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Third Trimester

As the third trimester of pregnancy arrives, consider yourself in the 'home stretch'. You may vacillate between excited anticipation of your baby's arrival and panic that you don't have everything ready to welcome the newcomer. Both ends of the emotional spectrum are natural and to be expected.

Weeks 28-40 (or delivery) mark a time of rapid fetal growth. Your baby needs more calcium, iron and protein at this point in its development, so be very attentive to these nutrients your diet. Also, prepare yourself to delivery this child. Now is the time to learn about labor and birth by reading books, asking questions and attending childbirth classes. Understanding the process can help alleviate some of the anxiety women commonly feel as they approach their due date.

The following table is meant to answer questions related to third trimester issues. These are common experiences and questions of women as they pass their 28th week of pregnancy.

Questions About Your Third Trimester
What happens during my prenatal medical visits now?
  • You will start out with once a month visits. By about the 32nd week, your health care provider may want to see you every two weeks. As you get very near delivery, they will probably want to see you weekly.
  • You will have your weight and blood pressure checked at each visit.
  • You will have your urine tested for sugar and protein at each visit.
  • The fetal heartbeat will be monitored.
  • Your health care provider will feel the size and shape of your uterus by pressing on your abdomen. They will also try to feel which position the baby is in, for example, head up or head down.
  • The fundus will be measured. This measures the size of the uterus and where it is situated in your abdomen.
  • Your health care provider may ask you to pay attention and record frequency of your baby's kicks (called kick counts).
  • When you are within a couple of weeks of your due date, your health care provider will do a pelvic exam to view your cervix.
  • Your health care provider will probably ask you about frequency of any contractions you have had.
  • Be sure to obtain a list of phone numbers and instructions so you know what procedures to follow once you go into labor or have concerning symptoms or complaints.
  • Any complaints or health concerns can be discussed at your medical visits. Be sure to bring a list of your questions to your prenatal medical visits.
What tests will need to be done, and why?
  • There are no routine lab tests done in the last trimester, but your health care provider will perform any specific tests they feel are necessary.
  • An ultrasound (sonogram) may be done near the due date to verify the baby's position for delivery.
  • If you go past your due date, your doctor may want to monitor your baby's well being with additional tests.
How will my body change?
  • Fatigue can occur because of interrupted sleep. Frequent nocturnal urination and discomfort because of the size of the growing belly may make getting a good night sleep difficult. Rest, and nap when you can.
  • Nasal congestion. Hormonal changes can cause swelling of mucous membranes, a stuffy nose, postnasal drip, and occasional nose bleeds. Allergies may seem worse. Be sure to check with your doctor before taking any medications to treat this problem.
  • Increased vaginal secretions are normal. Report any foul, itchy or discolored discharge.
  • Slight shortness of breath is a result of hormonal changes which affect the blood flow and muscles in the lungs. In the 3rd trimester, shortness of breath can also be attributed to the enlarged uterus pressing up against the diaphragm which makes breathing more difficult. Avoid overexertion.
  • Heartburn can occur as the growing uterus crowds the stomach. Acid reflux may occur.
  • Swollen gums. This is caused by hormonal changes. You may have some bleeding from the gums when you brush your teeth. Use a soft toothbrush and continue to brush and floss regularly.
  • Abdominal aches are usually related to the stretching tummy and the ligaments in the abdomen. The growing uterus and baby also cause crowding in the abdominal area.
  • Itchy skin can result from the stretching of the skin. Try a good moisturizer.
  • Leg and foot cramps may be bothersome. Don't point your toes down when you stretch, keep you feet flexed to reduce cramping.
  • Constipation can become a problem. Relieve constipation by drinking plenty of fluids, eating a diet higher in fiber and getting regular exercise.
  • Hemorrhoids can result if constipation isn't resolved.
  • Varicose veins (swollen/bluish veins, usually in the legs) occur in some women. To help prevent this problem, avoid sitting or standing for long periods of time, don't put on excess weight, be sure to walk or do other regular exercise, try wearing supportive pantyhose, and don't smoke.
  • Headaches may occur more frequently. Try to get enough rest and relaxation. Be conscientious of good posture. Massage the neck, shoulders and head. If you need a pain reliever, be sure to check the safety with your doctor. Most over-the-counter pain relievers are not recommended during pregnancy.
  • Backaches can occur as the enlarging belly affects your posture. Wear supportive shoes, not high heals. Gain appropriate amounts of weight, but not excess weight. Don't stand or sit for extended periods of time. Do exercises that are designed to improve muscle tone and posture during pregnancy.
  • Sometimes a nerve in the hip/buttocks area (sciatic nerve) gets pinched because of pressure exerted on it. Special stretching exercises may help.
  • Mild swelling of the hands, feet or face. This is also called edema. Mild swelling may be a normal result of the increase in your bodily fluids. Try to elevate your legs when possible. Don't stand for prolonged periods of time. Support pantyhose may help. Continue to drink at least 8-10 cups of fluid per day. Notify your doctor if swelling is extreme or persistent because this could be a sign of a more dangerous condition known as preeclampsia. (Pregnancy induced hypertension).
  • Feeling hotter than usual. This is a normal metabolic response during pregnancy. You may be sweating when everyone else around you is shivering.
  • Contractions are a way of the uterus preparing for delivery. The uterus muscle will harden and then relax. It's normal to have mild contractions that prepare your uterus for delivery and can start anytime after the 20th week. If they become stronger or more frequent (> 4 per hour) call your health care provider, as this may indicate preterm labor.
  • Colostrum may begin to leak from the nipples. Colostrum is a clear, nutrient-rich fluid that the baby will nurse on in the first couple of days after delivery. The milk usually starts to flow by the 2nd or 3rd day after delivery.
I have some concerns.
Am I doing everything I can to insure that the baby and I continue to do well?
  • Difficulty sleeping. Your size may make sleeping uncomfortable. The position that is usually recommended is to sleep on your left side. Sleeping on your back can put too much pressure on your back and compress important blood vessels. Try hugging a pillow or putting a small pillow between your knees.
  • Clumsiness. As you get bigger, it does get more difficult to maneuver. Step cautiously. Don't be afraid to ask for assistance when you need it.
  • Participating in sports and exercise. Fitness during pregnancy is important, but keep it a low risk activity. Discuss exercise options with your health care provider. Drink plenty of fluids and don't exercise to the point of exhaustion or overheating. Do safe exercises and exercises that are designed for pregnancy.
  • Leaking of urine. This is called stress incontinence. As the heavy uterus presses down on the bladder, a small amount of urine may be released during a cough, etc. Try strengthening your pelvic muscles by practicing contraction of the muscles surrounding the vagina and anus. These are the same muscles you would use to stop urinating in midstream. These exercises are called Kegels.
  • Travel. You should stay closer to home towards the end of your pregnancy, or at least be near a medical facility. Most health care providers discourage travel in the 8th and 9th month. Get clearance from your doctor before heading off on a vacation or distant destination.
  • Sex during pregnancy. Unless your doctor has given you specific instructions to curtail your sexual activity, sexual activity is safe during pregnancy. You might have to get more creative as the expanding belly gets in the way. Neither intercourse nor orgasm should cause premature labor in most women. If you have specific fears or concerns, be sure to bring them up with your health care provider.
  • Premature labor. Going into labor before 37 weeks gestation constitutes premature labor. To decrease risk of premature labor; avoid heavy physical labor or lifting, be sure to drink plenty of fluids and eat properly throughout your pregnancy, and of course, avoid use of alcohol, drugs and smoking. Discuss your personal risk of preterm labor with your doctor.
  • Preparing for delivery. Make sure you attend childbirth classes. Have a plan of how you would like your delivery to proceed. Be informed regarding pain relief options. Have your hospital suitcase packed in advance with all items you intend to bring. Learn about breastfeeding, as breastfeeding holds many benefits for you and your baby. Take a tour of the facility you plan to deliver at.
  • Cesarean section. Occasionally a cesarean delivery is planned well in advance. Once in a while a C-section must be performed because of a difficult labor, or fetal distress. Find out about C-sections in advance, in the slight chance that you may need one. This delivery method, although considered a major surgery, has been shown to have excellent outcomes and carries relatively minor risks.
How will I know when I am going into labor? What should I do?
  • Signs of labor include: uterine contractions that are 10 minutes apart or less, cramping, backache, pain or pressure in the pelvic area. Some women have nausea, vomiting or diarrhea. You may notice an increase in vaginal discharge that is mucousy or somewhat bloody. If your water breaks, you may have a significant amount of watery discharge.
  • Call your doctor when you think you are in labor. They will discuss your symptoms of labor and instruct you about when to go to the hospital.
  • It's best to plan ahead. Discuss your labor and delivery plan with your health care provider so you know what to do, where and when to go. Have important phone numbers for the doctor and the hospital handy. Have your hospital bag packed with items that you will want and need while you are in the hospital.
  • Stay calm. Remember that the vast majority of deliveries occur without complication. This is the end of your pregnancy journey and the beginning of your life with your new baby. Congratulations!

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