate pressure on the cervix to get labor going. Medical inductions that begin with a misaligned baby many times end in Cesarean. To promote proper positioning:
o   Choose sitting and resting positions that bring your belly forward – sleeping on your side (preferably left) while tilting your belly slightly down towards the mattress (with lots of pillows for support); sitting on a birth ball; avoiding slouching or leaning back (in the car, couch, armchair, etc).
o   Get on your hands and knees as often as you feel comfortable (adding cat-cow if you like), especially when you feel baby active.
o   Walk up and down stairs (two at a time if it feels good and you can do it safely). Alternatively, walk down the street with one foot on the curb, and one on the street (be sure to go both ways!). Creating asymmetry in the pelvis makes more space for baby to negotiate and find the best position.
o   Do hip circles.
o   Go swimming, using belly-down strokes (breaststroke, freestyle, side-stroke).
o   Consider visiting a chiropractor trained in the Webster technique.
o   Ask your doula to do some rebozo sifting or the side-lying release.**

·    Consider whether cervical scarring might be an issue. If you’ve ever had a LEEP, D&C, or other cervical procedure, scar tissue can sometimes form and prevent dilation. (Signs would be prodromal labor with little to no dilation despite significant cervical thinning/effacement). The good news is that your provider may be able to "rub out" the scar tissue in early labor.

·    Encourage the production of oxytocin (the love hormone, and the one responsible for starting contractions) through any of the following: cuddling (with your partner, children, even a pet!), hugging, holding hands, laughing, massage, sex, orgasm (with or without sex), watching a funny or emotionally compelling movie, spending time with friends and family, and singing, dancing, or exercising with others.

4.   And most of all…. be patient! Easier said than done, no doubt about it. But truly, baby will be in your arms before you know it. And patience is something that all parents need in astronomical quantities—might as well get a head start on practicing it now!
Good luck. =)

*Note: Only practice deep squats after 36 weeks if you are sure that your baby is properly positioned – head down, facing your back (anterior). Avoid squats if baby is suspected to be posterior, if you’ve had a prior Cesarean related to baby’s position or failure to progress, or if you have unusual pains in your pelvis, back, or legs that might indicate a pelvic misalignment.
**See for more information about these techniques.