The Third Trimester of Pregnancy: An OverviewDr. Gerard M. DiLeo
The third trimester of your pregnancy, from 27 weeks until 40 weeks or delivery, centers mostly on your baby. You and your doctor are now awaiting your growing babe to attain maturity and finally begin the delivery process. Throughout the third trimester, there is a heightened vigilance for any diseases and complications unique to pregnancy.
With your delivery just around the corner, you may be feeling nervous and have some concerns. Here’s a look at some common questions many women ponder during this late stage of pregnancy.
Monitoring the Fetus: The Biophysical Profile
Modern technology allows for extensive monitoring of the fetus. Doctors can see your unborn baby through ultrasound, take exact measurements to determine growth, and often confirm the baby’s position by physical exam. Doctors can measure amniotic fluid, a normal amount being one of the most crucial determinants of fetal well-being. Doctors can also directly observe fetal movement, tone, and even breathing-like movements, statistically assuring a mother-to-be of her baby’s good health.
Another test, the non-stress test (NST)–also called fetal activity determination (FAD)—makes use of the valuable relationship between fetal movement and fetal heart rate. When you run around the block, your own heart begins to race. This is your body’s way of speeding up the process of delivering more oxygenated blood to the muscles, where it is needed most. In the same way, when a baby moves, which the mother marks on a fetal monitor, we should also see a corresponding rise in fetal heart rate. This tells us that everything is pretty much working right in the baby, too.
The combined results of the ultrasound exam and the NST are referred to as a biophysical profile. Scores are assigned by adding all of the criteria which are met. Over the years, many researchers have exhaustively tabulated what these results mean. When all of the normal ultrasound items are found, and the non-stress test is normal, their statistics have demonstrated that a baby has a 99 percent or better chance of another week’s worth of fetal well-being ahead. So doing these evaluations once or twice a week on high-risk mothers is essential.
Prenatal Care Checklist
You’ve been having regular visits to the obstetrician since you became pregnant. Now that your baby’s birth is getting closer, so is the frequency of those visits and what takes place in the doctor’s office.
Here’s a checklist of what to expect in the last weeks of your pregnancy.
- Your provider will pay attention to signs of preterm labor and institute monitoring if indicated.
- Between 24 and 30 weeks, office visits are every two to three weeks.
- At around 26 weeks, you’ll have a glucola screen for gestational diabetes.
- At around 28 weeks, you’ll have a group B strep vaginal culture taken.
- At 32 weeks, your doctor will determine fetal position—the “lie.” This is the time a baby usually “locks into” position. Suspicion of a breech baby at this time is a concern and warrants an ultrasound.
- At 36 weeks you’ll begin weekly visits or even more frequent visits if you have a high-risk pregnancy.
- Your doctor may offer version of an abnormal position (breech) to normal position (vertex—head first).
- At 37 or 38 weeks, your doctor may begin weekly cervical checks.
- At 39 weeks, your doctor can now offer you an induction if the cervix is ripe.
- At 40 weeks, your doctor will begin “post-dates” surveillance, which means more frequent visits.
- At 42 weeks, you most probably will be induced. (Although doctors differ somewhat as to what point indicates mandatory delivery, 42 weeks seems to be a dividing line where further waiting creates unacceptable risks.)
In the Delivery Room
When asked to cut the umbilical cord at the birth of his child, some dads experience panic. Actually, cutting the cord is not really a big deal, medically, at least. The point is that there are many things in modern labor and delivery that aren’t medically important, like who cuts the cord, whether areas are shaved, or who’s in the room.
In many hospitals, video and photography are welcome, as are friends and other relatives. In the background, masked by all of the good cheer and warmth, is the real reason for having babies in a hospital—anesthesia if and when needed, a blood bank and surgery suite should complications arise, and a high-risk nursery for babies in jeopardy.
If a patient never needs any of the real hospital safeguards, then she and her partner come away with a very nice experience of the birth of their child. Hopefully, they will never know what emergency preparedness lurked in the shadows, waiting to spring into action should the need have arisen. And if Dad wants to cut the cord, that’s OK. If Mom wants to listen to music during her pushing, it’s not medically risky. Hopefully, all the expectant parents need to know is that the working end of the hospital is there immediately when needed; and that their obstetrician will judge what is medically necessary. All of the rest should be up to the couple. After all, it’s their family’s childbirth experience.
If there are little extras the couple wants and that are important to them and these extras pose no medical hazards, then we as obstetricians are happy to comply. After all, many other doctors and I have been there ourselves. We’d want the same consideration. Different techniques of labor—such as Lamaze and Bradley—should be welcomed. An epidural anesthetic is also a comforting way to have a baby should the laboring woman desire it. All of these labor techniques shouldn’t matter to the doctor or hospital as long as they don’t affect medical outcomes.