Pregnancy Week by Week: Week 36

THIRD TRIMESTER

WEEK 36

Week 36 marks a milestone in pregnancy and you will be comforted to know that the lungs are almost completely formed, so if your baby had to be born now, he would most likely be able to breathe independently. The little lungs remain deflated for now as baby still gets oxygen through the placenta. Birth at this stage of pregnancy is termed ‘moderate-to-late prem’ and would probably not need a stay in the neonatal unit but would require more careful monitoring than a full-term birth would.

With four weeks to go until your due date, you are starting your 9^th month.  Your baby is now perfectly formed and is about the size of a papaya, weighing 2.7kg - give or take - and measuring about 48cm from head to toe. All that is needed is for your baby to grow another centimeter or two, and to put on more weight.  In fact, he will put on another kilogram over the next few weeks.

The skin is tinged with a healthy-looking pink and is far less wrinkly and baby’s head is more in proportion to the body. Baby’s circulatory and immune systems have developed well and are ready for birth, but the digestive system still needs a little refining as baby has only had to rely on placental nourishment up until now. The digestive system will take 12-18 months to fully develop.

Baby’s position close to delivery date

The majority of babies will have 'dropped and engaged,' which means they are in the head-down, bum-up position, the baby has descended, and the head has entered the pelvic cavity. This is also sometimes known as ‘lightening’ as pressure is taken off the mother’s lungs.  This is the ideal position for delivery and is known as a cephalic or vertex presentation. This may mean that you have more pressure on your cervix and bladder, but it also means you can probably breathe more easily as the pressure is off your diaphragm and lungs.  You could also find that your appetite has returned as pressure on your stomach and intestines decrease.

By the time of delivery, 97% of babies have adopted the correct head-down position, facing forward (posterior position) or the more common backward position, facing towards the spine (anterior position) but occasionally a breech presentation occurs.  At full term, if a baby is breech, it is unlikely he will turn on his own.

There are different kinds of unusual positions and breech presentations:

• Frank breech, which is bottom first and feet up at head
• Complete breech, which is bottom first with legs crossed
• Incomplete or footling breech is when one or both feet are positioned to come out first
• Transverse lie is when baby is lying horizontally, with head facing up or down and a limb or shoulder presenting
• Oblique lie, baby lies diagonally in the uterus at an angle

The reasons for breech presentation are not really known, but professionals believe that there could be many contributing factors:

• Multiple pregnancy
• History of previous breech babies
• Too much or too little amniotic fluid
• Pre-term labour
• Abnormal shaped uterus
• Fibroids
• Short umbilical cord
• Advanced maternal age
• Low weight baby
• Placenta previa

These positions are usually quite rare, and if identified earlier on in pregnancy, your doctor may try to manipulate the baby into the correct position by conducting a procedure called an external cephalic version (ECV). Your gynaecologist would apply pressure to your abdomen while at the same time manually try to turn the baby.  This can be quite uncomfortable and only has about a 58% success rate. Your ob/gyn will assess whether this procedure should be carried out or not as it can carry risks and is not ideal in every situation.

Your doctor will discuss with you whether you should be allowed to proceed with labour and a vaginal delivery, or if a caesarean section should be performed.

You and your body at 35 weeks pregnant

At this advanced stage of pregnancy you are visiting your healthcare provider frequently, maybe even weekly. Your weight, urine and blood pressure will be monitored, and your doctor may want to perform an internal exam or a scan to check that baby is on track and to see if the cervix has started thinning or dilating. In addition, it may be suggested that a routine strep test is done.

This is a Group B strep (GBS) test that checks for a type of bacteria that is found in the vagina. The bacteria are usually harmless and an estimated 1 in 4 women carry it without even realising it. But it can cause a serious infection in a baby during childbirth if left untreated.

To test for these bacteria, your healthcare practitioner will take a swab of your vaginal and rectal areas, and if the results show positive, one of the most common ways of treating it is to give you an intravenous antibiotic during labour to minimise passing on the infection to your baby.

Symptoms at 36 weeks

At this stage your symptoms are all to do with the fact that your baby is almost ready to be born. The good news is that once baby has descended and engaged in the pelvic area, you will experience an improvement in breathing and possibly an increase in appetite.

Unfortunately other symptoms continue or worsen, like swelling in the feet and ankles. This should improve immediately after delivery, or certainly in the days following the birth. If sudden or severe swelling occurs, let your healthcare provider know immediately as it can be a sign of something more serious.

Vaginal discharge may increase in the last few weeks and is quite normal. But be on the lookout for a change in discharge, like blood or clear, watery liquid, both of which could be a sign that labour is about to start. Waters breaking may feel like a gentle popping sensation, followed by an uncontrolled trickle or flow of fluid. This usually only happens just before or during labour, but if it occurs at 36 weeks of pregnancy, it is known as preterm pre-labour rupture of membranes (PPROM) and you need to get to hospital right away to be checked out as it can sometimes trigger labour. Once the membranes have broken, the protective barrier around the baby is compromised, and an infection could develop.

Pelvic discomfort is a result of a low-lying baby putting pressure on your pelvis. This may make walking uncomfortable and will increase the need to pee.  But regular and rhythmic pain can be a sign of labour, so watch out for this.

This is a lovely time of pregnancy as you are probably on maternity leave by now, and as you feel too heavy for much running around, you can spend time relaxing and giving some thought to the kind of parent you would like to be.

You can ask yourself what it means to you to be a parent and how to be the best parent you can. You and your partner can give some thought to your respective family traditions that you have each grown up with, and how you would like to incorporate them into your new little family.