By this stage of pregnancy, the fetus weighs approximately 2.5kg and measures around 46cm in length from crown to heel. A steady weight gain will continue now, until birth although growing in terms of length tends to level out around this time. The amount of amniotic fluid within the amniotic sac is beginning to decrease to accommodate the ever-growing fetus. Body fat has now accumulated sufficiently that the lanugo – the hair that covered the entire body – is no longer needed to help control body temperature and is usually completely shed by this stage. In addition to body fat, the vernix – the greasy coating that covers the skin – provides a further method of temperature control.
The kidneys are now fully matured and are functioning, processing waste products. The fully developed liver is also now able to process some waste products. Brain development also continues during this week, with more and more neural connections forming and neural networks becoming evermore complex. Daily activity cycles, featuring periods of sleep and wakefulness become more refined as, due to the uterus becoming stretched, more light is visible and the fetus may respond to this by sleeping more during darkness.
Fetal movements are likely to be less ‘dramatic’ now, as space in the uterus is becoming more limited. The fetus will tend to ‘squirm’ or wriggle now, rather than kick or turn.
Many women feel breathless from time to time during pregnancy, and this is especially common during the last few weeks of pregnancy. Although your reduced lung capacity may feel uncomfortable for you, your baby’s oxygen supply will not be affected as the baby receives its oxygen through the placenta. If your baby has turned, and is head-down with the head pressed against your cervix, you may find breathing easier as there is more room for your lungs to expand. If this is the case, you may also find an increased pressure on your bladder. This may mean that you are needing to urinate more frequently and can also mean that you leak urine if you cough, sneeze or laugh. Ensuring that you keep up a regime of pelvic floor exercises will help to strengthen the muscles in your pelvis and help to prevent pregnancy-related stress incontinence.
Some women find that a bumpy, itchy rash appears on their stomach during the later stages of pregnancy. Although this is uncomfortable and unpleasant, it is not harmful to you or your baby. Aloe-vera lotion can help to sooth the itching, especially if it is applied after having a bath or shower. You should avoid using antihistamines during pregnancy but you should consult your Doctor or midwife if you are finding the itching difficult to cope with. You may also find that your gums are bleeding more, or are more tender or sensitive.This is a common occurrence during all stages of pregnancy and may be helped by ensuring that you are getting enough vitamin C in your diet. Your midwife or Doctor can recommend additional vitamin C supplements if you feel that you need them. During pregnancy, you are also more prone to gum disease so if may be worth speaking to your dentist or hygienist to make sure that you are taking good care of your gums.
You will now be having regular routine check-ups with your midwife. During these appointments your blood pressure will be monitored. If your blood pressure is elevated, you will probably be told to rest. Blood pressure is monitored throughout pregnancy, but particularly in the latter stages as it can be a sign of pre-eclampsia. Your midwife will explain any risks that are causing you concern during your appointments.
Symptoms to watch out for
The baby should have ten or more episodes of movement per day and this movement may be more rolling and squirming rather than vigorous kicking. This change is a gradual and progressive progress. Headaches, changes of vision, excessive swelling of the feet and face and upper abdominal pain could be symptoms of pre-eclampsia. Itching of the soles of the hands or feet suggest cholestasis. The vaginal discharge may become more as the cervix stretches ready for labour. The Braxton Hicks contractions may become more pronounced. You may feel more pressure on the pelvis especially when upright and may find walking more difficult.
What is routinely offered on NHS
There will be more visits to the midwife and an antenatal preparation class. Discussion will take place about issues around birth itself. As well as practical issue like what to bring to hospital and issues around recognising the signs of labour and what to expect.
What other care is available
In a private self referral clinic additional blood tests and ultrasound scans can be done at short notice with rapid reporting of results. This is important if the baby is smaller than it should be or not moving enough. The woman and her partner can see a consultant for opinion and advice. This is done at a convenient time and with plenty time for discussion.