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A placenta that has been providing nourishment to a fetus for longer than 42 weeks may not be able to provide a large fetus with a sufficient amount of oxygenated blood, which can cause an abnormal heart rate or brain damage. The placenta can also stop functioning normally, reducing the amount of oxygen and nutrients to the fetus or causing the fetus to secrete less urine, thereby reducing the volume of amniotic fluid. Because amniotic fluid provides cushioning between the fetus and the uterine wall, a deficiency of fluid (oligohydramnios; see page 526) can cause the umbilical cord to be squeezed, cutting off the fetus’s supply of oxygen and nutrients. Postterm fetuses may be too large to deliver vaginally. In addition, they may be so mature that they excrete their first bowel movement (called meconium) into the amniotic fluid, which can be life-threatening if they inhale the meconium and it blocks their air passages. The death rate of infants who are delivered long after the due date is almost double that of infants who are delivered closer to term.

If your doctor thinks that your pregnancy is postterm, he or she will use ultrasound and fetal monitoring (see page 533) to ensure that the fetus is healthy. Your doctor will induce labor (see page 533) only if there are medical reasons to do so or if your cervix has started to dilate (widen). He or she will monitor your labor and delivery carefully and, if your baby seems to be in distress, may use forceps or other techniques to assist the delivery or may perform a cesarean delivery (see page 534).

Stillbirth

Death of the fetus, or stillbirth, is the death of a fetus after the 18th week of pregnancy. In many cases, stillbirth results from a severe abnormality in the fetus, severe preeclampsia or eclampsia (see page 526), vaginal bleeding (see page 523), or postterm pregnancy (see left). It is also linked to gestational diabetes (see page 521), high blood pressure (see page 520), Rh incompatibility (see page 508), and infections in the pregnant woman. In many cases, the cause of death is unknown.

In most cases, the only indication that a fetus has died inside the uterus is lack of fetal movement. A doctor will listen for a heartbeat and will use ultrasound (see page 509) and an electrocardiogram (see page 559) to determine if the fetus is alive. If labor has not begun, the doctor will induce labor (see page 533).

Childbirth

As you near your delivery date, you may experience some signs of approaching labor. The first signs of normal labor are contractions of the uterus. Initially, these contractions may seem like irregular bursts of pain resembling indigestion or twinges of pain in the lower back. The closer you get to delivery, the contractions occur at more regular intervals and are closer together and more intense.

However, contractions are not always a reliable sign that labor has started. Throughout pregnancy, the uterus contracts in preparation for labor. These contractions, called Braxton Hicks contractions or false labor, are usually not noticeable until the last weeks of pregnancy. If you have contractions that do not increase in frequency or intensity and you have no other signs of labor, you probably are not in labor.

As labor starts, the mucus plug that has formed a protective barrier between the uterus and vagina during pregnancy may be expelled as a mucus discharge tinged pink or brown with blood (called bloody show). This discharge is a normal part of childbirth.

Another sign of labor is the rupture of the membranes that surround the amniotic fluid. This rupture may occur as a small trickle or a sudden gush of fluid from your vagina (usually referred to as the water breaking).

Call your doctor if you have any of these signs. He or she will probably tell you to go directly to the hospital where you are planning to give birth. Or he or she may tell you to wait before going to the hospital until your contractions are more regular and frequent. After you arrive at the hospital, the doctor will