Pregnancy - Third Trimester

28-40 Weeks

The third trimester of pregnancy (the last 3 months) is a period of the most rapid growth for you and your baby. During the last trimester the baby begins storing fat on the body. Although, the lungs are not completely mature until the end of the pregnancy the baby begins some rhythmic breathing movement. The bones are completely developed but they are still soft and pliable. At 37 weeks, the fetus is considered early term. At 38 weeks the fetus is considered full term and is ready to arrive at any time. Mom may notice a decline in fetal movement since there is less room in the uterus as the baby fills out. At full term the average baby is about 19-21 inches long and weighs 6½ to 10 pounds.

The baby is adding on fat and getting ready for life outside your body. While inside, babies have periods of sleeping and waking, suck their thumbs, and hiccups. You can often feel small contractions of the uterus. This is false labor. It is also called Braxton-Hicks contractions. This is like a practice for labor. The usual problems in this stage of pregnancy include more difficulty breathing, swelling of the hands and feet from water retention, and having to urinate more often because of the uterus and baby pressing on your bladder.

PRENATAL EXAMS

Blood work may continue to be done during prenatal exams. These tests are done to check on your health and the probable health of your baby. Blood work is used to follow your blood levels ( hemoglobin). Anemia ( low hemoglobin) is common during pregnancy. Iron and vitamins are given to help prevent this. You may also continue to be checked for diabetes. Some of the past blood tests may be done again.
The size of the uterus is measured during each visit. This makes sure your baby is growing properly according to your pregnancy dates.
Your blood pressure is checked every prenatal visit. This is to make sure you are not getting toxemia.
Your urine is checked every prenatal visit for infection, diabetes and protein.
Your weight is checked at each visit. This is done to make sure gains are happening at the suggested rate and that you and your baby are growing normally.
Sometimes, an ultrasound is performed to confirm the position and the proper growth and development of the baby. This is a test done that bounces harmless sound waves off the baby so your caregiver can more accurately determine due dates.
Discuss the type of pain medication and anesthesia you will have during your labor and delivery.
Discuss the possibility and anesthesia if a Cesarean Section might be necessary.
Inform your caregiver if there is any mental or physical violence at home.

Sometimes, a specialized non-stress test, contraction stress test and biophysical profile are done to make sure the baby is not having a problem. Checking the amniotic fluid surrounding the baby is called an amniocentesis. The amniotic fluid is removed by sticking a needle into the belly ( abdomen). This is sometimes done near the end of pregnancy if an early delivery is required. In this case, it is done to help make sure the baby's lungs are mature enough for the baby to live outside of the womb. If the lungs are not mature and it is unsafe to deliver the baby, an injection of cortisone medication is given to the mother 1 to 2 days before the delivery. This helps the baby's lungs mature and makes it safer to deliver the baby.

CHANGES OCCURRING IN THE THIRD TRIMESTER OF PREGNANCY

Your body goes through many changes during pregnancy. They vary from person to person. Talk to your caregiver about changes you notice and are concerned about.

During the last trimester, you have probably had an increase in your appetite. It is normal to have cravings for certain foods. This varies from person to person and pregnancy to pregnancy.
You may begin to get stretch marks on your hips, abdomen, and breasts. These are normal changes in the body during pregnancy. There are no exercises or medications to take which prevent this change.
Constipation may be treated with a stool softener or adding bulk to your diet. Drinking lots of fluids, fiber in vegetables, fruits, and whole grains are helpful.
Exercising is also helpful. If you have been very active up until your pregnancy, most of these activities can be continued during your pregnancy. If you have been less active, it is helpful to start an exercise program such as walking. Consult your caregiver before starting exercise programs.
Avoid all smoking, alcohol, un-prescribed drugs, herbs and “street drugs” during your pregnancy. These chemicals affect the formation and growth of the baby. Avoid chemicals throughout the pregnancy to ensure the delivery of a healthy infant.
Backache, varicose veins and hemorrhoids may develop or get worse.
You will tire more easily in the third trimester, which is normal.
The baby’s movements may be stronger and more often.
You may become short of breath easily.
Your belly button may stick out.
A yellow discharge may leak from your breasts called colostrum.
You may have a bloody mucus discharge. This usually occurs a few days to a week before labor begins.

HOME CARE INSTRUCTIONS

Keep your caregiver's appointments. Follow your caregiver's instructions regarding medication use, exercise, and diet.
During pregnancy, you are providing food for you and your baby. Continue to eat regular, well-balanced meals. Choose foods such as meat, fish, milk and other low fat dairy products, vegetables, fruits, and whole-grain breads and cereals. Your caregiver will tell you of the ideal weight gain.
A physical sexual relationship may be continued throughout pregnancy if there are no other problems such as early (premature) leaking of amniotic fluid from the membranes, vaginal bleeding, or belly ( abdominal) pain.
Exercise regularly if there are no restrictions. Check with your caregiver if you are unsure of the safety of your exercises. Greater weight gain will occur in the last 2 trimesters of pregnancy. Exercising helps:
Control your weight.
Get you in shape for labor and delivery.
You lose weight after you deliver.
Rest a lot with legs elevated, or as needed for leg cramps or low back pain.
Wear a good support or jogging bra for breast tenderness during pregnancy. This may help if worn during sleep. Pads or tissues may be used in the bra if you are leaking colostrum.
Do not use hot tubs, steam rooms, or saunas.
Wear your seat belt when driving. This protects you and your baby if you are in an accident.
Avoid raw meat, cat litter boxes and soil used by cats. These carry germs that can cause birth defects in the baby.
It is easier to loose urine during pregnancy. Tightening up and strengthening the pelvic muscles will help with this problem. You can practice stopping your urination while you are going to the bathroom. These are the same muscles you need to strengthen. It is also the muscles you would use if you were trying to stop from passing gas. You can practice tightening these muscles up 10 times a set and repeating this about 3 times per day. Once you know what muscles to tighten up, do not perform these exercises during urination. It is more likely to cause an infection by backing up the urine.
Ask for help if you have financial, counseling or nutritional needs during pregnancy. Your caregiver will be able to offer counseling for these needs as well as refer you for other special needs.
Make a list of emergency phone numbers and have them available.
Plan on getting help from family or friends when you go home from the hospital.
Make a trial run to the hospital.
Take prenatal classes with the father to understand, practice and ask questions about the labor and delivery.
Prepare the baby’s room/nursery.
Do not travel out of the city unless it is absolutely necessary and with the advice of your caregiver.
Wear only low or no heal shoes to have better balance and prevent falling.

MEDICATIONS AND DRUG USE IN PREGNANCY

Take prenatal vitamins as directed. The vitamin should contain 1 milligram of folic acid. Keep all vitamins out of reach of children. Only a couple vitamins or tablets containing iron may be fatal to a baby or young child when ingested.
Avoid use of all medications, including herbs, over-the-counter medications, not prescribed or suggested by your caregiver. Only take over-the-counter or prescription medicines for pain, discomfort, or fever as directed by your caregiver. Do not use aspirin, ibuprofen (Motrin ®, Advil ®, Nuprin ®) or naproxen (Aleve ®) unless OK'd by your caregiver.
Let your caregiver also know about herbs you may be using.
Alcohol is related to a number of birth defects. This includes fetal alcohol syndrome. All alcohol, in any form, should be avoided completely. Smoking will cause low birth rate and premature babies.
Street/illegal drugs are very harmful to the baby. They are absolutely forbidden. A baby born to an addicted mother will be addicted at birth. The baby will go through the same withdrawal an adult does.

SEEK MEDICAL CARE IF

You have any concerns or worries during your pregnancy. It is better to call with your questions if you feel they cannot wait, rather than worry about them.

DECISIONS ABOUT CIRCUMCISION

You may or may not know the sex of your baby. If you know your baby is a boy, it may be time to think about circumcision. Circumcision is the removal of the foreskin of the penis. This is the skin that covers the sensitive end of the penis. There is no proven medical need for this. Often this decision is made on what is popular at the time or based upon religious beliefs and social issues. You can discuss these issues with your caregiver or pediatrician.

SEEK IMMEDIATE MEDICAL CARE IF:

An unexplained oral temperature above 100° F (37.8° C) develops, or as your caregiver suggests.
You have leaking of fluid from the vagina (birth canal). If leaking membranes are suspected, take your temperature and tell your caregiver of this when you call.
There is vaginal spotting, bleeding or passing clots. Tell your caregiver of the amount and how many pads are used.
You develop a bad smelling vaginal discharge with a change in the color from clear to white.
You develop vomiting that lasts more than 24 hours.
You develop chills or fever.
You develop shortness of breath.
You develop burning on urination.
You loose more than 2 pounds of weight or gain more than 2 pounds of weight or as suggested by your caregiver.
You notice sudden swelling of your face, hands, and feet or legs.
You develop belly (abdominal) pain. Round ligament discomfort is a common non-cancerous (benign) cause of abdominal pain in pregnancy. Your caregiver still must evaluate you.
You develop a severe headache that does not go away.
You develop visual problems, blurred or double vision.
If you have not felt your baby move for more than 1 hour. If you think the baby is not moving as much as usual, eat something with sugar in it and lie down on your left side for an hour. The baby should move at least 4 to 5 times per hour. Call right away if your baby moves less than that.
You fall, are in a car accident or any kind of trauma.
There is mental or physical violence at home.

Document Released: 04/07/2004 Document Re-Released: 10/15/2010

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