42 Weeks Pregnant

If you are 42 weeks pregnant and there is still no delivery, we are talking about postdates.

Your prolonged pregnancy could be associated with hereditary factors, features of your endocrine system, a first pregnancy, incorrect calculation of your due date due to irregular menstrual cycle, psychological problems (terrifying thought of giving birth, pain in labour, worries about the baby’s well-being, etc.)

According to medical statistics, most babies born as a result of prolonged or rescheduled pregnancy are in good health and do not lag behind their peers in development.

Fetus at 42 weeks gestation

Exactly 40 weeks ago, conception occurred – fertilization of the female germ cell by a sperm cell after ovulation and fixation of the embryo (blastocyst) in the uterus of the future mother. This is when the development of the embryo began. Now it is the 42nd week of pregnancy and the fetus continues its growth.

Based on these large sizes, doctors might start to insist that it is time for childbirth. Otherwise, both mother and baby may suffer increased risk of complications. Often doctors advocate for the medical induction of labour.

• The head of the fetus is already firmly established in the pelvis area – it is pressed against the pelvic bones of the mother. His/her body begins to accumulate stress hormones produced by the adrenal glands. Those hormones will help your baby to overcome all the difficulties of childbirth.
• An alarming process of overdue pregnancy is the hardening of the bones of the skull. By design, they are supposed to remain soft and flexible as well as having large enough sutures and fontanelles until birth. The flexibility of the bones allows the baby to pass painlessly and easily through the birth canal, without trauma. The hard bones of the fetal head could increase the chance of the labour’s failure to progress (the head will get stuck in the birth canal) or the chance of severe vaginal or cervical trauma.
• The fetus becomes large and the shoulders are getting wide. This could lead to a medical emergency during labour called shoulder dystocia, when the shoulders get caught in the birth canal after the head is already born, creating sudden low oxygenation which causes fetal distress and could damage the brain. There is also the risk for severe trauma to the mother’s vagina.
• The placenta is getting old and calcified. It cannot continue to properly supply the oxygen and nutrients to the baby, which leads to fetal intrauterine distress and hypoxia.
• Amniotic fluid around the fetus decreases in volume, with several negative effects including: increasing the pressure on the umbilical cord, decreasing the protection from sudden hits or movements, decreasing the thermoregulation for the baby, and irritating/drying the baby’s skin.
• A hypoxic baby could start to pass meconium (fetal feces) in the amniotic fluid, leading to meconium aspiration, pneumonia/pneumonitis, and lung damage.
• An overdue fetus could have dry and wrinkled skin, which is no longer protected by the original lubricant (vernix), as well as overgrown nails on the hands and feet, and excessive activity/stress due to lack of oxygen.

Feelings and changes in 42 weeks of pregnancy

At this time, the mother’s body continues to prepare for childbirth. The pelvic bones are being pushed apart little by little every day to give a growing baby more room. Because of this, the woman increasingly suffers from aches and pains in the perineum area and her pelvic bones. The belly, which has reached its maximum size, presses heavily on the lower back and the bladder. The return of the venous blood from the low body is restricted by the enlarged uterus, so the legs becomes very swollen.

The harbingers of imminent labor become stronger every day: Braxton Hicks contractions become more intense. Colostrum (the initial milk that will be needed to nurse the baby in the first days of life) is secreted from your breasts. It becomes increasingly difficult to move around and stay mobile. The pregnant woman feels very tired, weak and drowsy. In the last days preceding delivery, the baby in the uterus puts so much pressure on the bladder that the woman is relentlessly running to the bathroom or might have some episodes of urinary incontinence.

At 42 weeks of pregnancy, fetal motor activity is reduced compared to earlier periods, and its actions are not as sharp due to the larger size and not enough room inside the uterus. The expectant mother should monitor fetal movements.

Medical supervision

At the end of the pregnancy (after 36 week of gestational age) a woman must see her obstetrician once a week for the antenatal visit. After the due date, if there are no labour signs, the doctor should arrange a number of tests to check the baby’s well-being:

• The amount and quality of amniotic fluid;
• The thinning of the placenta and its deformation;
• The presence of meconium (fetal feces) in the amniotic fluid;
• Fetal heartbeat rate and rhythm;
• Degree of shortening and opening of the cervix;

At 42 week of gestation age the baby would have to be assessed with Biophysical profile (BPP) again.

Score 8 out of 8 will be reassuring for the fetal well-being and ability to go through the labour process.

Obstetrical intervention

In most cases at 42 weeks of pregnancy, the obstetrician decides to medically induce labor and will book you for the induction of labour at the hospital. This is the point when further pregnancy could be life-threatening for the mother or baby. Your doctor will determine whether the delivery will take place through the birth canal or by cesarean section, depending on your risk factors and the baby’s well-being. If serious complications arise, a cesarean delivery may be scheduled.

Recommendations for expectant mothers

• Medical supervision at this term is very important, so it is necessary to be constantly under the supervision of a doctor. It is important to attend all appointments and examinations on time.
• Try not to overdo it with physical activity. At this stage it is time to forget about training in the pool or in the fitness room. But walks in fresh air should become a habit (for both physical and psychological/emotional reasons!).
• Do not panic because of the long wait to see the baby. For parents who are expecting, these are the last days that they can devote to each other. You need to remember that childbirth is a natural process, and it does not tolerate haste.
• If the examinations show that the fetus is postdated and it is necessary to induce the birth process, the obstetrician will recommend several methods to start with. These include long walks, enemas with castor oil, nipple massage and sexual intimacy.
• It is necessary to be prepared for childbirth in advance: pack your suitcase accordingly with the list you received from your obstetrician and keep it in an accessible place, organize the room for the baby and your breastfeeding spot, organize the babysitting arrangements for the other children, if any, in case you would have to go to the hospital in the middle of the night, pack your cord blood collection kit, if you are planning to save the cord blood, discuss your husband’s involvement in the labour process and support him in his concerns and worries.
• Do not go out alone for a walk or a trip. Whenever you leave home, take your medical records, documents and phone with you.

Nutrition before childbirth

By the 42nd week of pregnancy you are most likely very tired of being pregnant and do not feel well. To avoid aggravating your condition, to give your body energy and strength for the future birth, you need to eat a proper and balanced diet. Your food should be light and quickly digestible. The diet should include vegetable salads, fresh carrot juice, linseed decoction, as well as foods containing protein – beef, fish and chicken. At this time, you should not eat too many dairy products, so as not to accelerate the process of hardening of the baby’s cranial bones.

Drinking regime should remain the same: about 1-1.5 liters of water without gas (non-sparkling), morsels, compotes from dried fruits, green tea.

As before, alcohol, soda and coffee/caffeinated drinks are not recommended, as well as fast food, smoked foods, pickles, fried and fatty foods. You should reduce the amount of salty food in your menu, because it retains fluid in the body and causes edema. Buns and sweets should be excluded, to avoid further baby growth and weight gain, as well as blood sugar derangements.

Many pregnant women in the late term sometimes feel nauseous and have heartburn. Eat small portions, while increasing the number of meals to 6-7 per day. It is best to steam, bake or stew your food. After eating, avoiding lying down for 2-3 hours (keep gravity as your friend, keeping stomach contents down rather than refluxing).

When to go to the hospital

The 42nd week of pregnancy can suddenly be interrupted by labour and delivery. In some situations, the process is so rapid that the mother-to-be may be confused. In order to reach the labour and delivery floor in time and get qualified medical help, a woman should know the signs of real labour or the red flags that should prompt immediate medical attention:

• When a large amount of bright red blood suddenly appears from the vagina (it is possible that the placenta got detached from the uterus – a medical emergency!!!);
• If there is leakage or sudden outflow of amniotic fluid and there are no contractions, and the fluid is anything other than a clear color (yellow, green or “pea soup-like”) and/or a foul odor to the fluid;
• If your contractions start spontaneously and got regular and more intense (50-60 sec long and 5 minutes apart);
• If you do not feel your baby at all for the last 6 hours, or the kicking is much decreased in last 12 hours;
• If you have symptoms of pre-eclampsia – nausea, vomiting, fainting, swelling of arms and legs, high blood pressure, intense headaches;
• If there is acute pain in the uterus that is not easing up after 5 or more minutes (could be a sign of uterine rupture – a medical emergency!!!);