Pregnancy week 39 is one of the biggest milestones of the entire pregnancy because you have now entered the full-term period.

Under the terminology endorsed by the American College of Obstetricians and Gynecologists (ACOG), pregnancy from 39 weeks 0 days through 40 weeks 6 days is classified as full term.

Labor may begin naturally at any time. The fetus now looks very much like a newborn, but development is still continuing, particularly in the brain, lungs and nervous system.

At the same time, the pregnant person’s body may be preparing for labor through changes such as:

• stronger pelvic pressure;
• increased vaginal discharge;
• Braxton Hicks contractions;
• backache;
• mucus plug loss or a “show”;
• possible rupture of membranes.

Week 39 is also the first week in which elective induction may be discussed in certain healthy pregnancies, although this is an individualized decision rather than something every pregnant person should automatically have.

Quick answer: At 39 weeks pregnant, the fetus is around 50.7 cm from head to heel according to NHS guidance—approximately the size of a small watermelon. The pregnancy is now full term, the fetus continues late-stage maturation, and spontaneous labor may begin at any time.

Is 39 Weeks Pregnant Full Term?

Yes.

ACOG defines:

• Early term: 37 weeks 0 days through 38 weeks 6 days
• Full term: 39 weeks 0 days through 40 weeks 6 days
• Late term: 41 weeks 0 days through 41 weeks 6 days
• Postterm: 42 weeks 0 days and beyond

Therefore:

39 weeks pregnant = full term.

This is different from weeks 37 and 38, which are classified as early term.

Why Is 39 Weeks Such an Important Milestone?

ACOG notes that neonatal outcomes, particularly respiratory outcomes, vary across the weeks traditionally grouped together as “term.”

Among uncomplicated pregnancies, adverse newborn outcomes are lowest around 39 weeks 0 days through 40 weeks 6 days.

That is one reason nonmedically indicated delivery before 39 weeks is generally discouraged.

How Big Is the Baby at 39 Weeks?

The NHS estimates the fetus at around 50.7 cm from head to heel.

That is approximately the size of a small watermelon.

This is an average rather than an individual target.

Fetal size at 39 weeks varies according to:

• genetics;
• fetal sex;
• placental function;
• maternal factors;
• individual growth pattern.

A healthy baby can be smaller or larger than this average.

What Is Developing at 39 Weeks?

Although the fetus appears fully formed, development does not simply stop at 39 weeks.

MedlinePlus describes weeks 38–40 as a stage when:

• most lanugo has disappeared except around the shoulders and upper arms;
• fingernails may extend beyond the fingertips;
• small breast buds are present in both sexes;
• scalp hair is thicker and coarser.

The fetus is now primarily focused on:

• final maturation;
• fat storage;
• neurologic development;
• preparation for birth.

Is the Baby’s Skin More Mature at 39 Weeks?

Yes.

The NHS notes that fetal skin, which earlier in pregnancy was almost transparent, has now developed a tougher, more solid layer.

This helps:

• protect internal organs;
• support temperature regulation after birth.

The skin may still be covered partly by vernix.

What Is Vernix?

Vernix is the white, creamy, waxy substance that coats fetal skin.

The NHS explains that vernix:

• protects fetal skin;
• can help the baby pass through the birth canal.

Some newborns are born with a noticeable coating of vernix.

Others have very little remaining.

Both can be normal.

Is Lanugo Mostly Gone?

Yes.

MedlinePlus states that during weeks 38–40 most lanugo is gone except around the:

• shoulders;
• upper arms.

Lanugo is the fine hair that covered much of the fetal body earlier in pregnancy.

Are the Fingernails Long?

They can be.

MedlinePlus notes that fingernails may now extend beyond the fingertips.

This is one reason some newborns have surprisingly long nails at birth.

Is the Baby’s Hair Thicker?

It may be.

MedlinePlus states that scalp hair becomes coarser and thicker during weeks 38–40.

However, newborn hair varies widely.

A healthy newborn may have:

• thick hair;
• fine hair;
• sparse hair.

Is the Baby’s Brain Still Developing?

Yes.

Full term does not mean brain development is complete.

Late pregnancy continues supporting:

• breathing control;
• feeding coordination;
• sensory processing;
• sleep regulation;
• movement control.

Brain development also continues rapidly after birth.

Are the Lungs Mature at 39 Weeks?

The lungs are considerably more mature than they were several weeks ago.

This is one reason ACOG considers 39 weeks an important threshold for healthy pregnancies.

Babies born at or after 39 weeks generally have better outcomes than babies delivered electively before 39 weeks without a medical indication.

Is the Baby Still Gaining Weight?

Yes.

The fetus can continue gaining weight through:

• fat deposition;
• muscle growth;
• tissue growth.

This contributes to:

• energy reserves;
• temperature control after birth.

Is the Baby Still Moving at 39 Weeks?

Yes.

Fetal movement should continue right up to labor and birth.

Because space is limited, movement may feel different.

You may notice more:

• rolling;
• stretching;
• pushing;
• twisting;
• strong localized kicks.

But movement should not simply stop because the fetus is larger.

Should Movement Become Less Frequent at 39 Weeks?

A clear reduction in movement should not be dismissed as “normal because there is less room.”

Continue recognizing your baby’s usual pattern.

Contact maternity care promptly if movement:

• becomes much weaker;
• becomes clearly less frequent;
• stops;
• changes significantly from normal.

Should You Use a Home Doppler?

No.

A home Doppler should not be used to reassure yourself about reduced fetal movement.

Hearing a heartbeat does not prove fetal wellbeing.

Professional assessment is safer when movement changes.

Is the Baby Usually Head Down at 39 Weeks?

Most babies are head down by this point.

This is called cephalic presentation.

The fetal head may also be:

• engaged;
• partially engaged;
• still relatively high.

Position can influence how labor begins and progresses.

Does Engagement Mean Labor Is Imminent?

Not necessarily.

Engagement means the fetal head has moved lower into the pelvis.

It may happen:

• weeks before labor;
• days before labor;
• during labor.

It cannot reliably predict the exact birth date.

Can Labor Begin at Any Time?

Yes.

The NHS states that pregnancy normally lasts around 40 weeks and that many people go into labor about a week either side of the estimated due date.

At 39 weeks, spontaneous labor may begin at any time.

What Are Signs That Labor May Be Starting?

Possible signs include:

• increasingly regular contractions;
• back pain;
• increasing pelvic pressure;
• loss of the mucus plug;
• a “show”;
• waters breaking.

Some people have several signs.

Others may have very few warning symptoms before labor becomes established.

What Is a “Show”?

The NHS describes the show as a slimy blob of mucus that may be yellow or blood-streaked.

This mucus previously helped seal the cervix.

Its release can be one of the first signs that the cervix is changing.

Does a Show Mean Labor Starts Immediately?

No.

The NHS specifically notes that after a show, there may still be days to wait before labor begins.

So losing the mucus plug is not an exact labor countdown.

Is a Show the Same as Heavy Bleeding?

No.

A small amount of blood mixed with mucus can occur.

Heavy vaginal bleeding is different and requires urgent maternity assessment.

What Are True Labor Contractions?

True labor contractions generally become:

• more regular;
• stronger;
• longer;
• closer together.

Braxton Hicks contractions usually remain irregular.

How Long Should Contractions Last Before Calling?

The NHS week-39 guidance advises contacting the hospital or midwife when contractions last around 60 seconds and occur every 5 minutes, while also emphasizing that you should call sooner if you are worried.

However, follow the specific instructions provided by your own maternity unit, because advice can vary according to:

• previous births;
• distance from hospital;
• pregnancy complications;
• membrane status.

Are Braxton Hicks Still Normal?

Yes.

Practice contractions can be common at 39 weeks.

They may make the abdomen:

• hard;
• tight;
• uncomfortable.

But they generally do not steadily become stronger and closer together.

What If the Waters Break?

The NHS notes that waters can break at any time and may present as a trickle rather than a dramatic gush.

If you think your waters have broken, contact your maternity service.

Why Is Rupture of Membranes Important?

Once membranes rupture, the protective barrier around the fetus is no longer intact.

The NHS notes that infection risk can increase after waters break, and labor management may need to be discussed.

Could Leaking Fluid Just Be Urine?

Yes.

Late pregnancy can cause urinary leakage.

But because it can be difficult to distinguish urine from amniotic fluid, suspected membrane rupture should be discussed with maternity care.

Is Increased Vaginal Discharge Normal?

Yes.

The NHS notes that discharge may increase at week 39.

Normal discharge is generally:

• thin;
• white;
• mild smelling.

Contact a healthcare professional if discharge is:

• foul smelling;
• green or yellow;
• painful;
• itchy;
• associated with fever.

Is Back Pain Common at 39 Weeks?

Yes.

The NHS notes that back pain can increase as the fetus moves lower into the pelvis and places pressure toward the spine.

Back pain can also occur with labor.

If it becomes rhythmic or is associated with contractions, contact your maternity unit.

Is Pelvic Pressure Normal?

Yes.

As the fetal head descends, pressure at the bottom of the abdomen and pelvis can increase.

You may feel:

• heaviness;
• pressure;
• difficulty walking comfortably;
• bladder pressure.

Is Nesting Common?

Some people experience a sudden urge to:

• clean;
• organize baby clothes;
• prepare the home.

The NHS describes this as a possible nesting instinct.

It is not a reliable predictor of when labor will begin.

Avoid exhausting yourself or lifting heavy objects.

What Symptoms Are Common at 39 Weeks?

Possible symptoms include:

• Braxton Hicks contractions;
• sleep problems;
• backache;
• heartburn;
• constipation;
• hemorrhoids;
• pelvic pressure;
• frequent urination;
• leg cramps;
• swelling;
• increased vaginal discharge;
• sore or leaking breasts.

The NHS lists many of these among common late-pregnancy symptoms.

Is Swelling Normal?

Mild swelling may occur.

However, seek prompt assessment for:

• sudden major swelling;
• severe headache;
• vision changes;
• pain under the ribs;
• feeling seriously unwell.

These can be warning signs of pre-eclampsia.

What Warning Signs Should Not Be Ignored?

The NHS highlights several warning symptoms at week 39, including:

• vaginal bleeding;
• severe persistent headache;
• visual disturbance;
• pain below the ribs;
• extreme swelling;
• persistent abdominal pain;
• high temperature.

These symptoms need professional assessment.

Is Group B Strep Still Important at 39 Weeks?

Yes.

By week 39, most people in healthcare systems that routinely screen for GBS will already know their result.

ACOG states that routine GBS culture is performed between 36 and 38 weeks.

What If GBS Is Positive?

ACOG states that antibiotics are usually given through an IV once labor begins.

The goal is to reduce newborn exposure during delivery.

Do You Take GBS Antibiotics Before Labor?

Routine colonization is generally managed with antibiotics during labor rather than days or weeks beforehand.

Different management may apply if GBS is found in urine or another medical reason exists.

What If Your Waters Break and You Are GBS Positive?

Contact your maternity service promptly.

Your team will consider:

• GBS status;
• membrane rupture;
• contractions;
• maternal temperature;
• timing.

Do not delay contacting maternity care because you are waiting for contractions.

What If GBS Status Is Unknown?

ACOG notes that antibiotics may be recommended when status is unknown and certain risk factors are present, such as:

• maternal fever;
• prolonged rupture of membranes;
• previous newborn with GBS disease.

Management is individualized.

Can Elective Induction Be Discussed at 39 Weeks?

Yes.

ACOG states that induction at 39 weeks may be discussed for some healthy pregnant people when:

• this is the first full-term pregnancy;
• there is one fetus;
• both the pregnant person and fetus are healthy.

This is an option, not a requirement.

Can 39-Week Induction Reduce the Chance of Cesarean Birth?

ACOG notes that research suggests induction at 39 weeks in certain healthy first full-term pregnancies may reduce the risk of cesarean birth.

This finding should be discussed in individual clinical context.

Does Everyone Need Induction at 39 Weeks?

No.

Many uncomplicated pregnancies can continue while waiting for spontaneous labor.

The choice depends on:

• clinical situation;
• cervical readiness;
• patient preferences;
• hospital resources;
• maternal and fetal health.

What Is Labor Induction?

Labor induction means using medical methods to start labor.

ACOG lists possible methods including:

• cervical ripening;
• membrane stripping;
• oxytocin;
• artificial rupture of membranes.

Not every method is appropriate for every pregnancy.

What Is Cervical Ripening?

Cervical ripening helps the cervix become:

• softer;
• thinner;
• more ready to open.

It may involve:

• medications;
• mechanical methods.

Your maternity team chooses a method based on clinical circumstances.

What Is a Membrane Sweep?

A membrane sweep is different from breaking the waters.

During a cervical examination, a healthcare professional may gently separate the membranes from the lower part of the uterus.

This can release natural prostaglandins and may encourage labor.

It is not the same as formal induction with medication.

Does a Membrane Sweep Guarantee Labor?

No.

A sweep may increase the chance that labor begins, but it does not guarantee it.

Some people experience:

• cramping;
• spotting;
• irregular contractions;

afterward.

Is Oxytocin Used for Induction?

Yes.

ACOG lists oxytocin as one method used to start or strengthen uterine contractions.

It is given under medical supervision.

Can Induction Fail?

Yes.

ACOG notes that induction does not always result in immediate labor progression.

Depending on maternal and fetal wellbeing, management may include:

• allowing more time;
• trying another approach;
• reassessment;
• cesarean delivery if needed.

What Are the Risks of Induction?

ACOG notes that some induction methods can cause the uterus to contract too frequently, which can affect fetal heart rate.

Other potential complications include infection.

The risks and benefits depend on:

• indication;
• gestational age;
• cervical condition;
• maternal and fetal health.

What About Planned Cesarean Birth at 39 Weeks?

For uncomplicated planned cesarean birth without a reason for earlier delivery, 39 weeks is commonly used because it reduces respiratory problems compared with elective birth earlier in the early-term period.

This aligns with the broader recommendation to avoid nonmedically indicated delivery before 39 weeks.

What Happens if Labor Starts Before a Planned Cesarean?

Contact your maternity unit.

The team will determine the safest next step depending on:

• contractions;
• cervical changes;
• membrane status;
• fetal presentation;
• reason for planned cesarean.

Is a 39-Week Ultrasound Routine?

Not necessarily.

Routine ultrasound at exactly 39 weeks is not required for every uncomplicated pregnancy.

Ultrasound may be used when there are concerns about:

• fetal growth;
• fetal position;
• amniotic fluid;
• placenta;
• fetal wellbeing.

What If the Baby Seems Very Large?

Estimated fetal weight late in pregnancy is approximate.

A suspected large baby should be interpreted in context with:

• maternal diabetes status;
• previous birth history;
• ultrasound findings;
• clinical examination.

Delivery decisions should not be based on internet size comparisons.

What If the Baby Seems Small?

Your healthcare professional may assess:

• growth trajectory;
• placental function;
• amniotic fluid;
• fetal wellbeing.

A small fetus may simply be constitutionally small, while others may need closer monitoring.

Is Special Fetal Monitoring Needed at 39 Weeks?

Not automatically.

Higher-risk pregnancies may require additional testing such as:

• nonstress testing;
• biophysical profile;
• ultrasound assessment.

An uncomplicated pregnancy may not need these tests.

What Is a Nonstress Test?

A nonstress test records fetal heart rate and assesses how it changes with movement.

It may be recommended when additional fetal-wellbeing assessment is needed.

What Is a Biophysical Profile?

A biophysical profile combines fetal-heart monitoring with ultrasound assessment of factors such as:

• movement;
• breathing movements;
• muscle tone;
• amniotic fluid.

It is used when clinically indicated.

Should the Hospital Bag Be Ready?

Yes.

By week 39, the hospital or birth-center bag should ideally be ready.

Useful items may include:

• pregnancy records;
• identification;
• birth plan;
• comfortable clothing;
• toiletries;
• newborn clothing;
• postpartum supplies;
• phone charger;
• routine medications.

Should the Car Seat Be Installed?

Yes.

If the newborn will travel home by car, ensure the car seat is:

• appropriate for a newborn;
• installed correctly;
• used according to manufacturer instructions and local law.

Should You Know the Route to the Birth Facility?

Yes.

Have:

• primary transport;
• backup transport;
• maternity phone numbers;
• childcare arrangements if needed.

At 39 weeks, labor can begin at any time.

Should You Finalize the Birth Plan?

Yes, while keeping it flexible.

Birth-plan topics may include:

• labor support;
• pain relief;
• movement;
• epidural preferences;
• cesarean birth if needed;
• skin-to-skin contact;
• newborn feeding.

Birth circumstances can change.

Should You Learn What Happens Immediately After Birth?

Yes.

The NHS notes that newborns are assessed shortly after birth, including observation of:

• heart rate;
• breathing;
• muscle tone;
• responsiveness;
• skin color.

The newborn may not cry immediately like babies often do in films.

Normal adaptation takes time.

What Is the Apgar Score?

The Apgar score is a quick newborn assessment performed shortly after birth.

It evaluates:

• heart rate;
• breathing;
• muscle tone;
• reflex response;
• skin color.

It helps clinicians assess how the newborn is adapting.

Is Blue Color in Hands and Feet Always Dangerous?

The NHS notes that newborn hands and feet can initially look bluish while circulation adapts after birth.

However, newborn appearance should always be assessed by trained healthcare staff.

Does the Uterus Shrink Immediately After Birth?

No.

The NHS notes that it can take around six weeks for the uterus to return toward its pre-pregnancy size.

Uterine contractions after birth help this process.

Should You Think About Newborn Screening?

Yes.

Newborn screening is offered soon after birth in many healthcare systems.

Tests vary by country but may include:

• blood-spot screening;
• hearing screening;
• physical examination.

Should You Think About Postpartum Contraception?

Yes.

Fertility can return sooner than many people expect after childbirth.

Discuss options with your healthcare professional before delivery if possible.

Is Mental Health Still Important at 39 Weeks?

Absolutely.

Waiting for labor can bring:

• anxiety;
• frustration;
• excitement;
• sleep difficulty.

The NHS advises speaking with a midwife or doctor if you feel persistently anxious or low.

Is Exercise Still Safe at 39 Weeks?

For many uncomplicated pregnancies, gentle physical activity can remain appropriate.

Walking may support:

• circulation;
• mobility;
• comfort.

Stop and seek advice for:

• pain;
• dizziness;
• fluid leakage;
• bleeding;
• concerning contractions.

Should You Continue Pelvic Floor Exercises?

Yes.

Pelvic-floor exercises remain useful for:

• bladder control;
• pelvic support;
• postpartum recovery.

Is Sex Safe at 39 Weeks?

For many uncomplicated pregnancies, sexual activity may still be possible.

Seek individual medical advice if you have:

• vaginal bleeding;
• ruptured membranes;
• placenta complications;
• instructions to avoid intercourse.

If waters have broken, contact your maternity service because infection risk becomes relevant.

Can You Travel at 39 Weeks?

Long-distance travel is usually impractical this close to birth.

Labor could begin at any time.

Consider:

• distance from maternity care;
• airline restrictions;
• insurance;
• emergency transport.

Discuss essential travel with your healthcare professional.

What If You Are Still Pregnant at 40 Weeks?

That can still be normal.

The NHS antenatal schedule includes a 40-week appointment, particularly for first pregnancies, with review of:

• blood pressure;
• urine;
• bump size;
• fetal position;
• movement;
• options if pregnancy continues.

Forty weeks is still within ACOG’s full-term period.

What Happens at 41 Weeks?

At 41 weeks, pregnancy enters the late-term period under ACOG definitions.

The NHS schedule includes a 41-week visit to discuss options if pregnancy continues, including induction planning.

When Should You Seek Medical Help at 39 Weeks?

Contact maternity care promptly if:

• fetal movement is reduced or stops;
• you think your waters have broken;
• contractions become regular and increasingly painful;
• you have vaginal bleeding;
• you develop severe headache;
• you have visual changes;
• you develop sudden severe swelling;
• you have severe pain under the ribs;
• you have severe abdominal pain;
• you develop high fever;
• you have chest pain;
• you develop sudden severe breathlessness;
• you feel something is seriously wrong.

At full term, concerning symptoms still need professional assessment.

Pregnancy Week 39 FAQs

Is 39 weeks full term?

Yes. ACOG defines full term as 39 weeks 0 days through 40 weeks 6 days.

How big is the baby at 39 weeks?

The NHS estimates the fetus at around 50.7 cm from head to heel, approximately the size of a small watermelon.

Is the baby still developing?

Yes. Late-stage brain, lung and nervous-system maturation continues even at full term.

Is lanugo mostly gone?

Yes. MedlinePlus states that most lanugo is gone by weeks 38–40 except around the upper arms and shoulders.

Can fingernails extend past the fingertips?

Yes. MedlinePlus notes that this may occur during weeks 38–40.

Is scalp hair thicker?

Yes. Scalp hair becomes coarser and thicker during this stage.

Should fetal movement continue?

Yes. Movement remains important right up until birth.

Can labor start naturally at 39 weeks?

Yes. Labor may begin naturally at any time.

What is a show?

A show is thick cervical mucus that may be yellow or blood-streaked and may indicate that the cervix is beginning to change.

Does a show mean labor starts immediately?

No. The NHS notes that labor may still be days away.

What if the waters break?

Contact your maternity service. Waters may appear as a gush or a slow trickle.

Can induction be discussed at 39 weeks?

Yes. ACOG states that induction may be discussed for some healthy people in their first full-term pregnancy with a single healthy fetus.

Does everyone need induction at 39 weeks?

No. It is an individualized option, not a routine requirement for everyone.

Can 39-week induction reduce cesarean risk?

ACOG notes that research suggests it may reduce cesarean risk in certain healthy first full-term pregnancies.

Is elective delivery before 39 weeks recommended?

Not in an uncomplicated healthy pregnancy. ACOG advises against nonmedically indicated delivery before 39 weeks.

Is GBS still important at 39 weeks?

Yes. If your GBS test was positive, antibiotics are generally given during labor when indicated.

How many weeks are left at 39 weeks pregnant?

Approximately one week remains until a 40-week estimated due date, although spontaneous labor can naturally occur before or after the due date.

What Comes Next?

Pregnancy Week 40 remains within the full-term period.

If labor has not started, prenatal care may focus increasingly on:

• fetal movement;
• blood pressure;
• urine;
• fetal position;
• pregnancy growth;
• discussing what happens if pregnancy continues into week 41.

The NHS schedule includes a 40-week appointment and a separate 41-week appointment if pregnancy continues.

ACOG defines:

• 39+0 through 40+6 = full term
• 41+0 through 41+6 = late term
• 42+0 onward = postterm.

Previous: Pregnancy Week 38
Next: Pregnancy Week 40
Tool: Pregnancy Due Date Calculator

Medical References

This article is based on current information from established medical organizations, including:

• NHS — 39 Weeks Pregnant
• NHS — Antenatal Care and Appointments
• American College of Obstetricians and Gynecologists (ACOG) — Definition of Term Pregnancy
• ACOG — Induction of Labor at 39 Weeks
• ACOG — Labor Induction
• ACOG — Group B Strep and Pregnancy
• MedlinePlus — Fetal Development

Editorial & Medical Information

Last content review: October 2026

This page provides general educational pregnancy information only. It does not diagnose labor, ruptured membranes, reduced fetal movement, pre-eclampsia, GBS-related complications or other pregnancy conditions; determine whether induction or cesarean birth is appropriate; prescribe treatment; or replace individualized maternity care.

Pregnancy management, induction availability, GBS protocols and labor instructions differ between healthcare systems and individual pregnancies.

Contact a qualified maternity healthcare professional for concerns about movement, contractions, bleeding, fluid leakage, headache, swelling, severe pain, fever, breathing difficulty or other symptoms.

Conclusion

Pregnancy week 39 marks the official beginning of full term. ACOG defines full term as 39 weeks 0 days through 40 weeks 6 days, and neonatal outcomes in uncomplicated pregnancies are generally best within this period compared with earlier term delivery.

The NHS estimates the fetus at around 50.7 cm from head to heel, approximately the size of a small watermelon. The skin is now more protective and mature, while vernix may still coat some of the body.

MedlinePlus describes other final-stage developments during weeks 38–40: most lanugo has disappeared, fingernails can extend beyond the fingertips and scalp hair becomes thicker and coarser.

Week 39 is also when labor preparation becomes immediate rather than theoretical. A show, stronger regular contractions, back pressure or ruptured membranes can signal that labor is beginning, although losing the mucus plug alone does not guarantee that birth will happen the same day.

For some healthy first pregnancies with one fetus, 39-week induction can be discussed as an option. ACOG notes that research suggests this may reduce the chance of cesarean birth in certain eligible pregnancies, but it is not something every pregnant person automatically needs.

Continue paying attention to your baby’s usual movement pattern and keep your maternity contact information immediately available. Reduced fetal movement, significant vaginal bleeding, suspected waters breaking, severe headache with visual changes, sudden major swelling or other concerning symptoms require prompt professional maternity assessment.