HEALTH COLUMN - The third trimester (weeks 27-birth) - Part one

Birthing with Bridget

HEALTH COLUMN - The third trimester (weeks 27-birth) - Part one

THE THIRD TRIMESTER... From 37 weeks onwards, the pregnancy is full-term. Should anything happen such as pains, waters breaking or the birth of your baby, from 37 weeks on, the baby is not premature.

Hello everyone, I hope this article finds you all safe and well. In previous articles we have discussed the 1st and 2nd trimesters. Today we will talk about the 3rd trimester of pregnancy.
From week 27 of pregnancy until the birth of your baby. Pregnancy is measured in forty weeks, but some babies like to stay tucked up in your womb a little longer and can go a week or two past their due date.
The 3rd trimester is the home stretch and you will meet your little girl or boy soon.
This trimester can be a bit challenging as your belly keeps growing and you have some new symptoms as a result of carrying around more weight and you may also find yourself anxious to have your baby and ready to be finished being pregnant.
Your baby is also going through a lot of changes this trimester in preparation for life outside the womb. Keep in mind that you are almost there, and when you meet your baby all the challenges of being pregnant is 100% worth it.
From 37 weeks onwards, the pregnancy is full-term. Should anything happen such as pains, waters breaking or the birth of your baby, from 37 weeks on, the baby is not premature.

Body changes and ailments in the 3rd trimester
A woman’s breasts increase in size and fullness during pregnancy, by the 3rd trimester, hormone changes will cause your breasts to get even bigger as they prepare for breastfeeding. Your breasts may feel full, heavy or tender.
Some pregnant woman begin to leak from their breasts in the 3rd trimester.
It is colostrum that is leaking out. Colostrum is the first milk that your breasts produce for your baby.
I call it “liquid gold”. It is a thick, yellowish fluid containing antibodies that protect newborns from infections.
If your breasts get bigger, leak colostrum or have blue, vein like lines appear on them, then, these are all very encouraging signs that you will have a good milk supply.
Not all women have these signs in pregnancy, some have one or more and some women have no breast changes.
A good tip, if you find your breasts have got bigger, is to wear a maternity bra with good support and if you are fearful about leakage or if you have started to leak colostrum, put a soft breast pad into your bra to absorb any leakage.
Tell your GP or midwife if you feel a lump or have nipple changes or discharge (that is not colostrum) or any skin changes.

Heartburn and Indigestion
Hormones and the pressure of the growing womb causes heartburn and indigestion. Pregnancy hormones slow down the muscles of the digestive tract, so food tends to move more slowly causing digestion to become sluggish. This can make many pregnant women feel bloated.
Hormones also relax the valve that separates the food pipe from the stomach. This allows food and acid to come back up from the stomach into the food pipe.
The food and acid cause the burning feeling of heartburn. As your baby gets bigger, the womb pushes on the stomach making heartburn quite common, especially in the 3rd trimester.
These are a few things that might help:
-eating several small meals instead of 3 large meals, eat slowly.
-drink fluids between meals, not with meals.
-avoid citrus fruits or juices and avoid spicy foods.
-try not to eat or drink within a few hours of bedtime.
-try not to lay down straight after eating.
-drinking cold milk may give you some relief.
Pregnant women often take Gaviscon to relief heartburn. Gaviscon is safe to use in pregnancy, however, in my experience, if women are needing to take more and more every day, and if they are trying to increase their iron level with iron supplement, then their iron number may not be increasing.
Taking a lot of Gaviscon everyday can stop your iron supplements being absorbed properly.
If this is happening to you, or if you can not get relief from the heartburn speak to your GP and they may prescribe you an anti-acid tablet that will relief the heartburn. Severe heartburn can result in vomiting and can make for a very unpleasant 3rd trimester, speak to your GP or midwife about this.

Numbness or Tingling In your Hands (Carpel Tunnel Syndrome)
Carpel tunnel syndrome (CTS) is a condition that causes pain, numbness and tingling in your hand and fingers. It is caused by pressure on a nerve in your wrist.
Other symptoms include pins and needles, a burning sensation in your fingers and weakness of the muscles that control your thumb, which can affect your grip strength.
Symptoms may affect both hands. One maybe worse than the other. Pain is especially common at night. CTS is common in pregnancy, especially in the 3rd trimester.
For most women, symptoms will ease a few weeks after your baby is born. Daily gentle hand and wrist exercises can help. You will find examples of these exercises online.
Try to avoid repetitive tasks. I advise placing your hands and wrists on a pillow or cushion when you are resting.
Make sure it is placed higher than your heart. Some women say that hanging your hand can help also, e.g. let your hand hang down over the side of the bed.
Try not to sleep on the side of your painful hand, also, try running cold water over your wrist before bed, this may help reduce the swelling.
If these tips are not giving you any relief and you are in pain, please speak to your GP or midwife. They may suggest a physio referral and sometimes the physio will fit you with splints to wear at night to keep your wrists in a comfortable position and help reduce pain.

Constipation
Many pregnant women suffer from constipation. Signs of constipation include having hard, dry stools; fewer than 3 bowel movements per week, and painful bowel movements.
Higher levels of hormones during pregnancy can slow digestion and relax muscles in the bowel which can leave women constipated.
The pressure of the growing womb on the bowels can contribute to constipation. Also, many women take iron supplements in the pregnancy (we will talk about iron supplements in next week’s article).
Some iron supplements can contribute more to constipation than others. Constipation, especially in pregnancy can lead to haemorrhoids(piles). Haemorrhoids come easier in pregnancy due to pregnancy hormones.
The best way to avoid haemorrhoids is to avoid constipation.
My tips on avoiding constipation include:
-try to drink 1.5-2lites of water per day (8-10 small glasses, at least).
-try not to drink caffeine.
-eat fibre-rich foods, such as fresh or dried fruit and vegetables, wholegrain cereals and breads, brown rice and brown pasta.
-try to keep active, go for a short walk, every day.
Talk to your GP or midwife if constipation or haemorrhoids are a problem for you in your pregnancy.

Leg Swelling
Many women develop mild swelling in the face, hands or legs/ankles during their pregnancy, especially in the 3rd trimester. Leg swelling can be associated with raised blood pressure in pregnancy.
If your blood pressure is normal and there is no sign of protein in your urine, then leg swelling is not a medical concern, it is just comfortable. Try to drink 8-10 glasses of water per day.
When you are resting put your feet up. Support tights or stocking can help to support the legs and reduce the swelling.
Your legs should not be swollen first thing in the morning, but they may swell as the day goes on, especially if you are standing on your feet a lot.
This is often your body’s way of telling you to rest more. If you notice swelling that comes on very quickly, especially if this swelling is on your face and/or around your eyes, contact your GP or midwife, they will ask you to come and have your blood pressure and your checked to out rule pre-eclampsia (PET), which is raised blood pressure, protein in the urine and swelling. Good supportive footwear is an essential purchase in pregnancy.

Back Pain, SPD, Pelvic Girdle Pain
Back pain, especially lower back pain is very common during pregnancy. Hormones of pregnancy allow the ligaments in your back to become softer and stretch to prepare for labour.
This can put a strain on the joints of your lower back and pelvis, which can cause back pain.
Some pregnant women especially in the 3rd trimester, experience sciatica.
Unlike your average pregnancy back pain, sciatica is a sharp, shooting pain, tingling or numbness that starts in the back or buttock and radiates all the way down the back of your leg.
The sciatic nerve, the largest nerve in the body, starts in your lower back and runs down the back of your legs. Your growing womb can press on the sciatic nerve, or your baby’s head can rest on this nerve.
This will not affect your baby at all. If you are experiencing sciatic pain try using a warm compress, such as a heat pack, on the spot you feel the pain, sit down and rest when you can, sleep on the side of your body that is pain free.
Try placing a pillow between your legs, when in bed, this will help to keep the pelvis in better alignment and take some pressure off the sciatic nerve.
Symphysis pubis dysfunction (SPD) and pelvic girdle pain are different ways of saying the same thing. SPD is a collection of uncomfortable symptoms caused by stiffness of your pelvic joints, or the joints moving unevenly at either the front or back of your pelvis. SPD is not harmful to your baby. It only affects the Mum-to-be and often makes it difficult for her to mobilise around. I advise my patients to keep their pelvis together, all the way around, and try not to abduct from centre, such as moving one leg then the other, especially when getting in or out of bed or the car.
Try to pretend there is an elastic band around your pelvis and anytime you are moving try to bring the whole pelvis together, i.e. both legs together, not one leg and then the other.
Other helpful tips to manage SPD include, sitting with your hips higher than your knees (use a wedge cushion), roll out of bed- gently, take the stairs one at a time and slowly, get dressed while sitting and place a thin pillow between your legs, in bed, to support your pelvis (don’t use a fat pillow as this will abduct the legs and hurt your pelvis).
Try to avoid pushing heavy trolleys/buggies or hoovers. Try not to carry small children on one hip. Avoid sitting in low chairs with your knees higher than your hips. Please speak to your GP or midwife if you are troubled by back pain, sciatic pain or SPD.
They may refer you to a physio who may give you a support belt to wear during the pregnancy.
If you have mild back pain, exercises to strengthen your core, such as pregnancy Pilates or pregnancy yoga may help. Due to Covid 19, class-based exercises are not happening but have a look online, just make sure that the class you chose to follow is suitable for pregnancy.

SCHEDULE OF CARE – 3rd TRIMESTER
The timing of your visits to see your GP/midwife are similar in the Republic of Ireland to Northern Ireland. Most pregnant women see their GP/midwife in their local surgery and attend their local maternity unit for appointments. This is called shared or combined care. The recommended schedule of these visits are every 4 weeks up to 28 weeks. Every 2 weeks from 28-36 weeks and weekly from 36 weeks until your baby is born. Therefore, you will have more visits in the 3rd trimester. Women attending Letterkenny University Hospital are invited to attend for a consultants visit, to antenatal outpatients at 28 weeks approx. At this visit, your hospital doctor will perform a check-up on Mum, including blood tests to look at your iron level and blood group and check your baby. Women who are the Rhesus Negative blood group (about 20% of the population), will be offered an injection of Anti-D.
This injection of Anti-D is seen as a prophylactic dose (a just in-case dose). This has become routine practice (and is viewed as good practice) nationally in the last few years.
You will see your GP/midwife 2 weeks, approx., after your hospital antenatal appointment and this will start your more frequent visits.

Your baby in the 3rd trimester
As midwives we can listen to your baby’s heartbeat and you can have a scan performed at the hospital.
Both tell you how your baby is doing, but these are just snap shots in time. Feeling your baby kick and move is your constant assessment of how your baby is doing.
Babies start to move in the 1st trimester, but Mums often feel the first movement, known as quickening, somewhere between week 19-21.
Sometimes it can be later depending on the location of your placenta.
By the 3rd trimester the baby’s movements should be strong and easily felt by Mum. Some people advocate for counting the movements and this is a good way of assessing how many movements you are having but in a well, healthy pregnancy, it is all about the pattern of baby’s movements.
Women often report that when they are busy, during the day, that the baby can be quiet, however, if they sit down or when they sit down at night then the baby becomes very active. It is a good idea to know when your busy baby movement period is throughout the day and what triggers makes the baby move.
The trigger for movements could be as simple as Mum sitting down, having something to eat, talking to your baby or listening to music. If you think you baby is quiet NEVER doubt yourself, even if this is your first pregnancy, you know your baby’s movements best, after all, the baby is moving inside you,
I encourage woman, if they feel baby has been quiet, to stop what they are doing right away, lay down on their left-hand side.
Do not get distracted by phones or iPads, put them away. Have a drink of ice-cold water or a sugary drink or treat and focus on your baby’s movements for 20 minutes.
If in that 20-minute period you have a normal, good pattern of movements, then all is well, but take this as a little lesson to concentrate harder on the importance of your baby’s movements.
If you are not happy with your baby’s movements after this 20-30 minute period and you have rested and taken some water, then do not hesitate, night or day, to contact your local maternity unit and go in to have a check-up.
You will never regret going in, having a monitor and a little scan and being told all is well. Baby movements are the single best indicator of how your baby is doing.
Sometimes, babies are very active and if this is the norm for your baby then this is perfect.
However, if you have a period of excessive baby movements, unrelated to you having lots of sugary drinks or treats, then, again, I advise calling your local maternity unit for advice.
They may invite you in for a check-up, especially if there was no reason for these excessive movements.
The take home message regarding baby movements is that they are so important and as a Mum-to-be never doubt yourself, you know best.
During the 3rd trimester your baby will start to lay down its own fat stores, going through rapid growth phases in preparation for birth.
The baby’s lungs will mature and senses such as hearing, taste and sight will develop. The baby’s bones are fully developed, and they have eye lashes. By the end of the 3rd trimester your baby will have a grasp reflex which is perfect for holding onto your fingers when they are born into this busy, bright world.
I hope you have found this article helpful. If you have any questions or you want to contact me about an antenatal class in the future please email me; birthingwithbridget@gmail.com. Again, all the information and advice in this article is just a guide and if you are concerned about anything in your pregnancy please speak to your GP/midwife, hospital doctor or midwife. Next week we will look at the 3rd trimester Part 2, this includes iron supplements, the whooping cough vaccination and that important and exciting job- packing your hospital bags.

Until then,
Take Care,
Bridget the Midwife.

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