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What to expect in your third trimester – a four-part series

What to expect in your third trimester – a four-part series

How to care for baby and you during each stage of pregnancy and beyond

Wednesday, August 8, 2018

firsttrimester

The third trimester of pregnancy, beginning around week 28 and ending around week 40 when you give birth, can be pretty uncomfortable, but also exciting as the time draws nearer to delivery.

Expect some swelling, according to Tim Vierling, M.D., an OB/GYN who delivers at Northwest Community Hospital (NCH), who says virtually all women have some swelling during pregnancy, but only seven percent of first-time moms will develop preeclampsia.

Tim Vierling, M.D.

“For most patients, swelling is just a nuisance,” he says. “Fluid goes to your feet, usually. You can elevate them and if it’s winter time, you can wear support stockings. If you have any concerns about swelling, especially if you have headaches, call your doctor.” 

A simple test can tell if you are developing preeclampsia.

The only real cure for swelling is giving birth, at which time it will take about two weeks, he says, to rid your body of excess fluids. 

Visits

In the third trimester, expect to visit your OB/GYN physician every other week up until the last month, and then every week until you give birth. An ultrasound is performed at week 30 and as needed at the end if the baby is measuring too big or too small. Dr. Vierling also is on the lookout for diabetes or hypertension.

“We test urine for protein and sugar,” Dr. Vierling says. “Things can change quickly at the end, and usually we can catch things since it’s been only a week since the last visit. We want to catch things before they happen.”

What does labor feel like?

As the time draws near, it’s common for patients to question what labor pains and water breaking will feel like, Dr. Vierling says. Since leaking urine can be common at the end of pregnancy as the growing baby presses on the bladder, it may be confusing. (Try Kegels, by the way, to strengthen those muscles).

“The difference is that usually leakage of your water bag will continue,” he says. “If you’re concerned, there’s a simple office check. We can test the acidity of any discharge and we’ll know if it’s the bag or not.”

He suggests that if it persists more than once, see your physician. “If there are no contractions following it, it’s probably nothing. It’s one of the most frequent phone calls we get.”

If the water bag breaks, plan on going straight to the hospital, he adds.

Packing for the hospital

To prepare for the birth, parents should pack for the hospital about a month prior to the due date. 

“Most patients can wait two weeks before, but people might not be comfortable with that,” he says. “Essentially, if it’s a month out, you’re almost certain to catch that magic delivery day.”

Some key items to pack include a warm robe, lip balm, headband or ponytail holder, maternity bras, insurance forms, toiletries, loose, lightweight clothing and flat shoes.

Some not-so-nice symptoms

During this stage of pregnancy, breasts may begin to feel tender, and some patients may notice milk leakage. Although it’s still safe to have intercourse, it may be uncomfortable and a little spotting afterwards is not unusual.

Three symptoms commonly occur as the baby gets into birthing position – head down in the pelvic region.

  1. The first is a lack of appetite as the baby pushes its feet upward. Smaller meals may help, but you may feel fuller sooner and experience constipation, indigestion and/or heartburn. 
  2. I always tell patients who are concerned about nutrients that, in this country, there’s no lack of calories,” Dr. Vierling says. “Just do the best you can and still try to make wise choices.”

  3. The second symptom is pressure in the pelvic region that may be coupled with back pain.
  4. "Most babies are head down by 36 weeks and if you picture that head down there in the pelvis, all I can say as a male is that it must be very uncomfortable," Dr. Vierling says. "A mom can take Tylenol, use heating pads or Icy Hot if she wants. There are all kinds of cushions and pillows and supports to try to lift the baby and help you with your center of gravity and get that pain off your back."

    The best cure, as he says of swelling, is delivery. "You tend to trade that pain at delivery for pain to the side of your back as you carry the baby carrier and other things," he adds.

  5. The third concern is that moms tend to not feel the baby moving.
  6. "It's just because room is limited," Dr. Vierling reassures. "If it's a profound drop off in movement, it should be evaluated with a non-stress test, which is just monitoring, but it's usually just caused by space constraint."

Is it time?

Perhaps the greatest concern for mom at this stage is identifying when she’s in labor vs. having Braxton-Hicks, the body’s “practicing” contractions.

“If you’re having contractions for an hour or two hours, five minutes apart and lasting a minute or so a piece, it’s time to go to the hospital,” he says. “If you get there too early, don’t worry. It just means you get sent home. It’s not the end of the world.”

Dr. Vierling says the average time of labor for first time moms is around 10 hours; for second births, it’s around 8 hours; and third timers, around 6 hours. He says moms shouldn’t worry about not getting to the hospital in time.

“In 25 or 30 years, I’ve had less than five patients deliver outside of the hospital because they couldn’t make it there,” he says.

Once you’ve arrived at the hospital, Dr. Vierling says he offers pain medication as needed.

"The rate of taking epidurals these days is over 90 percent,” he says. “Usually, I let my patients know that they can have it on demand.”

Stay tuned for the final article in our series, “What to expect following childbirth.”

Dr. Vierling is part of Womancare at NCH in Arlington Heights. Learn more about the NCH Women’s Center. 

 

Physicians
  • Timothy Vierling

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