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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.
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| 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.
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| 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.
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| 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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