After day 280

You have reached the end of the daily entries. Tomorrow is your due date, 40 weeks 0 days, and your baby may already be in your arms, may arrive tomorrow, or may take another week or two. These chapters take you through what comes next: waiting past your date, labour and birth, the first days, and the weeks that follow.

Going past your due date

Most first babies arrive after their due date, and that is normal. A pregnancy is considered term from 37 to 42 weeks, and around one in five continues into the 41st week. Your body is not failing; the date was always an estimate.

From around 40 or 41 weeks your care provider will talk with you about the options. These usually include:

A membrane sweep. During an internal examination, your midwife or doctor runs a finger around the cervix to separate the membranes from it. This releases hormones that can start labour within a day or two. It can be uncomfortable and cause some spotting, and it may be offered more than once.

Extra monitoring. If you choose to wait, you may be offered checks of your baby's heart rate and the amount of fluid around your baby, often twice a week.

Induction of labour. Labour is started with medication that softens the cervix (a pessary, gel or tablet), a small balloon catheter, breaking the waters, and a hormone drip, usually in some combination. Induction is commonly offered between 41 and 42 weeks, because the risk of stillbirth rises slowly after 41 weeks. It is your decision, and it is reasonable to ask what each option means for you.

While you wait, keep doing what helps: walk, rest, eat well, and keep paying attention to your baby's movements right up to and during labour. Call your care provider straight away if your baby moves less than usual, if your waters break, or if you have any bleeding. A slowing baby is not normal at the end of pregnancy.

People will ask if the baby has come yet. A short message you can send to everyone at once ("No news yet, we will tell you when there is") saves a lot of energy.

Labour and birth

Labour is the work of opening the cervix, moving your baby down and out, and delivering the placenta. It is described in three stages, with an early phase before the first.

Figure 7. The stages of labour and how far the cervix opens, drawn to scale.

Early (latent) labour

Early labour can last hours or days, especially with a first baby. Contractions start irregular and mild, then grow longer, stronger and closer together as the cervix softens, thins and opens to about 4 to 6 cm. You may lose the mucus plug (a "show", often streaked with pink or brown) and your waters may break, though for many people they break much later. Home is usually the best place for early labour. Eat light food, drink to thirst, rest or sleep between contractions if you can, and use warm showers, a birth ball, walking and massage. Time your contractions from the start of one to the start of the next.

When to call or go in

Your care provider will give you their own guidance. A common rule for a first baby is to call when contractions come about every five minutes, last about one minute, and have done so for about an hour. Call sooner, whatever the timing, if:

Your waters break, especially if the fluid is green, brown or bloody, or smells bad.

You have bleeding that is more than a streaky show.

Your baby is moving less.

You have constant severe pain, a fever, or you feel something is wrong. You are planning a home birth, have had a fast labour before, live far away, or are Group B strep positive.

Figure 8. How to time contractions, and the 5-1-1 cue.

First stage: active labour

In active labour the cervix opens from about 6 cm to 10 cm (fully dilated). Contractions are strong and regular, every two to three minutes, and need your full attention. For a first baby this stage commonly lasts around 8 hours, and rarely more than 18; later labours are usually shorter. Your baby's heart rate will be checked regularly, either every so often with a handheld device or continuously with a monitor, depending on your situation. Keep moving and changing position if you can: upright and forward-leaning positions use gravity and give your baby room. Empty your bladder every hour or two. Sip water.

Near the end of this stage, often called transition, many people feel shaky, sick, overwhelmed, or sure they cannot go on. That feeling is a sign the birth is close.

Pain relief

There is no right or wrong way to manage pain in labour, and you can change your mind at any point. The options are often grouped like this: Option What it is Things to know

Having support from one continuous person, whether a partner, friend, doula or midwife, is one of the best-proven ways to have a shorter, more positive labour.

Second stage: pushing and birth

Once the cervix is fully open, your baby moves down through the pelvis. Most people feel a strong, involuntary urge to push, like needing to have a bowel movement. This stage can take minutes or a few hours; with an epidural it is often longer, and it is fine to wait for your baby to descend before pushing.

As the head crowns, you will feel an intense stretching or burning. Your midwife or doctor will guide you to push gently or breathe your baby out slowly here, which helps protect the perineum. Warm compresses at this point also reduce tearing. Many people have a small tear; most heal well on their own or with a few stitches.

Sometimes help is needed: forceps or a vacuum cup (ventouse) to help your baby out, or a caesarean birth if labour cannot progress safely. These are common, and your team should explain what they recommend and why.

Third stage: the placenta

After your baby is born, the placenta separates and is delivered, usually within an hour. Most people are offered an injection of oxytocin as the baby is born to speed this up and reduce heavy bleeding. Clamping of the umbilical cord is usually delayed for at least one minute while your baby is healthy, which gives your baby extra blood and iron.

Caesarean birth

About one in four or five babies is born by caesarean in many countries, some planned and some decided during labour. You are usually awake, with a spinal or epidural anesthetic, and your partner can usually be with you. The operation takes about 45 minutes, and your baby is typically born within the first 10. Skin-to-skin contact in the operating room is often possible, so ask for it. Recovery takes longer than after a vaginal birth: plan on help at home, no heavy lifting for about six weeks, and pain relief taken regularly for the first days.

The first hours and days

The golden hour

If you and your baby are well, your baby is placed straight on your chest, skin to skin, dried, and covered with a warm blanket. Skin-to-skin contact steadies your baby's temperature, heart rate and breathing, and helps start breastfeeding. Routine checks can wait; most babies will move toward the breast and try to feed within the first hour.

Your baby's condition is scored at one and five minutes after birth (the Apgar score), usually without disturbing you. In the hours that follow your baby will be weighed, and you will be offered a vitamin K injection to prevent a rare but serious bleeding disorder, and often eye ointment. A full newborn examination happens within the first few days.

Feeding

Your first milk, colostrum, is thick, yellow and small in volume: a newborn's stomach holds only about a teaspoon on the first day. Babies commonly feed 8 to 12 times in 24 hours, including at night. Your milk "comes in" around days two to four, and your breasts may feel full, warm and heavy.

A good latch should not be painful after the first few seconds. Pain, cracked nipples, or a baby who seems unsatisfied after most feeds are reasons to ask for help from a midwife, nurse or lactation consultant early, not later. If you are formula feeding, make each bottle up fresh following the instructions exactly, and hold your baby close for feeds too. Signs your baby is getting enough: by day five or so, at least six heavy wet diapers a day, yellow stools, and steady weight gain after the first few days. Most babies lose some weight at first and are back to birth weight by about two weeks.

Your body after birth

Bleeding (lochia) is heavy and red for the first few days, then turns pink, brown and finally creamy over four to six weeks.

Afterpains are cramps as the uterus shrinks, often strongest during breastfeeding.

Your perineum may be sore and swollen. Ice wrapped in cloth, rest, keeping stitches clean, and pouring warm water over yourself as you pee all help. Drink plenty and eat fibre to make the first bowel movements easier.

Night sweats and big emotions are common as hormone levels drop. Get help right away if you have heavy bleeding that soaks a pad in an hour or passes large clots, chest pain or difficulty breathing, a severe headache, a fever, a painful swollen leg, or wound or tear pain that gets worse rather than better.

Your baby in the first days

Newborns sleep a lot, between 14 and 17 hours a day, in short stretches. Always lay your baby on their back to sleep, on a firm flat surface in their own crib or bassinet, in the same room as you, with no pillows, bumpers or loose bedding. Never sleep with your baby on a sofa or armchair. Many babies become a little yellow (jaundiced) in the first week. Mild jaundice is common and fades. Call your care provider if your baby is very yellow, the yellow appears in the first 24 hours, or your baby is sleepy and hard to wake for feeds. Call urgently for a temperature of 38 °C (100.4 °F) or more, breathing that looks like hard work, or a baby who is floppy, unusually pale or blue, or has fewer wet diapers.

The fourth trimester

The first twelve weeks after birth are sometimes called the fourth trimester. Your baby is adjusting to life outside, and you are recovering from pregnancy and birth while learning a whole new person. It is a lot, and it is meant to be shared.

Recovery takes longer than six weeks

The traditional six-week check marks when your uterus has returned to its usual size and most bleeding has stopped, but many people take months to feel like themselves. Rest whenever your baby sleeps if you can, accept every offer of food and help, and keep visitors short. Start gentle pelvic floor exercises in the first days, and build up walking gradually. Wait for your care provider's go-ahead before high-impact exercise, usually not before 12 weeks.

Sex can resume whenever you feel ready and bleeding has stopped. You can become pregnant again before your first period returns, so talk about contraception before you need it.

Feelings

Up to eight in ten new parents have the "baby blues" in the first two weeks: tearfulness, irritability and anxiety that come and go and fade on their own. If low mood, anxiety, intrusive thoughts or not being able to enjoy anything last more than two weeks or start later, it may be postpartum depression or anxiety. These affect about one in seven birthing parents and many partners, and they are treatable.

Get help right away if you have thoughts of harming yourself or your baby, feel confused, or see or hear things that are not there. Tell your care provider, call your local emergency number, or go to the nearest emergency department. This is a medical emergency, not a failing.

Your baby in the early weeks

Crying usually increases from about two weeks and peaks around six to eight weeks, then settles. Some evenings will be long. Holding, rocking, white noise, a walk outside and a change of arms all help. If you ever feel you might lose control, put your baby down safely in the crib and step away for a few minutes. Never shake a baby.

Your baby will have regular checks of weight and development and will start vaccinations, usually from about two months. Somewhere around six weeks, you will likely see the first real smile, and the world will feel different again.

Looking after the people looking after the baby

Partners need rest, food and someone to talk to as well. Divide the night if you can, so each of you gets one longer stretch of sleep. Keep up the habits that helped in pregnancy: water, decent meals, daylight, and short walks. About 280 days before your baby arrived, this all started with a single day on a calendar. Now there is a person who knows your smell, your voice and your heartbeat. Be kind to yourselves. You are learning together.