In this episode of the Healthful Woman podcast, Dr. Nathan Fox speaks with Dr. Sara Kostant about what to expect in the final stretch of pregnancy — the visits, the symptoms, and the signs that labor may be getting close. Even in a pregnancy that has been completely low-risk from the start, the last four to six weeks bring a shift in how closely patients and their doctors are watching things, and a lot of new questions about what’s normal and what’s worth a call.
What Changes in the Home Stretch
Once patients reach around 36 weeks, visits typically move to a weekly schedule. As Dr. Kostant puts it, “even in a pregnancy that’s been completely low-risk, there are things that we look out for more in the last month.” Every visit includes a blood pressure check and urine test to screen for preeclampsia, since it can develop quickly and without warning — Dr. Kostant notes that “we’ll have patients whose blood pressure has been 100 over 60 the entire pregnancy, and then they’ll come in feeling great at 39 weeks even, and it’ll be 150 over 100.” Providers also measure fundal height to track growth, confirm the baby is head-down, and ask about fetal movement, which should stay consistent in frequency even as it may feel different once the baby has less room to move.
Patients are also encouraged to pay close attention to their own bodies in these final weeks. A sudden drop in movement, a severe headache, blurry vision, or pain under the rib cage are all reasons to call right away, even if a routine visit just happened and everything looked fine.
Understanding the Signs of Labor
By the ninth month, most of the questions patients bring to their appointments are really about one thing: how will I know it’s actually time?
Recognizing true labor. Dr. Fox offers a simple rule of thumb: “if contractions don’t hurt, you’re not in labor. If you can sleep through them, you’re not in labor.” True labor contractions are painful, come at regular intervals — often every five minutes — and are strong enough to stop a person in their tracks, unlike the irregular tightening of Braxton Hicks contractions. Water breaking doesn’t always look like the dramatic gush shown in movies, either; it’s often a continuous trickle that keeps happening even after changing underwear. Dr. Kostant’s advice is straightforward: “if you just feel something trickling out, just give us a call.” Providers would rather hear from a patient who isn’t sure than have someone wait it out at home.
What cervical exams can and can’t tell you. Many patients assume dilation is a countdown to delivery, but Dr. Kostant is clear that it isn’t: “a woman could be three centimeters dilated, and stay three centimeters dilated for two weeks,” while others go from no dilation to labor within a day. Because of this, cervical exams aren’t required, and patients are never obligated to have one if it’s uncomfortable for them. Membrane sweeping — a gentle sweep of the cervix to release prostaglandins — is sometimes offered once a patient is dilated a centimeter or two, but it’s optional, requires consent, and isn’t guaranteed to start labor. Popular tricks like walking, certain foods, or acupuncture aren’t proven to induce labor either, though most are harmless to try. As Dr. Kostant notes, an uptick in contractions is really “the only thing I can point to as things may be gearing up to start.”
Beyond the medical side, the episode also touches on practical preparation: packing a hospital bag, arranging childcare and transportation, choosing a pediatrician, and deciding in advance how a patient wants to handle pain relief and support during labor.
Learn More
To hear this full conversation between Dr. Fox and Dr. Kostant, listen to the episode on the Healthful Woman podcast.
If you’re expecting and have questions about what to expect as your due date approaches, Carnegie Women’s Health provides compassionate, personalized obstetric care and support throughout every stage of pregnancy. Contact Carnegie Women’s Health through the online appointment request form to schedule a visit.
