As you enter the final trimester of pregnancy, you may feel more sensitive, emotional, or anxious. These feelings are common, however, if you feel like these feelings become overwhelming or unbareable we encourage you to speak to your provider about them. In the third trimester you will meet with your provider every 1-2 weeks. The providers will also begin talking with you about your hospital stay and post partum goals.
27-28 Weeks: At this visit you will most likely have your 1-hour glucose challenge. You will also have additional blood work, HSV titers and CBC. If your blood type calls for it, you will also be given RhoGAM. The TDAP vaccine is also offered at this appointment. Your blood work will be discussed at the next visit. Visit frequency will now be every 2 weeks after this appointment as well.
36 Weeks: Group B strep culture is done. Your provider will discuss closer to that time, what the culture is testing for, and what it means to be positive after this appointment. You may also have a sonogram to determine the baby’s position. Also, if your HSV titers were positive, this will be the time that you start Valtrex, provided you agreed to treatment. Visits from here on out will be once weekly.
Your provider may talk with you about the use of evening primrose oil after 36 weeks to help get your cervix ready for labor. We will also encourage you to get ready for your hospital stay and discharge!
40-41 Weeks: You will receive a sonogram, non-stress test and an exam to check for cervical dilation. At this time possible induction can be discussed if desired.
Lightening: During pregnancy the uterus becomes larger, thus rising gradually out of the pelvis and up into the abdomen. By weeks 34 or 36, it will be under your ribs. After that, it will start to descend, and your baby's head will drop into the pelvis. You'll most likely know when this has happened because breathing will seem easier and you may have increased pressure in the pelvic area. That can also cause more frequent urination. Not everyone experiences lightening. Some baby's remain high until labor begins.
Mucous Plug/Bloody Show: One of the signs that labor may begin is the passage of a small to moderate amount of mucous (“show”) from the vagina. At times there can be some blood in with the mucous, or it can be pink, red, or dark brown tinged. This does not mean labor will begin that day. This can take up to 2 weeks for labor to begin. It is NOT necessary to contact the office if this occurs. However, if the bleeding is menstrual like you must call the office immediately.
False Labor/Braxton Hicks Contractions: During the third trimester it is very common to experience irregular, often painless contractions. This can occur, or even increase, if you have spent a significant amount of time walking or on your feet, dehydration, or recent intercourse. To help alleviate the discomfort of these contractions try changing the position which you are sitting; walking if you have been resting; sitting or lie down if you've been on your feet; or drink water. Often this will occur simply by not being hydrated enough. Once your body becomes hydrated the contractions may subside. If contractions are regular and time-able (i.e. every 10 minutes), please contact our office.
Timing of Actual Labor Contractions: When labor contractions begin, they are usually not close together timewise, and often only last a short amount of time (i.e. 30 seconds). They also may present as back pain as well. As they continue you will get a feel for how far apart, they have become, and how long they are lasting for. It may be helpful to keep a log, or there are apps on your phone that can be downloaded to help keep track. Please see the table below on when to call the office regarding contractions.
Rupture of Membranes: This is defined as the rupture of the membranous bag which holds the baby and surrounding fluid. When the bag breaks it can cause a slow trickle or big gush of fluid from the vagina. Also, as you approach closer to term, the baby's head on the bladder may cause an uncontrolled gush of urine. This can be evaluated in the office or at the hospital to ensure there is no loss of fluid. A simple test with a special type of paper will tell if it is urine or fluid.
When to Call the Office with Contractions/Rupture of membranes:
-If this is your first baby: Call when your contractions are 5-7 minutes apart lasting 45 seconds to 1 minute each, this lasting for 1 whole hour.
-If this is NOT your first baby: Call when your contractions are 10-12 minutes apart, lasting for 45 seconds to 1 minute each, this lasting for 1 whole hour.
-If you experience a trickle of fluid, or a large gush of fluid from the vagina. You must call the office immediately.
-Should you experience vaginal bleeding more than the “show”.
DANGER SIGNS: The following should be IMMEDIATELY reported to our office:
-Any decrease or change in fetal movement
-Sudden severe swelling of the face or fingers
-Visual changes (dimness, blurring, spots, floaters, flickers, “sparkles”)
-Severe abdominal pain or cramping (that is not relieved by bowel movement or rest)
-Chills and fever (over 100 degrees)
-Sudden gush of water from vagina
New York State requires that your baby be tested for a number of metabolic and rare disorders in the hospital. The results will be reported back to your pediatrician. For more information regarding Newborn Screening Click Here