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

Birthing with Bridget

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

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 well. We are all delighted to hear that the hairdressers and barbers are getting ready to open again.
I have not, yet, heard anything about any change to visiting restrictions, or fathers-to-be attending scan appointments in our local maternity units.
As I write this article, Daddies are celebrating Father’s Day. A very happy Father’s Day to all the men out there who support and help Mammies and Grannies.
Last week we looked at the 3rd trimester of pregnancy, the final hurdle of your pregnancy. Today we will relook at the 3rd trimester again, things we did not have time to talk about last week.
Today we will discuss iron supplements in pregnancy, the whooping cough vaccine, the big job that is packing your hospital bags and some important things to make time for before your baby arrives.
Hopefully, you are finding these articles helpful and informative.
Remember if you would like to contact me about future antenatal classes or topics you would like me to discuss please email me on;

Iron Supplements
in Pregnancy
Your iron levels, also called your haemoglobin level, is checked on a blood test called a full blood count (FBC).
Pregnant women have a FBC taken as part of their booking bloods (often taken at the dating scan appointment in the hospital).
This is repeated by many antenatal outpatients’ departments around 28 weeks. Ideally, a woman’s haemoglobin should be 12g/dl or above.
Babies are absolutely beautiful but as they grow inside you, they will take from you what they need to grow and often leave you depleted, this is true for your iron level too.
Having a low iron level is called anaemia. Anaemia in pregnancy is common, worldwide.
If you are anaemic you may feel tired, cold, short of breath, especially when climbing stairs, people may tell you that you look paler than normal.
Anaemia can reduce your resistance to infections and it can make it more likely for you to have a bleed directly after the birth of your baby.
For all these reasons, and so that you can feel well and healthy in pregnancy, especially in the 3rd trimester, it is important to have a good iron level.
As a practising midwife, this is what I see in practice; a woman’s booking iron level will usually fall by 2 grams, approx, by the time she is 26-28 weeks gestation.
For example, if a woman booked with a haemoglobin of 13g/dl at 12weeks, by 28 weeks it will usually be 11g/dl if we have not discussed an iron rich diet and depending on which, if any, iron supplement the woman is taking. I always tell my clients, that your baby takes about 2grams of your iron.
Your diet is the first and easiest way to increase your iron levels. Foods that contain iron include red meat, oily fish, eggs, pulses (such as beans and lentils), green leafy vegetables (the greener the better), wholegrain or wholemeal breads, nuts and some breakfast cereals have added iron.
Absorption of iron into your body is decreased by caffeine and by taking large amounts of anti-acid liquids such as Gaviscon.
Absorption is increased by ascorbic acid found in orange juice and fruits. Often women will take their iron supplements with a glass of orange juice.
Many pregnancy supplements contain iron. Pregnacare contains iron. If a woman’s iron level is good and she feels well then Pregnacare or a similar pregnancy vitamin supplement and an iron rich diet is perfect for her during pregnancy.
If a pregnant woman becomes anaemic, and she needs to get her iron levels increased, in preparation for birth and motherhood, then she may need an iron supplement.
There are many iron supplements on the market. Galfer is popular and Galfer FA contains folic acid. Galfer is a very good iron supplement however, in my experience, it can be poorly tolerated by pregnant women.
Other women have no problems at all taking Galfer. Ferrograde C is often my iron supplement of choice. Women often report that it is easier to take and women report less stomach and bowel upsets with Ferrograde C. Ferrograde C has added vitamin C to aid absorption. Some women can not tolerate Ferrograde C, if this is the case, I would consider Active Iron as an iron supplement.
Active Iron is new to the market and the manufactures report that it will maintain your iron levels but not necessarily bring it up. Often pregnant women need to increase their iron levels.
However, it is all about quality of life and comfort, there is no point in taking an iron supplement if you are not able to eat, or if you are feeling sick or getting constipated or getting haemorrhoids related to that iron supplement. It is all about balance and finding the best iron supplement for your digestive system.
I recommend taking your iron supplement after a good-sized meal (some manufactures may say to take on an empty stomach, but this may make you feel sick).
I also recommend not drinking tea for at least 30 minutes after you take your iron supplement. Normal tea contains tannin, tannin can affect the absorption of iron.
If you have been advised to take 2 iron tablets per day, I recommend splitting these up; take 1 after your breakfast and 1 after your dinner. This should help absorption.
Staying on an iron supplement for a few weeks postnatally is a good idea. However, be sure to have a bowel movement, a normal bowel movement after delivery before you start back on your iron supplement.
I also advise taking your own iron supplements to hospital with you, as your hospital may not stock your iron brand.

Whooping Cough Vaccination
Whooping cough (also known as pertussis) is a highly contagious illness that can be life threatening.
The disease is most serious in babies less than 6 months of age; many babies are hospitalised with complications such as pneumonia and brain damage.
Babies less than 6months old are too young to be fully vaccinated.
Whooping cough causes bad bouts of coughing and chocking making it hard to breath. Not all children get the “whoop” and often older children and adults just have a cough. Whooping cough is spread from person-to-person by coughing, sneezing or close contact. The best way to prevent whooping cough is to vaccinate.
Whooping cough vaccinations are offered to all children as part of the 6 in 1 vaccination that they receive at 2,4 and 6 months of age, at 4-5 years old (4 in 1 vaccinate) as part of the pre school booster and in the 1st year of second level school.
The whooping cough vaccine is now offered to all pregnant women, free of charge in the Republic of Ireland.
The whooping cough vaccination protects you and your baby by stimulating your immune system to produce high levels of antibodies to the whooping cough bacteria.
These antibodies will also pass to your baby in the womb and protect them during the first few months of life.
The antibodies you pass to your baby in the womb decline rapidly in the first 6 months of your baby’s life, therefore it is important your baby gets their routine childhood vaccinations.
You also need to get the whooping cough vaccination during every pregnancy so that high levels of theses antibodies are passed to each of your babies in the womb.
The best time to get the whooping cough vaccine is between 27-36 weeks of your pregnancy. Getting the vaccination at this time will give your baby the best protection.
However, it is safe to receive the vaccination in pregnancy anytime from 16-36 weeks. The vaccination is given into a muscle, often the deltoid muscle of your upper arm.
Women often report soreness or redness around the injection site, usually lasting 48 hours.
A good tip is to get the injection into your non-dominant arm; get the injection into your left arm if you are right-handed. The vaccination is safe for pregnant women and recommended.

Packing your Hospital Bags
Packing your hospital bag is an exciting job. Some Mums buy bits and pieces over the course of their pregnancy, this is a good idea as you don’t always get them in the shops when you need them.
Another good idea is to have a designated place in your home to store all these items you buy in advance. Maybe close to your car seat.
Often, we know that we have bought something and put it into a safe place, this place turns out to be too safe and we can not find it.
By keeping all this stuff together, you will be able to quickly assess what you still need and prevent you buying things you already have.
It has been very difficult for Mums-to-be over the last few months, as many shops were closed, and their online supplies were often sold out.
I advise buying very little newborn size clothing as babies, unless born premature, get very little use from this size. 0-3 months clothing will give your full-term baby more room to stretch out their legs and they will get more wear from them.
Baby grows and baby vests are the stable of your baby’s first few months of life.
Clothing that is soft, comfortable, and handy for Mum and Dad to put on and off, is what you are aiming to buy.
I recommend baby grows that button straight down the front. Some may button at the shoulders or under the nappy, they may look very pretty but in the middle of the night, how they look does not matter. Comfort and convenience matters.
Ideally you should have your hospital bags packed at least 3 weeks before your due date. As from 37 weeks onwards your baby is considered full-term.
A top tip is to leave your coming home outfit (clothes that fit you around 26-28 weeks of pregnancy) laid out at home.
Ask your partner, or whoever is collecting you to bring it to you on the day you are being discharged from the hospital.
My top tip is to pack a small bag for you and a small bag for your baby. The small bags are for you directly after birth and your baby’s will have the first set of clothes in it your baby will wear.
These two small bags can be taken by you to the delivery ward or are ready for baby directly after their birth by C-Section. These bags can stay at the top of your other bags.
Women often put baby’s things into a large zippy bag. In your small bag I recommend putting in a night dress, fresh underwear, small toiletries, and anything else you feel you will need for immediately after delivery, for your shower or freshen up in the delivery room.
Do the same for your baby, they will need a nappy, baby wipes if you want to use them or cotton wool, a cotton drying pad for their bum and Vaseline.
A baby vest, baby grow and a hat for your baby. Your maternity unit will have baby towels and blankets available in the delivery room, but if there is a special blanket that you want your baby wrapped in after delivery, for photos or for comfort, then take this blanket with you to the delivery room.
You may want to include a phone charger in your labour/delivery bag or a camara with a good memory space, as it’s likely that you will want to take pictures.
It is a good idea to pack 2 separate bags. 1 bag for your hospital stay and 1 bag for your baby. The small labour/delivery bags or zippy bags can sit at the top of each of these bags.
Here is my suggested list of items for Mammy’s Hospital Bag:
-your maternity folder (Green Folder in Republic of Ireland).
-a wide opening night dress for labour (preferably opening down the front for skin-to-skin contact, breastfeeding your baby following birth).
-4 nightdresses/pyjamas or leisure wear (again if you intend to breastfeed, front opening is preferred, I recommend dark colours, red and black is great).
-pair of socks or slipper socks (your feet can be cold after labour).
-personal items, toiletries, lip-balm (I recommend ear plugs, especially if you know that you will be in the antenatal ward before the birth of your baby)
-a hairband to keep your hair back during labour and spare hair elastics to help tell you what breast you next need to feed from (put an elastic on your wrist on that side).
-TENS machine and spare set of pads (for pain-relief, we will discuss this in an upcoming article).
-breast pads.
-support bra/breastfeeding bra.
-nipple cream if you are planning to breastfeed (try to get lanet based nipple cream).
-maternity sanitary pads (the bigger the better).
-disposable/ old underwear, dark if possible, for after birth.
-dressing gown.
-2 pairs of slippers (1 pair is nearly always a victim of your waters!!!).
-towels (1 for every day).
-mobile phone charger/camara.
-pen and paper/notebook (often there are advise, tips, feeding times you want to write down).
-any relevant prescribed medication (your iron supplements).
-shower cap (1 of my absolute essentials, you will be taking regular showers, especially if you needed stitches, but you do not need to wash your hair in hospital unless you want to).
-flip flops for the shower.
- a few plastic or reusable bags for sending/bringing laundry home.

My Suggested list of items for your Baby’s Bag
-6-8 baby grows.
-6-8 baby vests.
-baby towel.
-pack of nappies (newborn size).
-cotton wool balls/ cotton dry pads (for drying baby’s bum), Vaseline for baby.
-muslin clothes.
-2 baby blankets (cotton and cellular, if possible).
-baby socks- 2pairs (good for putting on baby’s feet the night before the heal prick test is due).
-a small bowel (approx. 10inches in diameter, plastic for topping and tailing your baby).
I advise that all babies clothes, blankets, sheets, and towels should be pre-washed in non-biological washing powder before packing into your bags.
I also recommend saving all your loose change for car parking and for using in a vending machine in the hospital.
I suggest that Mums should leave a few spare sets of pre-washed baby grows and baby vests, in a designated place at home, that your partner can bring into the hospital if needed.
Some newborns go through 3-4 vests/grows per-day and some newborns only need a daily change. Best to pack for the “just-in-case”.
All new parents will need a car seat to bring their new baby home in. The car seat can stay at home until someone is ready to collect Mum and baby from the hospital on the day of discharge.
It is a very good idea to do a practice run with the car seat. Use a doll or teddy and get practice mastering the straps and get practicing putting the car seat into the car.
They look simple but with all the excitement of bringing your new family home, car seats can be a challenge.

Things to do Before Baby Arrives
Sleep will be hard to come by when your newborn arrives, with most parents getting far less than the recommended 8 hours of sleep during a baby’s early years. While you can’t stockpile sleep, enjoy those precious hours while you can and have a lie in.
2.Make freezer meals
In the first few days when you come home from hospital it can make your life so much easier to have a stockpile of healthy, tasty food ready to go.
Spend a day leading up to your due date cooking up some healthy freezer meals, and portion them out into takeaway containers or plastic lunchboxes, pop them in the freezer, and then all you need to do when you get home from hospital is defrost and reheat.
3.Have a date with your partner
Finding time to be together alone will get a lot more challenging with a newborn in the picture, so save some time while you are pregnant to enjoy a date with your partner.
Going out to a restaurant is not an option at the moment but enjoying a meal at home followed by your favourite film can still be a date night option. Make sure when your baby arrives, to save some time for each other.
4.Start a baby book
If you haven’t already started, the best time to start your baby book is while you are still waiting for your baby to arrive.
Chances are in the days that follow the birth you won’t have much time for filling out a book. I recommend buying the newspaper on the day your baby is born and keeping it as a keepsake.
5.Relax and have a lazy day
Lazy days will become a thing of the past when you are at the beck and call of a newborn, so while you still can, enjoy a day of doing nothing but chilling out. Grab your partner, get a takeaway and sit down and relax.
My top tip is to enjoy the alone time with your bump, every wee kick and movement. These are special moments between you two. Talk away to your baby and rub your bump. Building that amazing connection, soon the world will meet your beautiful baby.
I really hope you have enjoyed this article and found it helpful. Remember all this information and the tips are just a guide. If you are concerned or worried about anything in your pregnancy please speak to your GP/midwife, hospital doctor or hospital midwife.
There will be no article next week, I am taking a week’s holidays. My next article will be in the Inish Times on Wednesday 8th July.

Until then,
Take Care,
Bridget the Midwife.

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