The third trimester of pregnancy
For many people, the third trimester of pregnancy can be an anxious time. You’re in the home stretch and excited to meet your baby-to-be. But you’re also busy making preparations for your new addition while trying to stay healthy and comfortable.
Here’s a list of the main concerns you might have about the third trimester, plus tips to help you make it safely and comfortably to delivery day.
Traveling creates additional concerns if you’re pregnant. You have an increased risk of some medical problems, including:
- increased blood clot formation because of prolonged sitting
- exposure to infections
- unexpected miscarriage or pregnancy complications
Avoid long car trips and airplane flights, if possible. If you must travel, stretch your legs and walk around at least every hour or two.
Your doctor will generally permit you to travel by air until 32 to 34 weeks, unless you’re at high risk for premature labor. After that time, most airlines may not let you board the flight if you appear obviously pregnant because of the possibility of an unexpected delivery on the plane.
If you have any current problems with your pregnancy, you’ll be discouraged from flying.
If you’ll be away from home for a long time, your doctor may recommend a local doctor where you’re visiting for you to contact. Be sure to take a copy of your prenatal records with you.
For foreign travel, check with the Centers for Disease Control and Prevention (CDC) for recommended vaccinations or preventive medications for the area you’re visiting.
Avoid drinking unpurified water, unpasteurized milk, and inadequately cooked meat or vegetables.
Movement is an important sign that the fetus is doing well. As your pregnancy progresses and your fetus gets larger and larger, the type of movement can change.
Instead of your fetus punching you or doing flips, the baby may roll more or stick an arm or leg out.
Pay attention to these movements. If your fetus is not moving as much as normal, keep track of its movements. Eat something and then lie down on your left side. Count fetal movements for one hour and you should notice at least 10 in that hour.
You may be asked to lay down once a day for an hour and count fetal movements on a regular basis. You should always feel at least 10 movements in an hour.
If you don’t, call your doctor. There are many ways to count fetal movement. Ask your doctor how they want you to count. If the fetus isn’t moving, your doctor will order a nonstress test, a contraction stress test, or a biophysical profile (BPP) to check on it.
Lap and shoulder belts should be worn at all times when riding in a motor vehicle, particularly in the front seat. Being an unrestrained passenger during a major automobile accident is dangerous, whether or not you’re pregnant.
Position the lap belt below your belly and protect mom and baby in the event of an accident. If you’re in an accident, you must be seen by your doctor and assessed.
Generally, women in their third trimester are encouraged not to sleep on their backs. When you’re on your back, your heavy uterus can reduce blood flow to the uterus and fetus.
Most women aren’t comfortable lying flat on their backs during the third trimester anyway. Most experts recommend sleeping on your side.
The left side is considered the best choice because the uterus naturally rotates to the right during pregnancy and left-sided lying will bring it more to the center and improve blood flow. A pillow placed between your legs or a long body pillow to support your back are often helpful.
A wedge-shaped pillow along your back can also be helpful.
Pregnancy is usually not affected by most occupations. Particular occupational hazards include prolonged exposure to lead-based paints, working in a poorly ventilated setting with noxious fumes (such as anesthetic gases or volatile chemicals), and unregulated radiation exposure.
Before you stop working in a potentially worrisome site, you should check with your supervisor about OSHA (Occupational Safety and Hazards Administration) standards for your workplace.
Pregnancy is considered a healthy state. It’s not a disability. But if you stop working without a valid statement from your doctor, worker’s compensation for disability pays only a fraction of your normal wages.
If conditions change in your pregnancy and your doctor thinks you should stop working, they will provide documentation.
It may be difficult to change jobs during pregnancy, but you may want to do so before you become pregnant. An understanding employer may reassign you to a position that involves less risk, but employers aren’t under any obligation to do so.
Some obstetrical conditions require bed rest during pregnancy, such as preterm labor, incompetent cervix, placenta previa, and preeclampsia. If you have any of these conditions, your doctor may complete disability forms for you so that you can take time off from work.
There’s no medical reason to prohibit working up until delivery, and most people can. Some employers allow time off before your due date.
Most employers allow six weeks maternity leave after a vaginal delivery and eight weeks following a cesarean delivery. If you want more time, you may need to use vacation time or take time off without pay.
In recent years, several commercial companies have advertised a service that banks leftover umbilical cord blood after birth for potential use by the baby or other family members. This is used for a possible future illness that could require stem cell transplantation.
There’s a significant cost associated with processing and cryopreservation of this blood (approximately $1,500 initially and then $100 per year for storage).
The American College of Obstetrics and Gynecology considers this a speculative investment that can’t be supported with scientific data. It’s not currently known what happens to the blood after long-term storage or if the amounts of blood saved would be enough to treat someone.
It’s also been estimated that the probability of a person needing a stem cell transplant is exceedingly rare (between 1 in 1,000 and 1 in 200,000 by age 18) and these for-profit companies may be playing on the fears of the general public.
But in very rare families that have certain hereditary anemias, it may be important for fresh stem cells to be obtained from cord blood for a sibling of the baby. This requires special advance arrangement.
If a family has a specific set of medical conditions that tend to be passed on, then cord blood collection may be an option. There also may be future uses for cord blood that aren’t yet available.
X-rays in moderation and with appropriate lead shielding over the abdomen are quite safe during pregnancy.
Many serious conditions can develop or worsen during pregnancy if diagnostic X-rays aren’t used, such as pneumonia, tuberculosis, or broken bones.
Sometimes, X-rays of the pelvis and baby may even be required to determine whether or not the baby can be delivered safely (for example, if the baby is in a breech position).
Remember, some babies need multiple X-rays immediately after birth to assess their health. The careful use of X-rays of the baby inside or outside the womb is justified in many situations.
Epidural anesthesia is an excellent option for pain management. But it’s usually not available for a home birth or at a birth center.
Pain management in these settings may include Lamaze techniques, sensate focusing, hypnosis, or mild narcotics or sedatives.
If pain management is important to you, labor and delivery in a hospital gives you access to epidural anesthesia.
Most doctors decide when you should receive epidural anesthesia on an individual basis. Some doctors don’t place an epidural anesthetic until you’re at least 4 centimeters dilated.
Talk with your doctor about your wishes and your doctor’s epidural preferences as your due date approaches. Complications of epidural anesthesia are rare, but include headache, bleeding, and infection.
There have been reports of back problems after epidurals. It’s possible for the mother to be paralyzed after an epidural.
There is disagreement about whether or not epidural anesthesia slows labor. But this type of pain control doesn’t cross the bloodstream to the baby. Other types of pain medications do cross the bloodstream and may potentially make the baby sleepy at birth.
The third trimester is a good time to consider whether you want to breastfeed or formula feed your baby.
Doctors generally recommend that you breastfeed your baby for the first year of life.
Exceptions are women with HIV, active tuberculosis, and some forms of hepatitis. Talk to your doctor if you have any concerns about being able to breastfeed.
Breastfeeding has benefits for the mother, including:
- uterus and stomach return to pre-pregnancy size faster
- return to pre-pregnancy weight faster
- no bottles to wash or carry and no formula to prepare or carry
- no money spent on formula
- decreased risk of breast and ovarian cancer
- decreased chance of getting pregnant (breastfeeding suppresses ovulation)
- decreased risk of osteoporosis
Breastfeeding also has benefits for your baby, including:
- immunoglobulins that prevent illness and infections
- decreased risk of allergies
- easy to digest
- decreased risk of diarrhea and constipation
- always ready and at the right temperature
- decreased risk of obesity and diabetes later in life
- bonding time with mom
Although breastfeeding has many benefits, it’s still a choice. If you’re unable to or prefer not to breastfeed, then feeding your baby with formula is still fine.
Call the labor and delivery department or the nursery at your hospital. Most hospitals let you tour the facilities before your labor and delivery.
In addition to calling your healthcare provider, you should also call your health insurance company. Each insurance company has its own rules about this. Talk with your insurance company early in pregnancy about their preferences.
Most allow you to notify them within 24 hours of admission. Talk to your health insurance company representative to check on their requirements. Many birth facilities will notify the insurance companies for you.
You, your doctor, and your health insurance company decide what’s best for you. If there’s a medical reason for you to stay in the hospital, your health insurance should allow it.
Many insurance companies encourage women to leave the hospital 24 hours after delivery. For some women, this is safe and appropriate. It’s not appropriate for everyone.
If your doctor feels that you need to stay in the hospital longer than your insurance company allows, the healthcare facility will help you negotiate more time.
Most health insurance companies cover the cost of a semiprivate room postpartum. Check with your hospital to see if you can upgrade to a private room and what the difference in cost is.