Month Nine
Releasing
WEEK THIRTY-SEVEN
• Baby is 19.5 inches and 7.5 pounds.
• You are officially full term!
WEEK THIRTY-EIGHT
• Baby is 19.5 inches and 7.5 ounces.
• Baby’s head is now filling out your abdomen.
• Head hair is visible on ultrasound (if they’re growing it—plenty of babies are cute and bald).
• Baby is shedding the vernix caseosa.
• Lungs are continuing to mature and produce surfactant.
WEEK THIRTY-NINE
• Baby is 19.5 inches and 7.5 ounces.
• Fingernails and toenails are completely grown.
• New skin cells are beginning to generate.
• Brain is still rapidly developing.
• More fat has been deposited to ready baby for insulation in the world.
• Baby is 19.5 inches and 7.5 ounces.
• All of baby’s bones have solidified (except for the skull, which remains relatively soft in order to make the journey through the birth canal).
• Baby is engaged in birth position and may be on the way out!
East-West Fetal Development
Month nine is associated with the Chinese Kidney system, which is analogous to the endocrine system. This month is a culmination of all of the reproductive processes that have transpired from conception until now, and the Kidneys as much as they are responsible for holding the baby in, also govern the letting go. The element associated with the Kidneys is water. This is a time of going with the flow, so to speak. Very literally, your water will break this month to pave the way for the passage of your baby.
The Kidneys are the most fundamental system in Chinese medicine. This system gives rise to immunity and genetics—all things that you have passed onto your baby. The Kidneys are also associated with winter, so no matter what season it is, this is a good time to go inward and be as dormant as possible in order to build your reserves for birth and beyond.
Hair and Nails
Most people think that hair thickens during pregnancy, but what actually happens is perhaps a little less glamorous: hair just falls out much slower because the increased estrogen delays hair loss. That’s why there’s a mass exodus of your hair during your postpartum period—you’re not actually going bald, just resuming normal hair loss and making up for the ones that were spared during pregnancy.
In Chinese medicine, head hair is associated with the Kidney as well. While you’re storing up all of your reserves during birth, the head hair reflects this with its thickness and shine. After birth, the Kidney system is drained a bit, so the hair falls out. It’s important to nourish and support this Kidney system throughout pregnancy with rest and good food in order to set you up for a healthy postpartum recovery and equip you with all the resources you’ll need for yourself and baby.
HAIR AND NAIL RESTORATION TEA
4 cups filtered water
3 tablespoons each dried oat straw, bamboo leaf, and horsetail*
Directions
Combine herbs and water in a glass jar and let soak at room temperature overnight. Strain liquid and keep in fridge. Drink one cup a day.
NOTE: Do not use horsetail herb if you take an ACE inhibitor for high blood pressure or if you have congestive heart failure, as this combination can cause an excessive accumulation of potassium.
* See the resource section for ingredients for this tea.
Nails do actually grow faster during pregnancy, but can also become more brittle or develop grooves. This echoes back to our discussion about the Chinese idea of blood deficiency in pregnancy. So this can be a great indicator to boost up on iron-rich, or blood-building foods.
Inflammatory Rheumatic Diseases
Rheumatoid arthritis, ankylosing spondylitis. and systemic lupus erythematosus are all conditions characterized by chronic inflammation, joint pain, and swelling. The body’s immune system can also become hyperactive in these conditions, leading to further attack on healthy tissue.
Pregnant women with any of these conditions are capable of having uncomplicated pregnancies, but since the risk for complications is increased, it is advisable to enlist the cooperation of a rheumatologist and nephrologist in addition to your gynecologist. An acupuncturist is a great addition to this team as well.
For all of the above conditions, anti-inflammatory eating strategies can help with management. Combining the following foods in your dishes can sprinkle some potent anti-inflammatory and immune-boosting action into your meals:
• Blueberries
• Celery
• Cinnamon
• Ginger root
• Oregano
• Parsley
• Rosemary
• Shitake mushrooms
Scoliosis
Outside of its potential to increase discomfort as you start to carry more weight, scoliosis has little correlation to difficult pregnancies—or even an increased need for caesarean delivery. But to bolster and strengthen your bones, I suggest you eat mineral-rich broths and calcium-rich foods throughout your pregnancy and find a balance between maintaining mobility and good rest.
Multiple Sclerosis
Multiple sclerosis (MS) is the most commonly acquired neurological disorder affecting young women, but the good news is that it does not usually have a negative impact on pregnancy. Some studies suggest that estrogen exposure during pregnancy may even have protective effects against the disease’s progression.
Other studies indicate that women with MS do have a slightly increased risk for having small-for-gestational-age newborns, but most babies of MS women do not develop MS themselves.
However, if you are on immunomodulatory therapy for MS, you should discontinue it before conception or as soon as you find out (though low doses of prednisone may still be okay).
Coming to Terms with Your Readiness
In 2014, the American College of Obstetricians and Gynecologists (ACOG) released a statement refining some of its previous definitions around full-term birth and estimated dates of delivery (EDD). An excerpt from the ACOG statement reads “Babies born between thirty-nine and forty weeks, six days have the best health outcomes, compared with babies born before or after this period. This distinct time period is now referred to as ‘full term.’”
Of course, the above parameters don’t account for your own feelings of readiness, but anchoring yourself in the thought of what’s optimal for your baby’s health will continue to give you stamina to endure these last weeks. You’re almost there! Most babies come when they’re ready—and most are ready within the timeframe above.
While you are patiently or otherwise waiting for the moment to arrive, see if there are any remaining ways you can nurture yourself and indulge in a little more “me” time. If you’re able to maintain some regular, gentle exercise, all the better for continuing your preparation. Swimming, in particular, can be fantastic right now. Most importantly, rest up. You’ll need all of your stamina for birth and beyond, and you’ll reminisce soon about the opportunity to nap at will.
As uncomfortable as you may be, try to find ways to enjoy and revel in these last moments of your pregnancy, and know that babies typically come when they’re good and ready.
Nesting
Before the baby arrives is the best time to get your home to a place that makes you feel comfortable and cozy. After birth, you’ll be grateful to have your home ready to receive not just baby, but you.
I recommend lining up some help with food and daily duties, or even creating your own food stores of the stuff you love to eat that’s geared toward nourishing you in your postpartum phase. Refer to month ten for some recipes that you can prepare in advance and freeze.
Evaluating Birth Interventions
When evaluating birth interventions such as epidurals and C-sections, the first factor in your decision is of course your own and your baby’s safety. I’ll present some information about potential risks, but remember that there are also numerous advantages to any of these interventions, depending on your unique situation and needs. Always weigh the information below against your own value system and your evaluation with your healthcare providers.
Primary obstetrical interventions during labor and birth include electronic fetal monitoring (EFM), epidural analgesia, labor induction, two types of delivery instruments (forceps and vacuum), and caesarean section (See more on C-section and VBAC on page 161).
Electronic Fetal Monitoring
Electronic Fetal Monitoring (EFM) is done with elastic belts that use Doppler technology to tell you more about what’s happening with your baby during labor, specifically with changes in the heartbeat. The disadvantage is that it can restrict your movement and ability for positional changes during labor, which can potentially interfere with the progress of labor. This process can also be done through periodic auscultation, or listening.
Epidural
About 50 percent of women who give birth at hospitals choose epidurals for pain relief. An epidural is a local anesthetic that significantly dampens, but doesn’t usually completely diminish, sensations by blocking nerve impulses that govern the lower half of your body. In order to decrease the medication dose that’s required for the local injection, epidurals are often combined with narcotics or other medications to prolong the epidural’s effect.
You can also get a “walking epidural,” which is an initial injection of pain relievers and a catheter that will enable easy placement of an epidural later, if it becomes necessary.
Epidurals can cause your blood pressure to drop and confine you to one position, which may ultimately slow or stall labor and potentially lead to interventions such as a C-section, but on the other hand, they can also allow you to rest and cope. Many women have positive experiences with epidurals, reporting that it allows them to enjoy the birth of their baby. As with any of these aspects of pregnancy and birth, whether or not to get an epidural is a very personal decision made on the backdrop of your life, your unique definitions of well-being and the actual course of your birth.
Forceps and Vacuum
In experienced hands, forceps or the vacuum method can be tools to help reposition the baby for a vaginal delivery and potentially avert the need for C-section. These two interventions are comparable to each other in terms of safety, and the overall safety for successful birth is very good—the controversy being potential damage to the baby in the process.
Labor Induction
Labor induction to promote uterine contractions is common in 30 percent of pregnancies. You and your healthcare provider should make the assessment together about whether to continue to wait for natural labor or utilize an induction method, but some evaluations that may help your decision-making process include:
• A fetal nonstress test to assess if the baby is receiving enough oxygen
• Stability of your blood pressure
• Sufficient amniotic fluid levels (low amniotic fluid is called oligohydramnios and too much is called polyhydramnios)
• Whether your amniotic fluid membrane, or “water,” has broken
Abnormalities in any of these areas can be legitimate reasons to consider natural, manual, or medication-based labor induction methods.
Natural Labor Induction
Some natural induction options which can be effective for safely kick-starting labor are acupuncture, transcutaneous nerve stimulation (TENS), and intercourse with ejaculation of sperm—all of which promote the release of prostaglandins, which are in part responsible for cervical ripening. Additionally, nipple stimulation via massage, sucking, using a breast pump, or a warm compress for an hour three times a day helps stimulate oxytocin (a hormone necessary for uterine contractions).
There are also a few age-old plant-based approaches to helping labor along. The most widely used is evening primrose oil: two 500 mg capsules taken twice a day, plus one capsule inserted as a vaginal suppository at night beginning at week thirty-six may contribute to cervical ripening.
Castor oil has also been used since ancient times to induce labor. It induces prostaglandin stimulation through its laxative and uterine-relaxant effects, but it also contains ricin, which is a potent toxin. I personally don’t feel this is worth the benefit of the prostaglandin stimulation that you can get in safer ways through the above modalities.
Black cohosh and blue cohosh are also common remedies, but have been associated with some adverse effects. Black cohosh, although it can relax the uterine muscles, contains salicylic acid (the same compound found in aspirin), so it can contribute to an increased risk of bleeding, both herbs may contribute to elevated liver enzymes (which is something usually monitored during late stages of pregnancy), and interfere with the way the body processes other herbs and supplements you may be taking. If you are working with a midwife, they will be able to advise you about these methods.
Manual Labor Induction
Manual labor interventions, usually done by a midwife or physician, include rupturing the membranes—a manual way to help the water break. The mechanism is similar to some of the natural options in that local pressure stimulates the release of prostaglandins. Most studies show that this is most effective when combined with oxytocin.
The risks associated with rupturing the membranes include infection, abnormal bleeding, and placental disruption.
You can also opt for a hygroscopic dilator—basically a balloon-like device that expands the cervix and provides mechanical pressure. There are natural versions, such as Laminaria japonicum (a seaweed), and synthetic versions, such as Lamicel.
Medication-Based Labor Induction
Pharmacologic agents useful for cervical ripening and labor induction include prostaglandins, misoprostol, mifepristone, relaxin, and oxytocin (also known as Pitocin). These are mostly used when the cervix is already ripe.
In the broad research of low-risk pregnancies, medication-base labor induction shows a higher correlation with the need for the use of either forceps, vacuum, or C-section—and higher rates of episiotomies with more severe tearing. Additionally, mothers who receive labor pain medications (which are often combined with induction drugs) are more likely to report a delayed onset of lactation, regardless of delivery method.
If you choose the medication-based route and have any negative associations or physical repercussions from your birth, know that every mother does the best she can during birth, and that it is impossible to predict the outcome, despite your best decision-making efforts. With the help of the ones you trust, make the best decision that you can make, and strategize about how to move on from there and continue to have the postpartum experience and long life ahead of you and your baby that you desire.
Group B Strep (GBS)
If you’ve had a history of recurrent yeast infections or urinary tract infections, premature labor, or water breaking before contractions start—or if you have already had a baby who became infected with group B strep (GBS)—you may be particularly predisposed GBS. A simple vaginal culture can be done anywhere from twenty-six to thirty-six weeks to determine if you are positive. I recommend doing it closer to the thirty-six-week mark, since things can change in the last weeks of pregnancy, and that will give you more current information prior to birth.
But group B strep is a tricky one, because it is often a part of normal vaginal flora. You don’t necessarily want to jump to advanced interventions such as C-sections just because GBS is present, since only about 1 percent of newborns actually contract it from the active mother.
If you have a propensity toward yeast or urinary tract infections, in addition to good hygiene, the best prevention you can try is to bolster your immune system with probiotics and rest. As long as your water hasn’t broken, you can also use a vaginal suppository of goldenseal (one of nature’s antibiotics) each evening, beginning at week thirty-four.
If you are positive for group B strep, it’s crucial that the baby is born within twenty-four hours of your water breaking, to minimize the complications that can arise in newborns—some of which include meningitis, loss of sight or hearing, and kidney damage.
If this is a subsequent pregnancy for you, the medical community says once GBS positive, always treat as if you were, which means a standard course of antibiotics. However, you may want to consider evaluating this option against what’s actually happening (read: insist on test for GBS).
Signs of Labor
Baby Dropping
“Dropping”—one sign that your body is preparing for birth—means that the baby is settling into your pelvis and her head is most likely engaging with your cervix, in preparation for the trip through the birth canal. You may notice that you have a little more room to breathe now! So, take a few breaths as you prepare for birth. Baby is coming soon.
Mucus Plug
The mucus plug is a layer of mucus that blocks the cervix and protects against bacteria entering the uterus throughout your pregnancy. When your cervix begins to dilate to prepare for birth, the mucus plug is discharged. It can be clear, pink, greenish, or slightly bloody, and means that you’re on your way toward labor—eventually (it might still be days away). Don’t be discouraged if you lose your mucus plug but nothing happens immediately. Some women don’t even notice the passing of their mucus plug. If you do notice that you have passed your mucus plug prior to the thirty-seven-week mark, check with your provider to troubleshoot any warning signs of preterm labor.
Braxton-Hicks and Labor Contractions
(See Differentiating Between Braxton-Hicks and Labor Contractions in month eight.)
Effacement
Effacement—often called “cervical ripening” or “cervical thinning”—happens as you get closer to the delivery time. The baby engages with the pelvis, and the cervix (which connects the uterus to the vaginal canal) begins to soften and shorten. Throughout your pregnancy, the cervix is about two to three centimeters; by close to birth, it will be about one centimeter (aka 50 percent effaced). Eventually, when your cervix is 100 percent effaced, it will start to open and you will give birth—simple!
Cervical Dilation
When the cervix begins to open, it’s called dilation. Typical cervical dilation and labor follows this pattern:
• Latent phase: 0 to 3 centimeters
• Active labor: 4 to 7 centimeters
• Transition: 8 to 10 centimeters
• Complete or ready for birth: 10 centimeters
Water Breaking
You’ll most likely know if your water has broken, but to give you a sense, it can be a trickling or a large gush of fluids—as if you’ve wet yourself, which you have, just not in “that” way. During pregnancy, it isn’t uncommon to have some urinary incontinence, especially from anything that causes a down-bearing pressure, like coughing or laughing, but urine has more of an ammonia smell than when your water breaks.
You are more susceptible to infection while you are pregnant, so never use a tampon to contain fluid. If you suspect that your water may have broken during intercourse, do not introduce anything else into the vagina at this point, in order to prevent infection.
By the way, if you’re reading this right now, and this has already happened, I am wishing you well, as you are about to deliver your baby!
A Note on Baby’s Size
Barring any of the positional changes that we discussed in the last chapter, or health concerns that may lead to certain proportional changes in baby, I’ve rarely seen a woman whose birth canal can’t accommodate the size of her baby. Many women get nervous about birthing a large baby, but in the throes of labor, there’s really no difference between a couple of pounds. Just remember, it’s not the size of your visible hips that matter; your pelvic outlet opens as much as baby needs it to. So, if you’re aiming for vaginal birth, go for it. There are always options along the way to assist you in the ultimate goal—a healthy and safe delivery for you and baby.
Herpes Syndrome and Relevance to Birth
Herpes, specifically herpes simplex virus type 2 (HSV-2), is one of the most common sexually transmitted infections. If you have it, it’s important to monitor it with your healthcare provider throughout your pregnancy—especially as you near birth, which is the most likely time the virus can potentially be transmitted to the baby.
You can draw on an ancient Egyptian lore: propolis. If you’re having an outbreak, some clinical research shows that applying a propolis ointment (see resource section for a recommended brand) significantly improves healing of recurrent genital lesions caused by HSV-2 and may even help heal lesions faster than the acyclovir ointment (a prescription antiviral medication).
A side NOTE: Pemphigoid gestationis (PG) is a rare autoimmune disorder of pregnancy. It was originally named herpes gestationis because of the similarity of the blisters, but this condition is not related to herpes virus infection and is usually treated with corticosteroids.
If you have a history of recurrent genital herpes, you may want to consider opting for an oral antiviral medication from thirty-six weeks on as a preventative measure, but if there’s no visible outbreak around delivery time, the risk of your baby contracting the virus is less than 1 percent. If you do have an active outbreak or impending symptoms such as tingling, burning, or pain, this could warrant a C-section. Always discuss the nuances of herpes and the health care considerations and treatment options with your provider.
By the way, even cold sores on one’s mouth can be dangerous to a newborn. So, be sure you (and anyone your baby comes into contact with) are aware of this. Cold sores can benefit from the same propolis-based ointment noted above (apply five times daily at the start of symptoms).
Cytomegalovirus
Cytomegalovirus is in the same family as herpes, a name which literally means “to creep,” a reference to this family of viruses being latent until provoked by things such as stress, fatigue, or exposure to someone else with the virus. It is shared through fluids such as saliva and urine. So, this is mostly an issue after baby is born, and although it is recognized as the leading infectious cause of some congenital issues such as hearing, vision, and brain damage, most babies who are born with cytomegalovirus never develop symptoms or complications. There are no readily available Western treatments, so again we turn to the age-old remedies of boosting up our immunity and, of course, hygiene.