28 to 35 Weeks
The third and last trimester often feels longer than all the rest. This is when you start to get uncomfortable. You may have difficulty sleeping, moving, and tying your shoes. This is also the time when we start to watch for problems. We will recheck your blood count (CBC), check for diabetes (one hour glucola), and rhogam if you are rh negative.
This is a type of diabetes that is caused by the pregnancy and can occur even if you don't have it otherwise. The risks of gestational diabetes include a large baby, difficulty for the baby to control its blood sugar after birth, and if very uncontrolled, stillbirth. We test for this around 24-28 weeks with the one hour glucola. You will have to drink an orange sugary drink and get your blood drawn 1 hour afterwards. If this test is abnormal, a confirmatory test will need to be done (three hour glucose tolerance test).
Preterm labor occurs in about 10-12% of pregnancies (less than 5% if you have delivered your other babies full-term). It is actually hard to diagnose because preterm contractions (contractions that don't dilate your cervix) are very common at this time. Labor is defined as contractions and cervical change. These contractions can come often and be somewhat painful so it's hard to know when they become concerning. The time when you should call or come in is when you are having regular tightening of your uterus, or periodic backaches or pressure that can be timed. For example, if you feel a tightening every 3 minutes, you should call. If these contractions go away with a little rest or fluids they are usually nothing to be concerned about. If you lay down for a while and they only seem to be getting worse then you need to be seen. We do have some tests that will help us differentiate between contractions and labor if the need arises. If you have any questions about the amount that you're contracting it's better to be safe than sorry and come in and be checked.
Preeclampsia / Toxemia
Pregnancy induced hypertension (formally called toxemia) occurs in about 8-12% of pregnancies. It is a disease unique to pregnancy, is essentially from an unknown cause, and affects your small vessels (the ones that reach your organs). You may, therefore, have problems with your blood pressure, liver, kidneys, placenta, brain, eyes, etc. The first sign is almost always your blood pressure, which we check each visit. If your blood pressure is elevated we check a 24 hour urine protein. You collect all your urine in a 24 hr time period and bring into the lab for testing. Headaches are common in pregnancy, but unusually persistent headaches with changes in your vision are something you need to tell us bout. The same goes for swelling. Swelling in your feet is very common, and some in your hands as well, but worsening swelling, particularly in the face, is something you should tell us about.
If you are planning on taking a class you should look to start around 30 weeks. The updated schedule is available online - please select "Maternity Services" from the drop-down menu.
Choose from the following titles:
- Baby Basics
- Body Benefits Prenatal/Postnatal Exercise
- Home Study Childbirth Prep
- Prenatal Breastfeeding
- Breastfeeding clinic
- Boot Camp for New Dads
- Great Expectations Sibling Class
If you can't make a class, you are welcome to call Labor and Delivery to schedule a tour, then we can answer questions in the office about pain control.
Back Pain / Sciatica
As your baby grows you will probably get more back pain and perhaps even pain and numbness shooting down your leg. This is due to your baby and uterus putting pressure on your sciatic nerve and unfortunately, may not go away until you deliver. There are some back exercises that we can give you that may help. You may also try ice, heat and/or Tylenol as well. We prefer that you don't take Ibuprofen at this point in your pregnancy.
After 28 weeks you should start to count your baby's movements each day. Babies sleep a lot of the time. However, at least once a day, when your baby is most active, you should be able to count at least 10 movements in one hour. If this does not occur call our office or Labor and Delivery.
If you are having trouble sleeping you may want to consider a small dose of Benadryl or Unisom before bed. Also, try to take shorter naps during the day and try a warm bath before bed.
If you have an Rh negative blood type, you will need an injection of rhogam around 28-30 weeks to protect future pregnancies from anti-bodies that your body might create.
You'll need to pick a pediatrician that you're comfortable with. You do not need to notify them of your choice before delivery. St. Francis has pediatric providers who will care for your baby during your hospital stay. They will also attend the delivery if the need arises during labor.