Week 33 of pregnancy (Days 231-237)

Baby

Now weighing around 2kg and measuring up to 44cm in length, (from crown to heel), the growth spurt continues during this week. The fetus may, or may have already, turned head-down (cephalic) in preparation for birth. The position of the fetus will be monitored by your midwife or Doctor throughout the remaining weeks of pregnancy. If the fetus turns, the head moves down into your pelvis and presses against the cervix. This happens in around half of first pregnancies during this week. If it is not your first pregnancy, your baby may turn later, maybe a week or so before labour; however, in some cases the baby does not turn until the start of labour. Your midwife will be able to advise you on exercises that you can do that may encourage the baby to turn.

The plates of bone that form the skull are still not completely fused together and are quite pliable. They will remain only partially fused to aid the birthing process, making it possible for the head to pass more easily through the birth canal. Although the bones of the skull remain relatively soft, the other bones that make up the skeleton are continuing to harden and the appearance of the skin is less wrinkled as body fat is laid down beneath it. In addition to this, the fetal immune system is developing and antibodies are being passed through the umbilical cord to aid this process.

Sleeping and waking periods are becoming more regular, with the fetus spending most of the time asleep. There are now variations within the sleep pattern with alternate periods of REM (dream sleep) and non-REM sleep, which is a deeper, more restful sleep.

You

If your baby has turned and is now sitting lower in your pelvis, you may find that some of your pregnancy related symptoms, such as digestive discomfort and breathlessness have eased somewhat. This is simply because there is more space for your lungs to expand and your stomach to digest food.

However, if your baby has not turned yet, you may be finding it hard to eat large amounts of food because of your uterus limiting the available space for your stomach. If this is the case, you may find it helpful to eat smaller meals throughout the day rather than one or two larger meals. If you are feeling breathless, it may help to stand up straight, as this will allow your lungs to expand more fully.

As throughout pregnancy, good nutrition is important during the last few weeks. Ensuring that you maintain good levels of iron in your body will help both you and your baby. Eating iron-rich foods such as green leafy vegetables, wholemeal bread and dried apricots will help to ensure that you avoid having an iron deficiency, but you should seek the advice of your midwife if you are concerned that you may be anaemic.

You may start to, or continue to experience Braxton Hicks (‘practice’ contractions). Women more commonly feel these if it is not their first pregnancy. Braxton Hicks are distinguished from ‘real’ contractions because, even at their most intense, they will usually stop if you change your position, e.g. stand up if you are sitting, lie down if you are standing.

Some women experience swelling in their lower legs, ankles and feet during the latter stages of pregnancy. This is caused by water retention, also known as oedema. You may notice that the swelling is worst during warm weather and at the end of the day. If you are suffering from swelling in your lower limbs, you should not reduce your fluid intake. It is important that you remain hydrated for your own, and the health of your baby and keeping up your fluid intake will actually help reduce water retention. If you notice a sudden swelling in your hands or face, you should see your midwife or GP, as this could be a sign of pre-eclampsia.

Symptoms to watch out for

It is important to ensure that the baby is moving well. This means at least ten episodes of movement per day. The baby may not move much one day but the next it should. If it does not you should see a medical professional. In essence the tummy should be growing and the baby moving.

Pre-eclampsia, vaginal bleeding, premature birth and obstetric cholestasis are important complications in late pregnancy. Pre-eclampsia manifests as headaches, disturbances of vision, swelling particularly of the legs and face and upper abdominal pain. It can result in a small baby and the tummy being smaller than it should be. Vaginal haemorrhage (bleeding) is abnormal in late pregnancy. Painful contractions can result in premature birth. Itching of the palms of the hands and the soles of the feet may be due to obstetric cholestasis which is a threat to the baby. A blood test can check for this. More generalized itching is common and usually harmless.

What is routinely offered on NHS

Visits to the midwife or GP become more frequent in later pregnancy. She will ask about symptoms, take the blood pressure and check the urine. The midwife will measure the tummy with a tape measure. This is a crude, basic method of estimating the size of the baby. Referral will be made to the consultant as necessary. If there is a serious threat of early birth then an injection of steroids is given to the mother which will help to protect the baby from respiratory distress.

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.

Pregnancy Reflexology, which can help with relaxation and reducing stress levels is available.