What to expect in the ninth month of pregnancy

Your baby

At this stage, the chances of survival are high, but a premature birth may still need medical care; the organs, especially the lungs, are continuing to mature. Your baby is starting to look like the baby you picture: fat is building under the skin, which is losing its wrinkled appearance, and as your baby becomes plumper, the lanugo — the fine down covering the body — gradually disappears, as does the vernix, the white, waxy substance that protects the skin in the womb.

Your baby now measures around 45 cm from head to toe and weighs about 2.4 kg.

By now, your baby will usually have settled head down — known as a cephalic presentation. There is less room to wriggle, with arms crossed over the chest and legs tucked up. This does not stop those little kicks you can feel, and sometimes a small bump may appear under your ribs.

The weight of your baby is beginning to tell in your lower abdomen. Your baby may move down into your pelvis earlier or later; this often happens early in a first pregnancy and can happen later, sometimes during labour, in later pregnancies.

You may feel very heavy indeed: you can have stretching, tension and even pain low in the abdomen, explained by your pelvis gradually widening as its joints loosen to make room for your baby to pass.

To counterbalance the weight of your bump, your spine curves more, so you are effectively more arched, and your back aches while moving around becomes increasingly difficult.

On top of this, you are tired but may find it hard to sleep, not least because of the discomfort and perhaps a few anxieties.

The ninth month also brings your final scheduled antenatal appointment. This is when your team checks that the end of pregnancy is going smoothly: your baby's development and the size of your uterus, your baby's position and estimated weight, your blood pressure, and whether there is protein in your urine. In short, it is a check on the health of both you and your baby. You may also discuss the birth: your birth plan, an epidural, the appointment with the anaesthetist and returning home.

Now is the time to pack your hospital bag and your baby's clothes and essentials. Make sure the nursery is ready for your baby and that everything is in order at home. As for the room, it does not need to be perfect. A cot that meets safety standards, with a firm, fitted mattress, no pillow and a room temperature of around 19°C — those are the essentials. The rest can wait.

It is not always easy to know when to set off for the maternity unit. It is common to have irregular contractions that do not mean it is time. So there is no need to rush to the unit at the first contraction: you may be sent home until labour is properly under way, or later.

Pay attention to how you feel. Before labour begins, it is common to notice early signs such as nausea, marked tiredness and, of course, the loss of your mucus plug. A word on the mucus plug: it is a gel-like plug that seals the cervix throughout pregnancy. Losing it does not mean labour has started, unlike your waters breaking. It can be a sign that labour is approaching, but it may happen days or weeks before the birth, or even during labour; on its own, it cannot tell you that birth is imminent. Many mothers-to-be do not even notice it, so there is no need to worry.

If your contractions start to become regular, labour is beginning gently. Again, there is no need to hurry, especially with a first baby: hours can pass between these contractions and the birth itself. They will first become closer together, longer and more painful. Once they are regular, note the time between contractions.

If this is not your first baby, it is better to go to the maternity unit as soon as contractions become regular: a second labour is usually much faster than the first.

For first-time mothers, pay close attention. Contractions may seem to grip the whole lower abdomen, spreading to the back; they build gradually to a peak and then ease off for a few minutes. You may feel your bump harden with each contraction. Labour has begun. This is the time to use the breathing techniques you learned in antenatal classes: try to relax and release your muscles rather than tensing up.

In practice, your maternity unit will give you its own instructions; go when contractions become regular and close together according to its advice. If your waters break, however, that is the signal to go to the unit immediately, regardless of whether contractions are regular or whether you can feel them at all. The sac of amniotic fluid protects your baby from the outside world, so it is important to set off as soon as it has ruptured.

Once you arrive at the maternity unit, the medical team will take over and guide you, which can be reassuring. They will check how dilated your cervix is. If it is not yet very dilated, you will be shown to a room while the contractions do their work. It is worth knowing that dilation is the longest stage of labour. The duration varies greatly: the pushing stage can take from a few minutes to more than an hour, and dilation is often longer in a first labour.

During this stage, a midwife will check regularly on how labour is progressing and how your baby is doing. If your waters have not broken yet, the sac may rupture spontaneously at any point in labour; if needed, the team can decide to break it.

Once you are in the delivery room, let the team guide you: they will tell you when to push and when to rest, how to breathe, and so on.

After your baby is born, the placenta is delivered: it separates from the uterus and comes away. You will feel a few small contractions, but nothing like the earlier ones. If the placenta does not come away naturally, the midwife will see to it. After a few hours under observation, you will return to your room with your baby.

On epidurals: an epidural allows you to be fully conscious during birth, because it numbs only the lower part of your body. Some women still feel some sensation; others feel nothing while the anaesthetic is working. An epidural needs preparation: it must be given by an anaesthetist and usually requires some tests beforehand.

It involves injecting anaesthetic into the lower back, between the third and fourth lumbar vertebrae. That said, timing varies between maternity units and teams: it may be placed once labour is established, sometimes at around 3 cm dilated, but this threshold is not universal. If you are considering an epidural, ask your maternity unit well before the birth about the formalities and tests involved.

Now, something important: any pain, any worry, any unusual sensation — you can talk to the team caring for you. Maternity teams are there to answer your questions, even when everything is fine. That, too, is part of a good start to meeting your baby.

We will finish by wishing every mother-to-be much happiness and a good birth. You are now in the ninth month, with pregnancy coming to an end — which may come as a relief. If you have felt reasonably well until now, tiredness may be starting to weigh on you, as may your bump, which can feel cumbersome. There is no shame in having had enough; your baby is starting to feel cramped too. The prospect of meeting your little one may delight you as much as the thought of giving birth frightens you. The ninth month means your baby's arrival is imminent: it is time to finish getting everything ready, but also to rest ahead of the effort to come.

Sources

• Pregnancy monitoring and tests, Assurance Maladie (France).
• Antenatal care, NHS.