Congratulations!James W. Brann, MD
You are now considered early term. This means that if you were to deliver your baby this week, there is a good chance that he or she would be perfectly healthy.
Your Pregnancy MD
Pregnancy Week Thirty Seven
A term baby can be born anytime between 37 weeks and 42 weeks of pregnancy.
Definition of term pregnancy weeks:
- early term ( between 37 weeks 0 days and 38 weeks 6 days )
- full term ( between 39 weeks 0 days and 40 weeks 6 days )
- late term ( between 41 weeks 0 days and 41 weeks 6 days )
- post-term ( between 42 weeks 0 days and beyond )
Though your due date is three weeks away, keep in mind that only five percent of babies will be born on their estimated due date. Over 80 percent of babies are born between pregnancy week 37 and 42 weeks.
Do you Think you are Going into Labor?
What is term labor?
Term labor begins when you have contractions between 37 and 42 weeks of pregnancy. Your due date is set at the first day of the 40th week. When you have contractions that begin before 37 weeks, it is called preterm labor and if they wait to start past 42 weeks you are considered post-term.
What are the signs (Braxton Hicks Contractions) that labor is starting, here is a list:
- When you feel that the baby has moved lower in your belly. This is called lightening or the baby has dropped.
- When the fluid coming from the vagina is a thick mucus and/or slightly bloody. This is called the mucus plug or bloody show.
- Increase lower back discomfort or lower abdominal cramping.
- You will start to feel the uterus tighten. This sensation can be mild at first, only to become painful later on.
What are the signs of true labor:
True labor contractions can be difficult to distinguish from false labor (Braxton Hicks) contractions. But here are a few general rules:
- Contractions that come every couple of minutes and become more regular and frequent are true labor contractions.
- Contractions from true labor do not go away with rest. False labor contractions can come and go and usually stop with rest.
- The best indicator of true labor contractions is that they get stronger and stronger with time, whereas false labor contractions do not get stronger.
When you start having contractions you should time the interval between them and note if they are becoming stronger. You will need to use a clock with a second hand or a stop watch app. Makes sure to write down the time between the start of a contraction and the start of the next contraction. If the interval is becoming shorter you may be in true labor.
When you think you have started true labor your physician will want to know this, and will give you instructions on what to do next. You should call your doctor also if you have an increase in bloody mucus or if your bag of water breaks. Make sure to call your physician if you think labor has started before 37 weeks of pregnancy.
When does Labor Start for Twins?
At 37 weeks pregnant, you are considered “early term,” which means your baby (or babies) may arrive any day now. If you are pregnant with twins, you’ll want to be on the lookout for labor this week. A majority of twin pregnancies end in premature infants. The average pregnancy for twins ends at 35 weeks, though some women can carry their babies until 40 weeks of pregnancy .
Many healthcare providers typically recommend that women carrying twins induce their labor between 37 and 40 weeks pregnant to avoid potential complications. Studies have indicated that twins that are delivered from 37 weeks pregnant until pregnancy week 40 have the best outcomes.
If you haven’t gone into labor yet, you will want to prepare for it at any second. Make sure that your hospital bag is packed and ready to go by the door, and double check that both of your infant car seats are properly installed. You will not be able to go home with your newborn twins without their car seats.
Expect Delivering Earlier than Your Due Date
Expecting two babies can be stressful—and expensive! In addition to differences in how much you need to eat and how many strollers you need to buy, you should also know what to expect for labor and delivery.
Many twin pregnancies are delivered earlier than pregnancies with only one baby. This is because twin pregnancies distend the uterus more than singleton pregnancies. The uterine distension causes the uterus to contract earlier.
How early are Twins born on Average?
More than 50% of twins are born preterm. If you are carrying twins your risk of preterm birth in the United States is 59 percent before the 37th week of pregnancy and 11 percent before the 32nd week of pregnancy. More than half of the preterm twins weigh less than 5.5 pounds and 10 percent weigh only 3.3 pounds or less. [Ref.] If you are carrying two boys you are at the highest risk of having a preterm birth. [Ref.]
If you are not having contractions or other signs of preterm labor, your physician routinely will not perform any tests to identify your risk for early birth. If you are having signs of early labor your physician will then perform two tests, a fetal fibronectin test and cervical length test. The fetal fibronectin test will predict if you are at an increased risk for early birth.  A short cervical length will also indicate you are at risk for early delivery.
If you go into labor before the twins are 36 weeks along, your doctor will probably check to see how developed your baby’s lungs are. If they are not quite ready, you may be given a steroid shot. Your doctor will then try to delay the birth for 48 hours, until the steroids have had time to help your baby’s lungs develop.
If you and the twins do not have any health problems, you may be able to carry the twins up to 40 weeks (full-term). No matter how long your pregnancy lasts, when you go into labor, your babies will be monitored closely to make sure you have the safest delivery possible.
What Type of Twin Pregnancy Do You Have?
Depending on the
“type” of twin pregnancy you have, your delivery options may differ. Many
doctors will try to find out whether your twins are in their own sac or not. If
the twins are in the same sac, your doctor may encourage you to consider
elective delivery at 36 or 37 weeks. If they are in different sacs, you may be
able to carry the twins the full 40 weeks.
Twins in the same sac (monochorionic) often have higher risks than twins in different sacs. Because the risk of problems increases as the pregnancy continues, you may need to be induced. A doctor may give you drugs to start contractions at 36 or 37 weeks. If you want a C-section instead of a vaginal delivery, your doctor will probably schedule it around this time.
What is the Position of Your Twins?
The position of your twins will be a big part of what you can expect for the delivery of your twins. Depending on how they are positioned inside your uterus, you may not be able to choose how you want to give birth. Sometimes, the position of the babies makes a C-section delivery the only option.
Your twins may be in any of the following arrangements when you go into labor or are induced:
- Vertex/Vertex: Both babies are head-down. This is the best position, especially if you want to have a vaginal birth.
- Vertex/Breech: The first baby is head-down; the second is bum- or feet-first. This is the second best possibility if you want to have a vaginal birth. Many times, the first baby is born normally and the second is moved or turned inside of you to be born vaginally as well.
- Breech/Vertex or Breech/Breech: The first baby is bum or feet-first; the second is either head-down or in the same position as the first baby. This combination can make vaginal delivery risky. Your doctor will probably recommend a C-section if this is how your babies are lying.
- Transverse/Any position: The first baby is sideways (horizontally across your uterus). No matter what position the second baby is in, your doctor will probably recommend a C-section delivery.
In general, if the first baby is head-down, there is a good possibility that he or she can be born vaginally. The second baby may or may not be able to be delivered vaginally. If the first baby is not head-down, it is safer in most cases to have a C-section delivery, regardless of the position of the second baby.
How will I deliver my twins, vaginal delivery?
If the babies are both
head-down, most doctors will recommend a vaginal delivery for twins. Unless
there is a health risk for you or the babies, vaginal delivery has fewer
complications than C-sections do. Vaginal childbirth for twins is even possible
for women who have had a C-section in the past. Your healthcare provider will
check you and the babies before and during labor to make sure a vaginal
delivery is a safe option.
During labor, the doctors will monitor the heartbeat of both twins. If they notice warning signs of a problem, they may try to speed up delivery. Doctors may help labor along by giving drugs to increase your frequency of contractions. This often happens when the labor is going too slowly.
Many doctors try to deliver the second twin less than half an hour after the first twin is born. If the second twin’s heartbeat appears normal, though, no particular time limit is needed. Up to 25% of second twins are born via C-section after the first twin was delivered vaginally. This can be due to problems the second baby is having or a risky position of the second twin.
How will I deliver my twins, C-Section delivery?
More than 60% of twin births are C-section deliveries. Sometimes the C-sections are “elective,” or chosen and planned ahead of time. Other times, they are emergencies: no one planned the surgery in advance, or something happened during vaginal labor that made a C-section necessary and urgent. Overall, C-sections are common and safe for the delivery of twins, but they are not needed in every case.
Elective C-Section with Twin Pregnancy – Depending on your health and the health (and type) of your twins, your doctor may recommend a planned C-section before natural labor starts. This may be done if the twins are in the same sac and labor hasn’t begun by 37 weeks. Sometimes, vaginal delivery can be risky, and an elective C-section is planned to avoid danger for the twins or the mother. The mother can also choose, in many cases, to have a C-section at her request once the twins have reached a minimum of 36 weeks.
Emergency C-Section with Twin Pregnancy – When a C-section is not planned ahead of time, it is called an emergency C-section. This can happen when the twins show slow heartbeats or other problems occur. Emergency C-sections also happen when the first twin is born vaginally but the second twin is not doing well. Sometimes, when a woman is pregnant with twins, labor naturally begins very early or another problem happens that makes an emergency C-section necessary. In general, C-sections are safer when they are planned ahead of time.
Are Twin Pregnancy Symptoms different?
Twin pregnancy symptoms –Twin pregnancy symptoms are similar to singleton pregnancy symptoms, but are usually more extreme. Even though you may think you are having twins, due to the exacerbation of your symptoms, it is impossible to know for sure. An ultrasound showing two babies or hearing two heart beats is the only way for sure to know.
The following are hints or observations that you may be pregnant with twins:
- Nausea seems to start earlier and be more severe with twins.
- Breast tenderness can become very uncomfortable.
- Blood pregnancy test (Beta-hCG level) will be higher for twins.
- Trips to the bathroom are more frequent with twins.
- Extreme fatigue is a common twin symptom.
- Your belly will be much larger, for the same week of pregnancy of a singleton pregnancy.
- You will eventually notice a lot more fetal movement then with a previous singleton pregnancy.
- Your weight gain will be faster and greater.
- A very suspicious and scary twin symptom is a high or positive AFP (Alpha fetoprotein tests for downs syndrome).
What are identical twins?
Identical twins are called Monozygotic Twins. They result from the division of one egg after fertilization. This division forms 2 separate babies. The incidence of identical twins is 4-5 times per every 1000 pregnancies. They have all of the same genes, are of the same sex and look very much alike. The twins are often mirror images of each other. If one is right handed the other usually is left handed. Of interest is the fact that their fingerprints are different.
What do they call non-identical twins?
Non-identical twins are called fraternal twins (dizygotic twins). They are formed from two different eggs and two different sperms. They do not have the same genes and may only resemble each other. Despite that they have the same birthday, they are different as a singleton sibling. Fraternal twins are more common after stopping long term use of an oral birth control pill. Even though non-identical twins can be any sex, 75-percent of the time they are the same sex.
What is the best way to diagnosis twins?
The routine prenatal ultrasound, in the first or early second trimester of pregnancy, is the best way to diagnosis a twin pregnancy. The ultrasound exam will also determine an accurate gestational age of the twins and if they are identical or not.
How to tell if twins are identical or fraternal?
The best and most reliable way to tell if you are having identical twins is with an ultrasound examination. Identical twins share a single placenta and the same amniotic sac. Whereas fraternal twins have separate placentas and are inside their own sac of water.
Which type of twin is more common?
The most common type of twin is fraternal, (dizygotic or non-identical twins). The percent of fraternal twins depends on race, but the incidence of identical twins remains stable at 3 to 5-percent worldwide. On average the incidence of twin births is 3-percent.
Are twins at a greater risk of delivering early?
All twin pregnancies are high risk and at an increased risk of delivering early. Most twin pregnancies delivery early before the 37th week of pregnancy (59-percent) and 11-percent deliver before the 32nd week. Of note boy-boy twin pairs are at the highest risk of delivery early. [Ref.]
How much weight can I gain with twins?
Healthcare providers recommend a total weight gain of 25 to 54 pounds for you if you are pregnant with twins. If you are obese, you should gain closer to 25 pounds. If you are considered overweight you should gain toward the middle of recommended weight gain and if you are a normal weight you can gain up to 54 pounds.
Do twin babies weigh less than single babies?
One of many complications associated with twin pregnancy is the slow growth or weight gain of the babies. All twin pregnancy babies grow at a slower rate than singleton babies. The growth rate in the first two trimesters for twins is similar to singletons, but in the third trimester the babies start to slow down. Ultrasound examinations are performed every four to six weeks to watch for the slowing of growth. If it is found that the babies are growing slowly, your physician will start monitoring your pregnancy closely.
Are Prenatal Visits different for twins?
Yes, prenatal visits are very different for a pregnancy with twins. The increased risk for complications requires increase visits and monitoring than a singleton pregnancy. Preterm birth and the twin slow weight gain (growth restriction) are the two most common complications seen. In the latter half of your pregnancy your physician will require frequent prenatal visits and fetal monitoring visits to avoid morbidity from these common complications.
What increases your chance of having twins?
There are several main factors that will increase your chances of having twins. The most obvious is the use of fertility drugs. In the United States one third of all twin pregnancies are a result of fertility drugs.
Your age influences the increase chance of having a twin pregnancy. As you get older your ovaries require more follicle stimulating hormone (FSH) to release an egg. This increase in FSH stimulation will cause the ovary to release multiple eggs at one time. Thus, increasing your chances of a twin pregnancy.
Race and geographic area influences your chance of having twins. The chance of having twins in the United States and Europe is 8/1000 births, whereas the twin birth rate in Nigeria is 50/1000. Twins are more frequently seen in African American women then Asian or Caucasian women.
The more times you have given birth, the greater the chance of having twins with a subsequent pregnancy. This is especially true if you have a family history of twins. A family history of twins increases your chances of twins. This is because there is a genetic component expressed in women that can be inherited from her parents.
Your weight will influence weather you are at an increase chance of having twins. Obese and tall women will increase your chances for a twin pregnancy over underweight and short women.
Diet and folic acid can influence your chances of having twins. Folic acid supplementation has been show to increase your chances of twinning. [Ref.]
The Birth of Twins
Remember that it’s OK to ask your doctor all of your questions about having twins. He or she can help explain what you can expect based on your twins’ type, growth, and position. Finally, don’t be afraid about giving birth to twins! Even if you end up with a surprise delivery or an unexpected C-section, your twins have a good chance of being safe and healthy.
Breech Position and How it Complicates Pregnancy
Understanding a breech pregnancy
Before a child is born, it will be in various positions within the mother’s womb. A baby may have its shoulders, legs, buttocks or head closest to its mother’s vagina. A baby is breech when the child’s buttocks or feet are closest to the vagina.
During the first part of pregnancy, it’s not uncommon for babies to lie in a breech position. As pregnancy progresses though, most unborn babies will end up with their heads closest to the mother’s vagina. The safest position for a child to be in for a normal vaginal delivery is head-down. A pregnancy is considered breech when the baby is in the breech position as the mother reaches the end of her pregnancy.
Causes of a breech pregnancy
For a majority of breech pregnancies, they just happen. Sometimes, though, a breech pregnancy may occur because of either a problem with the placenta, the mother’s uterus or even the baby. There may also be an issue with the amniotic fluid, which surrounds the baby.
Symptoms of breech pregnancies
Occasionally a woman may feel some discomfort as her child’s head presses under her rib cage in a breech pregnancy. If you baby is breech, you may also feel your child kicking your lower belly.
How will I know if my baby is in a breech position?
To find out for sure if your baby is breech, your doctor will do an exam checking your baby’s position. This includes pressing on your pregnant belly so that they can feel where your baby’s head is. During the final three months of your pregnancy, expect that your doctor will check your child’s position during every visit.
An ultrasound may also be used in checking your child’s position. This type of test uses sound waves to show pictures of your baby in your womb.
If my baby is breech, what should I do?
For most breech babies, they eventually turn themselves around before you go into labor. However, if you’re baby’s still breech when your due date gets closer, your doctor may want to intervene. Your doctor can try pressing on your belly to try to move your child. If this is successful, and your child moves to a head-down position, you will likely be able to at least try a vaginal delivery when you go into labor. If this doesn’t work, though, your doctor may want you to have what’s called a C-section, or rather surgery to deliver your child.
There are some situations where a breech baby may be delivered vaginally. This is referred to as vaginal breech delivery. However, this type of delivery is at a greater risk of problems to both the mother and her baby. For this reason, vaginal breech deliveries are more rare than other types of deliveries.
At 37 weeks pregnant, your baby may weigh over 6.3 pounds and he or she might be as long as 19 inches.
As your baby moves downward into your pelvis, in preparation for delivery (a process called “engagement“), you will feel less pressure underneath your rib cage. You may also find that you can breathe more easily than in the previous weeks, because your lungs now have more room to expand.
Your baby continues to gain weight. Fat now covers his or her arms, legs, and belly. When your little bundle of joy is born, he or she will look very similar to how he or she looks now.
The lanugo hair that has covered your baby’s body until now is being shed and replaced by short, fine hairs called “vellus hairs” (more commonly known as “peach fuzz”).
Your baby’s ears are fully developed. Since noises easily penetrate the womb at this stage in your pregnancy, you may notice that loud noises startle your baby. You and your partner should also spend time speaking to your baby, since he or she can hear you. In fact, it’s the mother’s voice that all babies first recognize after birth.
Now that you are early term, the level of amniotic fluid surrounding your baby will slowly decrease from here on out.
Giving Birth Do’s and Don’ts
The birth of a baby is one of the most magical and remarkable days in a woman’s life. As you look back upon that day, it will seem as though it flew by in mere seconds, but at the time that it is happening, it might feel as though the whole delivery is occurring in slow motion. Perhaps the anticipation of the day you get to meet your son or daughter for the first time is what makes that day feel so laborious (no pun intended).
In the meantime, it may behoove you to get ready for the birth of your baby by learning as much as possible about the labor and delivery process. There are a lot of misconceptions about what actually takes place on the day the baby is born, as well as how it is handled by the medical team.
You can only make decisions based on what you know; therefore you should equip yourself with as much qualified information as possible to make sure the birth of your baby runs smoothly. Ultimately, having a baby should be a joyful experience.
It is essential to know a few “do’s and don’ts” about the labor and delivery process.
DO’S of Giving Birth
Do: Research/Plan Ahead
Doing your own research, asking your doctor the right questions and creating a flexible plan for your baby’s delivery will ensure a smooth process. From the moment a woman discovers she is expecting, the opinions and advice of others will come pouring in. Some of these opinions are not suitable for every woman, which is why she should find trusted sources to give her the assurance she needs. Reading is essential, especially for first-time moms. As she is faced with many decisions regarding her newborn, the well-researched mom will be better equipped to determine the best choices for herself and for her new baby.
Do: Communicate Your Needs
Your partner, the medical team and your doctor are not mind readers. If you have a personal vision for your labor, such as whether or not to receive epidural, natural delivery or cesarean, pain medication or none, etc. then you must communicate these issues before you are actually going through with the birthing process.
When you are in pain is not the time to express those needs, although no one can predict any complications that could arise at the last minute. Just like riding a motorcycle, you should wear a helmet and protect yourself from any unforeseen circumstances that may arise! Have a backup plan, just in case.
Do: Participate in Lamaze or Yoga Classes
There are many benefits of taking childbirth classes. Many women experience easier labor and delivery as a result of learning breathing techniques, practicing meditation and relaxation, as well as the exercise aspect. You will also meet other expectant mothers, which can become a strong support system during your pregnancy. The instructors also give you valuable insight and assistance.
Do: Get to Know Your Body to Recognize Contractions
It is common for first-time mothers to rush to the hospital at the sign of their first contraction, but you should wait until they are less than ten minutes apart. Most women have contractions for ten to twenty (or more) hours before the baby’s arrival, which means they should keep occupied until the contractions become more intense or until the water breaks. Don’t wait until the last minute, but don’t drive at breakneck speeds to get to the hospital only to discover that it is a false alarm or too early, either. Count the minutes in between your contractions to know when it is the right time to go.
Do: Keep Moving During Labor
Most women lie in bed while enduring labor pains, but this is not the best method. It may be easier for a woman to endure the delivery process to keep moving, either through the help of her partner or by walking slowly around the room. You could also bring an exercise ball or try doing some light squats and yoga exercises to open up the hips and help the baby move through gracefully.
Do: Have a Coach or Doula by Your Side
A doula can help you get through the birthing process, even if your partner is present. This is a woman who is professionally trained to offer emotional support, as well as pulling you through the physical difficulty of childbearing. Having a doula, midwife or birthing coach present can make your delivery more memorable, pleasurable and safer for you and your baby, especially if you plan on having a natural childbirth.
Do: Delay the Cord Cutting for at Least Two Minutes
Science has revealed that the blood in your baby’s umbilical cord offers an abundant source of iron, which is something the baby cannot produce on its own for a few months. Traditionally, the medical team cuts the cord almost immediately upon birth, but you can ask them to wait at least two minutes so that the baby can extract as much iron as possible before the umbilical cord is snipped.
Do: Create the Skin-to-Skin Connection with Your Baby Right Away
Most hospitals take the baby away from its mother right away, placing the infant in an incubator, where it remains hooked up to a monitor for a few hours. You are the mother and have a right to ask to hold your baby, and it is recommended that you do! Commonly referred to as the “Kangaroo” Method, the concept of putting the naked baby on the mother’s bare chest creates a powerful bond, while promoting breastfeeding and infant-mother attachment right away.
Do: Give Breastfeeding a Chance
It may take your baby a day or two to learn how to latch on, but some new mothers give up too easily on breastfeeding because they are afraid the baby will starve. Breastfeeding is natural and there are many benefits of breastfeeding, both for the baby and the mother. It builds up the baby’s immune system, helps the mother recover quickly, as well as strengthening the bond between them. Babies who breastfeed have a higher IQ than those who do not, studies reveal. Plus, formula is expensive, so opt for nature’s abundant source and choose breast milk; if you are able to do so.
Don’ts of Giving Birth
Don’t: Elect an Episiotomy
Some outdated practices still include giving a woman an episiotomy, which is an incision that enlarges the vaginal opening. Why did doctors do this? Many believed that it would prevent mothers from getting incontinence or having a rip that would be difficult to fix. Others believed it would prevent fetal head trauma by lessening the need for forceps, while improving healing. This is false!
Episiotomies are very risky and can lead to increase of blood loss, infection, clotting or other objectionable side effects. The only reason to have an episiotomy is if your baby is in distress or if the labor persists, whereupon this type of incision can speed up the baby’s ability to come out of the womb. It should not be done as a routine procedure, so ask your doctor and express your desire that it should be done only as a last resort.
Don’t: Schedule Early, Induced Labor
Although this is becoming more common with today’s modern technology, getting induced early poses more risks to both the baby and the mother. Mainly, this is becoming a common practice for convenience’ sake, because doctors can schedule other things around the patient’s delivery. Some studies have pointed to an increase in complications among newborns who were delivered too early, so this should only be an option out of medical necessity, rather than opportuneness.
Don’t: Choose a C-Section Over Natural Birth
Some women opt for a caesarean because of personal reasons, such as wanting to get tubes tied, or doctor going on vacation, or because they are afraid they will be too “loose” down there after having a baby naturally; or just because they heard from another mother that it was easier. This is actually not true, and can harm the baby.
The C-Section should only be used as an emergency measure. It requires major abdominal surgery, with more blood loss and longer healing time. It can be very painful to recover from a C-Section, whereas women who give birth naturally often bounce back quickly. Your stomach muscles can heal, meaning less likeliness of having that “pooch” and some ugly track marks where the incision is made, typically just at the bikini line.
The other reason is for the baby’s sake. Babies born by caesarean are far more likely to spend time in NICU (neonatal intensive care unit) due to fluid in their lungs, etc. than babies born vaginally. By all means, give a natural childbirth your best attempt!
Don’t: Rush to Say ‘Yes’ to an Epidural without Knowing the Risks
Understandably, childbirth is uncomfortable and painful. Despite the many mothers out there who will tell you to willingly get an epidural – without knowing what it entails – you should be informed. The epidural numbs the lower half of your body, and if done too soon, it can double the chances of needing a C-Section delivery. An epidural can also leave intense side effects, such as itching, shaking, coldness, maternal fever, or a migraine headache. For the baby, it could double the chances of having to use forceps or lead to head trauma, vacuum extraction or increased chances of the baby not lining up properly to exit the womb. The epidural is administered through a long needle in your spine, so if done improperly, can damage your spine. Be careful!
Don’t: Take Pain Medications without Fully Understanding the Effects
Your doctor might offer opioid narcotics to help you ease through the pain, but do not readily accept them until you know what they can do. Some common pain meds include Nubian, Stadol or Demerol, which are supposed to dull your brain’s perception of pain. Some of these come with side effects, such as nausea, drowsiness, plummeting blood pressure, vomiting or headaches. They could also affect your baby and make your newborn unresponsive upon arrival. No matter what the medical team says, it is up to you. Use caution.
Don’t: Be Discouraged if Things Don’t Go As Planned
Just like you can’t predict the weather, you cannot predict the things that may happen during childbirth. Sometimes you just have to “roll with the punches” and remain positive, flexible and less rigid. Things will work out for the best.
There is no question, having a baby is a life-changing event. Every woman has her own personal reasons for the choices she makes, but the best thing is to go with what your heart tells you to do in all matters, including the delivery and labor of your baby.