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

34 Weeks Pregnant

In This Article

Pregnant Belly Changes

At 34 weeks pregnant, your baby's due date is creeping up on you. It won't be too long now. Only three more weeks until your baby is early-term and six more weeks until your estimated due date!

If you are expecting twins or multiples, you should expect them to arrive any minute now. Although the ideal length of a term twin pregnancy is between 37 and 42 weeks, over 50 percent of all twins are born premature (before 37 weeks).

34 week pregnant belly

As you close in on the final weeks of your pregnancy, you may find yourself consumed with thoughts of your labor and delivery. You may be nervous about the pain of labor, or perhaps you are worried that your labor will drag on for hours and days.

In the last month of your third trimester, try to educate yourself on the labor and delivery process, what your pain relief options are, and what the hospital's procedures are for complications that arise. Education will alleviate many of your fears.

You should also keep in mind that stress and anxiety can make your labor last longer, and it may also make you experience more pain than you would if you were totally relaxed.

You may want to practice the breathing and relaxation techniques that you learned in your prenatal classes to help you relax and prepare for labor and delivery.

Along with the anxiety of your impending birth, you may find that you're feeling very uncomfortable. Not only are you feeling more Braxton-Hicks contractions, but you may also find that your baby is moving around more frequently than before.

Space is running out in your womb, so whenever your baby moves this way or that, parts of his body may start to stick out from your belly. If your little one is in the head down position, his or her little feet may push against your ribs, causing you some discomfort.

You may also notice that your baby has "dropped" into your pelvis. This is called "lightning," and it typically occurs several weeks before your labor begins. (However, in some cases, lightning can occur a few hours before the onset of labor).

Lightning can make some of your pregnancy symptoms worse, while it improves other pregnancy discomfort. For example, you may notice that you have to urinate more often, due to your large baby and growing uterus pressing against your bladder.

Some women also get an uncomfortable feeling of pressure deep in their pelvis, making it uncomfortable to walk normally. You might even start to waddle a bit.

On the other hand, lightning takes the pressure off your stomach, because your baby has descended into your pelvis, so you may find that you can eat more without having heartburn or indigestion. You will also get some relief from feeling short of breath.

Pregnancy Symptoms

Now that you are getting closer to your due date, you should be on alert for any of the warning signs of labor, such as your water breaking, the discharge of your mucus plug, and contractions.

34 week pregnant with backache

Backaches and low back discomfort is a regular pregnancy symptom at 34 weeks pregnant that you must struggle with. The heavy weight of your uterus, as well as hormonal changes relaxing the ligaments and muscles in your body, can lead to extra strain on your back.

Three out of four pregnant women will suffer from backaches and back pain during pregnancy. To cope with this uncomfortable symptom, try to be aware of your posture at all times and use a heating pad or a cold compress to give you some relief.

Fatigue is another pregnancy symptom to expect. Although you had a temporary break from exhaustion in the second trimester, fatigue is back in full force now. Your tiredness and exhaustion is due to the physical strain your body is undergoing from carrying all that extra weight. Stress and all those nighttime runs to the bathroom to urinate aren't helping your energy levels either.

"Lightning" (baby drops into pelvis) may occur anytime now. Dropping usually takes place several weeks before the onset of labor, but it can also occur several hours before labor starts. When your baby drops into your pelvis, you will notice that your bump is situated lower in your abdomen. You might also realize that it's easier to breathe, since your uterus is no longer pressing against your diaphragm and lungs. Any rib pain that you've experienced will disappear.

While some pregnancy symptoms will get better after your baby drops, you may start to develop some uncomfortable new symptoms, too.

Pelvic pressure is a common experience after your baby drops. You may start to waddle as a result. Walking normally may be too uncomfortably. Although you may worry that your baby is going to fall out, he or she is perfectly safe as long as your cervix has not started to efface or dilate.

Weight Gain

Regardless of whether you are expecting twins or just a single baby, you are rather big at this point in your pregnancy. You probably feel like there is no more room for your baby to grow. Your pregnancy weight gain at 34 weeks for a single baby may be between 27 and 28 pounds, or over 30 lbs. if you are carrying twins.

Pregnancy Health Section

Back Labor

The process of labor and delivery is one of the most exhausting and painful life experiences that a woman may experience. Although it is possible to experience mild pain during labor, most women who had previously given birth will most likely describe the pain as horrendously or excruciatingly painful. However, if there is one type of labor that an expecting woman would never want to deal with during childbirth, it will be back labor. It comes with a good reason. Back labor is known to cause more intense labor pains and longer hours in the labor room. The term “back labor” is commonly used to describe labor where most of the discomfort and pain occurs in the lower back, more specifically above the coccyx or tailbone.

Back pain is real. As dreadful as it may sound, back pain can happen to any expecting mother. In most cases, back labor is not predictable or preventable.

34 week pregnant with back labor

What is back labor?

Labor pain initially starts in the back. As the labor progresses, the pain typically radiates to the lower abdominal region. By the time the baby comes through the birth canal, the pain radiates down to the perineal area and later on, in the thighs. What distinguishes back labor from the usual labor is its marked persistence in the lower back. A few number of women who experienced back labor reported that the pain was exclusively limited in the tailbone area.

Most women report slight cramping in their lower back at some point during labor, but with back labor, the discomfort is most severe during uterine contractions. The pain and the contractions may even linger in between contractions. It is estimated that 25% of laboring mothers may have back labor.

Occiput posterior: The most common cause of back labor

Back labor is frequently associated with the baby’s position. Back labor is most likely to occur when the baby enters the vaginal canal face up instead of the usual face down position. This position is medically termed occiput posterior or OP. The OP describes the baby’s position in relation to the mother’s pelvis. In the position, the baby is faces the mother’s abdomen. As a consequence, the baby’s occipital bone located in the back of the skull presses directly on the mother’s tailbone, which is richly supplied by nerves. The pressure applied into the tailbone and its nerves is often the cause of intense pain related to back labor.

Other causes of back labor

Although delivering a baby in the face up position is the most common cause of back labor, it is not the sole cause. There are some laboring women who simply perceive more pain and tightening in their backs during labor than others. A research revealed that a woman who has a history of back pain during her menstrual cycle is more susceptible to experience back labor, irrespective of the baby’s position in relation with the pelvis.

Back labor experience

Aside from the excruciating and persistent pain in the lower back, laboring women who experience back labor are more likely to experience a slower progression of labor. The labor may be longer than the usual due to the odd positioning of the baby’s head during the delivery. It is important to keep in mind that every woman goes through labor and delivery differently. A woman who finds out that she is delivering a baby in occiput posterior must not immediately conclude a definite longer labor process.

How to ease back labor

Back labor is not preventable; however, it is a relief to know that a mother delivering a baby in face up position can do something to ease the back pain.

Change positions
One of the most effective ways to relieve back labor is to change positions. If back labor is suspected, it is advised to get off your back, straddle a chair and lean forward. Kneeling against a birthing ball or a pile of pillows can be helpful. It is also recommended to get up on all fours. These positions can significantly reduce the pressure applied by the baby’s bony back on the spine.

Perform pelvic tilts
Pelvic tilts are a simple and non-stressful exercise used to minimize the pressure against the tailbone. Start by kneeling on all fours. Place your hands directly under the shoulders; the knees must be directly under the hips. Inhale and gently lift the pelvis forward. Allow the hips to drop or move toward the floor. Exhale, and gently squeeze in your abdominal muscles as the pelvis is titled backward and up toward the ceiling.

Another person may apply a firm back rub against the lower back between or during the contractions. A tennis ball or any rounded object may be rolled down the back. Back rubs with steady counterpressure during contractions may also relieve the discomfort. Massage is generally accepted as a technique that can help reduce pain, control anxiety, and promote relaxation.

A warm bath may relieve some of the pain. Application of warm compresses or indirect application of hot-water bottle can relax the tense muscles. For some women, application of cold packs can be more soothing. Whatever feels best is recommended.

The pain arising from back labor can be intense. For some women, the pain may be too much to endure. An epidural anesthesia may be considered to temporarily block the pain in the lower part of the body. Back labor is hard to predict. Every expecting mother is recommended to work with a health care team before labor to evaluate the options should back labor occurs. The mother must understand the benefits and risks of the anesthetic drugs.

Preventing back labor

Back labor cannot be prevented; however, there are a number of approaches that an expecting mother can do to increase the chances of having a satisfactory laboring position during birth. It is recommended to perform pelvic tilts to loosen the ligaments and relieve the pain. Sitting in positions that knees lower than the hips can be useful. During early labor, it is not recommended to lie on the back. It is encouraged to maintain positions that keep the pressure off from the lower back. Walk, sit on the ball or lean. Pelvic tilts can be safely performed during labor.

Can I Walk During Early Labor?

Expecting mothers, especially first-time mothers, are more than anxious about giving birth to their babies even after nine months of physical, mental, and emotional preparation. Most women who have had experienced labor and delivery would describe the experience as severely painful. Labor is not an easy process, although it can be one for the selected few. Because of fear of pain and of uncertainty, some expecting mothers would rather skip the process entirely. Is there a way to pick up the pace of your delivery? Can walking during early labor help you speed up the process? Can you walk during early labor?

34 week pregnant walkin in early labor

What goes on during the first stage of labor?

Some women believe that labor should be entirely spent lying in bed; however, experts and physicians strongly recommend mothers in early labor to stay active by getting out bed and take a walk. Yes, walking can be one of the best things that you and your birth partner can do during the first stage of labor. If you are having second thoughts about its safety and feasibility, it is good to start by understanding the first stage of labor.

The early stage of labor is the longest of the labor stages, but it is the least uncomfortable and painful. First-time mothers are expected to go through the first stage of labor between 12 and 16 hours, whereas women who have previously given birth usually spend 6 and 8 hours on this stage alone. What is unique about labor is that each stage differs from the others. Although the first stage is the longest, it is not particularly uncomfortable for most women, especially during the latent phase, which can last from 4.6 hours in first time mothers and 4.8 hours in mothers who are in their subsequent deliveries.

The latent phase is characterized by mild and irregular uterine contractions. The cervix opens from 0 (long and closed) to 4 cm; the rate of dilation is not normally rapid. The active phase is characterized by stronger, longer and more painful contractions. The cervix opens more rapidly, going from 4 to 7 cm. The transition phase begins when the cervix dilates at 8 cm and ends with full cervical dilatation at 10 cm.

Given these events, a woman in the latent phase (before first stage) labor and the first stage of labor, may continue doing her daily activities and are strongly encouraged to walk during this phase for its beneficial outcomes.

Benefits of walking during early labor

Walking is one of the most recommended physical activities to improve health and fitness. Walking has also proven to be one of the most effective activities during early labor. Can walking during early labor have an effect on labor and its outcome? If so, how does walking exactly help during early labor? Is it safe?

Stronger and regular contractions
Researchers reported in the Cochrane Review that staying upright can actually reduce the first stage of labor by an hour. The conclusions were based on the data obtained from 21 research studies involving nearly 4,000 women. For a mother who endures labor pain, which usually progresses from mild to severe in intensity in hours, an hour of less discomfort and pain is a welcome relief.

Walking can naturally help pick up the labor progress more effectively. Researchers found that walking during early labor and staying upright can be helpful in promoting and maintaining the regularity of the uterine contractions. These positions are more likely to strengthen the contractions, thereby promoting easier descent of the baby through the birth canal.

Lying down is discouraged. When lying down, the weight of the uterus and the baby can put some pressure on the on the blood vessels in the abdomen. This pressure weakens the strength of the contractions, leading to slowing down of cervical dilation and of the baby’s movement down the birth canal.

Promotes baby’s descent
Walking during early labor does not only maintain the regularity of your uterine contractions, it also induces some changes in your pelvic joints that facilitate the descent of your baby down the birth canal. Walking changes the shape and diameter of the pelvis; it involves movement of the hips back and forth. These pelvic changes and movements, along with the assistance of gravity, will help your baby to find his or her way down through your pelvis and then through the birth canal. Walking or swaying back and forth during uterine contractions can also help your baby rotate.

Reduced need for an epidural
How does walking lead to reduced need for an epidural? The perception of pain is a complex one. It is the end outcome of a mixture of connections between memory, anxiety, and fear. Walking is a form of physical activity that can help you turn your attention to something other than the pain. Being able to ambulate and continue some of your usual activities increases your sense of control. These outcomes may decrease your need for pain medication.

Walking during early labor

Your physician will most likely encourage you to get out of bed and walk during early labor usually until your cervix opens to 4 cm. Walking is strongly encouraged unless continuous monitoring is required. It is recommended to walk with your birth partner in the room or along the hall. Avoid slippery areas and narrow curbs. Once you feel the contractions, lean against your birth partner or against a wall or counter, and sway your hips back and forth and side to side.

Keep yourself hydrated. During early labor, it is recommended to have sips of clear liquids to avoid dehydration. Find a pair of properly fitting and well-supported walking shoes. Sneakers with a no-slip tread are a good and safe choice.

You may not feel like walking during contractions during the later stages of labor. If the contractions become intolerable, stop and assume another position or lean against a wall in a standing position. Walk again as soon as you are able to tolerate walking.

One of the most important but commonly overlooked recommendations is to walk at a comfortable pace. Maintain proper breathing. You need all the energy you have during the late stage of labor.

Baby Section

Your Baby at 34 Weeks of Pregnancy

By 34 weeks pregnant, your baby weighs roughly 4.5 to 5 pounds, and he or she may be as long as 18 inches! Your baby is quickly reaching his or her birth weight and length.

34 week old baby delivered

Your baby is filling out as your pregnancy continues. Fat layers are making your baby rounder and giving his or her skin a smoother appearance. These fat layers will help regulate your baby's body temperature after birth.

By now, your baby has settled into his or her birth position. The occiput anterior position (head down, head slightly turned to the side) is the most common position and it is the easiest position for a natural, vaginal delivery.

Your baby's digestive system is mature now. If your baby were born this week, he or she would be able to digest food. The digestive enzymes in your baby's gut are now functional.

By pregnancy week 34, the level of amniotic fluid in your womb has reached its maximum amount and will stay the same until you reach 37 weeks pregnant, when it will slowly decrease.

Estimating the weight of your baby may prove challenging as you continue your through your pregnancy. Many women hope to get an estimate about how big their baby is via ultrasound in the final weeks of pregnancy. Truthfully however, this estimate can be off by a pound or more!

There are many reasons weight prediction is so challenging. It is difficult to guess how much a baby will weigh when you consider the weight of the amniotic fluid and placenta. Ultrasound while helpful may still measure a baby incorrectly. An ultrasound can be helpful however for estimating your baby's size and weight. Your doctor will usually measure the diameter of your baby's head, the circumference of your baby's head and the size of your baby's abdomen to get an idea of how large your baby will be during delivery. At best however, this is only an estimate!

Doctor's Corner

Pregnancy Week by Week - Women's Healthcare Topics

It is Recommended that Mothers know more about Episiotomies before the Start of Labor.

Episiotomy is a common obstetric practice. It is estimated that episiotomy is performed in around 40% of vaginal births. For decades, episiotomy has been routinely used to speed up the process of labor. Research revealed that between 50% and 90% of women who got pregnant for the first time underwent the procedure. Since the 1980s, the number of women opting to have an episiotomy has been on a steady decline. Research indicated that episiotomy was performed in about 60% of all deliveries in the U.S. in the 1980s.

34 week pregnant cutting episiotomy for delivery

What is episiotomy and what are the risks involved? Is there a way to avoid episiotomy? Labor pain is one of the leading fears of pregnant women, but the thought of having an area near the vaginal cut during delivery can be frightening as well. Mothers planning on a vaginal birth must seriously consider whether or not to have an episiotomy. It is recommended that mothers know more about episiotomies before the start of labor.

What is episiotomy?

Episiotomy is an incision made in the bottom part of the vaginal tissue to prevent tearing during a vaginal birth.

Why Would You Need an Episiotomy?

By creating an incision (episiotomy) serious tears that may stretch to the anus are prevented. Performing an episiotomy, with blunt-tipped scissors, releases the pressure on the fetal head. The episiotomy decreases the baby’s risk for trauma and the mother’s risk for injury.

Some researchers and health care providers say that there is no need for a routine episiotomy; however, there are cases where the procedure continues to be warranted. An episiotomy may be indicated in the following conditions :

  • A labor that progresses too fast does not allow the perineum to stretch, increasing the risk of perineal tearing.

  • If the head of the baby is too large to move down into the birth canal or if the mother has a tight perineum, the risk of perineal tearing is significant.

  • A complicated vaginal birth may cause fetal distress and cause maternal exhaustion. An episiotomy is considered if the baby is in breech position or if shoulder dystocia is anticipated. Forceps delivery or a vacuum extraction may also require an episiotomy.

Natural Tears versus Episiotomy

The benefits of episiotomy have been discussed; however, there are health care providers that support the occurrence of a natural tear of the vagina over an in an episiotomy during delivery. Should mothers be allowed to tear naturally? The opinions are divided.

The most recent findings suggest that routine episiotomies do not prevent extensive tears during childbirth and that episiotomies increase the risk of tears in the back of the vagina, though they reduce the tears in front. It is my experience (James Brann MD) that women with a natural tear generally recover in the same or even less time and usually demonstrate fewer complications than those who had a surgical incision (episiotomy). For these reasons, natural tears facilitate less pain during the recovery procedure.

At this time, the World Health Organization wishes physicians avoid using an episiotomy unless the delivery absolutely requires the procedure.

Tips to Prevent an Unnecessary Episiotomy

Mothers are encouraged to adhere to preventive measures that can minimize their risk of needing an episiotomy.

  • Before labor and delivery, mothers are encouraged to maintain good nutrition and hydration to help the perineum prepare for stretching during birth. Food sources must contain nutrients, such as vitamins E and C, supporting regeneration and elasticity of the tissues.

  • Kegel exercises are recommended. These exercises promote improved blood flow and strengthening of the pelvic floor muscles.

  • Perineal massage promotes stretching of perineum. Massage improves the blood flow and promotes enhanced overall wellbeing.

  • During delivery, mothers are instructed not to lie on their backs to push. Pushing must be well-controlled to prevent a rapid delivery of the head. The uncontrolled delivery of the head is the number one cause of tearing.

Episiotomy Procedure

There are two types of episiotomy: midline episiotomy (most common type) and mediolateral episiotomy (rarely used). A midline episiotomy, the type that is more common in the U.S., involves cutting of the skin and muscles from the back of the birth canal opening straight toward the anus. A mediolateral episiotomy begins in the midline but is cut away from the rectum toward the side.

Research showed that a mediolateral episiotomy has an advantage over a midline surgical cut because the risk for anal injury or damage is less likely when the incision is off to one side of the perineum. If tearing occurs beyond the incision, it will be away from the rectum and rectal muscle tearing becomes unlikely. A midline episiotomy has an advantage over a mediolateral episiotomy when it comes to tissue healing. Midline episiotomies seem to heal more readily than mediolateral episiotomies and are more likely to bring about less blood loss. Midline episiotomies can also have a great advantage of reducing postpartum pain. In this type of surgical incision, a cut is created between the muscles and not through them, so the tension on the suture line is almost zero. Less swelling, infection, and scarring with a midline incision than that with a mediolateral incision.

The pressure of the baby’s head against the area where the episiotomy will be cut is exceedingly intense, and because of the pressure the nerve endings in the skin are momentarily numbed. It is for this reason that an episiotomy can be done without the aid of an anesthesia. In some cases, a pudendal block is administered. A local anesthetic is injected through a long needle through the walls of the vagina near the ischial spine. Administering an anesthetic in this area numbs the lower vagina and the entire perineum.

Recovery from an Episiotomy

For most women, healing of an episiotomy is achieved without complications. The process of healing is promoted by the following:

  • Maintain good nutrition and hydration. Food sources should include nutrients that facilitate tissue healing, such as vitamin C. Mothers are encouraged to increase their fiber intake to prevent constipation. Straining can put a considerable amount of pressure on the stitches.

  • A sitz bath a few times a day may also relieve the discomfort.

  • Pads must be changed frequently to avoid infections.

  • To keep the stitches clean and dry, a hair dryer can be used to dry the perineum.

  • Kegel exercises must be continued to strengthen the pelvic floor muscles.

  • Light activities may be resumed a week after the delivery. Any activity that might apply pressure on the stitches, such as intercourse, may be resumed six weeks after birth.

“Am I Allowed to Shower or Bathe during Labor?”

34 week pregnant women in water bath during early labor

Labor is often associated with severe pain. The common association of labor with intense pain is not unsupported. Almost every woman who experienced childbirth will most likely describe it as a strenuous and painful experience, despite the feeling of fulfillment after delivery. It is not a surprise that most expectant mothers, especially women who are yet to deliver their first babies, are exceedingly anxious about going through the entire process of childbirth.

It is good to know that there are ways on how you can help yourself have a satisfying birth and relieve the discomfort associated with labor and delivery. Taking a bath or shower is one of them. It may not be one of your priorities on the onset of signs of true labor, but bathing is one of the best things you can do before the contractions get much stronger and labor pain escalates to an almost intolerable level.

Is there time to take a bath or have a shower?

The signs of true labor have just begun. Your contractions are not slowing down by walking and the contractions seem to take on a regular pattern. You reach for your packed bag and your partner drives you to the hospital where you have chosen to deliver your baby. After completing the admission procedures, your physician or nurse encourages you to take a bath. Aren’t you supposed to be lying down until you deliver your baby? Are you even allowed to take a bath during labor?

If you are a first-time mother, it is likely that the delivery of your baby and placenta will be completed in 16 hours, on average. If you have previously delivered, complete delivery is typically expected in 9 hours. Certainly, you can, and should, make time to take a bath during your labor.

Your physician will most likely recommend you to have a bath when your cervix is dilated less than 3 to 4 cm, which occurs during the latent phase of labor. During this phase, your contractions are less intense. A bath much later in labor is not advised due to exhaustion associated with increased pain intensity.

What are the benefits of taking a bath or shower during labor?

Immersion in a bath of warm water or a warm shower during labor offers an alternative option to decrease pain. Women who went into labor report that the feeling of warm water on the abdomen and on the back during labor can be an effective pain relief measure. For women who had a back labor, where the pain is more intense than the usual labor, deep immersion or showering can be a lifesaver. In addition, taking a bath during early labor seems to increase the speed of labor and delivery. Research suggests that bath speeds up labor for one to two hours. Certainly, a warm bath or shower is one of the safest, inexpensive and least invasive methods to relieve labor pain.

How does a shower or bath relieve pain and speed up the labor process?

For many centuries, water has been used as a healing agent. When you sit in a deep warm bath, physiological changes are expected to take place immediately. The warmth and movement of water on your body improves the circulation of blood and alleviates muscle tension. The buoyancy of water allows you to feel lighter, taking the pressure off your body. This effect promotes relaxation and enhanced sense of comfort. The effect is more apparent in women having back labor.

When you are more relaxed, the production of stress hormones decreases. Stress hormones, specifically adrenaline, counter the effect of oxytocin, another hormone that induces the contractions of uterine muscles. The more relaxed you are, the more oxytocin produced. With increased oxytocin, your contractions become more effective, which can help speed up labor.

When should you get into the bath?

The beneficial effects of taking a bath during labor can only bring about short-term effects. For this reason, timing of the bath is essential. If you take a bath too early, it is most likely that you will not experience its benefits. There is even a possibility that your labor may not progress. It was found that baths may temporarily slow the contractions when taken to early.

What temperature should you use?

The temperature of your water should be close to normal body temperature, which is about 98.6°F or 37°C. The temperature of your water is essential. If it is too warm, your temperature may increase. Women with higher than normal body temperatures at labor are at greater risk of delivering babies with poor muscle tone and Apgar scores less than 7. A newborn with an Apgar score less than are more likely to require oxygen therapy. Moreover, taking a bath in a hot tub may expend your energy, leading to exhaustion. You need all the energy you need during the advanced stages of labor, so make sure to use the right temperature.

How do I take a bath?

A staff member will prepare a tub filled with warm water. Change into your bathing suit, and immerse yourself in warm water. In certain hospitals, tubs may not be available; however it is most likely that they have showers for mothers in labor. The pressure of water flowing through the shower nozzle may also provide effective relief of pain.

Each bath should not last longer than 20 to 30 minutes. Discuss this with your physician to their recommendations.

When should I not take a bath?

If you had a normal pregnancy and there are no complications during your labor, taking a bath during active labor is not contraindicated. One of the most common contraindications of bathing during labor is premature rupture of membranes. This condition is manifested by rupture of the amniotic sac, the bag that contains your baby and the amniotic fluid, without the onset of uterine contractions. Mothers with PROM are at risk of intrauterine infections. Immersing in water further increases the risk.

(next week)