For pregnant women, by the time the third trimester arrives many changes have already taken place. As the body grows and prepares to give birth, more changes are on the way – both physically and mentally.
Dr. Radha Rani Padhy of Keystone Women’s Care shares information about what women can expect during the last trimester of pregnancy, and when they should seek medical advice.
What kind of physical changes start to happen during this trimester?
During this trimester, the uterus gradually expands from the pelvis up to the rib cage. This can cause tremendous physical pressure and discomfort. In addition to lower back pain, there may be pressure on the sciatic nerves causing pain, tingling or numbness down the legs. Finding a comfortable position to sleep may become challenging. The best position is lying on the side, preferably the left side to allow for maximum blood flow. Body pillows may be helpful in maximizing comfort.
Hemorrhoids may develop, which are varicose veins in your rectum, and swelling of the fingers, face and ankles may become more evident. The skin across the abdomen may become dry and itchy from the stretching. Pink, reddish or purplish indented streaks may become visible reflecting stretch marks.
False contractions, known as Braxton Hicks contractions, may become more frequent. These are irregular and sporadic contractions. As unpleasant as the physical symptoms become, the highlight will be consistent movement of the baby. Get to know your baby’s patterns of movements, including the frequency and intensity. There may be a slight decrease in activity in the last few days before birth as the baby descends further down in the pelvis in preparation for delivery.
What kind of emotional changes may be taking place?
By this point, the fatigue of pregnancy may be overwhelming, leading to growing eagerness towards the estimated due date. Many women also experience feelings of apprehension about the birthing process. A good way of overcoming this is to talk with others who have had positive birth experiences. If you’re frightened and anxious during labor, your birthing experience may be more difficult. Educating yourself and asking questions about the process can greatly ease your qualms.
What are common tests that will be run during this time?
Prenatal visits become more frequent during this trimester. After 28 weeks of pregnancy, visits occur every two weeks and visits will be scheduled weekly after 36 weeks. These appointments are important as they include checking the position of the baby to see whether the head or the buttocks is facing the down towards the mother’s pelvis.
A group B strep test is performed, which is a swab of the vagina and rectum. Group B strep is a bacteria that is normally found in the vagina or rectum, but it can cause a serious infection for the baby if there is exposure during birth. If you test positive for group B strep, you will require antibiotics during labor.
If you pass your due date, the baby’s heartbeat may be monitored with an electronic fetal monitor. An ultrasound may also be performed to assess the baby’s breathing, movement, muscle tone and the amount of amniotic fluid. You may also be offered an induction of labor, which involves the stimulation of uterine contractions before labor begins in order to achieve a vaginal birth. Your provider will explain in detail all the modalities of induction available and individualize a plan appropriate for you.
What do healthcare providers generally recommend when it comes to over the counter medications and physical activity during this trimester?
As stressed throughout your pregnancy, always ask your provider before starting any medications. This includes prescription and over-the-counter medications. Daily exercise is still recommended (30 minutes at moderate intensity) if there are no medical or obstetric complications. However, avoid lifting heavy weights (greater than 20 pounds) and any exercises that involve lying on your back.
What warning signs should the expectant mother be concerned about? When should she call her doctor or midwife?
Babies establish movement and sleep patterns as the pregnancy progresses. It is important to be aware of and account for these movements. If you perceive decreased fetal movement, sit down in a quiet place and count your baby’s kicks. You should count at least 10 movements within two hours. If there are less than 10 kicks or you don’t feel any movement at all, call your provider immediately.
Toward the end of the trimester, it may be difficult to tell the difference between false contractions and true contractions. False contractions usually are irregular, don’t get consistently closer together, vary in length and intensity and dissipate with walking, changing positions or resting. They are mainly centered in the lower abdomen and pelvis. True contractions have a regular pattern that grow closer together, last at least 30 seconds, become longer and stronger and strengthen despite walking, changing positions or resting. They most often radiate throughout the abdomen and lower back. If you start experiencing contractions every two to three minutes lasting for one or more hours, or painful contractions with heavy vaginal discharge, call your provider immediately.
Other reasons to call your provider immediately during any trimester include: heavy bleeding or bleeding that lasts longer than a day, severe abdominal or pelvic pain (especially if accompanied by a fever or bleeding), a fever greater than 102 degrees Fahrenheit, a severe and persistent headache (especially with dizziness, faintness or visual disturbances), severe shortness of breath or chest pain, inability to urinate or painful urination, leg pain with redness or swelling, worsening swelling of the hands or feet, heavy or foul-smelling vaginal discharge and a low mood, loss of pleasure and thoughts of harming yourself or others.
What are common concerns that expectant parents have during this time?
Concerns about breastfeeding, scheduling difficulties with maternity and/or paternity leave and anxiety over becoming parents are common worries. The best way to overcome this anxiety is to be organized before the baby is born. Find a pediatrician or provider with whom you are confident and stock up on baby supplies that you will need immediately once you arrive home with your baby for the first time.
Buy a car seat as it is one of the most important pieces of equipment in the care of your baby, starting with the first ride home from the hospital. Car seats are required by law in every state. Correct and consistent use of them is one of the best ways to protect your child. You should also buy a crib as the newborn baby will spend more than half their time sleeping. When purchasing or borrowing a crib, make sure that it meets specific safety guidelines.
Fears about the birthing process are also normal. As you anticipate the day of your baby’s arrival, it becomes exciting but can also be very stressful. Knowing what to expect can help you have the most positive birth experience. Acknowledge that childbirth can be painful, so inquire about all the pain management options that are available. Address all your fears with your provider and ask as many questions as you need to be prepared. Remember that you are not alone. Childbirth can be a scary experience, but we are here to guide you through it every step of the way. As your provider, we take the utmost pride and pleasure in having a healthy mom and healthy baby.
This article contains general information only and should not be used as a substitute for professional diagnosis, treatment or care by a qualified health care provider.