Women's Healthcare Topics
James Brann, MD. Ob/Gyn

32 Weeks Pregnant

Pregnant Belly Changes

At 32 weeks pregnant, your uterus typically measures about five inches above your belly button. If you're pregnant with twins, your uterus is probably the same size as it would be at 40 weeks in a singleton pregnancy.

You have five weeks to go until your baby is considered early term and ready for life outside the womb. You should expect your belly to simply grow and grow in the upcoming weeks.

Don't be surprised if you start to feel very fatigued. All that extra weight that you are carrying around takes its toll on your body. Your exhaustion may also be related to the dramatic increase of the hormone progesterone in your pregnant body. (Progesterone helps prepare your body for labor and delivery.)

Although fatigue is a normal pregnancy symptom in the third trimester, you should try to take it easy, if you can. Take short breaks at work, and extra naps in the middle of the day (if you have this luxury). You can look forward to the fact that your fatigue won't last forever. Pregnancy-related fatigue will disappear shortly after you give birth.

As your belly expands, try to be aware of your posture. Postural changes in pregnancy are linked to some painful pregnancy changes, including backaches and leg cramps.

You may start to experience heart palpitations (the sensation that your heart is pounding or racing, or beating irregularly). Though you may feel concerned about this, it is a common experience in pregnancy, especially around 32 weeks pregnant. Heart palpitations are simply the result of your increased blood volume during pregnancy (which peaks around this week), paired with the influences of the hormone progesterone, and the stress and anxiety of pregnancy.

If your heart palpitations are paired with chest pain or a sensation of breathlessness, you should contact your healthcare provider. You may want to start thinking about the type of delivery that you want. Do you want to have a planned C-section, or would you prefer a vaginal birth? What are your plans on pain medication, if you deliver vaginally? In some cases, you may not have a choice in how you deliver. But in most cases, you can choose.

Discuss your plans with your healthcare provider at your prenatal visits. (You should be going to see your OB/GYN or other healthcare provider every two weeks in the third trimester.)

At 32 weeks pregnant, all that extra weight that you're toting around is probably taking its toll on your body. Your third trimester aches and pains are going strong, and you may be feeling quite exhausted and worn out.

Fatigue is a pregnancy symptom that you feel will never disappear. You can blame your fatigue in these final weeks on the dramatic increase in the hormone progesterone, which is helping your body get ready for the difficult task of labor and delivery. If it's possible, try to take as many breaks as you can. Napping may also give you a much needed boost of energy.

Back pain is a common annoyance now. Hormonal and physical changes contribute to an achy, painful back in the final trimester. You may be able to get some relief from your back discomfort by using a heating pad or a cold compress on the painful area.

Frequent urination is probably plaguing you and contributing to your insomnia. As your uterus gets bigger and bigger, it will press against your bladder and make you feel like you always have to go. It can be annoying to keep running to the bathroom, but it's a normal pregnancy symptom in the third trimester. It's very important that you don't stop drinking water - hydration is important to your overall sense of well-being, and being dehydrated will only make you more tired.

Weight Gain

You are probably still gaining about one pound per week. Your ever growing belly is probably making it difficult for you to find a comfy position to sleep. All that weight that you're carrying around is probably also contributing to your back discomfort or pain. Control your back pain with a prenatal massage or pregnancy pillow.

Your weight gain at 32 weeks pregnant may be 25 to 26 pounds, more or less. Expect to gain another five or ten pounds before your baby is due.

Remember, you want to aim for the recommended weight gain for your size. Normal sized women should aim for a total weight gain of 25 to 35 pounds; overweight women should only gain 15 to 25 pounds when pregnant; and underweight women should gain 28 to 40 pounds.

Pregnancy Health Section

In Depth Look at Cesarean Delivery

It's important for you to learn about both giving birth vaginally as well as by a cesarean section. Even if you are dead set on having a vaginal birth, you should learn about the reasons for an unplanned cesarean birth and what goes on during a cesarean section in the event that you require an emergency C-section.

Typically, you may need an unplanned cesarean birth if problems arise during your labor. This includes the following situations:

  • Your baby's heart rate drops, signaling that he or she may be in fetal distress. Your doctor may decide that your baby won't be able to withstand a natural labor and that the best option for your baby is to be born via cesarean section.

  • Your cervix stops dilating or your baby has stopped progressing down the birth canal, and your doctor can't stimulate contractions to labor moving again.

  • The umbilical cord slips through your open cervix into the vagina, before your baby does. This is called an umbilical cord prolapse, and it occurs in one out of every 300 births. When this complication occurs, your baby needs to be delivered via C-section immediately, because the prolapsed cord can cut off your baby's oxygen supply and lead to a stillbirth.

  • Your placenta starts to peel from the inner wall of your uterus before your baby is delivered. Called placenta abruption, this complication can deprive your baby of his or her oxygen supply. If this occurs, your baby will need to be delivered right away.

Fortunately, in most cases, you will have an uncomplicated labor and delivery and you will get to choose whether you have a natural birth or a planned C-section.

Cesarean Section Delivery - Pregnancy Week 32.

What Happens During a Cesarean Section (C-Section)?
Whether you are planning on a cesarean delivery or not, it is a good idea to know what exactly the procedure entails. Remember, not all cesarean sections are planned, so knowing what to expect will definitely help you feel more comfortable should the need arise.

If you require a C-section, you will be asked to sign a consent form. This states that you are allowing the doctor to perform the procedure. You will then undergo some routine blood testing.

Finally, a nurse will start an intravenous (IV) in your arm. The IV will be used to keep you hydrated during your surgery, and it will also be used to give you medication.

Once all the preparations are completed, you and your support partner will be brought to the operating room. Just as with a vaginal delivery, your support partner will be allowed to attend the birth.

After arriving in the operating room, you will receive either a general or regional anesthetic. The most common anesthetic used is a regional anesthetic. There are two types of regional anesthetic: the epidural and spinal. With both of these analgesics, you are awake during the cesarean delivery.

With either procedure, the anesthetist will numb the skin over the spine with a local anesthetic, then the spinal or epidural needle is inserted, and the anesthetic medication is placed close to the spine. The spinal anesthetic causes complete numbness of the abdomen and legs. The epidural anesthetic causes less numbness and works quite well. The choice of anesthetic depends on your operating team's preference.

Very rarely, a general anesthetic is used. With a general anesthetic, you will be put to sleep during the delivery of your baby. The general anesthetic is used mainly in emergency situations that do not allow the time needed to place either an epidural or spinal anesthetic. General anesthetic carries a greater risk of complications, so it is usually avoided unless the situation warrants its use.

After your anesthetic is given, the nurse will place a Foley catheter in your bladder. A Foley catheter is a thin tube used to help you eliminate urine. Keep in mind that you are now numb and, therefore, will not feel this procedure.

Finally, the lower abdomen will be shaved and prepped with an antiseptic solution. Now you are ready to go!

The physician will then check to see if your anesthetic is working well before the surgery begins. He will usually make a small horizontal or "bikini" cut above the pubic bone. Sometimes, however, the doctor will make an incision in a vertical direction in order to make it easier to deliver your baby. You can expect to hear your baby cry about 5 to 10 minutes after the doctor begins. The entire surgery will only take 30 to 40 minutes.

What Happens After a Cesarean Section (C-Section)?
After the cesarean delivery, you will be brought back to the recovery area. There the nurse will monitor your vital signs and make sure you do not have any pain.

You will remain in the recovery room for about 45 minutes. Some hospitals will bring your baby to you at this time, and others will wait until you return to your room. When you return to your own room, you will be able to visit with family and really get to know your newborn baby.

Once in your room, the nurse will be checking on you often during the first few hours - much more so than if you had a vaginal delivery. She will be monitoring your vital signs, making sure that your uterus is not bleeding excessively, and making sure you do not have any pain. You will also have to stay in the hospital for a bit longer than if you had a vaginal birth - from 2 to 3 days.

During the time at the hospital, you will probably experience some or all of the following:

  • Mild uterine cramping

  • Light vaginal bleeding

  • Some incision discomfort

This is all very normal. Remember, you just had surgery and a baby!

As you leave the hospital, you will be told to watch for fever, increased pain, or heavy vaginal bleeding. If you experience any of these, do not hesitate to call your doctor.

You also need to be aware that you are recuperating! All patients after cesarean delivery should avoid heavy lifting, strenuous activity, douching, and tampons until your doctor clears you for such activities at a follow-up visit. You will see your physician for follow up visits at 2 and 6-week intervals. You should expect to feel back to normal by six to eight weeks.

Understanding a Breech Pregnancy

Before a child is born, it will be in various positions within the mother’s womb. A baby may have its shoulders, legs, buttocks or head closest to its mother’s vagina. A baby is breech when the child’s buttocks or feet are closest to the vagina.

During the first part of pregnancy, it’s not uncommon for babies to lie in a breech position. As pregnancy progresses though, most unborn babies will end up with their heads closest to the mother’s vagina. The safest position for a child to be in for a normal vaginal delivery is head-down. A pregnancy is considered breech when the baby is in the breech position as the mother reaches the end of her pregnancy.

Causes of breech pregnancies
For a majority of breech pregnancies, they just happen. Sometimes, though, a breech pregnancy may occur because of either a problem with the placenta, the mother’s uterus or even the baby. There may also be an issue with the amniotic fluid, which surrounds the baby.

Symptoms of breech pregnancies
Occasionally a woman may feel some discomfort as her child’s head presses under her rib cage in a breech pregnancy. If you baby is breech, you may also feel your child kicking your lower belly.

How will I know?
To find out for sure if your baby is breech, your doctor will do an exam checking your baby’s position. This includes pressing on your pregnant belly so that they can feel where your baby’s head is. During the final three months of your pregnancy, expect that your doctor will check your child’s position during every visit.

An ultrasound may also be used in checking your child’s position. This type of test uses sound waves to show pictures of your baby in your womb.

What should I do?
For most breech babies, they eventually turn themselves around before you go into labor. However, if you’re baby’s still breech when your due date gets closer, your doctor may want to intervene.

Your doctor can try pressing on your belly to try to move your child. If this is successful, and your child moves to a head-down position, you will likely be able to at least try a vaginal delivery when you go into labor. If this doesn’t work, though, your doctor may want you to have what’s called a C-section, or rather surgery to deliver your child.

There are some situations where a breech baby may be delivered vaginally. This is referred to as vaginal breech delivery. However, this type of delivery is at a greater risk of problems to both the mother and her baby. For this reason, vaginal breech deliveries are more rare than other types of deliveries.

Baby Section

Growth and Development of Baby

At 32 weeks pregnant, your baby continues to put on the weight. He or she weighs around 3.7 pounds now, and he or she is about 16.7 inches long from head to heel.

32 week baby

The level of amniotic fluid in your uterus is reaching its maximum volume. From this point onward, the amount of amniotic fluid will stay constant until your baby is early term (week 37 of pregnancy). At 37 weeks, the amount will steadily decrease.

Your baby is starting to fatten up this week. He or she is packing on fat and muscle underneath the skin, giving your baby a more rounded look. By the time that your baby is born, he or she will simply be the cutest, chubby baby that you ever did see!

The fingernails have grown long enough that they reach the tip of his or her fingers. Your baby may even be smiling. It is not uncommon for unborn babies to smile, sticking out their tongues, and even make faces. Now that your baby's face is more mature and developed, his or her face is much more rounded and cute.

The skin is less translucent and is also become pinker. It's harder to see the blood vessels underneath the skin. You can now see creases on the skin of your baby's wrists and on the palms. (next week)


Doctor's Corner

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