Third Trimester 12
Third Trimester Teaching Sheets
INFORMATION ABOUT PREGNANCY:
THIRD TRIMESTER WEEKS 27 – 40
Be sure mom gets the video (which includes a tour of Women’s Hospital Birth Center, care of newborn…except remind them of “back to sleep” and not to have baby propped on side as the video suggests, and postpartum care). Mom should also get the anesthesia pamphlet. References for listed page numbers are at the end of these sheets.
ABOUT MAKING LIFESTYLE CHANGES AND ADAPTING TO PREGNANCY1. I have information about handling common physical and emotional changes of later pregnancy:
a. Backache
· Common in pregnant women because of postural changes. During pregnancy the uterus tilts the pelvis forward, shifting the center of gravity forward with it. This affects the pelvic joints and increases the lumbar sacral curve (the curve in the lower back) causing a sway back (lordosis). Increased breast size can also contribute to back pain by weighing down the front of the body, causing the shoulders to become stooped.
· Prevention or relief of back pain
o Use good body mechanics
o Wear low-heeled shoes
o Watch diet and weight gain
o Continue exercising (with permission from provider); stretching exercises work well for alleviating back pain.
o Pelvic tilt exercises
o Get adequate rest; avoid fatigue
o Sleep on side, on firm mattress
o Avoid excessive exercise, walking, bending, lifting or standing
o Apply heat or cold to sore area
o Some analgesics may be acceptable to take with approval from provider
o Consider Pregnancy & Back Pain Class sponsored by U/M Spine program ~ See handout
o *If pain becomes severe or constant contact provider. Back pain is also a symptom of pyelonephritis (kidney infection), kidney stones or possibly pre-term labor.
L&P, p. 425, 433
b. Varicose Veins
· Varicose veins can range from just a blemish to being painful and bulging.
· The amount of blood circulating throughout your body during pregnancy continues to increase, hormones cause vasodilatation and relaxation
· Increased pressure from the uterus on the iliac veins and inferior vena cava cause increased pressure on the perineum and leg veins
· Varicose veins are strongly inherited, and unfortunately there is little you can do to prevent them. However, things you can do to keep them from getting worse and from aching are:
o Lie on your side or with hips and legs elevated whenever possible
o Do not cross your legs (this cuts off circulation and can aggravate the problem)
o Exercise regularly
o Move around after sitting or standing for a period of time
o Wear support hose every day (consult your provider first)
o Wear clothing that doesn’t restrict circulation
o Avoid excess weight gain
L&P, p. 433
c. Shortness of Breath
o Common in the third trimester due to the growing uterus
o Uterus presses up on diaphragm and makes it difficult to catch one’s breath
o After lightening (“baby dropping”, occurs ~2 weeks before labor onset in nulliparous women), it is easier to breath
o Things to help: maintain good posture, eat smaller meals, sleep with pillows to keep head elevated; stop smoking
o Contact health care provider if symptoms worsen to rule out anemia, emphysema, and asthma
L&P, p. 434
d. Braxton Hicks Contractions
o Contractions that occur on and off for days or weeks before true labor
o Often felt in the front of the abdomen; contractions do not increase in intensity and are not rhythmic
o May be relieved by rest, change of position, effleurage
o Practice breathing techniques when contractions are bothersome
L&P, p. 336, 351-352, 434, 987
e. Increased frequency of urination
o Occurs in the third trimester because of the pressure of the growing baby “sitting” on the bladder
o Especially increases after the baby drops (lightening)
o For relief of frequency try: empty bladder regularly, Kegel exercises, drink fluids earlier in day, limit fluid intake before bedtime, wear perineal pad
o Contact health care provider for pain or burning sensation
L&P, 361, 431, 434
f. Interest in/safety of sexual activity
§ There is a wide range of sexual responses, interest and frequency of intercourse
§ It is safe to continue to have and enjoy consensual sex during pregnancy
§ Sexual desire may change, or it may remain unchanged
§ Women in the3rd trimester have decreased desire due to discomfort and fatigue
§ Side-lying position, female superior or vaginal rear entry may be more comfortable intercourse positions in later pregnancy
§ Orgasms maybe be more intense followed by cramping during last weeks of pregnancy
· Intercourse should be restricted and physician notified if:
o Bleeding occurs
o Rupture of membranes occurs
o Partner has a sexually transmitted infection
o Hx of miscarriages or shows signs of miscarriage
o Hx of premature labor or experience signs of premature labor
L&P, p. 435-437
g. Hands and feet swelling
o It is important to determine if it is normal pregnancy swelling or if it’s pathological some edema occurs with pregnancy because of hormonal and structural changes.
o If it’s in the lower extremities it can be relieved by foot elevation, lying on your side, increasing water intake, and reducing the amount of standing time, avoid crossing legs, ankle exercises, maintain balanced nutrition
o Extreme finger swelling may be an indicator of pregnancy-induced hypertension.
L&P, p. 361, 434, 840, 845
h. Breasts leaking colostrum
o Normal during third trimester.
o Body is preparing itself for the baby’s nutritional demands.
o Wearing absorbent pads in bra can help elevate staining clothing.
L&P, p. 356, 616, 758, 764
i. Fatigue/Activity intolerance
o The level of fatigue and activity intolerance increases as the fetus grows and carrying the expanding uterus becomes difficult and the weight of the fetus increases.
o The blood and nutritional demands are increased by the fetus, causing the mother to be easily fatigued.
o Mother may be anemic
o Daily activities may become increasingly difficult i.e. bending, stooping, and squatting
o Treatment ideas
o Practice relaxation. Take time out for yourself.
o Get enough sleep: Have a routine. Go to bed at the same time every night.
o Avoid coffee, tea, or caffeinated drinks at bedtime
L&P, p. 431
2. I have information about the following class offerings (give her a handout, refer to local paper or Women’s Resource Center. Classes fill up quickly. It is wise to sign up early!)
a. Childbirth preparation (Natural Childbirth, Prepared Childbirth, Lamaze, Bradley, other)
o Childbirth education classes offer the opportunity to learn about pregnancy and childbirth. They often will help you prepare for labor and delivery as well as inform you about things you can do to have a healthy and happy pregnancy.
o There are many different options in childbirth preparation classes for you to choose from (i.e. Lamaze, Bradley, Birthworks etc.) depending on what you would like to gain from these classes.
o Your provider may be able to provide you with a list of local classes. You may wish to check with your insurance company to see if they cover the cost of this class. If they do, they may have a specific provider you need to take the class through.
§ Lamaze Childbirth Preparation Association of Ann Arbor (734-973-1014)
§ Bradley Method of Husband-Coached Birth (734-475-0022)
§ Brighton Community Education – Lamaze, Childbirth Preparation Refresher (810-229-1419 or 810-231-2820)
§ Plymouth Childbirth Education Association (Lamaze) (734-459-7477)
§ North Campus Nursing Center at the University of Michigan – Childbirth preparation (734-747-1636)
L&P, p. 451-454
b. Breastfeeding
o A breastfeeding class is designed to teach women techniques that will help promote breastfeeding of their newborn.
o Breastfeeding requires effort and patience and a class may give women more confidence.
o These classes typically cover material such as latch on, positions, pumping, pacifier and supplemental bottle use, advantages of breastfeeding, hunger cues, nutrition, potential problems and common mistakes and misunderstandings.
o Your provider may be able to provide you with a list of local classes. You may wish to check with your insurance company to see if they cover the cost of this class. If they do, they may have a specific provider you need to take the class through.
o La Leche League (734-994-0113)
o Breastfeeding Class, North Campus (734-747-1636)
o Breastfeeding Class, Plymouth Childbirth Education (734-459-7477)
o Breastfeeding Class, Livingston County Department of Public Health (517-546-9850)
L&P, p. 761-769
c. Infant Care
o Infant care classes teach parents how to care for their newborns
o Topics often covered: umbilical cord care, bulb syringe use, feeding cues, breast & bottle feeding basics, newborn adaptation to extrauterine life, bathing, car seat use, newborn complications, etc
· Infant Massage Classes (734-741-9706
· Baby Care Class, North Campus (734-747-1636)
· Newborn Class, Plymouth Childbirth Ed. Assoc. (734-459-7477)
YYB&U, p. 53-57
d. Parenting classes
o Classes may cover expectations of self and others, emotional adjustments, coping strategies, expression of intimacy
o Anticipatory guidance of new roles
e. Hospital Tour (sign up at Taubman OB clinic check out desk)
o These tours can be beneficial to both you and your partner because you will feel more comfortable with your surrounding. It will be helpful during labor for your partner to know where to find refreshments, the waiting room, a pay phone etc. You will also likely appreciate seeing the facility before delivery and knowing what amenities they have available (whirlpool, shower, squatting bar etc.)
o Tours are offered weekly. They take place in the early evening and last 60 – 90 minutes.
o A walking tour of Women’s Hospital Birth Center, followed by a question & answer session
o The tour is also included on videotape
o Register at Taubman Center’s OB-Gyn Clinic (at check out) or call 734-763-6295
YYB&U, p. 21
f. Sibling preparation for new baby
Sibling classes are designed for children who are expecting a new sibling. They will teach the children about what to expect with the new infant with emphasis on them still being important. Some classes may teach older siblings how to help care for the infant so they feel more involved. Your provider may be able to provider you with a list of local classes.
YYB&U, p. 22-24
g. What is available in my community
3. I am satisfied that I can manage job/career/school/parenting responsibilities
o Recognize that you can’t be “superwoman” ~ you can’t do it all, especially in the beginning
o Decide on what your priorities are; what things will work best for YOUR family
o Learn to compromise: if job, husband and baby are top priorities, an immaculate house may not be the top priority
o Learn to ask for and accept help (from dad, baby’s grandparents, other relatives, play groups, etc)
o May need to make job adjustments as abdomen enlarges with growing baby (i.e. decrease heavy lifting, minimize prolonged standing
L&P, p. 672
4. I understand that the following could be signs of labor:
a. Contractions
b. Loss of mucus plug/bloody show
c. water breaking
· Term labor occurs after 37 weeks.
o Labor is preceded by lightening, nesting instinct (burst of energy)
o Contractions are regular and at closer intervals, progressing to 5 minutes apart, lasting 40 – 60 seconds
o Contractions progress in frequency and intensity
o Discomfort begins in back, radiates to abdomen
o Activity such as walking increases contractions; contractions continue when sleeping
o Progressive effacement and dilatation of cervix
o Bloody show usually present
L&P, p.480-481
· Preterm labor is when there are consistent uterine contractions that result in effacement and dilation of the cervix after 20 weeks but before 38 weeks.
· Assessment is critical! Some risk factors for preterm birth: African-American; <17 years; > 34 years; hx of preterm births; smoking; alcohol use; poor nutrition and low weight gain; multiple gestation pregnancy; infection; incompetent cervix; domestic violence
· A common screening tool for preterm labor is cervical length assessment
o Cervical length is assessed via vaginal ultrasound
o Cervical length of < 30mm may predict preterm labor
· Call provider immediately if any of the following s/sx of preterm labor are present:
o Uterine cramping (menstrual-like cramps which are intermittent or constant)
o Uterine contractions (10-15 min apart, or more often)
o Low abdominal pressure or pelvic pressure
o Dull low backache (constant or intermittent)
o Increase or change in vaginal discharge
o Feeling that baby is pushing down
o Abdominal cramping
o Diarrhea
· If sx of preterm labor occur, stop what she is doing, lie down on left side, drink 2 – 3 glasses of water or juice, wait 1 hour. If sx persist, call health care provider immediately. If in doubt…call health care provider!
L&P, p. 435-436
o
5. I know what to expect of 3rd trimester care:
a. Appointments with a physician, midwife, or nurse practioner every 2 (28 – 36 weeks gestation) and every week after 36 weeks weeks plus extra visits is my health or my baby’s health requires them
b. If I have Rh negative blood type, I should receive an injection of RhoGam at about 26 - 28 weeks of pregnancy, and also if I have any episodes of bleeding
· Maternal Rh negative blood and a negative ABS titer is an indication for prophylactic Rhogam at 26 - 28 weeks gestation
L&P, p. 1085-1086
c. Complete blood count and screening test for diabetes at about 26-28 weeks of pregnancy.
Complete Blood Count
Hgb (normal) 2nd & 3rd trimester 11 g/dl (at sea level)
Hct (normal) 2nd & 3rd trimester 33 %
WBC (normal) < 15,000/cc
L&P, p. 358, 918
Blood Group and Rh Factor
Grouped to be A, B, O, and AB
Rh factor is either negative or positive [The Rh factor is positive if the Rh D antigen is present on
the surface of the woman’s RBCs—LMH]
L&P, p. 1083, 1084
Antibody Screening Test (if the woman has a negative Rh factor)
o An Antibody Screen (ABS) [also called an indirect Coombs test—LMH] is done before RhoGam is given (at 26 - 28 weeks)