3rd Trimester of Pregnancy | Doctor Ryan - Family Medicine

The 3rd Trimester of Pregnancy

Common questions and what to expect

QuestionsOther Considerations

Congratulations on completing your 2nd trimester of pregnancy! For those who don’t know, the 3rd trimester of your pregnancy is week 27 through week 40 (months 7 through 9).  This part of the pregnancy may be more uncomfortable due to the baby’s growth and movement.  There is a lot of excitement and a bit of nervousness that comes with the last few weeks of pregnancy.  Baby showers, baby room set up, and other last minute preparations seem to bring on a flurry of activity.

CLINIC VISIT INFORMATION
Weeks 28 to 36: clinic visits every 2 weeks

-Weeks 36 to 40: clinic visits every week

Labwork:

Group B Strep Test: At 36 weeks a cotton swab test of your cervix looks for a special kind of bacteria (Group B strep).  If your swab test is positive for this bacteria, then providers will recommend an antibiotic during your labor so that this bacteria cannot affect the baby when it is born.

Imaging:  There usually is not any special testing such ultrasound that is required during a normal pregnancy.

Special situations in pregnancy sometimes require extra monitoring of the baby’s heart beat and ultrasound to look at the baby’s activity level.  This is common in cases of diabetes, a pregnancy that has gone beyond the due date, and other situations.

 

COMMON 3RD TRIMESTER QUESTIONS

1) What can I do right now to give myself the best chance of a healthy 3rd trimester?

This is a good time to look at my suggestions for your 1st and 2nd trimester, if you haven’t been to those sections quite yet.

Track your fetal kick movements

At least once a day you should keep track of the baby’s movement.  Our goal for the baby is 10 movements in 2 hours.  Most of the time (especially at night), this is not a difficult chore; a baby seems to move endlessly at times.  If there is a time where you have not felt the baby move for a while, you should lie down in a quite place where you can concentrate on the baby’s movements.  Any twist, turn, kick, or other movement counts.

Call your provider if there has been a significant change in the baby’s activity or your baby hasn’t moved 10 times in 2 hours. 

-Kegel Exercises!
Kegels are exercises that you should do during and after pregnancy that help strengthen the muscles around your cervix, uterus, and vagina. It improves healing around the vagina after delivery and reduces problems with leaking urine. It can also help reduce hemorrhoids and make intercourse more enjoyable.
The easiest way to perform a Kegel exercise is to If you’re not sure you’ve got it, check your technique by inserting a clean finger into your vagina before doing a Kegel. If you feel pressure around your finger, then you’re on the right track. You should keep your abdomen muscles relaxed.

At the beginning, you will only able to hold a Kegel for a few seconds at a time, but eventually should be able to hold one for 10 seconds at a time. Start slow by performing a few in a row, eventually working up to 30 kegels per day.

Updating yourself with any important vaccines, such as your flu shot! It’s possible that it was not available during your 1st trimester, but now it is!

-NO SMOKING! Have you tried to quit yet? How many cigarettes are you down to? Has your partner started his process to quit? See the link below from “Babycenter.com” for tips and tricks!
http://www.babycenter.com/0_quitting-smoking-during-pregnancy-compare-your-options_1406034.bc

Also try to stay away from second hand smoke!

Continue to eat healthy foods when you’re hungry and exercise for 30 minutes most days of the week! Always discuss your exercise schedule with your doctor and stay well hydrated!

Continue taking your prenatal vitamin

Wear your seatbelt! Now with a noticeable pregnancy, you will wear the lower lap belt BELOW the “baby bump

 

2) What are contractions? What do contractions feel like?

You might already know that you uterus which holds the baby is one big muscle. This muscle will sometimes tighten causing a contraction. Often times a mild contractions will feel just like random mild tightening of your entire abdomen or generalized pressure. If you are in true labor, these contractions become very regular occurring every couple minutes and increasingly uncomfortable.

Braxton-Hicks contractions: This is a term typically used for irregular contractions that feel like abdominal tightening for 20 seconds or so. They often appear during your 2nd trimester and 3rd trimester. They go away with resting. They do not cause your cervix to dilate and do not bring about your delivery.

True Labor contractions:This is a term used for contractions that cause your cervix to dilate and lead to the delivery of your baby. They are usually regular, initially starting out 10 minutes apart but eventually occur every 2 minutes or so. They often times last 30 seconds or longer. They are mild at first (just tightening), but become more uncomfortable as time goes on. They do not go away with resting.

ALWAYS call your provider OR the hospital if you are not sure if you are having Braxton-Hicks or true labor contractions.

When do I call my doctor for contractions during the 3rd trimester?

If you have tightening that occurs 6 times or more in one hour, any painful contractions, or contractions that don’t go away with rest, you should CALL LABOR AND DELIVERY RIGHT AWAY. A nurse will ask you questions about your symptoms and help you with your concerns.

3) What are common symptoms during the 3rd trimester

  • Dizziness and lightheadedness: make sure you stay well hydrated with 8 to 10 glasses of water a day. Especially during the summer months.
  • Charley horses” or cramping in your calves, thighs and feet is very common in the 3rd trimester. They can be very uncomfortable, but are usually resolved with stretching. The best stretch is to lie down and have a partner slowly and gently push your toes toward your knee. Have him or her hold this stretch for 20 seconds at a time and repeat as often as necessary.
  • Bloating and swollen everything (especially feet).  This probably is one of the tougher symptoms to overcome before delivery.  The good news is that it all goes away once that baby is here!  Common tricks include keeping you feet up often, go for a swim, and long hot soaks in the bathtub.
  • Emotional symptoms. You might feel moody, forgetful or unable to concentrate.  Most women at some point say at their clinic visits “I am ready to be done!”  You are not alone.  The good news is that you are likely close to your due date…  I often encourage new moms to enjoy the quiet now
  • Constipation. Pregnancy hormones typically slow down your digestive tract which can help you absorb nutrition, but also back you up. The extra iron in your prenatal vitamin doesn’t help either. Increased fiber, fluid intake, and exercise usually are enough.  Pears and prunes (most people favor pears) can “move” things along.  Certain types of stool softeners can be helpful, but talk this over with your doctor first.
  • Acid reflux. Your digestive tract is relaxed and food stays in your stomach longer, which may cause heartburn. You can reduce the amount of heartburn by eating small, frequent meals and avoid laying down for about 1-2 hours after a meal or snack. Many women also find that avoid spicy and acidic food and drinking a glass of milk also reduces heartburn. Prop up your head and back with any extra pillow when laying down. Talk to your doctor about using “Tums” or other medication if the above suggestions are not working.
  • Visible veins. The blue veins in your belly, breasts and legs may become more noticeable as your body makes extra blood and your heart pumps faster to meet the needs of pregnancy. This is quite normal and most of the time goes away after the pregnancy.
  • Breast changes. Many women notice changes in their breasts early in pregnancy. The hormones in your body are changing to help prepare you for breastfeeding. As these changes occur, your breasts may larger and tender. It is also common to begin to leak milk. However, if you have not noticed any leaking DO NOT be alarmed. This DOES NOT mean you will not be able to breastfeed.
  • Vaginal changes. Often times, women notice thin, whitish discharge, which is normal during pregnancy. If you have significant vaginal itching/pain or any other rash in that general area, its a good thing to call your doctor about.

4) Can I have sex?

Usually; but when in doubt, ask your doctor. Most pregnant women can have intercourse without concern. It is one of the pieces of maintaining a normal healthy relationship. However, on a very rare occasion, if a woman has symptoms of labor that is too early (pre-term labor), we discuss holding off on intercourse for a while.

I do tell couples that sometimes their sex life can change with pregnancy. A woman’s attitude toward sex can be affected by how her body changes and how her hormones change during the pregnancy. And as her body changes finding a comfortable position might be a little more challenging too. So its important for couples to be patient and at times creative during the 2nd and 3rd trimesters.

5) Can I travel in the 3rd trimester?

Yes, but once you get close to 36 weeks there may be some restrictions for airline travel, Be sure to check with the airline regarding their travel policies before you book your ticket! Regardless of what kind of traveling you will be doing it is a good idea to let me know so we can review how the pregnancy is going and your activity plans. Fortunately, it is very rare that I need to place any restrictions on vacation plans.

If traveling by car, It’s important to stop the car every couple hours to get the blood in your legs moving. This rule also applies to airplane flights. If you are travelling abroad, you always want to clear this trip with your doctor at a separate visit and review any travel vaccine updates that might need.

5) WHEN TO CALL YOUR DOCTOR

Like I mentioned during your 1st and 2nd trimesters, there really isn’t a bad time to call me when you have a medical concern. Now that you are getting closer to you due date you may start to expereince some labor like or other symptoms. Remember, it is important to call your provider if you begin to have any sign/symptoms of preterm labor before 37 weeks.  Below are some general guidelines that includes the very important signs of preterm labor and preeclampsia.

Signs of preterm labor

1) Your abdomen tightens up every 10 minutes and especially if this happens more than 6 times in 1 hour.

2) Change in vaginal discharge such as leaking fluid or any vaginal bleeding

3) Pelvic pressure. It might feel like the baby is pushing down

4) Low dull backache

5) Period-like cramps

6) Abdominal cramps that may or may not include diarrhea.

If you begin to experience any of these symptoms, stop what you are doing. The lay down on your left side and drink 2-3 glasses of water. If the symptoms continue after an hour of laying down, call me RIGHT AWAY!

For more information about preterm labor check out the March of Dimes website below.

http://www.marchofdimes.com/pregnancy/preterm_indepth.html

Preeclampsia

Sudden weight gain of more than a pound per day

-Swelling in your hands and face

-Decrease in urination. Your urine might also appear darker

-Constant or severe headache

-Blurred vision or if you start seeing spots in your vision

-Pain in the upper right part of your abdomen (that isn’t just a little baby foot kicking you)

-An overall jittery feeling.

If you notice and of these symptoms don’t hesitate to call the clinic or hospital right away.

 

Other things to consider while preparing for your baby’s arrival

1. Creating a birth plan

A birth plan is way to communicate your labor hopes and preferences with the nurses and doctors. Creating a birth plan also gives you a chance to reflect on things such as who do you want present at the delivery and do you want a natural delivery or would you like pain medications? Remember that labor and delivery is different for every woman and things often don’t go the way you might have planned. So my best piece of advice is to create a birth plan, but also try to remain open minded during your labor and remember that the most important goal is have a healthy mom and baby.

http://www.healtheast.org/images/stories/maternity/birth_plan.pdf

2. Pack your bags!!

Around 34 weeks many women start packing their hospital bag. Most women choose to wear a hospital gown while they are laboring. After you have your baby the hospital will also provide another gown that has special openings in the fabric to make breastfeeding easy. You can also choose to wear your own clothes during labor and for the duration of you hospital stay. Just remember that is that when you wear your own clothes during labor there is a good chance that blood and othe fluids might get on them.

Below is a handout to give you ideas on what to bring for yourself, your labor companion, and new baby!

http://www.healtheast.org/images/stories/st-johns/maternity/johns-mat-whatbring.pdf

3. Car seat safety

You just spent 9 months taking good of your growing baby and now it’s time to think about keeping your little one safe during the many car rides you’ll be taking. Many women often ask me which car seat is the best or the safest. The fact is that all car seats in the store are required to meet the same safety regulations. However, the best seat for your baby is the one that you will use correctly everytime and that fits the best in your car.

There is a lot to know about car seat safety and installation. A few basic things to remember are:

-Babies and small children under 12 years old must always ride in the back seat.

-It is recommended that babies and toddlers ride rear facing until a minimin age of 2. Yes, I know this seems like a long time but the position offers the best protection for your little ones.

-Make sure the car seat harness straps fit snuggly over your child’s body.

I have listed some links below that will give you some good advice. I also recommend that parents bring their car and seat to car seat safety clinic or agency that will install the seat for your (usually for free).

https://dps.mn.gov/divisions/ots/child-passenger-safety/Pages/default.aspx

4. Safe Sleep for baby

Sleep is precious for both you are your baby and during first few months of your baby’s life you both might be struggling to get enough of it. Now I know sometimes desperate times call for desperate measures, but I want you to consider these safe sleep AAP (American Academy of Pediatrics) recommendations:

  • Always place your baby on his or her back for every sleep time.
  • Always use a firm sleep surface. Car seats and other sitting devices are not recommended for routine sleep.
  • The baby should sleep in the same room as the parents, but not in the same bed (room-sharing without bed-sharing).
  • Keep soft objects or loose bedding out of the crib. This includes pillows, blankets, and bumper pads.
  • Wedges and positioners should not be used.
  • Pregnant woman should receive regular prenatal care.
  • Don’t smoke during pregnancy or after birth.
  • Breastfeeding is recommended.
  • Offer a pacifier at nap time and bedtime.
  • Avoid covering the infant’s head or overheating.
  • Do not use home monitors or commercial devices marketed to reduce the risk of SIDS.

http://www.healthychildren.org/English/news/Pages/AAP-Expands-Guidelines-for-Infant-Sleep-Safety-and-SIDS-Risk-Reduction.aspx

 

For those past their due date (and there are a lot of you out there…

    100 Things to Do Before Giving Birth

1. Read another pregnancy book.
2. Take a bubble bath.
3. Get a manicure or pedicure.
4. Eat something spicy.
5. Talk to an old friend.
6. Learn to time contractions.
7. Pick out a baby book.
8. Go over your list of baby names one more time.
9. Write a birth plan.
10. Change the message on your answering machine to inform callers you’re still around.
11. Get your hair done.
12. Get a pregnancy massage.
13. Go for a bumpy ride.
14. Recalculate your due date.
15. Hang out with us on the pregnancy forums.
16. Watch reruns on television.
17. Wash all of your baby clothes.
18. Check out a matinee movie, alone or with a friend.
19. Make a rice sock for labor.
20. Try a new recipe for dinner.
21. Pack your birth bag for the hospital or birth center.
22. Look through your pregnancy journal or pregnancy blog and relive some of the better moments.
23. Buy a new nightgown.
24. Go dancing!
25. Look at some birth announcements.
26. Put the baby’s car seat in the car.
27. Go window shopping.
28. Daydream about the baby.
29. Eat something else spicy. Might I recommend Samosas?
30. Buy a nursing bra.
31. If you have older kids, read to them.
32. Shave your legs.
33. Visit someone else with a new baby and practice holding them.
34. Think of goofy answers to the questions about whether or not you’re still pregnant.
35. Try a new nail color. Change it again.
36. Call your mom.
37. Sit in your baby’s room for a while.
38. Buy a cute baby toy.
39. Get lots of fiber.
40. Put together any unmade furniture.
41. Buy stamps for birth announcements.
42. Work out – go to yoga, aerobics, whatever you like to do.
43. Practice a new position for labor.
44. Walk around the mall.
45. Check to be sure your insurance information is packed in your birth bag.
46. Do you have batteries for your camera?
47. Listen to a favorite CD and consider making a play list for your birth.
48. Buy a pack of diapers.
49. Buy a new toothbrush for the birth.
50. Make a birthday cake.
51. Call your best friend.
52. Play with your pets.
53. Do nothing for a change.
54. Give your husband a back massage. Show him how you like to have your back rubbed.
55. Buy any birthday cards or presents you’ll need for the first 6 weeks after your baby is born.
56. Have a smoothie.
57. Recheck your birth bag for the hospital or birth center.
58. Go to a La Leche League meeting or breastfeeding class.
59. Take your husband dancing.
60. Pack some snacks for the hospital or birth center.
61. Make a belly cast of your belly.
62. Buy some sexy underwear, or at least not granny panties, for after the birth ( a couple of weeks).
63. If you have older kids, make I’m a big sister/brother t-shirts for them.
64. Bake a batch of cookies for the doctors and nurses at the hospital or birth center.
65. Go to your last prenatal appointments.
66. Order your favorite pizza for dinner.
67. Have sex! *wink*wink*nudge*nudge*
68. Think about anything but the new baby or labor.
69. Tell your husband how much you love and appreciate him.
70. Make sure you have a long distance phone card for the birth if your cell phone doesn’t have long distance.
71. Have someone inspect your car seat for safety. Try AAA or local car dealer.
72. Get a new scented lotion for labor.
73. Pack a diaper bag.
74. Page your honey to make sure he’s paying attention.
75. Bake a casserole to eat after your baby is born.
76. Put your birth bag in the car.
77. Make sure you have some postpartum help lined up.
78. Start a scrapbook for your baby if you haven’t already.
79. Call your pediatrician to see if they have a recommended list of first aid items.
80. Look through your old baby books and pictures.
81. Have a lunch date with a friend.
82. Read positive birth stories.
83. Chat with your doula about any last minute worries.
84. Feel your baby’s movements. Remember how you waited to feel the first fetal movements?
85. Make a romantic dinner for your honey.
86. Make a list of everything you will miss about being pregnant.
87. Learn to knit baby booties.
88. Ask your mom about your birth.
89. Clean out the refrigerator.
90. Rent a movie.
91. Take a practice drive to the hospital.
92. Listen to a book on tape.
93. Read a novel you’ve been dying to read.
94. Go to work – why not?
95. Think about your postpartum birth control choices.
96. Read a new breastfeeding book.
97. Practice a new relaxation technique.
98. Refold all the baby clothes.
99. Write a letter to your baby telling him or her how much you can’t wait to meet them!
100. Make a list of everything you won’t miss about being pregnant.
101. Give birth!