Amy and Maria discuss Amy’s pregnancy.(9:24)
Amy and Maria discuss fetal development at the 34 week point. (1:48) (Scroll to the 1:24 mark in the video to see this discussion.)
Speaking of Labor
Amy and Maria discuss how labor might proceed during Amy’s second delivery. (2:40) (Scroll to the 4:57 mark in the video to see this discussion.)
M: Well, it’s good to see you, Amy. You’re thirty three weeks. You’ve got about seven weeks to go or less… How’s has it been going?
A: Good. Good, good, good.
M: How’re you feeling?
A: I feel good. Yea, other than the, um, pressure.
A: I feel a lot of pressure, especially in the morning, when I’m sitting a long time, when I stand up.
M: Does it feel like contractions or does it just feel like a heaviness?
A: A heaviness.
M: The baby’s low…
A: And then — yeah, because my hips and my groin is what hurts.
M: They kind of ache.
A: Yeah. It’s kind of like it’s stretching.
M: Does it prevent you from sleeping at all?
A: Uh, yea.
M: So you wake up because you need to reposition?
A: Oh, yeah. Every night.
M: Do you ever take Tylenol?
A: Mmm-uh. (Negative)
M: Do you have Tylenol at home?
A: Mmm-uh. (Negative) I have ibuprofen and you can’t take ibuprofen, right?
M: Right. Um, it’d be good to get some Tylenol. Sometimes it just helps with the mild aches and pains. Do you ever take a bath?
A: No, but I should do that, too. I’m getting a massage this week, too.
M: You are? Good.
A: A full body massage.
M: And do you know if this place has trained people to work with pregnant people?
A: But right now, because there are those certain pressure points, right?
M: Mm hmm.
A: But even if I did go into labor…
M: Yeah, but I don’t think they’re going to be trying to stimulate labor. I think that you don’t need to worry about that. I’m just worried about relaxation, you being comfortable, having a table that accommodates the pregnancy. So…
A: Okay. But what if, say, I did go into labor tomorrow, how healthy is the baby right now with the lungs developing and the heart and everything like that?
M: You’re thirty three weeks in a couple of days. Typically, we … full term, you know, is 37 weeks. We want moms and babies to deliver after 37 weeks. Typically, because the lungs are ready, the heart is ready, all the…
A: (overlap) After 37 weeks?
M: After 37 weeks.
M: Lungs really are the last things to get ready, so between 34 and 37 weeks, um, the lungs are getting mature and stronger. And the baby will start practice breathing. We can even see that on ultrasounds. Um, they’re also putting on fat. It’s the last thing they do. They put on what’s called this “brown fat.” And that fat keeps them warm. It protects them from exposure to the changing temperatures outside the womb. So, the biggest thing when babies come at 34 weeks – it’s kind of where you’d deliver if you delivered right now – is related to infection risk, um, exposure to viruses or bacteria; and, um, changes in their temperature; and the other big thing is eating. They don’t eat real well at 34 or 35 weeks. Because they’re working so hard and concentrating their–conserving their energy and trying to stay warm. And also, their suck re?ex isn’t that strong. A: Okay.M: So the big things right now, the big challenges would be, if the baby would be born, is breathing on its own-which it would probably do ?ne, but it would be working hard to do that; temperature control; and eating. And so, the ideal time for babies to come is 37 weeks. But 34 weeks is much better than 28 weeks as far as, um, how the baby would probably do. So…
A: (overlap) Okay.
M: … typically, we have some moms who deliver at 34 weeks, and they’re in the NICU sometimes. The neonatal intensive care for a while..
A: (overlap) What are they about 4 or 5 pounds?
M: Typically, 4 pounds is the average.
A: Mine is 6 pounds then, right now? (Both laugh)
M: I don’t know if we can tell. We’ve got to check you… But 4 is kind of average. So..
A: Okay, okay. Uh, okay. And she’s been kicking a lot, too.
M: Everyday? You feel good movement?
A: Oh, gosh, yeah. More with this one than with Ella, because it’s the, I think the placenta must have been in front with Ella because the placenta’s behind with this one.
M: (Overlap) Mm – hmm. In back. And that’s…
A: Because this one, I can feel, like, all the time.
M: And you feel movement everyday?
A: Mm-hmm. (yes)
M: Typically, we want moms, um- I’m just looking for your ultrasound here- to feel movement sometime in the morning. Sometime in the afternoon and sometime in the evening. Not that we really worry so much about the movement all day, but just knowing that – Yeah, it’s regularly moving. There wasn’t a real big change. If there’s a big change, I want you to call me or call the clinic and let us know.
M: I’m just going to take a look and see where your placenta is. This is your….yep, this is your ultrasound from, um, June. And it says the placenta’s in the back. So, where it implanted on the back of your uterus allows you to feel more movement in the front. Because of where the placenta is.
A: I, uh, I mean I actually like it better because it’s — it feels cool.
M: Okay. So, massage I think is great. I think Tylenol would be a good thing to consider. Even a hot water bottle if you have that. That sometimes helps just with kind of achiness.
M: You don’t feel uterine contractions? You don’t feel cramping? Like the baby’s coming…
A: (Overlap) No, but sometimes when I get up, I feel like sharp pains…
M: (overlap) Pulling.
A: …going through my abdomen.
M: And that’s – the uterus is tethered with ligaments and they come from the back and they wrap down into your groin. So, when you move real quickly, or the baby changes position, you get a real stitch in your groin area. And that’s normal, but it’s related to position.
A: (overlap) It’s like I just have to stand there for a minute ‘cuz, yeah, I can’t move. Okay. Um, and we discussed that I want to do an epidural again?
M: Mm – hmmm (nodding.)
M: That worked well for you last time.
A: Yeah. Drugs are good. Yeah. (Laughs) The drugs are good.
M: Um, so, yeah typically, things are going to go a lot faster. Last time, your water broke and you were in the hospital for a couple of days. That’s only about ten percent of the time. The water breaks before they go into labor. Usually they’re in labor ?rst, and then the water breaks.
A: Oh, really?
M: Mm- hmmm.
A: Oh, so I don’t have to worry about…
M: (overlap) Typically, labor starts and then the water breaks later …. We had to induce your labor because you weren’t in strong enough labor.
A: Oh, I just thought that the water broke…so, I’ll feel labor pains ?rst. Well, I don’t even know how many minutes, and stuff like that ‘cuz…
M: (overlap) it didn’t happen last time…
A: …. because with Ella, I didn’t — I was already in the hospital and I didn’t have to pay attention to any of that stuff.
M: The things we want you to call us and let us know about … the things that tell us you are in labor are 1: If your water breaks, we always want to hear about it. Give us a call or give me a call if your water breaks. The baby’s not moving regularly, we want to hear about that. But as far as labor goes, it’s contractions, menstrual-type cramps that come, you know, they can come irregularly it can be one every twenty minutes. It’s probably not going to bring the baby. But one every ?ve minutes or closer, you feel a strong contraction. It’s lasting 30 seconds or more. And it’s uncomfortable.
A: So, that’s when you should call?
M: You know, it’s variable from woman to woman. Some women can’t tolerate it every ten minutes. Some women can tolerate ‘til every two minutes. But we want to see you long before your contractions are two minutes apart. Or at least hear from you. Some people have contractions and they’re not painful. Those are probably not going to bring the baby either. But typically, people who have painful contractions, that’s a sign that labor is becoming regular and gonna bring the baby.
A: And then when do you start to dilate?
M: Anytime. I mean you could be dilated a little bit right now. You usually dilate when your contractions are coming regularly. Most moms, if it’s their second baby, their labor’s cut in half.
A: Oh, it will be?
A: (overlap) Do you promise?
M: Yes. (Both laugh) I promise…I promise to be there. But if your labor didn’t really start until the third day, it probably started some time that morning. You delivered around three? Is that right?
A: No. Ten.
M: Oh, it was ten in the morning. I’m trying to think when I got there…it was 5 or 6 in the morning that labor really didn’t start.
A: Right. M: So you had a pretty short labor, once labor started. From three to ten so it may be a matter of a couple of hours.
M: Typically, that time is cut in half. The pushing phase, for ?rst time moms, typically is two hours. That’s the average. The second time is usually about 20 minutes. So, your ?rst labor pushing experience was less than an hour.
M: Like 45 minutes, so.. it probably wouldn’t be any longer than that.
A: Oh, okay. Good.
M: Barring that the baby’s, you know, in the similar position, Babies come in different positions but typically they come with the baby’s looking down at the ground as opposed to looking up. That’s how Ella came.
M: Um… what other thoughts do you have? Everything looks good. Your blood pressure looks great.
A: Four pounds, too, I gained. What was my..
M: (Overlap) Yea.
A: What did you tell me last time I was here? How much more weight can I gain?
M: What’s ideal? Um, I think we said a pound a week. You gained 40 pounds last time and now you’re at 33.
A: (Overlap) 33…
M: And so a pound a week is all you get.
A: And so I can still eat a couple more cheesecakes, and chocolate cake and ice cream.
M: You can …
M: in moderation. Do you have questions about that? You know what good nutrition is and what our goals are with fruits and vegetables?
A: (overlap) Yes. I should eat more vegetables. And I don’t. I mean I should…. Yeah.
M: Okay. Even splurging on a good salad.
A: Yea.M: Okay. Um, if the pain in your hips, your groin, gets really bad, we can send you to physical therapy, too, if you like. If that would be helpful, too. They may…
A: (overlap) Okay. What about a chiropractor?
M: You can go to a chiropractor, too, if you want to. I’m a little bit more experienced with with with physical therapists, and the ones we work with deal largely with women that are pregnant, and that’s all they deal with, and so, they kind of take that into consideration, and we just have a good established relationship. But if you’ve had experience with chiropractor and you’re happy with that, you can certainly try that, too.
M: (overlap) Do you have somebody you go to?
A: … no, but, uh, Jen Bischoff just recommended someone and so I was gonna check him out, maybe. I’m going to go get a body massage this week ?rst and see how I feel after that.
M: Physical therapy is also a bene?t that’s covered, and chiropracty is too, but you need to ?nd out whether it is covered and your insurance will pay for it.
M: All right. What other thoughts? Concerns?
A: Nothing. I think that’s it.
M: Should we take a listen to your baby and measure your baby?