26.05.2014

40 weeks pregnant and pressure in the pelvic

You're in the home stretch of your pregnancy, and your body is switching its focus from rapid growth to labor preparation.
Dealing with so much discomfort and anticipation can really take a toll on your body and mind, and you're probably losing patience these days. Since your baby has finished the vast majority of his development, he would probably be healthy and strong if you gave birth this week. The birthing ball is one of the most familiar tools for labor, and it's surprisingly versatile. Mom-to-be is probably still dealing with a good deal of discomfort, though the aches and pains tend to move south at this point in pregnancy. It may sound strange, but attending to the perineum now can reduce pain and blood loss during childbirth.
I'm beginning to feel pressure in the perineal area, and it's making me worry about tearing during labor. In the last weeks of pregnancy, the building pelvic pressure may have you worried that your baby won't make it out without damaging your body. Although tearing and cutting your vaginal area seem equally horrifying, there's a pretty big difference in how each affects your health and recovery. I can't seem to get my mind off the labor, and I'm feeling very distanced from everyone around me.
Pregnancy is a very personal experience, so it's fitting that you feel like you're on your own. It's no secret that a baby will change your life, but it doesn't have to change for the worse. There are several reasons to be flexible with your birth plan, especially when it comes to labor medication. It's normal for mood swings to return and your anxiety to skyrocket, but don't let your fears get the best of you. The central nervous system is still maturing, but the lungs should be fully developed by now and the digestive system is nearly complete. Personal items like a favorite photograph, an inspirational poster or a comforting accessory can make you feel more at home and ease your stress a little, but there are some great accessories that can actually help your labor proceed more quickly and more comfortably. It can help you relax in a position that will ease back pain, it allows you to roll your pelvis to encourage your baby to move down the birth canal and it's also an indispensible tool for postpartum fitness. In most cases, your baby will have chosen a head-first position by week 36 or week 37, but between 3% and 7% of babies present the opposite way by delivery day, with their buttocks against the cervix and their legs up around their head.


The technique is called external cephalic version (or ECV), and it's fairly low-tech: your doctor will use her hands to press your belly in certain spots, which will hopefully persuade your baby to turn. The pressure of your baby's head on your partner's pelvic floor can be painful at times, serving as a reminder of the pain and difficulty that lies ahead. If she's comfortable with it, help your partner massage her perineum (the area between her vagina and her anus) so it will stretch more easily during delivery and hopefully make an episiotomy unnecessary. While vaginal tissue is incredibly stretchy, the perineum is not quite as elastic, so it may not stretch as much during delivery as you had hoped. If it's possible to go through labor and delivery without either, that's obviously the best course; if it seems that your baby's head will be too much for the walls of your vagina to handle, it makes good sense to open the space with a small, clean cut than with an unpredictable (and perhaps uncontrollable) tear.
After all, you are the only one who is carrying this child, and she's affecting your body and mind acutely. Don't feel bad about calling on friends and family for help, and accept their generous hand-me-downs and words of wisdom with a smile. There's virtually no way for you or your doctor to know how long your labor will be, and the length of your labor has a lot of bearing on what kind of assistance you'll need. Your belly may expand a few more inches in the next couple of weeks, but you'll likely experience a shift in abdominal pressure: your baby's head may engage a few weeks before labor begins, which can put an alarming amount of pressure on your pelvic floor muscles.
Finish your birth plan, take a breastfeeding class and begin to delegate duties to friends and family that have offered to help out during your labor and in the first weeks of baby's life. A 35 week old fetus is about 13 ? inches from crown to heel (and around 18 inches from head to toe) and he's plumping up, so there's not much room for him to move around in your uterus. He likely has hair on his head, fingernails that reach the tips of his fingers and a strong sucking reflex at 35 weeks, but he'll still need to put on some more fat to better regulate his body temperature once he leaves the womb.
But there are plenty of other valuable labor tools, like specially designed heating pads, massage balls, resistance bands and the Rebozo (a multipurpose swath of fabric that's been used for generations in Mexico). Breech births carry a number of risks, and in many cases, a vaginal delivery is simply out of the question. As you may have figured out by now, good education and preparation is some of the best stress relief you can get and give during pregnancy, and that goes for the physical act of labor and delivery, too. Using a cold pressed olive oil and firm pressure, perineal massage improves the flexibility of the tissues and provides the stretching sensation she will feel during delivery, a familiarity that will help her to stay comfortable and relaxed when she's most vulnerable to tearing. Perineal massage is probably your best preventative measure, but the fact remains that 80% to 90% of first births will require an episiotomy right before the baby is born. If you're set on a completely natural birth, by all means prepare your perineum before the birth and use natural relief during delivery, but remember to keep your mind open to all options right until the birth, as the decision to have an episiotomy is most often made the moment before the baby's born.


Add to that your discomforts, impatience for the pregnancy to end and anxiety about becoming a parent, and you may begin to feel a little glum. There's also plenty you can do to calm your mind and have fun fashioning a new daily routine for you and your baby. For instance, if your labor is too short, there may not be time for an epidural, and if it's exceptionally long, you may want one to preserve your strength (and sanity). The tingling sensation or shooting pain around your vagina and perineum is probably aggravated by the pressure of your uterus on the nerves in your back and legs. Preparing yourself will help you gain confidence for the challenge ahead of you and overcome many of your worries. His little 5 ? pound body is rounding out and his smooth skin has lost some lanugo along with the wrinkles.
Of course, there are plenty of gimmicks out there that won't do much for your discomfort, so test some labor tools now to find the one that will work best for you. There's still time to encourage a breech baby to turn around, but you'll probably need your doctor's help. Also, there is a chance that a problem can arise during the procedure, so only have an ECV if your physician is trained in the technique and is prepared to deliver via c section if an emergency should arise.
Since it can be very difficult for your partner to do this herself (balance and perspective are both working against her now), she will likely welcome your help.
If you're up for a stroll, take an easy walk around the neighborhood, looking for picturesque streets and maybe finding nicer routes to your favorite shops and venues. It's also not unheard of for an anesthesiologist to have trouble placing the epidural needle correctly, and even when she does, there's a chance it won't work for you! Take some time to master any special techniques involved -- the way you use the tool will make all the difference!
Keep an eye out for posters or boards advertising mom and baby classes at a local gym or pool. But instead of getting hung up on these fears, explore different ways to prepare for the event and think hard about the "worst case scenario" -- generally, a little research will show that it isn't as bad as you had thought at first, which should calm your worries. Getting out into your community will be the best way to meet other moms like you and continue to enjoy a healthy social life.



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