The Third Trimester: What to Expect

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A woman can expect that she will experience tiredness and be uncomfortable during the third trimester of her pregnancy.  It helps to have an understanding of the expected symptoms during this stage of your pregnancy in order to have a chance at gaining some relief.  Achieving some relief may also serve to ease the anxiety that you are feeling as your delivery date approaches.  The third trimester of a pregnancy can prove to be challenging to a woman on both an emotional and a physical level.  The growing size of the baby, combined with its position in the abdomen, can make it difficult for the mother to get comfortable, making it challenging for her to get rest or sleep.  It is not uncommon for some women to grow frustrated during the later stages of their pregnancy, and to just want everything to be done and over with.  With all of the time and energy that you have invested thus far, you should be looking forward to the approaching end of your pregnancy.  It is very important that you remain positive, that you continue to focus on healthy living, and that you remember that soon you will be holding your beautiful baby in your arms!  The following is a breakdown of some of the things that you can expect to experience during the third trimester of your pregnancy: 

Your Body: 

As the baby continues to grow throughout the third trimester, you will notice that the movement in the uterus has become more pronounced.  The sensations associated with this movement can be very exciting for the mother, however, the growing size and activity levels can also be directly associated with increasing degrees of discomfort.  The following is a list of some of the physical symptoms that can be expected during the third trimester:

•    Back Pain:  During the later stages of the pregnancy, as the baby continues to grow, the woman’s body is producing hormones that are intended to relax the joints located between the bones in the pelvic area in preparation for delivery.  This relaxation of the joints tends to be difficult on the woman’s back, and can also cause hip pain.  If you need to stand, it may be beneficial to place one foot on a stool or on a box, as this position can help to alleviate some of the back pain.  It can be beneficial to make sure that your back is well supported should you choose to sit in a chair.  You can use either heating pads or ice packs on areas of concentrated pain, and focused massages can be very helpful.  It is suggested that you avoid wearing flat shoes, but low-heeled shoes are acceptable, and you should always make sure that your shoes have good arch support.  If you find that the back pain that you are experiencing does not go away after attempts at alleviating it, or if the pain is accompanied by other symptoms, you should notify your health care provider and advise them as to what you are experiencing.

•    Shortness of Breath:  The expanding uterus tends to impact the woman in various ways.  One of these ways is by applying pressure to the diaphragm, the large muscle located directly beneath your lungs, resulting in shortness of breath.  The impact on the diaphragm tends to decrease in the later stages of the pregnancy, as the baby positions itself lower into the pelvic region in preparation for delivery.  If you are experiencing shortness of breath, it is suggested that you try to maintain a good posture and that you consider learning to sleep with the upper portion of your body positioned on pillows.  These practices will help to alleviate some of the pressure that is being applied to your diaphragm, making it easier to breathe.  Studies have also shown that certain aerobic exercises may help to relieve some of this pressure during the third trimester of a pregnancy, however, your exercise routine should be discussed and approved in advance by your health care provider.

•    Indigestion and Heartburn:  As stated above, the expanding uterus during the third trimester can have significant impacts.  Sometimes, this growth will result in a shifting and minor relocation of the stomach from its original position in the abdomen.  This can result in a disturbance to the stomach acids, which can cause heartburn and indigestion.  One thing that can be done to counteract the disturbance of the stomach acid is to drink plenty of fluids throughout the day and to try to eat smaller portions.  You may also want to avoid spicy and fried foods, along with carbonated beverages and citrus juices or fruits.  If you find that you have taken these precautions and that the heartburn does not subside, you should contact your health care provider.

•    Continued Breast Development:  By the time that the third trimester of a pregnancy is concluded, a woman can gain up to two pounds of additional breast tissue.  One other facet of breast development is the production of colostrum, which tends to leak from the nipples.  Colostrum is a yellowish fluid that will enhance the nourishment that your baby will receive during the first few days of nursing, and assist with the fortification of the baby’s immune system.

•    Varicose Veins, Spider Veins, and Hemorrhoids:  During the third trimester, the pregnancy is resulting in increased blood circulation for the mother, which can cause small spots that are reddish in color that give rise to tiny blood vessels.  These marks tend to appear on the neck, face, or arms, in particular if the woman has fair skin.  The increased circulation may also cause the appearance of varicose veins, which are blueish or reddish lines below the surface of the skin that most notably appear on the legs.  Varicose veins can also occur in the area of the rectum, which are called hemorrhoids, and these can sometimes be painful or get irritated and become itchy.  The best suggestion for dealing with varicose veins in the legs is to wear support stockings, and to elevate your legs whenever possible.  Some steps that can be taken to help prevent hemorrhoids are associated with avoiding constipation, which entail the drinking lots of fluids and the inclusion of plenty of fiber in your diet.

•    Frequent Urination:  As the third trimester of the pregnancy progresses, the baby will start to position itself lower into the pelvic region in preparation for delivery.  This repositioning tends to apply even more pressure to the bladder, resulting in a greater need for urination than previously, perhaps even while you are trying to sleep at night.  This increased pressure may also cause the woman to leak urine at various times, in particular when they cough, sneeze, or laugh.  It is suggested that a non-deodorant panty liner be worn for protection if you are dealing with bouts of leakage. 

It is very important that a woman be mindful of any indicators of urinary tract infection during the third trimester of the pregnancy.  This tends to be difficult, as frequent urination is a common indicator, however, it the increased bathroom visits occur in combination with a burning sensation in the vaginal area, abdominal pain, fever, or backache, you should notify your health care provider.  A urinary tract infection can damage the kidneys and can sometimes result in preterm labor.

•    Vaginal Discharge:  It is very common for the amount of vaginal discharge during the third trimester of a pregnancy to be quite heavy at times, especially as you draw closer to your delivery date.  If you find that the panty liner that you are wearing becomes saturated after only a few hours of use, or if you have any concerns that the discharge may include the leakage of amniotic fluid, you should contact your health care provider to discuss the situation

•    Braxton Hicks Contractions:  These are contractions that tend to be weak and they come and go with no predictable cycle.  They essentially represent the body warming itself up for the actual contractions that will occur during labor and delivery.  You will soon find that the actual contractions associated with active labor are stronger, last for a greater length of time, and start to occur with regularity.  If at any time the contractions that you are experiencing give you cause for worry or concern, you should contact your health care provider to discuss the situation.

•    Weight Gain:  It is not uncommon for a woman to have gained between 25 and 35 pounds by the time that she has reached the end of the third trimester.  This weight gain represents the weight of the baby, as well as the weight of the placenta, the new breast tissue, the amniotic fluid, the uterus, and the extra fat stores that have developed throughout the pregnancy.  Some of the additional weight can also be attributed to the increased blood supply and overall increased fluid volume of the body.

•    Swelling:  As stated previously, the growing size of the uterus can be very impactful on the body of the woman!  The enlarged uterus can also apply pressure to the veins that serve to return blood to your heart from your legs and your feet, resulting in swelling of the ankles and feet.  It is not uncommon for the swelling in your legs, and sometimes the arms and hands, to result in pressure being applied to various nerve endings, which can cause sensations of numbness or tingling in the extremities. 

It is also common for pregnant women to experience slight swelling or puffiness in the face and eyelids, in particular in the morning, which results from the retention of fluids in the body and the dilation of various blood vessels.  You may want to try applying a cold compress to the face in an effort to help reduce the swelling, but should this facial swelling become persistent, you should notify your health care provider.  Swelling in the feet and ankles can sometimes be alleviated by using a footrest or simply by lying down, and it is suggested that you may want to try to elevate your legs and feet while you are sleeping.  It has also been proven that swimming, or simply standing in a pool, can help to alleviate some of the swelling to the lower extremities.

Your Emotions: 

As the third trimester of the pregnancy progresses, it is very common for women to become anxious about the approaching delivery date.  Fears and concerns may start to develop regarding labor:  “Is it going to hurt?  How long will the pain last?  Will I be able to handle it?  It is strongly suggested that a pregnant woman attend childbirth classes prior to her delivery date so that some of these fears can be addressed and these questions answered.  These classes also give you an opportunity to meet other expectant mothers and to openly discuss what you have mutually been experiencing.  Some of these women may have already given birth, and may be able to share stories of positive birth experiences.  You may want to have a conversation with your health care provider regarding the options that are available to you for pain relief during your labor and delivery.  It is very important that you give yourself a mental edge, and that you convince yourself that you are going to do the best that you possibly can.  Remember that there really is no right or wrong way to have a baby!

As the delivery date approaches, some women become overwhelmed and anxious as the reality of being a parent and all of the associated responsibilities start to manifest, in particular if this is their first child.  It is best to stay calm and try to enjoy the experience, focusing on the fact that shortly you will be holding your beautiful baby in your arms!  You should take the time to talk to your baby, as studies have shown that they can hear sounds and can recognize the familiar sound of your voice.  You may consider keeping a pregnancy journal to record your feelings, thoughts, and emotions as your pregnancy progresses.  Some women take photos of the changing size of their bellies to be able to share with their children some day when they are older.  Most importantly, take the time to revel in the experience!  This may also be an ideal time to start thinking about some of the things that are on the horizon.  Do you intend to nurse your baby?  What types of supplies, such as a breast pump, might you need?  If you are having a boy, are you going to consider having him circumcised?   If you are going to be returning to work soon after delivery, who do you plan to use as your primary childcare provider?  Ultimately, you should give time to thinking about how you intend to spend the first weeks that you are going to have in the company of your beautiful new baby!

Appointments with your Health Care Provider: 

During the third trimester of your pregnancy, you will most likely find that the frequency of your doctor visits is going to increase.  More often than not your appointments will increase to every other week right around week 30, and then to every week right around week 36.  Similar to your previous appointments, your health care provider should monitor your blood pressure and your weight, and take the opportunity to inquire about any pregnancy symptoms that you may be experiencing.  These doctor visits may also include screening for various conditions that could arise during the third trimester of the pregnancy, including the following:

•    Gestational Diabetes:  This is a temporary diabetic condition that can manifest itself during a pregnancy.  It is best if this condition is identified early, so that the woman can make dietary changes to ensure a healthy lifestyle and the proper maintenance of blood sugar levels.  This will also improve the chances of the delivery of a healthy baby!

•    Anemia:  This is a condition marked by an abnormally low level of hemoglobin and red blood cells.  Hemoglobin is a protein located in red blood cells that specifically contains iron.  Severe anemia may adversely affect the growth and development of the baby, and it can sometimes contribute to preterm labor.  One of the identified treatments for anemia is for the mother to take iron supplements.

•    Group B Strep:  This is a form of bacteria that can develop in the vaginal area or in the rectum.  This bacteria does not pose a health risk to the mother, however, it can be detrimental to the baby after it is born, as it can cause a serious infection.  Typically, a woman who tests positive for Group B Strep will be prescribed antibiotics during labor and delivery.

During the third trimester doctor visits, your health care provider will also be monitoring the size and the heart rate of the baby.  You can also expect that vaginal exams may be conducted by your physician in an attempt to determine the position of the baby inside of the uterus, and that cervical exams are conducted to determine softening of the cervix or dilation in preparation for labor and delivery.  Please bear in mind, however, that cervical exams offer no insight as to when exactly you will deliver your baby. 

The third trimester is the perfect time to address your personal birth plan, especially if you have any specific expectations, such as a delivery in water or the desire to receive no pain medications or epidurals.  You should also take the opportunity to discuss the details of your birth plan with your health care provider in advance so that there are no misunderstandings when the big day arrives.  Keep yourself open to asking the necessary questions as you approach the later stages of your pregnancy, and having these questions addressed by your health care provider.  You should have a clear understanding of the difference between false labor and actual labor.  Have an understanding of when you will need to leave for the hospital, and the point in time when it is too late to receive an epidural.  When it comes to the later stages of the third trimester, there are no silly questions.  The better understanding that you have of what you are experiencing, the better prepared you will be to do everything that you can to try to ensure a positive birth experience!


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By Jack Rambadt of Expecting Parents Alliance of America

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