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By now, you’ve probably had or are about to have your 36-week appointment.
You’ll receive your next update from us when you’re at 40 weeks.
Part 1: Reminders and recap
Have you thought about writing a birth plan or map? It can help you explore your options, make informed decisions, and share your preferences.
For more information, read our fact sheet creating a birth plan.
Your very familiar to feeling your baby move now. Whether it’s light flutters, a swish, a roll or stronger kicks and punches. these are all signs that your baby is well. Paying attention to your baby’s movements is a simple thing you can do to help keep them safe and healthy. Regular movements are a good sign of wellbeing.
Your baby will continue to move during your pregnancy, changing position and stretching. How often they move varies from baby to baby. They’ll also have periods of being awake and asleep. These movements continue throughout your pregnancy.
It’s a myth that babies’ movements slow down or become weaker towards the end of pregnancy. When a baby is unwell, they may try to save energy by reducing their movements. This may be the first sign of a problem and can occur at any time in a pregnancy.
If your baby is unusually quiet at a time when they’re normally active, it might be a sign that your baby is becoming unwell. Please come to the Women’s Emergency Care department immediately if you notice a change in your baby’s movements that worries you. Don’t wait until the next day or your next hospital appointment. You know your baby best - it’s your body and your baby, so trust your instincts.
For more information, visit The Centre of Research Excellence in Stillbirth website - Movements matter.
The Women’s Emergency Care department is located on the Lower Ground Floor, near our carpark entrance on Flemington Road.
Timing counts
Your baby continues to grow and develop until 39 to 40 weeks. Research shows that every week your baby stays inside you improves their short and long term-health and development.
For uncomplicated pregnancies, it’s usually best for you and your baby to wait for labour to start on its own and as close to your due date as possible.
In some cases, a planned birth before your due date may be safer. A planned birth is when you give birth at a specific time, either through an induction of labour or, less commonly, a caesarean section. Sometimes babies need to be born earlier to reduce the chance of complications, especially if you or your baby are unwell or have conditions that increase your risk of stillbirth.
Deciding between a planned birth or waiting for your baby to be born is not always easy. Your midwife or doctor will discuss benefits and risks of both options with you, answer your questions, and support you in making your decision.
The chance of stillbirth and other major complications is generally very low. Your midwife or doctor will explain your risk of stillbirth, discuss the timing of your baby’s birth, and if you or your baby need closer monitoring.
For more information:
- Talk with your doctor or midwife
- Visit the following websites for information in English and other languages
- Every Week Counts
- Let’s Talk about Timing of Birth - The Centre of Research Excellence in Stillbirth
Rest and exercise are so important, especially as your baby gets bigger. Taking care of your back, getting enough rest, and doing gentle exercise will improve your stamina in labour and support a good recovery after the birth. Look back at Week 22 for more information.
Relaxation is best practised on a regular basis. If you haven’t found a relaxation method that suits you, now’s the time to explore some options and include them in your daily routine. Week 22 explains the importance of relaxation and includes suggestions on things you could try.
During pregnancy, your pelvic floor muscles stretch and weaken from your baby’s weight and pregnancy hormones. It's important to exercise them to keep them strong.
For tips, check out our fact sheet on pelvic floor exercises or look back at Week 22.
Before going into hospital, think about what you’ll need during labour and what you and your baby will need afterward.
It may be helpful for you to gather everything but let your partner or support person pack the bag.
That way, they’ll know where everything is and can quickly get anything you might need during labour.
Read our fact sheet things to bring into hospital for suggestions. It’s available in many languages.
In Week 28 we provided information about siblings or older children.
If you haven’t done so already, start planning now for who will take care of your child or children when you go into labour.
Make 2 or 3 plans, depending on the time of day or night you go into labour. Having back-up plans is important in case someone is unavailable due to illness or work. This can also help reduce stress on the day.
Let your midwife or health professional know if you need an interpreter. They can usually arrange for a qualified interpreter to help, either in person or by phone.
Family violence and sexual assault are unacceptable and against the law. Everyone deserves to live without violence and make their own choices.
If you’re experiencing family violence, you can speak to a midwife or doctor at the Women’s or call the Safe Steps Family Violence Response Centre on 1800 015 188. You can call any time, day or night.
In an emergency or if you’re in danger now, call Emergency Services on Triple zero (000).
You can find a list of support services in Week 28.
Part 2: Things related to pregnancy now
By now, you’ve been told about or completed your Group B Streptococcus (GBS) test. The test involves swabbing of the vagina and anus, which you can easily do yourself. You’ll be given instructions on how to do this.
If you do have GBS, you can get antibiotics during labour to reduce the risk of infection to your baby.
See our fact sheet Group B Streptococcus (GBS) screening test for more information.
When labour starts, the amniotic bag around your baby usually breaks. Sometimes, this may happen before labour begins.
If you think this has happened, please call the hospital on (03) 8345 3635. You’ll usually need to go to the hospital for assessment.
Treatment will depend on how many far along you are in your pregnancy and your baby’s health.
Read our fact sheet premature rupture of membranes for more information.
As you get closer to your due date, usually from 39 or 40 weeks, a midwife or doctor will ask for your permission to do a vaginal examination. This is to help your doctor or midwife assess your cervix to help understand labour ‘readiness’ and progress.
Before the exam starts the doctor or midwife will:
- explain the reason they’re recommending the exam and how it will be done
- if you give your verbal consent for the examination you’ll be given some privacy and asked to undress from the waist down
- ask you to lie down on an examination table with your feet together and your knees bent and apart.
They will gently insert 2 gloved fingers into your vagina to measure cervical changes. This may feel uncomfortable or mildly painful.
For more information, please see Vaginal examinations in pregnancy and birth | Pregnancy Birth and Baby.
Part 3: Things to consider
The best healthcare decisions happen when you and your healthcare team make them together. Your healthcare team should explain things clearly, discuss your options with you, and listen to your concerns. This is shared decision making.
In shared decision making, you take an active role in choosing your healthcare. This helps make sure the decisions reflect what matters most to you.
You and your healthcare team will work together to develop your treatment and care plan. You’ll discuss different treatment options, their risks and benefits, and consider your preferences and values. This helps you agree on a plan that leads to the best results for you and your baby.
Asking questions is important when it comes to shared decision making because it helps you understand your situation and the options available to you.
Questions to consider:
- What options do I have?
- What are the benefits?
- What are the risks?
- Can you provide written information for me to read at home?
To learn more about shared decision making, visit Australian Commission on Safety and Quality in Health Care website.
In Week 32, we focused on labour and natural ways of working with your contractions and the role of hormones.
Sometimes, you may choose medical methods to reduce your pain.
In this section, we’ll explore some of the medical pain relief options available at the Women’s. You can also talk to your midwife or doctor about your options and ask any questions to make sure you feel confident in your decision.
TENS (Transcutaneous Electrical Nerve Stimulation)
TENS is a small, portable device that has leads connected to sticky pads (electrodes). These electrodes are placed on your lower back. The device sends electrical pulses through the electrodes, creating a pins and needles sensation.
The electrical pulses help block pain messages from reaching your brain. The TENS machine also promotes the release of endorphins which help reduce pain. It may relieve lower back pain and contraction pain.
TENS is most helpful in the first stage of labour. It works well if used early in the labour and can be used for many hours, even at home.
If you choose to use TENS, you’ll need to hire or buy a TENS device before your labour starts.
Sterile water injections
A midwife may inject 4 tiny amounts of sterile water under the skin of your lower back, creating 4 small pockets of water. The injections can feel like a bee sting, lasting about 30 seconds before going away.
These injections can help ease lower back pain in the early stages of labour. They block pain messages and cause your body to release endorphins. They provide relief for 1 to 4 hours and can be given again if needed.
These injections help with lower back pain, but don’t relieve contraction pain.
Gas (nitrous oxide and oxygen)
Gas is a mixture of nitrous oxide and oxygen, also known as laughing gas or Entonox. It comes from a machine in the hospital birth room. A tubes connects the machine to a mouthpiece.
Using regular deep breaths, you breathe the gas in and out through the mouthpiece during contractions.
After each contraction, you breathe air to remove the gas from your lungs. The pain relief is temporary.
Gas is most effective during the first stage of labour. It reduces pain by blocking pain messages and lowering adrenaline levels. It can help reduce the intensity at the peak of a contraction.
Morphine
Morphine is a pain medicine from the opiate family. During labour, it is normally given as an injection into your thigh or bottom.
Morphine is a strong medicine that imitates endorphins, blocking pain, and promoting relaxation and rest. It’s most effective in the first stage of labour.
Morphine circulates throughout your whole body and the placenta and may affect your baby’s responses at birth. A vaginal examination before the morphine injection can help estimate the baby’s time of birth to reduce any impact on your baby.
It takes 15 to 40 minutes for morphine to work, and can last for 2 to 4 hours.
When possible, it’s given at least 2 to 3 hours before birth, with no more than 2 doses in labour.
Epidural anaesthetic
In maternity care, epidural anaesthetics target pain from the waist down to the toes. It’s a regional anaesthetic, meaning it only affects a specific part of your body. If you have an epidural, you’ll need to stay in bed as you won’t be able to move around.
An anaesthetist administers it through a needle and fine tubing into the epidural space in your spine. The procedure takes about 10 to 20 minutes, with the medicine taking another 15 to 25 minutes to work. The medicine is usually given using a computerised pump.
During this time, you’ll also:
- receive fluids and/or drugs through a small tube called an intravenous (IV) drip, placed in a vein in your arm
- have a thin plastic tube called a urinary catheter inserted into your bladder to keep it empty.
A cardiotocograph (CTG) will monitor your baby’s wellbeing.
Epidurals provide effective pain relief for about 8 out of 10 people (about 85%). It may reduce or get rid of the pushing sensation during contractions.
Due to the length of the procedure, the medicine used, and its impact on sensation, it’s recommended you have a vaginal examination beforehand to estimate the time of birth.
After the epidural is removed or turned off, it takes between 30 minutes to 3 hours for you to recover physical sensation.
For more information read our fact sheets:
Sometimes, you may not be able to have a vaginal birth without medical intervention because it may be unsafe for you or your baby.
Here, we’ll discuss some procedures that may be used to help you birth your baby and induce labour. Your doctor or midwife will explain these procedures to you if they think you may need them. They will ask for your permission before doing any of these procedures.
Interventions to help start your labour
Sweeping the membranes, also known as ‘a stretch and sweep’ or ‘stripping the membranes’, is a technique that helps to start labour when you’re near your due date.
During a vaginal examination, your doctor or midwife will try to separate the membranes around your baby from the cervix. About half of the time, this releases prostaglandins, a hormone that softens your cervix and may trigger labour within 48 hours.
This procedure can be uncomfortable and painful, and you may have some vaginal bleeding or contractions in the next 24 hours.
It may be offered to you at around 40 weeks of pregnancy before attempting a formal induction of labour. This is when your labour is medically started because you have certain risk factors like diabetes, if your waters break without labour beginning, or your pregnancy goes beyond 41 weeks.
Induction of labour is usually done in 2 steps.
Step 1: Cervical ripening or softening
This is done in the hospital to soften and shorten the cervix. It involves inserting either a synthetic hormone gel or a balloon catheter into the vagina. A balloon catheter is a thin tube with a balloon on the end that is inflated with water.
It can take several hours or days for the cervix to ripen. Sometimes you’ll be able to go home between this step and the next.
Read our fact sheet on balloon catheters for more information.
Step 2: Induction of labour
Inducing labour begins in the Birth Centre by breaking your waters (the baby’s amniotic sac). If the baby responds well, a needle is placed into your vein and attached to a drip containing a synthetic form of oxytocin. This is the same hormone that makes you go into labour naturally.
The amount of oxytocin increases over time to make your contractions begin. This makes the labour start more quickly and become more intense.
Using synthetic oxytocin doesn’t have the same benefits for you or your baby as natural oxytocin. Your baby will need constant monitoring during labour. This might limit your movement and choice for a water birth.
If your pregnancy is induced, you may use medical pain relief and might need help during birth with vacuum or forceps.
Unless medically necessary, induction of labour isn’t recommended before 39 weeks. Please read the ‘Timing of birth’ section in Week 36 for more information.
To learn more:
- watch our induction of labour video
- read our fact sheet on induction of labour. It’s available in many languages.
Interventions to help progress your labour
If your labour starts on its own (spontaneously) but has slowed down, this process will help your labour progress.
Augmentation of labour is done by breaking your waters (the baby’s amniotic sac) and/or giving you synthetic oxytocin through an intravenous drip, as described in the Induction of labour section above.
Interventions to help you give birth
If your labour isn’t progressing or you or your baby are in distress, you may need help to birth your baby.
Depending on the reason and the stage of labour, an obstetric doctor will discuss your options with you.
We have outlined the options below, and you can find more information on our webpage – Assisted birth.
Vacuum birth
A vacuum birth happens when your cervix is fully dilated, your baby’s head can be seen, and you’re having contractions.
During a vacuum birth an obstetric doctor will do a vaginal examination to put a small vacuum cap on your baby’s head. As you push during a contraction, the doctor uses the vacuum suction to help guide your baby’s head out.
You might also need an episiotomy. This is where the doctor or midwife makes a small cut to widen the vaginal opening. The cut is stitched up after the birth.
Vacuum births are more common when epidural anaesthetic is used.
Forceps birth
A forceps birth can only happen when your cervix is fully dilated, your baby’s head can be seen, and you’re having contractions.
An obstetric doctor will do a vaginal examination so they can apply 2 forceps. Forceps are a medical tool that look like metal spoons or tongs. The forceps are positioned on either side of your baby’s head to support its skull.
As you push during a contraction, the doctor uses a guiding motion to help your baby’s head to come out. Most babies will have temporary red marks or bruises on their face or head from the forceps.
An episiotomy is usually needed when you have a forceps birth. The doctor or midwife will make a small cut to widen the vaginal opening. The cut is stitched up after the birth.
Forceps births are more likely when epidural anaesthetic is used.
Caesarean section birth
A caesarean section is a major surgery to birth your baby through a cut in your lower abdomen and uterus.
During your pregnancy, a caesarean section birth may be planned or arranged, if there are signs that a vaginal birth is not possible or too risky. This means a date and time will be organised for the birth. This is an elective caesarean section birth.
Sometimes, if complications develop during labour or if your cervix doesn’t fully dilate to 10cm, an emergency caesarean is needed.
An obstetric doctor and team perform the surgery, usually with a regional anaesthetic, like an epidural or spinal anaesthetic. This allows you to be awake and for your support person to be with you. You’ll also need an intravenous drip and urinary catheter. A screen will block your view of the surgery, but it can be lowered for the birth.
The baby is usually born about 10 minutes after the surgery starts. Whenever possible, your baby will be placed on your chest for immediate skin-to-skin contact. The entire surgery, including birth of your baby and placenta and stitching the surgical cuts, takes about an hour.
After surgery, you’ll spend at least 30 minutes in recovery. A midwife will stay to help with skin-to-skin contact and your first breastfeed, if possible.
For more information see:
Your healthcare team will do several things to monitor you and your baby’s health and the progress of your labour while you’re in hospital.
Some or all of the following may happen during your labour:
- feeling your belly to check your baby’s position
- listening to your baby’s heart rate
- monitoring your baby’s heart rate and response to labour, using external monitors
- monitoring your baby’s heart rate and response to labour, using an internal, vaginal probe
- monitoring your contractions with an external cardiotography (CTG)* machine
- observing and feeling your contractions
- if your waters have broken, we check the colour of the fluid to see if your baby is coping well or not
- observing and listening to your reaction to labour
- performing a vaginal examination to get information about changes to your cervix and your baby’s position
- taking your pulse, temperature, and blood pressure at different times during the labour.
* Cardiotocography (CTG) monitors your baby’s heartbeat and your contractions during pregnancy and labour. To record this information, straps are placed around your belly, or sometimes an internal, vaginal probe is attached to your baby’s scalp.
After your baby is born, the midwife or doctor will examine you and your baby to make sure you’re both well. You’ll then be transferred to the postnatal ward.
There, midwives will care for you by:
- checking your temperature, pulse, and blood pressure
- monitoring your vaginal blood loss
- checking the position of your uterus
- examining your breasts
- helping you breastfeed
- asking about your emotions and addressing any concerns or worries you have.
They’ll also check:
- your baby’s weight
- how often your baby feeds
- how often they wee and poo
- their skin colour.
You and your baby will stay together in the hospital. Room sharing reduces the risk of sudden infant death syndrome (SIDS). It also helps you recognise when your baby is hungry, tired, or needs a cuddle.
It’s important to give your baby a safe sleep environment night and day. We covered safe sleeping in Week 28.
Your hospital stay will depend on the type of birth you had, your baby’s age, and their needs.
The hospital staff will tell you how long your stay is likely to be so you can plan for going home, caring for other children, and any other responsibilities.
We welcome visitors at the Women’s. Please check our website for any current restrictions.
- General visiting hours: 2.00pm to 8.00pm
- Visiting hours for partners: 8.00am to 8.30pm
- NICU visiting hours for parents: No restrictions.
To keep our patients comfortable, healthy, and safe, we ask all visitors to follow these hours. Ask friends, family, or carers not to visit if they feel unwell, have an infection, or have recently been sick.
In special circumstances, you may arrange alternative visiting hours with the nurse-in-charge.
Sometimes if a baby is premature, sick, or needs extra care, they may be admitted to our Special Care Nursery or Newborn Intensive Care Unit.
In these cases, you can visit your baby at any time. Sometimes, your baby will need to stay in hospital even after you go home.
You can be involved in your baby’s care in many ways, like:
- talking, reading, and singing to them
- changing their nappies
- skin-to-skin contact and holding them, when possible.
Breastfeeding may not be possible at first, but our midwives will help you express milk and feed your baby.
Here are a few tips for while your baby is in hospital:
- take lots of photos
- keep a diary and record milestones
- collect cards and other mementos
- if you can’t be there, call the staff or leave a camera for them to take photos
- ask siblings, family, or friends to make cards.
Leaving the hospital to go home is exciting, but it can also be busy and demanding.
Before leaving, you’ll be given paperwork for registering your baby and for Centrelink, as well as your Baby’s Health Record Book.
Once you’re home, a hospital midwife will visit you 1 to 2 times as part of our Postnatal Care in the Home program.
Starting around 7 to 10 days after giving birth, you can get support from the free Maternal and Child Health Service, managed by the Department of Health.
For more details about their clinics, services, and helpline, visit the Maternal and Child Health Service website.
You can also find lots of information on our website about what to expect after your baby is born and getting ready to go home.
Planning ahead can help you ease into parenting and recovery after birth.
Here are some simple things to include in your planning:
- eat a balanced diet and drink enough fluids
- prepare nutritious meals and snacks ahead of time
- manage changes in sleep patterns and make time to rest
- understand that your relationships with family members may change. Discuss ways to help each other through these changes
- recognise that feelings, tiredness, and responsibilities can affect how you adjust to new roles and family dynamics
- remember, “it takes a village to raise a child.” Gather support from family, friends, and community groups
- include gentle exercise into your daily activities, aiming for about 30 minutes every day
- start your pelvic floor exercises a few days after birth
- prioritise your recovery and self-care
- use our Women’s Health Information for information on recovery after birth and breastfeeding
- don’t hesitate to ask for help and accept it when offered
- prioritise and focus on things that are most important and ‘need’ to be done
- understand the physical and hormonal changes happening after childbirth and give yourself time for these changes to settle.
Most new parents go through an adjustment period after their baby is born. During this time, you might feel tired or have changes in your eating habits.
However, if these feelings persist, it could indicate postnatal depression. Any parent can experience postnatal depression.
Look out for these signs and symptoms:
- persistent sadness
- disturbed sleep
- increased anxiety or worry
- panic attacks
- feeling overwhelmed
- significant changes in eating habits
- feeling disconnected or cut off from others
- sudden mood swings.
If you have thoughts of hurting yourself or others, please seek help immediately or call Triple zero (000).
For information and support, contact these support services:
- PANDA (Perinatal Anxiety & Depression Australia)
1300 726 306
Monday to Friday between 9am and 7.30pm
Saturday between 9am and 4pm
Visit their website to access a range of online resources. PANDA also has information for LGBTIQ families. - Beyond Blue
1300 224 636
You can call any time, day or night.
Or visit their website for information on parenting and mental health. - Relationships Australia
Call 1300 364 277
Monday to Friday between 9am and 5pm
Visit their website for relationship support services. - Maternal and Child Health 24-hour Help Line (Victoria)
Call 13 22 29
You can call any time, day or night. - COPE (Centre of Perinatal Excellence)
COPE provides information to help new parents adjust to the changes and challenges of parenthood. Visit their website to learn more. - Australasian Birth Trauma Association
Supports people, partners, and families after birth-related trauma. Their website has helpful resources and support. Visit their website to learn more.
We hope you have found this information helpful.
Remember you can go back to previous weeks.
If you have any health concerns, please talk to one of your health care professionals – midwife, General Practitioner (GP), hospital doctor, etc.
There will be more to read and learn next month. Stay safe and well.