Month Eight

Preparing

WEEK THIRTY-THREE

• Baby has had a big growth spurt from last week to 18 inches and 5 pounds.

• Eyes are opening and closing during sleep and wake cycles.

• Bones are becoming denser.

• Baby is developing more coordinated breathing patterns.

WEEK THIRTY-FOUR

• Baby weighs in about the same a last week.

• He or she is urinating about a pint a day.

• Fingernails and toenails have grown in.

WEEK THIRTY-FIVE

• Baby is still about 18 inches and 5 pounds.

• Hearing is fully developed.

• Liver is now processing waste.

• If you’re having a boy, his testes are descending.

WEEK THIRTY-SIX

• Baby is holding at 18 inches and 5 pounds.

• Skin is smoothing out.

• Gums are more rigid.

• Baby’s immune system has absorbed your antibodies and is prepared for the world.

East-West Fetal Development

This month is associated with the Chinese Large Intestine system. On a functional Western level, the large intestine is about assimilating nutrients and eliminating waste. This month, you and your baby continue to absorb nutrition in preparation for baby to move out. This can be a good time to contemplate what you need to hold onto and what you can let go of in order to assist you in surrendering to the birth process with as few impediments as possible. It’s also worth noting that having a bowel movement is a normal part of the active birth process. So, if you knew this and had any particular reservations, work on letting them go, and if you didn’t know this, now you do!

Bed Rest

Bed rest, of course, doesn’t just mean spa day. It is a medical recommendation that means really only get up to pee and is typically instituted in order to prevent preterm delivery. So, the news isn’t usually celebrated, but if you’ve been put on bed rest, take full advantage of this time (however long it may seem) to catch up on quiet and productive activities that you may not have the luxury of doing amidst the normal bustle—and certainly not once baby arrives. Comfort yourself with the knowledge that you are in the first throes of parenthood, putting aspects of your agenda aside to accommodate someone else’s well-being.

Inflammatory Bowel Syndrome, Crohn’s Disease, and Ulcerative Colitis

Inflammatory bowel syndrome (IBS), Crohn’s disease (CD), and ulcerative colitis (UC) are all gastrointestinal (GI) conditions that can include, with some variances, bowel discomfort and changes, abdominal pain, and abdominal bloating.

Brain-gut interactions are increasingly recognized as paired mechanisms in GI issues, so mind-body medicine such as hypnotherapy and meditation can be useful approaches. Acupuncture has also been studied in the treatment of gastrointestinal symptoms. It works on the brain-gut disturbances and influences the bowels and gut in terms of cramping and acid secretion.

These conditions can be very stressful for you, and they can be stressful for baby too. Some studies have shown that nutritional approaches such as the use of probiotics are not only a possible preventative agent against your GI dysfunctions, but can also provide aid for your baby’s potential stressors. Probiotics have specifically been shown to modulate the sensitive gut characteristics of IBS.

Probiotic-rich foods include kefir, miso, sauerkraut, and yogurt with live cultures. Incorporating soluble fiber in the form of whole grains, fruits, and vegetables can instigate some relief as well. Also, consider approaching your diet with overall anti-inflammatory strategies (see the Easy Anti-Inflammatory Eating Plan for Candida sidebar on pages 110–111) and identifying foods that may exacerbate your condition, such a wheat or dairy. In other words, listen to your gut.

Headaches

Most headaches during pregnancy are just headaches. The management is usually the same as when you’re not pregnant: eat, drink (water, not martinis), and sleep. However, those predisposed to migraines are very sensitive to the hormonal milieu of pregnancy, and if you had migraines before pregnancy, they might very well appear during pregnancy with different patterns than you’re used to. Migraines without auras usually benefit from the spike in estrogen and the decrease in normal monthly hormonal fluctuations. But migraines with auras often don’t improve during pregnancy.

There are also some links between migraines and the potential for an increased risk of developing gestational hypertension or preeclampsia. If your migraines are on the rise during pregnancy, be aggressive about managing your well-being through nutrition and exercise and keep an eye on your blood pressure. Acupuncture works wonders for most migraines.

The silver lining: after delivery, breastfeeding has a bit of a protective effect against migraines.

Baby’s Position

Baby’s position prior to birth is called the presentation of the fetus. As the baby is getting ready for her big debut, she may move around right up until the very last moment, but when the moment does come, some positions are more ideal than others.

The most common and ideal position for labor is called cephalic presentation. This is when the baby is head-down, facing your back, with her chin tucked into her chest. If your baby is already settled in this position at this point, she’ll likely remain here.

Some other positions may indicate a more complicated birth and sometimes call for a cesarean delivery—although remember, babies do still move and adjust during the birth process.

• Occiput or cephalic posterior, or “sunny side up,” is when the baby is head down but facing your abdomen.

• In a breech presentation, the baby’s bottom is down. Coming through the birth canal in this way could increase the chance of forming an umbilical cord loop that could cause injury to the baby during a vaginal birth, but there are still opportunities for baby to turn right up until the end of your pregnancy (although, as space gets tighter, it does decrease the likelihood).

• In a footling breech, one or both of the baby’s feet are at the lowest portion of your uterus. This is a complicated presentation because of the potential impact on the umbilical cord.

• A transverse lie is when the baby is lengthwise in the uterus, making it likely that the shoulder will enter the pelvis first. Most babies in this position need some good maneuvering during the birth process or to be delivered via C-section.

For repositioning, there’s all sorts of folksy advice out there—somersaults in pools, playing music for your uterus, shining a flashlight up there, etc. Honestly, I always encourage you to do whatever does no harm and feels right for you, but the methods that tend to work the most reliably are:

• Your midwife or physician manually tries to shift the baby. This process should be carefully monitored in case it causes complications.

• A Chinese medicine technique of applying an herbal application called moxibustion on a particular point on the little toe has a lot of backing for helping to turn a breech presentation. Start this with your acupuncturist as early in your third trimester as possible.

It is also very important to remember that often, when baby doesn’t turn or shift despite all of your good intentions and coaxing for a vaginal birth, it may be and often is for a good reason. For instance, the umbilical cord may be wrapped around baby in a way that would make shifting dangerous. The most common instance of this is a nuchal loop—the cord wrapped around the baby’s neck. There’s really nothing you can do about a cord knot other than monitor the normal activity of your baby. So, trust in your wisdom, but also the baby’s.

Real, Uncomfortable Weight Gain and Fatigue

It’s important to revisit the concept of fatigue throughout pregnancy. It was probably your central focus during the first trimester, but it can be a growing frustration again at this stage. Some women do still walk marathons in their seventh month, but most are just trying to get through their day awake.

It’s normal to be tired. You are lugging around a lot of extra weight and still, as always during pregnancy, actively contributing to your baby’s growth. There’s no way around this feeling, and giving yourself permission to rest as much as possible is great preparation for the upcoming work of labor, delivery, and breastfeeding. If you feel like your weight is out of bounds, refer back to the section on healthy weight gain to help you further assess other strategies.

Back, Sciatic, and Leg Pain

Because enough wasn’t going on already, let’s add back and ligament pain into the mix! Fifty percent of pregnant women experience some kind of back pain. In fact, it’s the most common reason that pregnancy interferes with work, especially if you have a job that requires either sustained sitting or standing—in other words, pretty much every job. In combination with the structural aspects of carrying more weight and all the physical compensations that start to happen in order to balance this new load, there are hormones (of course) at play that can predispose you to being more susceptible to a lack of stability in your ligaments, and therefore joints—especially pelvic joints.

The Role of Relaxin and Its Effect on the Pelvis and Pelvic Girdle Pain

Relaxin is secreted by the corpus luteum and the placenta and is one of the prevalent hormones during pregnancy. Relaxin is a bit of a euphemistic name, because it’s less like something that helps you kick your feet up and relax and more like something that turns your connective tissue into noodles and creates general instability in your musculoskeletal system—although that’s certainly a good reason to put your feet up too.

Relaxin specifically targets the pubic symphysis and sacroiliac joints. It is helpful later on to assist with cervical ripening and relaxing and opening your pelvis to prepare for birth, but in the meantime, it can predispose you to low back and pelvic aches and pains.

Then there’s pelvic girdle pain, which presents as a persistent pain in the front and/or back of your pelvis. This pain can radiate across your hip joints and thighbones. Symptoms can start as early as the first trimester, at labor, or even begin after birth.

The Tug on the Round Ligaments

The round ligaments, which connect the uterus to the abdomen, bear more weight as your baby grows, and this strain can cause a tugging sensation—like a rope anchoring a sailboat on a windy day—that can feel like pulling, spasms, or cramps. This type of pain is usually found more on your right side because of the general uterine growth pattern.

The Shooting Pain of Sciatica

Sciatica is quite common during pregnancy. Sciatic pain is typically characterized by a one-sided (although, it can be both) shooting, burning pain or tingling sensation from your low back through your gluteus muscles and down your leg, and sometimes all the way into your toes.

Sciatica usually flares up in the third trimester, when baby is positioning himself for birth, which means your little bundle is resting on your nerve bundles. At term, the uterus weighs approximately two and a half pounds, and the baby adds about six and a half more pounds. (If it makes you feel any better, the largest baby recorded in medical literature was twenty-five pounds!) This weight puts direct pressure on the nerve roots in your back—hence, back pain. Unfortunately, severe vomiting earlier in pregnancy can sometimes trigger sciatic pain too.

Pelvic Discomfort and Symphysis Pubis Dysfunction (SPD)

Baby is preparing for her descent down the birth canal by settling lower and lower into your uterus. You may have heard the term “the baby has dropped.” This refers to baby’s head engaging your cervix and comes with some pretty sizeable pelvic, hip, back, and all-over discomfort. It also comes with the exciting news that you’re almost ready to meet your baby!

Even if you’re not having trouble with any of the above, there’s also the mechanics of your abdominal muscles that must stretch to accommodate growth, which causes muscle fatigue and an extra load on your spine.

The most important factor that aggravates low-back and pelvic pain during pregnancy is simply the progression of a normal, growing pregnancy. Many aches and pains may be inevitable throughout certain stages of your pregnancy, but some effective strategies to manage them and possibly reduce the aggravation include pelvic-tilt exercises (which can reduce ligament pain intensity and pain duration) and acupuncture. In the case of the latter, there’s lots of research to show its efficacy in relieving low-back and pelvic pain during pregnancy without adverse side effects, plus it can increase your capacity for some physical activity and help diminish the need for other interventions, which is a big advantage during pregnancy.

For some manual release, prenatal massage with an experienced practitioner can be incredibly beneficial. Other suggestions for relief and strengthening your postural support are a warm hot water bottle on your pubic bone (unless you notice that this creates more feelings of inflammation—then ice it instead), regular stretching and exercise (to whatever extent is available), prenatal Pilates, regular physical therapy, and swimming. A pelvic belt can also apply some compression, which makes you feel less loosey-goosey, and even though it seems like a chastity belt, clearly it’s not.

Often, enduring pain for a sustained amount of time becomes not about the pain itself, but more about the ways that pain interferes with daily functioning, sleep, and mental well-being. If you’re experiencing pain in your pregnancy, this is an opportune time for some nonrigorous breathing and relaxation exercises. Try to avoid prolonged walking or standing—there’s nothing like a midday rest to help you regenerate. The Kidneys control the bones in Chinese medicine and rest fuels the Kidney system and helps you not be literally bone tired.

Differentiating Between Braxton-Hicks and Labor Contractions

Most people are curious what Braxton-Hicks contractions are. First, let’s talk about who Braxton Hicks was. John Braxton Hicks was an obstetrician in the mid-1800s who was also a pioneer in midwifery. He was the first one to describe the rhythmic contractions of the uterus that occur throughout pregnancy (now simply known as Braxton-Hicks).

Most of my patients ask me how they’ll be able to tell the difference between a “real” contraction and Braxton-Hicks contractions. The simple advice is that you’ll just know. Until you have a labor-related contraction, you might think Braxton-Hicks are “real” contractions, but when you have an actual contraction, you’ll quickly feel the difference.

Braxton-Hicks, or preparatory contractions, are true contractions in the sense that oxytocin is stimulating the uterus to contract, just like it does during labor, but these contractions are not strong enough to elicit actual labor. Braxton-Hicks are simply a normal part of the body’s readying for labor. They don’t occur at regular intervals and often dissipate with positional or activity changes. I think of them as an erratic exercise routine—your body is alternately practicing for labor and then getting distracted and going about its day—then realizing again that it’s in training, and doing a little “sprint.”

Remember, your uterus is used to expelling things during menstruation. Now, it is also preparing itself to assist with birth. Incidentally, Dr. Hicks also had a large collection of Wedgwood china, so sit back and relax with some tea while you commemorate how this normal symptom will eventually contribute to shaping your birth process.

Some signs of actual labor onset (more on this in month nine) include contractions that feel like vaginal or menstrual cramps every five to ten minutes or less (more than five contractions in an hour), consistent pain and/or pressure in your back or lower abdomen or pelvis, leaking fluid, and nausea, vomiting, or diarrhea.

It can be confusing, and it’s okay to not be sure. If you need some help clarifying what’s going on, call your provider. Your safety and preparation for birth are always the most important thing.

Preterm Labor

Ready or not, baby may be coming. Labor anytime before your thirty-seventh week is considered preterm labor. It includes symptoms of—you guessed it—labor! These may be all or some of the symptoms you experience:

• Contractions at least every ten minutes

• Persistent backache

• Feeling of baby pushing down on pelvis (because he is)

• Discharge or profuse amounts of water leaking from your vagina (possibly premature rupture of the membranes)

• Spotting or bleeding

• Vomiting and/or diarrhea

Obviously, you and your delivery team will do everything you can to keep the baby in for as long as possible, but if you’re after thirty-four weeks, the evidence points to delivery usually being the most successful route in the face of other threats. Additionally, once your water breaks, you are far more susceptible to infections such as chorioamnionitis—an inflammation of the fetal membranes from a bacterial infection, which is mostly from bacteria coming from the vagina into the uterus. In general, this is why not too many vaginal exams are done later in pregnancy or during labor when the cervix is more open.

During pregnancy, there is a reduction in your stores of an omega-3 fatty acid called Docosahexaenoic acid (DHA), and the synthesis of long chain polyunsaturated fatty acids (LCPUFA) in the baby and placenta is low. So supplementing with up to 1 gram per day of omega-3 LCPUFAs (I recommend erring toward walnuts or flaxseed oil versus sardines since methylmercury exposure from fish can do more harm than good during pregnancy) has shown to potentially increase birth weight. So if you do need to deliver early, baby is at least fattening up! Another nice by-product of this type of supplementation is that it also tends to reduce allergies in babies (and susceptible immunity can of course be an issue with preterm babies).

See No Cons to Probiotics on page 77 to read a bit about their potential effect for preventing preterm labor as well.

The Art of Flattering Photos

If you read this as “fattening photos,” I get it. You may not be feeling your most svelte or photogenic, but try to remember that what’s making you feel somewhat enormous is that healthy baby inside of you. Photography during this time is not to memorialize your idea of your body you once knew, but to capture a time when your body was doing exactly what it was designed to do—and doing it beautifully. There are many wonderful ways to accentuate the beauty of this time. So, be creative with commemorating your body and this important stage in your life.

Checklist for Month Eight

• Stock up on household and baby supplies (see Bare Essentials Priority Checklist on page 155) such as toiletries and natural, unscented laundry detergent.

• Tie up loose ends.

• Make arrangements for your absence at work.

• Organize financial obligations.

• Finalize your intentions/plan for birth.

• Arrange help for after birth.

• Install baby’s car seat.

• Make sure all your ducks are in a row since you’re now in the zone of “anything goes.”