Month Seven

Processing

WEEK TWENTY-NINE

• Baby is 16 inches and 3 pounds.

• Fatty layer under skin continues to build.

• Buds for permanent teeth are forming in the gums.

WEEK THIRTY

• Baby is 16 inches and 3 pounds.

• Brain is now developing indentations, to accommodate important brain tissue and developments.

• Lanugo, the soft hair that has been covering baby, is starting to disappear. (The baby will end up swallowing it before birth, and it becomes part of their first poop!)

• Baby’s bone marrow is taking over red-blood-cell production from the spleen.

WEEK THIRTY-ONE

• Baby is staying around last week’s size and weight.

• All five senses are working and processing stimuli—such as reactions to light.

• Rapid brain growth continues to occur.

WEEK THIRTY-TWO

• Baby is still comfortable around 16 inches and 3 pounds.

• Many babies assume the head-down (labor-ready) position by this week.

East-West Fetal Development

Breathe deeply. Okay, more realistically: shallowly but frequently. This is the month of the Chinese Lung. The Lung system, includes our whole respiratory tract as well as our skin—our first two interfaces and boundaries against invading pathogens.

Just as keeping your immune system well is a priority in pregnancy, so is creating boundaries that enable you to focus on your task at hand and not overextend yourself. And just as breathing brings oxygen-rich regeneration to your cells, the Lung system is about renewal, so as you breathe in and breathe out, this is a great time to practice receiving and letting go—asking for help and disregarding the tasks you can’t get to. It’s great practice for impending motherhood.

The cyclical, involuntary nature of breathing is also a great thing to observe at this time. A guided, mindful, breath-orientated practice may help you move toward receptivity—especially during labor, when breath will truly be your guide.

Asthma

Asthma is one of the most common complications during pregnancy, and about a third of women with asthma find that it gets worse during pregnancy. Asthma can increase the risk of preeclampsia and preterm delivery, so it’s important to manage it as well as you can and also keep monitoring your symptoms with your healthcare providers. As ever, nature is onto this issue, and the placenta releases substances that can help to mediate asthma.

Asthmatic spasms in your lungs can result from overstimulation of your parasympathetic nervous system. Stress reduction techniques (physical and emotional) can help you breathe a little easier. Additionally, a Mediterranean diet has shown protective effects on childhood asthma. So, to help prevent asthma in your newborn and keep yourself well nourished along the way, keep relying on good eating habits, including regular meals balanced with good protein, healthy sources of fats and oils, and lots of veggies. And be sure to boost up on antioxidants to help reduce the inflammation that comes with asthma. Magnesium has also shown bronchodilating (lung relaxing) effects. Add that to your regimen too.

Cystic Fibrosis

Cystic fibrosis transmembrane conductance regulator (CFTR) functions as a channel that regulates the transport of ions and the movement of water across the lining of your respiratory tract. Mutations in CFTR affect this innate immune function in the lung and result in exaggerated and ineffective inflammation in your airway that creates a buildup of mucus and also fails to push out pathogens. This clogging can lead to blockage, not only in your respiratory system but also your digestive system. 

As treatment strategies are becoming more effective, it is becoming more common to pursue pregnancy with an existing diagnosis of cystic fibrosis (CF). Additionally, acupuncture works on a different type of channel and can be effective for obstructive respiratory diseases. And even though it’s hereditary, studies have shown that if you have CF, it can still be a viable choice to have a baby. The majority of these pregnancies produce healthy, noncystic fibrosis babies. The severity of your condition is a significant predictor to how well you and baby will fare.

Syncope, Dizziness, and Fainting

Your world may be spinning with the prospect of having a baby, and there might be actual dizziness to physically prove it. Fainting for a moment—called “syncope”—is on the spectrum of dizziness and isn’t for the faint of heart (pun intended). Everything is changing, including your circulation. Your blood vessels are more dilated, so although blood flow is increased to baby, it flows a bit slower for you; therefore, your heart beats a little slower, too, which lowers your blood pressure a bit and reduces blood flow to your brain. All of this can cause incidences of dizziness and even fainting. These are pretty common symptoms in the first trimester and even throughout pregnancy.

In the second and third trimesters, your growing uterus puts pressure on and can constrict your blood flow, which is related to why you don’t want to lie on your back as your pregnancy progresses—the weight of the baby compresses your vena cava, the vein that transports blood from your lower body to your heart (or, when you’re lying down, doesn’t so much).

The main reasons for dizziness and fainting are structural pressure, low blood sugar, and dehydration. To stave off the smelling salts, wear loose-fitting clothing, position yourself well when you sit or lie down, get up very slowly, snack often (especially on iron-rich foods) and stay hydrated (electrolyte—laced water is the best: see recipe page 37).

If your heart is beating noticeably faster, this may be due to increased fluid volume, which makes the heart work harder, and shortness of breath can be an inevitable and a very normal course throughout pregnancy. However, if it is a regular occurrence accompanied by dizziness or actual passing out, or if you’ve passed out for more than fifteen minutes at a time, it’s important to check in with your care provider and potentially consult with a neurologist and/or cardiologist.

Other symptoms to watch for include chest pain, incontinence, blurry vision, and vaginal bleeding. Any of the above can be normal but can also indicate something that is worth monitoring closely and looking into more comprehensively if it persists or progresses.

Incontinence

Pelvic floor muscle training is often recommended during pregnancy and after birth for the prevention and treatment of incontinence (both urinary and fecal—and yes, this is unfortunately something you may have to look forward to if you’re among the one-third of women who experience these symptoms post-birth). You can consider going to Pilates or yoga to address “the core,” or start doing traditional Kegel exercises while you are still pregnant.

Kegels involve contracting the pelvic muscles gradually up and back down again, like rungs of a ladder, as if you’re squeezing and holding urine in (but don’t actually do that, since it can weaken the bladder). Hold each contraction for one breath and gradually increase the rungs. Try to practice ten rounds a day. Since practicing is imperceptible to the casual bystander, you can spice up your day by doing several sets of Kegels while you’re doing something banal.

Carpal Tunnel Syndrome

There are a lot of reasons to avoid lifting heavy objects while pregnant, and carpal tunnel is one of them. This pain-in-the-wrist syndrome, often prevalent during pregnancy, can seriously interfere with routine activities. The first indicators can include symptoms such as hand pain or numbness, tingling sensations in your fingers, shooting pain in your forearms, and loss of grip strength or dexterity.

Why is this happening now? Carpal tunnel occurs during pregnancy because with all of the increased pressure and buildup of fluid in your body, there is increased pressure on the nerves that run through your wrists. They are impaired to some extent in virtually all pregnant women during their third trimester. Upper back and neck tension are also implicated, because the seized muscles pinch nerves and further decrease blood circulation to your arms.

Unfortunately, carpal tunnel can persist for months or years after birth, but it usually abates much sooner than that. To help manage your current symptoms and to prepare you for a quick recovery, strategies that I’ve found helpful are massage; acupuncture; yoga that focuses on the upper back, arms, and wrists; and the occasional need for a wrist splint to provide a little extra stability. Since the symptoms are often worse at night, if carpal tunnel is interfering with your sleep, check out the insomnia section for some extra tips.

Although its effectiveness is debatable, vitamin B6 is often used as a therapy in treatment of carpal tunnel syndrome. This might be because vitamin B6 helps the peripheral nerves and circulatory system, or because it can act as an analgesic (pain reliever) by raising pain thresholds. Regardless, if it works, it works. The typical therapeutic dose for addressing carpal tunnel with B6 is 100 mg a day. During pregnancy, B6 should only be taken for seven days in a row, while monitoring for any side effects such as light sensitivity or skin irritation. If these occur, stop taking B6 immediately; the symptoms should go away immediately. Nausea and heartburn can be symptoms of too much B6 as well, but those might be hard to tease out during pregnancy. Ironically, a very high daily dose of B6 (500 mg a day) can cause nerve damage. So, as I always recommend, before you turn to supplements, start with foods that are rich in B6 such as chicken, hazelnuts, salmon, spinach, sunflower seeds, and yams—and, if needed, then try a supplemental B6, taken alongside a B complex or your prenatal vitamin.

The bright side to carpal tunnel? This is a good time to really indulge in minimizing strenuous tasks and engage people to wait on you. May I suggest a bell?

Vivid Dreams

The record of dreaming and dream interpretation dates back to 4,000 BCE, when dreams were documented on clay tablets, and dreams have been used ever since—including in ancient Greece, Egypt, and China—to elucidate parts of the dreamer’s life he or she may not be conscious of. There are some modern studies in neurology, which demonstrate that recalling your dreams relies upon the same mechanisms in the brain as recalling actual memories.

Regardless of this blurred line between waking or sleeping, you’re bound to be bleary with wild and vivid dreams during pregnancy, and whether you think of dreaming as a way to learn more about yourself or just as a time to check out for a while, you may want to keep a journal by your bed to record your dreams. It can provide an interesting additional storyline to your pregnancy.

Practical Baby Preparation

Personally, my approach to baby paraphernalia is minimalist, so I’ve only included the bare essentials on this list. You can, of course, fluff it up with as many things as you need to help you feel comfortable, excited, and prepared. Just bear in mind, there’s a tendency to think you need everything right away, but the truth is that for many weeks, all that baby needs is you (and some essentials). Once the baby is born, you’ll figure the rest out as you go along, so no need to stress yourself out ahead of time.

Bare Essentials Priority Checklist

• Somewhere for baby to sleep (If you are planning to cosleep with your baby, look into cosleeping options for baby’s safety.)

• 1-2 blankets for wrapping or swaddling

• Onesies (You’ll probably change them multiple times a day, so having a week’s worth will minimize constant laundry.)

• Lots of burp cloths (You can use cloth diapers for extra absorbency.)

• Three large boxes of newborn diapers or the equivalent of cloth

• Two diaper covers if using cloth diapers

• Diaper cream

• Unscented baby wipes

• Changing pad

• Socks or booties, pajamas, hat

• Infant car seat, installed

• Baby thermometer

• If you’re breastfeeding: pump, milk storage bags

• If you’re not breastfeeding: eight containers of formula (see resource section for a good quality formula suggestion) and glass or BPA-free 4-ounce plastic bottles with slow flow nipples

• Unscented, perfume/dye-free laundry detergent

• Humidifier (optional but recommended—especially if you live in a dry climate or your baby will be born during the winter)

Birth Plan

While it’s a good idea not to overly anticipate exactly how your birth will go, a birth plan is a wonderful way to dream about your labor and the birth of your child and can be an important medium for clarifying an idea of how you’d like to approach the birth decisions you may be faced with. As you’re sketching out your desires, remember to stay with the idea of flexibility around all the many unknowns that may arise during birth. Be able to trust and invest in the team around you to safely support your preferences.

The Birth Plan

My approach to a birth plan isn’t the standard list of questions about step-by-step planning. In some ways I think that method can set you up for feelings of disappointment or confusion, because the truth is, birth goes how it goes. It doesn’t mean you shouldn’t be educated and map out what you’d like or not like—such as epidural or no epidural, photos or no photos of the actual birth—or abandon hope that your birth will go exactly the way you want. It’s possible that it will, but it’s also important to cultivate a lot of room for encountering the unknown and not only coping, but emerging confident that you had the best process you could have.

Take some time to mull over the following questions. You may be surprised at what you come up with.

1. When you imagine meeting your baby, what does that feel like? How does he or she feel in your arms? What does it feel like to gaze into each other’s eyes? What other images or emotions come up in this fantasy?

2. Do you imagine saying anything in particular?

3. What does the thought of being out of control bring up for you?

4. Can you imagine being wild? What does that look like for you?

5. Do have any fears or feelings of embarrassment when you imagine the birth scenario? Can you imagine letting those go? What would you need to help you let go?

6. Where in your body can you imagine letting go of more tension (even if it seems unrelated to birth)?

7. What fears or anxieties do you have about birth? Can you find where those feelings reside in your body? What do they need to be soothed?

8. What is one thing you absolutely don’t want to happen during birth? If this very thing happened, what would you do to cope?

9. Who would you like at your birth? Be honest with yourself.

10. Who are you going to have with you to represent your desires for your birth and interpret the choices for you as you go along in the birth process?

11. Do you trust and have confidence in your midwife or obstetrician? Is there anything you need to ask them or of them before birth?

Can you tuck your answers to all of these questions and the feelings you’ve connected with away somewhere in your body to draw on if you need some inspiration during the birth process? Can you tell a person who is supporting you during birth to remind you of this “plan” during the birth?

Since birth just goes how it goes, I would suggest that you intend these questions to provoke a deep sense of inner guidance in you and stimulate your preferences while leaving plenty of room for possibility.

Birthing Choices

There is a lot of discussion about natural birth choices versus routine medical interventions for birth, including controversies around the rationale for an increasing rate of caesarean sections in some hospitals. Labor and delivery can be a beautiful experience. Although nobody knows exactly how their birth will go, it can be an empowering experience to think about the elements of your birth process that are important to you and become educated about appropriate ways to modify your original intentions, should medical necessity warrant it. Knowing the difference between medical necessity and convenience is key. Having a competent doula at a hospital birth can free you up to safely explore your birth preferences.

Hospital births are the obvious choice for many, and each hospital has its own aspects and offerings for you to explore. Here are some other birth choices, as well as elements to consider utilizing to enhance your birth process—whether at the hospital or at home. Remember, there is no right or wrong. No matter what or how you choose to approach birth, the important thing is that you feel nurtured and safe.

Nurse Midwife in a Hospital Setting

Certified nurse midwives (CNMs) are trained in both nursing and midwifery and are certified by the American College of Nurse-Midwives (ACNM). CNMs function as primary care providers in hospital settings or birthing centers for women who are not in a high-risk birth category. Nurse midwives work in close collaboration with the OBGYNs at their facility. So, you get the full-fledged Western environment with a slant toward holistic birth methods.

Birthing Center

The ABC’s of alternative birthing centers are that they offer family-centered, home-like, low-technology maternity care. They are free-standing centers—not associated with hospitals—and like any practice based on midwifery, screen to rule out accepting women who are anticipated to have complicated pregnancies or deliveries that require more sophisticated, hospital-based technology (such as twins or breech presentation). If you’re considering giving birth at a birth center, this is something to keep in mind.

Home Birth

For many centuries, of course, births always took place at home. Hospitals with modern technology have enabled safer births for many women and newborns who may have otherwise had less favorable outcomes, but in the last twenty years, many women have begun to revisit their interest in homebirth. They choose home births for reasons such as privacy, comfort, convenience, cultural continuity, and finances, and to ultimately to have a hand in orchestrating their birth and birth attendants in the way they see fit.

Midwives who attend home births are either certified midwives or direct-entry midwives, and they have a larger scope of education and tools under their belt than most people realize. Plus, they typically collaborate with a back-up physician to account for any potential emergencies that may require transport to a hospital during birth. For some, this model can be the best of both worlds.

If you are not in the category of a high-risk birth, the medical literature continues to acknowledge that home births attended by a well-trained midwife typically require less medical intervention and are not associated with higher risks than hospital births. Although there is extensive documentation to support the safety of choosing home birth, each pregnancy and birth carries its own unique parameters and potential risks. Home birth is an extensive topic that deserves to be well researched by you and discussed with health care providers that you trust to best determine if it is the right choice for you.

See the resources section under midwives to links for further exploration of safety and resources for home birth options.

Methods and Tools to Enhance Hospital or Home Births

Water Birth

The American Pregnancy Association recognizes that there are many benefits to water births. Whether you actually deliver in the birthing tub or not, it can be a great tool to ease your labor—literal levity. Since the baby has been floating around in amniotic fluid, a warm tub of water can be a natural and gentle transition. The buoyancy can help your own transitions with positioning and labor stages as well. Bathing is an age-old way to reduce stress, and performing this ablution during birth can soothe and wash away some of your tensions and contribute ease to your birth.

As with anything, there are some potential risks with water birthing that include the baby gasping and inhaling water (which is rare, since their reflex is only to inhale upon exposure to air) or the umbilical cord tearing while baby is being lifted from the water.

A water birth is not a good choice if any of the following conditions exist:

• Bleeding disorders

• Breech presentation

• Copious amounts of meconium

• Pre-existing herpes (enhances the risk of transmission to baby)

• Preeclampsia

• Toxemia

You can rent birth tubs and have them installed, either at home or at the hospital (if permitted), and some centers already have them available. If you’re using a birth tub at a hospital, start the process well in advance of your birth to make sure that you can accommodate all of the red tape.

Overall, there is little difference in danger between babies delivered in water versus out of water. So sink into whatever choice is right for you.

Doula Support

The word doula originated from a Greek word meaning “female servant.” In a more modern sense, doulas provide a wonderful service to women before and during labor, by offering coaching and guidance on self-care throughout your process. A well-trained and experienced doula can also be a great intermediary between understanding and assessing the need for medical interventions in a hospital setting as well as helping you and your partner effectively collaborate during the birth (read: show partner where to rub, and so on).

A postpartum doula can be a delightful and arguably essential addition for your first few days to weeks after birth. They help with cooking, lactation consulting, and monitoring your postpartum recovery, and they will take the night shift so that you can get some sleep. It can be very reassuring to have a competent resource around in the middle of the night as you’re figuring it all out.

Hypnobirthing

Hypnosis has actually been used in obstetrics for over a hundred years, and the modern idea of hypnobirthing continues to be a soothing and efficacious choice for many women approaching and interfacing with their ideas or fears about birth. Hypnobirthing is less about avoiding pain and more about retraining your relationship to pain or sensation. This is a method that aims to connect the mind-body communication so that you really can dream up your birth. This can also be a great resource for women predisposed to anxiety—regardless of the normalcy of having anxiety when initially anticipating birth. This addition to your birth prep can be a great coping strategy and for such a minor intervention, potentially significantly enhance your experience of birth.

A Note on Vaginal Birth After Caesarean Section (VBAC)

Caesarean delivery is the most common operating-room procedure in the United States. But just because you needed or opted for a C-section in a prior birth doesn’t necessarily mean that you need or want a C-section this time. If you’ve previously had a Caesarean section and you want to aim for a vaginal delivery with this pregnancy, it’s called a Vaginal Birth After Caesarean, or VBAC.

Vaginal birth is, of course, more likely to injure your sphincter or cause trauma to your perineum than a C-section, but the benefits of VBACs include:

• Less scarring to the uterus (in case you may want to have more children)

• Reduced risk of infection

• Quicker recovery time after delivery, which can enhance the way you are able to care for your newborn and will reduce your hospital time

• Potential physiological benefits to the baby, including some immune transmission which occurs when passing through the birth canal, which may contribute to a full spectrum of hormone release and make breastfeeding a bit easier (although, many women can successfully breastfeed after C-sections as well)

• If you and your doctor are in agreement about the possibility of a VBAC, you’ll enter a “trial of labor”—meaning you’ll start out with the goal of averting the need for another C-section and see how it goes.

Delivery Prep Strategies

Anticipation of your birth is heightening, and you may be curious about how to prepare. There are many strategies, but the most important is always to take great care of yourself through nutrition, exercise, and rest and to find the balance between preparing for a set of unknowns and surrendering to an inevitable process that will simply go how it will go. Know that the healthier you are, the better it will most likely go.

How you approach childbirth is a choice. How it actually happens may be a bit out of your hands. Whatever you’re feeling, focus on working with your feelings, understanding the origin of any fears you may have, and examining your level of readiness. Keep staying with yourself—nobody else’s idea of how this will be for you is relevant. Each birth is incredibly different, and many women experience relatively pleasurable births. And know that nature has a wonderful built-in mechanism for helping you forget any trauma as soon as you see your new baby. This will imbue you with stamina and joy to focus on the new life you brought into this world.

Parenting Tips

At this point in your pregnancy, you may be thinking beyond the actual birth to the time when you will be a parent. There is no tried-and-true manual for parenting, but there is emerging evidence to support certain healthy parenting techniques. The best advice I’ve ever heard, which seems to be full of good foundational suggestions, comes from the research of John Gottman, a professor emeritus of psychology at the University of Washington. His books Raising An Emotionally Intelligent Child: The Heart of Parenting and And Baby Makes Three: The Six-Step Plan for Preserving Marital Intimacy and Rekindling Romance After Baby Arrives delve into keeping the parental unit strong and healthy to successfully transfer emotional stability to your child and ultimately have a well-balanced family unit.

Checklist for Month Seven

• Investigate birth strategies and choices.

• Develop your “birth plan.”

• Enlist a doula if you’re going that route.