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

40 Weeks Pregnant

In This Article


Pregnant Belly Changes

You probably feel quite large at this point. Now you can stop thinking about growing. Your weight gain and size have slowed considerably in the last few weeks of pregnancy. Most women find they feel quite tired and a bit clumsy by now. Remember however in no time at all you will be greeting your newborn.

Your Baby at 40 Weeks of Pregnancy

By 40 weeks pregnant most babies are ready to come out, weighing in at over 7 1/2 pounds and measuring as much as 19 - 21 inches long. Did you know some babies will topple the charts at over 10 pounds (though this is uncommon)!

Your baby will have little room to move about during the final weeks of pregnancy and is likely strongly considering making a move if he hasn't done so already.





When should You Head to the Hospital?

Should I go to the hospital now I am 40 weeks.

Your doctor should have already talked to you about when to head to the hospital or birthing center.

Some doctors may prefer for you to come sooner than later, depending on your individual situation. Women who have high-risk pregnancies may be asked to come at the first sign of labor, whereas others with low-risk pregnancies might be asked to come after contractions have been regular for an hour or more.

If your water breaks, regardless of whether you're having any other signs of labor, you need to go to the hospital right away. This is a sign that labor is imminent.

Congratulations! You have made it to 40 weeks pregnant. While many women will delivery sometime this week others may find they pass their due date and go on to deliver in the next two weeks. Remember that due date prediction is not an exact science though due dates do offer your doctor strong guidance about your babies potential delivery date. It is often hard for doctors and parents alike to predict the exact date their baby will be delivered, but many have fun trying.

Some baby's prefer to stay in a little longer, while others feel ready to come out a bit early. It's really hard to say.





Giving Birth Section



Signs of Labor

Should I go to the hospital I have all the signs of labor.

If you haven't already, review the signs of labor so that you can recognize them when the time comes. Signs of labor include lightening (baby drops into the pelvis), a loss of your mucous plus (also called a bloody show), your water breaks (rupture of membranes), and labor contractions that come at regular intervals and get progressively stronger and closer together.

Lightening (baby "drops" into the pelvis) - You should have felt your baby descend into your pelvis a few weeks ago. By now, your bump should be lower in your abdomen, and you have probably felt increasing discomfort in your pelvic area. (You're probably waddling too.)

Diarrhea and flu-like symptoms - In the hours prior to the onset of labor, you can experience frequent bowel movements and diarrhea. You may also start to get nauseous and even vomit. It may feel like you're battling morning sickness all over again.

Cervix effacement and dilation might be taking place without your knowledge. In late pregnancy, Braxton Hicks contractions can begin to thin out and open your cervix just a little bit. As you enter labor, your cervix will continue to dilate and efface. When your baby is ready to be born, your cervix will have dilated to 10 centimeters!

Your water breaks - If your bag of water breaks, you should be having regular contractions. Some women don't have any contractions until after their water breaks. This is a sign that your baby is ready to come out into the world. When your water breaks, it can be a gush of fluid - just like a dramatization that you'd see on TV. However, you may also feel a trickle of fluid from your vagina.

Braxton Hicks contractions will become more intense now. There's a good chance that these practice contractions will turn into real labor pains this week. If your contractions aren't going away, regardless of whether you take a short rest or walk around, you're having real contractions! At this final week in your pregnancy, it's a good idea to start timing your contractions.

Contractions - When you're in labor, you will start to feel true contractions. Unlike Braxton Hicks contractions, you are going to feel contractions that get stronger, occur closer together, and last longer. At first, they may be 10 or 20 minutes apart. As labor progresses, they are going to start hitting you every 3 to 4 minutes. It's a good idea to head to the hospital when your contractions are coming every five minutes for at least one hour.

Pelvic pressure is probably causing you a lot of discomfort. Most babies are in the head-down position by now, so don't be surprised if your little one's head decides to bump against your bladder and hips. Fortunately, this pelvic pressure will go away once your baby is born.

Difficulty sleeping is an understatement. Your huge belly makes it uncomfortable to even side sleep these days. Some women find that the only place to rest is a comfy recliner. Although it may be tempting to take some herbs or sleep aids, resist the temptation. You won't have to suffer through this symptom for much longer.





Post-Term Pregnancy



What Should I Expect if my Baby is Overdue?

Postterm pregnancy happens when the baby is not born by 42 weeks gestation. About 10% of pregnancies last longer than 42 weeks. The weeks are counted from the first day of the mother’s last menstrual period. The average length of a pregnancy is about 40 weeks, and the vast majority of births take place between 37 and 42 weeks.

Sometimes, a pregnancy may seem “too long” because the original due date was wrong. This can happen when the woman did not know the date of her last period or had long or irregular menstrual cycles. When this is the case, most women get an ultrasound in the first trimester of pregnancy. Early ultrasounds can help a doctor determine how far along the pregnancy is. The new due date from an early ultrasound is usually a better indicator of the baby’s gestational age than an ultrasound later in pregnancy.

If the gestational age is correct, and the pregnancy is truly longer than 42 weeks, most doctors will run a few tests to track the health of the baby and the safety of the mother.

Who is at Risk for a Postterm Pregnancy?

Doctors do not know the main cause of postterm pregnancies. You are at a higher risk of having a pregnancy longer than 42 weeks, though, if any of the following characteristics apply to you:

  • This is your first pregnancy.

  • You have had a postterm pregnancy in the past.

  • You were born postterm.

What are the Risks of a Postterm Pregnancy?

A term pregnancy is good for the baby because it allows time to grow and develop. In postterm pregnancies, this can mean the baby has time to grow too big to fit through the birth canal. In addition, a postterm pregnancy can make it hard for the baby to get enough nutrients and support from your body. If the baby is too big or is not growing safely, this can create problems for both the mother and the baby. Other risks are listed below.

Risks to the mother:

  • difficulty having a vaginal birth

  • tears to the vagina, labia, or rectum during vaginal birth

  • all risks associated with a C-section (like bleeding and infection) if surgery is needed

Risks to the baby:

  • restricted growth (from problems with the placenta or amniotic fluid)

  • injuries during vaginal birth (like broken bones or pinched nerves) because of being big

  • breathing problems at birth (from having a bowel movement and breathing it in through the amniotic fluid)

  • Size and growth problems can lead to other problems, like emergency cesarean deliveries (C-sections) or even stillbirth

What Types of Tests are Done for Postterm Pregnancies?

Because there are some risks to carrying the baby too long, your doctor will probably run several tests once you are 41 or 42 weeks along. They will probably do the following tests, some of which require monitoring over time:

  • the nonstress test, to monitor the baby’s heartbeat

  • the contraction stress test, to monitor the baby’s reaction to a medicine that induces contractions

  • a Biophysical Profile (BPP) score, to describe five test results (the baby’s movements, breathing, arm and leg stretches, amniotic fluid levels—each seen in an ultrasound—and the nonstress test results)

Depending on the results of these tests, your doctor will let you know whether it is safe to let the pregnancy continue. If not (because, for instance, the baby has a slow heartbeat or isn’t growing), your doctor may recommend that labor be induced or that a C-section be arranged.

What Can You Expect From Labor and Delivery with a Postterm Pregnancy?

If you do not naturally go into labor by 41+ weeks, your doctor can either induce labor or continue to wait with ongoing fetal monitoring. Both approaches have a low rate of harm to baby. [Reference]

If you would prefer a cesarean delivery, you should discuss this plan with your doctor. In some cases, your healthcare provider may recommend that you have a C-section instead of trying a vaginal birth. A cesarean delivery may be needed if the baby’s estimated weight is over 10 pounds, if the attempted natural labor takes too long, or if the monitors detect problems with your baby’s heartbeat or movements.

The American College of Obstetricians and Gynecologists recommends “induction of labor after 42+0 weeks and by 42+6 weeks, but considers induction at 41+0 to 42+0 weeks reasonable” [Reference].

Post Term Baby’s Appearance

Once the baby is born, he or she may have certain features. When babies are in the womb longer than expected, they may have the following traits:

  • long, thin arms

  • long hair and nails

  • dry, flaky skin (that may or may not be discolored)

  • loose skin, especially on the legs and buttocks

  • wide, alert eyes

After a few weeks the differences between your baby and any other baby born at term will be less noticeable. There are no known long-term negative effects of being born at or after 42 weeks.


Talking to Your Doctor about Labor Induction

Should I go to the hospital now I am 40 weeks.

After pregnancy week 40, you may be advised to undergo a labor induction. Labor induction is commonly used when your labor doesn't start on its own, and your doctor is worried about the risks of a prolonged pregnancy. After pregnancy week 42, the placenta becomes less effective at delivering nutrients to your little baby, and this can cause all kinds of complications.

In some cses, you may opt for a planned labor induction. Women plan to induce labor for a number of reasons, including convenience (such as being able to control when your baby will come into the world) and medical reasons (continuing the pregnancy is not recommended). In the United States, over 20 percent of all pregnancies are induced. Because labor induction can increase your likelihood of delivering a premature baby (due to the possibility of your estimated due date being inaccurate), most doctors do not recommend labor induction before 38 weeks pregnant.

Methods of Labor Induction
To induce your labor, your doctor may perform one of the following methods:

Stripping the Membranes - Your doctor places his or her gloved fingers just inside your cervix and sweeps the amniotic membranes (the thin membranes that connect the wall of the uterus to the amniotic sac). The purpose of stripping the membranes is to cause your body to produce prostaglandins, which help soften your cervix and start labor.

When your doctor stripes the membranes, you may experience intense cramping and some bleeding (or spotting). This procedure may feel uncomfortable, and it is only performed in term pregnancies.

Ripening or Dilating the Cervix - If your cervix is not quite ready for delivery, your doctor can induce labor by using certain medications or devices that will soften your cervix and help it dilate for labor. You may be given synthetic prostaglandins to help begin labor, either by mouth or inserted into the vagina.

Rupturing the Amniotic Sac - Your doctor may artificially break your water to induce labor. During this procedure, called an "amniotomy," your doctor uses a thin plastic hook to rupture, or break, your amniotic sac. This is performed for term pregnancies and only if your cervix is partially dilated and your baby's head has moved down into your pelvis.

In many cases, you will go into labor within a few hours of your water breaking. However, every woman's labor is different. Another method of labor induction may be performed, in addition to an amniotomy, if your labor does not occur.

Oxytocin or Pitocin - Your doctor may use oxytocin (Pitocin), which is a synthetic hormone that causes contractions. Oxytocin may be used to induce labor, or to make your contractions stronger.


Natural Labor Induction

Natural induction of labor

Are you thinking about ways to induce your labor naturally? If you are, you should take great care to make sure that you don't try to do anything that might be harmful to your baby.

Toward the end of pregnancy, nothing is more uncomfortable than well...being pregnant. Most women experience a host of symptoms including excessive fatigue, swelling and sometimes increased leg cramps and sleep problems when they near the end of pregnancy.

Almost everyone starts to think of ways you could naturally encourage or induce your body to go into labor toward the end of pregnancy. Realistically speaking, no labor inducing technique will work unless your baby is ready to come out. That means your baby has to be ripe for the picking.

There are a number of natural “labor inducers”. Some women will swear by these methods, whereas others simply had fun trying. Here is a list of the more common natural labor inducers women have been trying since the dawn of time:

  • Make Love With Your Partner This week - Not only will this help the two of you feel closer, but it may just start your labor. Semen actually contains natural prostaglandin's which can help ripen your cervix in preparation for delivery. Orgasms also release oxytocin in the body which can help trigger contractions. It's worth a try and if nothing else will help relieve the stress and anxiety of waiting for baby.

  • Walking - Walking is not just a labor inducer. It will help lift your mood and spirits and provides a great form of exercise. Walking can however stimulate labor or encourage labor to progress once it has started by helping contractions become more regular. You've probably seen many photos or movies with women in the labor and delivery ward walking the halls. That's because walking helps your baby move farther into your pelvis in preparation for delivery.

  • Spicy Cuisine - Some people swear by spicy foods for inducing labor. There is no exact recipe you can follow that will work every time, but certain spices including cumin are thought to trigger labor in some women. This is also a safe albeit often heartburn inducing way to try and induce labor.

  • Nipple Stimulation - Nipple stimulation can be a very powerful way of inducing labor. Nipple stimulation can lead to prolonged contractions which may stress your baby. Nipple stimulation causes the body to release oxytocin, which like Pitocin (a synthetic substance used to induce labor contractions) can cause uterine contractions. Nipple stimulation can lead to very long and very strong uterine contractions. This can be dangerous for your baby because the long contraction can cause your baby's heart rate to slow. You should only perform nipple stimulation if you have your doctor’s approval and even then you should monitor your contractions to be sure you don't over stimulate. Generally you should ease off nipple stimulation during each contraction to help minimize a prolonged contraction.

  • Castor Oil - You should not try inducing labor with castor oil unless you talk with your doctor first. Many midwives suggest that women who are past their due dates consider using castor oil. This is a bad tasting but traditional method of inducing labor that requires you swallow some castor oil. Castor oil generally smells and tastes very bad, but can help loosen the bowels and cause contractions in the colon which can stimulate the uterus to contract in turn.

  • Membrane stripping - In some cases, your doctor may strip your membranes. This can sometimes help start labor. During a vaginal examination your doctor will place a finger through the cervix and basically 'sweep' the membranes. This helps release the amniotic membranes from the lower uterine cavity. Sweeping of the membranes may release prostaglandins, which can help start contractions.

  • Primrose oil - There is also some evidence that supplementation with evening primrose oil may help soften the cervix and prepare your body for delivery. You should be able to find evening primrose oil supplements at your pharmacy. EPO contains the precursors to prostaglandins, substances your body needs to produce prostaglandins to help ripen your cervix. Some midwives rub evening primrose oil directly on the cervix during the last weeks of pregnancy to help the cervix thin and dilate. Keep in mind that placing anything in the vagina during pregnancy may increase your risk of infection and is not recommended.
  • Aromatherapy - Certain essential oils including clary sage may help promote or encourage labor contractions in women. Try adding a few drops to your shower.
  • Acupuncture and Massage - There are many trigger points in the body that can help inspire labor. Seek the help of a qualified masseuse or acupuncturist during pregnancy for help with these.

    Many women go into labor just by relaxing. Sometimes pent up stress and anxiety are all that are necessary to prevent labor. You may find a relaxing massage is all you need to go into labor simply because it allows your body to relax enough to encourage delivery!

Most natural labor induction methods will only work if your cervix is ripe and you are ready to go into labor anyway. You should never try to induce labor before you are 40 weeks pregnant to ensure that your baby is ready.


Coming to Terms with Postterm Pregnancy

If you have been pregnant for 42 weeks or longer, work closely with your healthcare provider to decide what the best choice is for delivering your baby. Whether you let the pregnancy run its course or opt for a C-section, you can rest easy knowing that most postterm pregnancies have happy, healthy endings.




Doctor's Corner

Pregnancy Week by Week - Women's Healthcare Topics

Recovery from a Vaginal Delivery

Reviewed by James Brann, M.D.

Recovery after Vagianl Birth

Just as every woman and baby is unique, so too is their labor and delivery experience. How well you recover after a vaginal delivery will depend on a number of factors.

The overwhelming feeling most women are consumed with immediately after a vaginal delivery is fatigue. The level of fatigue you experience may depend in part on your overall health and well-being, the number of hours of labor endured and how much rest you had prior to labor.

Most women will go through a period of both physical and emotional adjustment after delivery. How long it takes you to get back on your feet after giving birth will depend on a number of factors, including the degree of tearing and overall labor experience. For most women a relatively uncomplicated birth will result in a rapid recovery.

If however, you spend a large portion of your pregnancy on bed rest or if for example, you had a difficult birth it may take some time for you to feel 'normal' again.

How much energy you have after labor will also depend on whether this is your first child or not. If you have other children to care for, you will probably be more exhausted for a longer period of time after labor.

Pregnancy and delivery require a physical and emotional period of adjustment. For many women the physical recovery is often considered the easier of the two. Emotionally your body will go through a number of changes, including rapid fluctuations in hormones. In addition, taking on the role and challenges of motherhood may take some time adjusting to.

It is recommended that you wait six weeks before having intercourse after delivery, to allow your body to heal physically from the effects of labor and delivery. Your doctor may also suggest that you avoid any heavy exercise for the same period of time, and may advise you not to drive for a few days to a couple of weeks after delivery.

Exercise is just as important after pregnancy as it is during your pregnancy. You should be able to resume an exercise routine sooner if you have a vaginal birth than if you had a C-section. Some women are able to resume some mild exercise within days of giving birth, whereas others will need a full six weeks to recover.

The best form of exercise to engage in initially is walking. Walking is a great way to stretch your legs, get some fresh air and start into a routine gradually.

One of the best ways to recover from a delivery is to take advantage of as much help as possible in the early weeks. Accept offers to help clean and prepare meals. You should avoid housework for a short time and take advantage of every opportunity possible to sleep when your baby does. Doing so will help enhance your recovery experience and ensure that you are able to recover as swiftly as possible.


What can I expect from a C-section Recovery?

Recovery after C-Section

Recovering from labor and delivery is slightly different if you undergo a cesarean section. Typically after a C-section you will be whisked away to a recovery room, where you will be closely monitored for an hour to ensure that you don't develop any complications from surgery.

You will also receive pain medication to help alleviate the soreness in your abdomen. Believe it or not, within 24 hours your nurse or physician will encourage you to get up and start walking around, in order to help reduce chance of blood clots in your legs and improve your recovery rate.

Walking can also help relieve gas build up that commonly occurs in the abdomen after a cesarean birth. Generally walking around is uncomfortable at first, but most women find the pain subsides within a few days after delivery.

Most women should expect a hospital stay of between 3-5 days after a C-section. During this time you will be able to feed and care for your newborn as you feel up to it.

Cesarean section incisions may take 4 weeks or more to heal completely, and most women report some tenderness for several weeks along the incision line.

Recovery from a cesarean delivery is much like recovery from a vaginal delivery. You can expect to bleed for a few weeks after delivery, and you will feel many of the same 'labor pains' after delivery including contractions of your uterus as it shrinks back down to its pre-pregnancy size.

Many women will require a little extra help the first week after a cesarean delivery. It is not recommended that you attempt to lift anything heavier than your baby, and your physician may instruct you to avoid stairs or driving for a couple of weeks after delivery.

Remember that you are the best judge of your pain and comfort. If things seem overwhelming, slow them down and remember to ask for help when necessary.

When to Call Your Doctor

In certain circumstances complications should arise, and you should alert your physician immediately to reduce the likelihood of a life threatening or severe condition. After your cesarean, call your physician if you experience any of the following:

  • Heavy bleeding that requires a fresh sanitary pad every hour for more than 4-5 hours.

  • Vaginal bleeding that gets heavier instead of lighter.

  • If you are passing large blood clots the size of a golf ball.

  • If you have a fever or increased drainage from the incision, or if your incision starts bleeding.

  • You experience pain or swelling and redness in your calves, which may be a sign of blood clots.

  • If you have any symptoms of severe postpartum depression, including feelings of despair, hallucinations or other dangerous thoughts.

Generally the scar in your abdomen will gradually fade and you will feel like your pre-pregnant self in no time at all.

At your six week check up your physician should give you the green light to begin a regular exercise program and resume intercourse if she/he hasn't already.

Remember that every woman is different, and each woman will recover from their cesarean labor experience at their own pace. Avoid comparing yourself with others, and remember to pamper yourself in this time of newfound joy.

Revel in the new life you have created, and you will be sure to recover swiftly and thoroughly. Many women find recovery from a cesarean no more challenging than that of a vaginal birth, and some feel it is easier.


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