The 39-week prenatal appointment is often the final scheduled visit before the baby’s estimated due date. This visit serves as an important checkpoint to confirm the well-being of both the expectant mother and the developing fetus before labor begins. Providers use this time to gather final health metrics and assess the body’s physical readiness for childbirth. The appointment ensures physiological parameters are within expected ranges and prepares the family for delivery.
Routine Assessments and Fetal Monitoring
The appointment begins with standard maternal health checks to monitor any late-stage pregnancy complications. A nurse or medical assistant will measure blood pressure and weight, looking for any abrupt increases that could signal conditions like preeclampsia. A urine sample is collected to screen for protein, which is another marker for hypertensive disorders, and glucose, which can indicate gestational diabetes that requires last-minute management.
The provider then focuses on external assessments of the fetus, starting with the measurement of the fundal height. This measurement, taken from the top of the pubic bone to the top of the uterus, should generally correlate closely with the week of gestation, typically measuring around 38 to 40 centimeters at this stage. A significant deviation may prompt further investigation, such as an ultrasound, to rule out issues like intrauterine growth restriction or excessive amniotic fluid.
The baby’s presentation is confirmed using external palpation, a technique known as Leopold’s maneuvers. This helps determine if the fetus is in the preferred vertex (head-down) position, or if it remains breech or transverse, which would influence delivery planning. Listening to the fetal heart rate is a simple yet effective way to confirm the baby’s current status and reassure the mother of ongoing fetal well-being.
The provider confirms the fetal heart rate, which typically falls between 110 and 160 beats per minute. This routine check offers non-invasive reassurance regarding the baby’s health. The provider also inquires about the mother’s perception of fetal movement patterns. Consistent fetal activity is a positive indicator of oxygenation and overall health as the pregnancy nears completion.
The Internal Cervical Examination
The internal cervical examination is a distinct procedure often offered at 39 weeks to assess the cervix’s readiness for labor. This physical assessment involves the provider manually feeling the structure of the cervix. While not mandatory, the information gathered helps guide the discussion about labor expectations and next steps.
The provider looks for three specific metrics that collectively describe the Bishop score, a system used to predict the likelihood of successful induction. The first is dilation, the opening of the cervix measured in centimeters (0 to 10). The second metric is effacement, which describes how thin the cervix has become, expressed as a percentage (0% thick to 100% paper-thin).
The third measure is the fetal station, which indicates how far the baby’s presenting part has descended into the pelvis. This is measured in relation to the ischial spines; a station of 0 means the head is engaged at the level of the spines. These measurements are merely snapshots in time and should not be used as definitive predictors for the timing of delivery.
Key Discussions and Next Steps
A substantial portion of the 39-week appointment is dedicated to discussing the onset of labor and delivery logistics. The provider reviews the specific physiological signs that should prompt the mother to call the office or proceed directly to the hospital. These signs include the rupture of membranes (a sudden gush or steady leak of amniotic fluid) or any instance of significant vaginal bleeding.
The discussion also focuses on the frequency and intensity of contractions, instructing the patient on the “5-1-1” or “4-1-1” rule. This rule refers to contractions coming every five or four minutes, lasting for one minute, for at least one hour. Decreased fetal movement also requires immediate attention and should never be ignored.
The provider clarifies all logistical aspects of the hospital admission process. This includes the exact entrance to use, especially if arriving during off-hours, and confirming that registration paperwork is complete. Reviewing the birth plan and discussing pain management options, such as epidurals, are standard parts of this consultation.
The final element of the discussion centers on the plan for post-due date management. If the baby is not born by the 40-week mark, the provider schedules a follow-up appointment and begins discussing labor induction options. This conversation involves explaining the risks and benefits of various induction methods, such as cervical ripening agents or synthetic oxytocin.
To ensure continued fetal health while awaiting labor, the provider may order specialized monitoring to begin in the coming weeks. This typically includes a non-stress test (NST), which monitors the baby’s heart rate response to movement. Another option is a biophysical profile (BPP), which combines an NST with an ultrasound assessment of fetal breathing, movement, tone, and amniotic fluid volume.