Weeks 27 through 40
What is happening with your baby?
This is the period of greatest growth for your baby, who is starting to gain about one-half pound every week. Your baby’s organs are continuing to mature. Your baby sucks his/her thumb, looks around his/her snug little world and has definite periods of activity and rest. By 36 weeks or so, your baby will start settling into his/her birth position, which is head-down for most births.
What is happening with you?
The third trimester of pregnancy is very taxing on your body. Toward the end of your pregnancy, your pelvic joints feel loose, your back aches and your movements are cumbersome. Even getting out of a chair takes a little time. It is one of nature’s great designs that by the end of nine months, most women are tired of being pregnant and looking forward to delivery.
In the meantime, whenever possible in these last few months, try to take a nap or a least a short rest period during the day. Many women find it helpful to cut back on work hours in the last few weeks. Eating well-balanced meals, taking iron supplements and getting daily exercise can also help maintain your energy.
During this trimester, you will probably start to feel some mild contractions. Your abdomen will get hard and tight, then relax and soften. These irregular and mild contractions, called Braxton Hicks contractions, help prepare your body for labor. Changing positions, increasing fluids and resting on your left side can help if these become bothersome. If you still have painful contractions after trying these measures, be sure to call your provider.
In the last weeks of pregnancy, most women have difficulty sleeping at night. It’s hard to find a comfortable position, and just about the time you do, you have to get up to go to the bathroom again. Your baby may be on a different schedule than you are, merrily kicking when you’re trying to sleep. Increased anxiety about the birth and your abilities to be a good mother may also be keeping you awake. Lying on your left side with a pillow between your knees and more pillows under your head, back and abdomen can help you be more comfortable. Taking a warm bath or shower, drinking warm milk and practicing relaxation techniques before you go to bed can also help.
Other annoyances of late pregnancy include heartburn, swollen feet and ankles, leg cramps, hemorrhoids and constipation.
Heartburn is a burning sensation in your lower chest or upper abdomen. During pregnancy, it is caused by the pressure of the baby on your stomach and by hormonal changes. To minimize heartburn, eat frequent, small meals and try to avoid fatty, spicy foods. Avoid lying flat right after eating, and consider eating dinner to allow digestion before going to bed at night.
A slight swelling of the lower legs, ankles and feet is common in late pregnancy. Hot weather and long periods of standing or sitting can make swelling worse. To help minimize swelling, get moderate exercise and wear loose clothing. Wearing support stockings and resting periodically with legs and hips elevated on a chair or sofa can also help. If swelling is sudden and severe, especially if you gain more than 2-3 pounds in a week, contact your provider immediately.
Leg cramps can be caused by the pressure of the growing baby on the nerves in your legs, and by normal changes in the calcium and phosphorus levels in the blood stream. Massage, heat over the affected muscle and pointing your toes toward your knee can help relieve a leg cramp. Staying well hydrated is also very important! You may also want to talk to you provider about taking calcium supplements or other interventions if become severe.
The normal hormonal changes of pregnancy, pressure from the growing baby in the intestines, and iron supplements all contribute to constipation. If you are suffering from constipation, try drinking more water and eating more fresh fruits and vegetables, bran and whole grains. Moderate exercise such as walking can help improve regularity. Our provider may also suggest a fiber substitute or stool softeners. Hemorrhoids, which are varicose veins around the anus and rectum, are caused by pushing hard and bearing down for bowel movements. The best way to avoid hemorrhoids is to prevent constipation.
Be sure to let your provider know if you are experiencing any of the following symptoms: unusual vaginal discharge, itching or sores; severe vomiting or continued morning sickness; a temperature higher than 101 degrees; pain or burning with urination; sudden weight gain and/or swelling of the hands, feet, face or ankles; a marked decrease in urination; severe or persistent headaches; or dizziness or blurred vision.
You should also be aware of signs of premature labor, and contact your provider immediately if you experience any of the following symptoms:
- Vaginal bleeding (except spotting after a pelvic exam)
- A gush or uncontrolled leaking of fluid from the vagina
- Sharp, constant abdominal pain
- Cramps combined with a low, dull backache that lasts more than one hour
At the care provider visit
Your prenatal visits will now occur more often. Starting in your 28th to 32nd week, you will probably see your provider every two weeks, and then once a week starting at about 36 weeks. In addition to what has been routinely checked, your provider may do a pelvic exam at about 37 weeks to check the position of your baby and the condition of your cervix.
Now is the time to review plans for the birth with your provider. A written birth plan is a tool that lets your health-care team know what options are most important to you.
Depending on your specific needs and your provider’s style of practice, a variety of tests and screenings may be done during this last trimester.
A Glucose Tolerance Test (GTT) is usually done at about 28 weeks to screen for a condition known as gestational diabetes. This simple test involves drinking a bottle of sugar solution over a five-minute period, followed by a blood test one hour later. If the results are abnormal, more testing will be done.
Changes in our baby’s movements may reflect changes in his/her well-being. Some providers recommend doing Fetal Movement Counts, which involves keeping a record of the number of times your baby moves during the later part of your pregnancy. Because each baby has an individual pattern of activity, the normal range can vary widely—from 20 to 200 movements per day.
If you are beyond your due date, have complications or have low Fetal Movement Counts, your provider may order a Non-Stress Test (NST) to measure your baby’s heart rate in response to his/her own movements. An NST usually takes 20-30 minutes, but can take longer if your baby is asleep during the test. In addition, an ultrasound screening may be ordered to check your baby’s size and activity level, the amount of amniotic fluid and the placenta.
Sometime after your 28th week, you will be able to tour the childbirth facility, become familiar with the hospital’s procedures and discuss any questions or concerns you may have about your birth experience and hospital stay.
Keep in mind that a due date is an estimate, and that a full-term baby can be born two weeks before or after that date. For your own peace of mind, and for the health and well-being of both you and your baby, it is important to be prepared when your labor begins.
It’s also extremely helpful to get much of the paperwork and preparation for the baby done well in advance. Once your little one arrives, you’ll be glad you did: Your pre-registration form should be sent to the medical center by your 28th week. Other forms, including a birth-certificate application, can be filled out in advance and brought to the hospital with you.
Now is the time to pack your bag for the hospital, to gather the essential supplies you’ll want to have on hand when you bring your baby home and to arrange for help during those first few weeks after birth.
Now is also the time to get an infant car seat for your baby. State law requires that children under 8 years old be restrained in child-restraint systems, unless the child is 4’9” or taller. You will need one to take your newborn home from the hospital. For proper protection, a car seat must be used as recommended by the manufacturer. It is important, then, that you get an infant seat. If you have purchased or were given a used seat, you can call 1-800-BUCKLUP to obtain an instruction manual for it.
Packing for the hospital
Having a bag packed and ready to go helps eliminate unnecessary confusion and stress when the time comes to leave for the hospital. Here are suggestions on what to pack.
During labor and childbirth, you may want:
- A copy of your birth plan
- CDs or cassette tapes of favorite relaxing music
- A personal focal point—a picture, stuffed animal or item you have used in your labor rehearsals
- Warm socks or slippers
- Cornstarch, powder, lotion or oil for massage
- Lip balm
- Contact-lens case and glasses
- Toothbrush and toothpaste
- Snacks for your partner
- Camera and film
- List of phone numbers of people to call after the birth
For your hospital stay, you may want to bring:
- Undershirt and diapers
- Newborn nightgown or stretch suit
- Receiving blanket
- Booties, hat, blankets
- Special clothes for hospital baby picture, if desired
- An approved infant car seat
How will you feed your baby?
The decision to breastfeed or bottle-feed your baby is an extremely personal one. We will support whatever choice you make, and we encourage you to gather as much information as possible to help you decide.
The benefits of breast milk are significant. In addition to providing the best possible nutrition for babies, it also boosts their immune systems so they will have fewer respiratory and gastrointestinal infections. Breastfeeding also reduces the incidence and severity of allergies, which can be especially important if there is a family history of allergies. If, however, you have health-related factors that you are concerned about the safety of breastfeeding with, talk to your provider about bottle-feeding your baby.
The circumcision decision
If you are expecting a boy, you’ll need to decide whether or not to have him circumcised. This can be a difficult decision, with both potential benefits and complications to the procedure. You can talk to your primary-care provider, your baby’s provider or go to the American Academy of Pediatrics Web site, at www.aap.org, to have your questions answered about circumcision and to help you make the best choice for you and your son.
Developing a birth plan
Many couples prepare a written birth plan in advance of their trip to the hospital. The purpose of a birth plan is to let those caring for you know your preferences and choices regarding labor, delivery and newborn care. Writing a birth plan also helps you and your partner focus on your preferences and discuss important issues ahead of time.
Birth plans are highly personal and can range from a couple of paragraphs to several detailed pages. Your health-care team will make every effort to accommodate your wishes and make you as comfortable as possible—whether or not you have a birth plan. Having one in advance, though, can make decisions quicker and easier when the time comes.
In your birth plan, you may want to include a section that introduces you to the hospital staff. It is helpful for the staff to know if you have any religious or cultural preferences that may affect your care, if you have any particular fears about hospitals or if you have had previous negative experiences with childbirth. Birth plans also typically include your preferences regarding IV fluids, pain relief and fetal monitoring, as well as information regarding who you want to be present at the birth and who will cut the baby’s umbilical cord. Many people also include decisions they have made regarding breastfeeding, circumcision, etc.
While a birth plan can be a very helpful tool, it is important to remember that it is only a tool. Once you are actually in labor, you may change your mind regarding any number of factors. Also, your provider may recommend something different depending on the circumstances.
Help on the home front
Times have changed in health care. If you already have a child or two at home, you may recall a stay of two to three days. But today, unless your provider decides otherwise, most stays are 24 hours or less after a vaginal delivery and 72 hours or less after cesarean births with no complications. This makes it all the more important for you to line up support now for those first few weeks after the birth of your baby.
Support can come from a variety of sources, including family members, friends, neighbors, support groups, community services, religious organizations and professional services. If someone can come to stay with you, decide ahead of time when he or she can come and how long the stay will be. If you are planning to use a diaper service, call now to set up our account.