32 weeks pregnant: baby is the size of a spaghetti squash

Your baby this week

Your baby's toenails have grown, and the fingernails may reach the tips of the fingers. The bones are hardening, apart from the skull, which stays flexible. The skin is smoother and pinker as more fat collects underneath. Your baby practises breathing regularly and can yawn, blink and turn the head.

Most babies begin to settle head-down in the coming weeks, ready for birth, although many move around until later. The lungs are still maturing, and your baby has a good chance of doing well if born now, with specialist care.

How it happens. As your baby grows, the space in the uterus decreases. This limits the big rolls, but the number of movements should not fall (see week 28).

Your body this week

Your uterus is high under the ribs, and your bump is large. You may feel full after small meals, and you may need to pass urine more often. Your body makes more of the hormones that prepare the cervix and the pelvis for labour.

Your prenatal appointments may now be every two weeks in some systems. It is a good time to ask questions about your birth options while there is still time to consider them.

Where can you give birth?

The choices depend on your health, your area and the services available. Ask your provider which of these are offered.

Hospital obstetric unit. A labour ward with doctors, midwives and specialists on site. It offers all forms of pain relief, continuous monitoring and access to emergency care, including cesarean birth. It is recommended if you have a higher-risk pregnancy, for example with a medical condition, twins or complications.

Midwife-led birth centre. A homelike setting, often in or beside a hospital, led by midwives, for people with a low-risk pregnancy. It has fewer medical interventions, and it aims to support natural labour, though some pain relief is available. If a problem arises, you are transferred to the obstetric unit.

Home birth. For people with a low-risk pregnancy, and where a trained midwife or provider is available. It allows you to be in your own space. If a complication arises, you are transferred to hospital, which takes time. Ask about the transfer plan and the distance to the nearest unit.

Private care. In some countries, private hospitals and obstetricians offer an alternative. Costs and services vary.

Whichever setting you choose, ask what the rate of transfer is, who will attend, how quickly a doctor can be reached and what pain relief is offered. It is reasonable to revisit your choice as the pregnancy goes on.

Writing a flexible birth plan

A birth plan, sometimes called birth preferences, is a short document that tells your team what matters to you. Labour is unpredictable, so think of it as a set of preferences, not a script. Keep it to one page, and talk it through with your midwife or doctor.

Topics you might cover:

• Who you would like with you, and their role.
• The environment. Lighting, music, freedom to move, use of a birthing pool if available.
• Positions and movement. Walking, using a ball, a bath or a pool.
• Pain relief. What you would like to try first, and what you would like to keep as a backup. Options are covered in week 38.
• Monitoring. Intermittent or continuous.
• The moment of birth. Positions for pushing, and whether you want a mirror or to touch the baby's head.
• The cord. Whether you want delayed clamping, and who will cut it.
• Skin-to-skin. Holding your baby on your chest right after birth.
• Feeding. How you plan to feed, and whether you want support with it.
• If a cesarean is needed. Your wishes for the operating room, such as a clear drape, having your partner present and skin-to-skin in the operating room.
• Your baby's care. Vitamin K and any other treatments you would like to discuss.

It is normal for plans to change. A good birth is one where you feel informed, supported and listened to, whatever route it takes.

What newborns are usually offered

Practices vary by country. Ask which of these apply to you, and what the choice is:

• Vitamin K. Newborns have low levels of vitamin K, which helps blood clot. A single injection, or in some places oral doses, is offered to prevent a rare but serious bleeding condition.
• Newborn screening. A heel-prick blood test in the first days looks for several rare but treatable conditions. Hearing screening and a physical examination, including the hips, heart and eyes, are usually offered too.
• Other routine care. Some places offer eye ointment or a hepatitis B vaccine at birth.