Third Trimester Expectations

In the third trimester, you are starting down the home stretch! Your third trimester lasts from the twenty-sixth week after your last menstrual period until the birth of your baby, which usually takes place somewhere between the thirty-eighth to forty-second weeks. As with your first and second trimesters, it helps to be prepared for your last trimester by learning about the changes your body will likely go through, how your baby is developing, and what to expect at your doctor's visits at this stage.

Your Baby's Development

During your last trimester, your baby continues to grow larger, and his body organs continue to mature. Your baby is completing his development for his introduction to the world. With your baby growing and getting heavier, the last three months can get a bit uncomfortable-just keep thinking about the end result!

Your Seventh Month (26 to 30 Weeks)

Your baby will really start squirming around between the twenty-seventh and thirty-second weeks. Starting with your seventh month, the baby's lungs continue to develop, but they are not yet fully mature. To practice waking up Mom and Dad at all hours of the night, the baby begins to develop patterns of waking and sleeping. The baby's hands are active, and fingernails are growing. Muscle coordination is getting much better. The baby can now suck her thumb and can even cry. By week twenty-eight, the baby's eyelids are opening. The lungs are developed enough that if the baby were born prematurely, she would have a good chance at survival but would need to stay in a neonatal intensive care unit (NICU). Babies born earlier than seven months also have a chance for a higher survival rate with specialized neonatal care. As your seventh month progresses and the baby grows larger, he experiences a harder time moving around in the uterus due to space constraints. However, he still seems to find the room to do some kicking and stretching. The baby gains more fat on his body to help control his own temperature.

By the end of this month, the eyebrows and eyelashes are filled in and any hair the baby has on his head is becoming thicker. The head is now proportioned to the rest of the body. The baby's hearing is fully developed, and she can respond to stimuli such as pain, light, and sounds. Toward the end of this month amniotic fluid begins to diminish. Your baby now measures about seventeen inches from head to toe and weighs about 2 to 4 pounds.

Your Eighth Month (31 to 34 Weeks)

Starting with your eighth month, the baby is becoming too big to move easily inside the uterus. It may seem that the baby is moving less. The baby is developing more fat beneath his thin layer of skin, and he's starting to practice opening his eyes. Most of his internal systems and organs are now well developed except the lungs, which are not quite yet fully matured. The baby's brain continues to develop at a rapid pace. These weeks mark a ton of growth for the baby. During the last seven weeks, the baby gains more than half his birth weight. As the baby becomes larger, he begins to run out of room and takes the fetal position by curling up. By the end of the eighth month, the baby begins to move into a head-down position, although that may not be his final position at birth. Your baby now measures around 19.8 inches from head to toe and weighs about 5 pounds.

Your Ninth Month (35 to 40 Weeks)

By nine months, your baby's lungs are almost fully developed. She still doesn't have quite enough fat under the skin to keep herself warm outside of the womb, but she is working on it. By the ninth month, the baby begins to drop lower into your abdomen, usually with the head in a downward position. The brain has been rapidly developing, and the baby's reflexes are coordinated so she can blink her eyes, turn her head, grasp firmly with her hands, and respond to stimuli. Every day, the baby is taking on a rounder shape, developing pinker skin, and losing her wrinkled appearance. The baby is beginning to get antibodies from you that will help protect her from illness.

In this last month, the growth of your baby tends to slow down, yet he is still collecting fat under his skin and, therefore, putting on more weight. The toenails have grown to the tips of the toes, as have the fingernails, which have grown to the tips of the fingers. The baby's arm and leg muscles are stronger, and he is beginning to practice breathing and working out his lungs. By the end of the ninth month, your baby will drop farther into your pelvis, hopefully with head aimed downward to the birth canal, to prepare for delivery. The drop of the baby will help you breathe a little easier. Your baby's length at birth is about eighteen to twenty inches on average, and she weighs about 7.5 pounds. Length and weight vary greatly from baby to baby.

Changes in Mom

By your last trimester, you will have put on much of your pregnancy weight as your baby fully grows and develops. You should be gaining weight at a rate of about 1 pound per week. You will probably begin to feel some pain in the ribs as your baby grows and pushes upward on your rib cage. The pressure may also give you some indigestion and heartburn. You may begin to see stretch marks as your uterus expands. Your balance and mobility will also change as you get bigger. Throughout your last trimester, as your baby continues to grow, you will begin to experience some discomforts such as leg cramps, mild swelling of the feet and ankles, constipation, difficulty with sleep, shortness of breath, lower abdominal pain, backaches, and Braxton Hicks contractions. You may feel a more frequent urge to urinate again as you did in the first trimester.

All women "carry" differently. Some will carry the baby higher or lower, bigger or smaller, wider or more compact. All these depend on the size and position of your little one, your body type, and how much body weight you have gained.

By your ninth month, your weight gain should be somewhere around 24 to 29 pounds. It may get more uncomfortable to sleep and move around, and it is normal to become moody and irritable. As you near the end, you may notice alternating feelings of fatigue and bursts of energy.

It is a good time to think ahead and prepare for your return from the hospital with a newborn! Use those energy bursts to start stocking your freezer with foods you can easily pop in your oven or microwave. Cook casseroles, chili, soups, and other dishes that can be frozen and prepared later when you are too busy to worry about cooking.

Keep the Swelling Down

Moderate swelling or retaining of water in the hands, face, legs, ankles, and/ or feet, known as "edema," is very normal in pregnancy. Edema is caused in pregnancy by the increase in blood volume and other fluids needed for the baby as well as from an increase in hormones. Ankles and feet tend to swell because the size of your baby and uterus can put pressure on the return circulation to your legs. The key is to get the fluids moving and to maximize the output of the kidneys. Edema can happen at any time during pregnancy, but it tends to begin around the fifth month and increase in the third trimester.

Moderate swelling is expected and normal in pregnancy as long as it is not accompanied by an increase in blood pressure and protein in the urine, which can be a sign of preeclampsia. Sudden or severe edema can also be a sign of this condition. If you experience these noticeable symptoms, contact your doctor immediately.

Here are a few tips for minimizing any swelling during pregnancy:

• Put your feet up, and elevate your legs whenever possible. Try not to cross your legs, which only makes circulation more difficult. Any time you can, get off your feet; the blood can circulate better and not pool in the extremities.
• Dress comfortably, and avoid wearing clothes that are too restrictive or too tight. That includes shoes that are comfortable and not tight or too high-heeled.
• Wear supportive hose or stockings that are specifically designed for pregnancy. Make sure you are fitted correctly.
• Avoid standing in one place for long periods of time. Move around to keep your blood circulating. Moderate exercise such as walking and stretching can be helpful.
• Minimize your time outdoors if it is hot and humid.
• Rest by lying on your left side as much as possible, and not just at night, but several times throughout the day for about thirty minutes.
• Drink water and fluids, at least eight 8-ounce glasses per day, to help keep your kidneys functioning properly and help flush out retained fluids. Don't consume excessive amounts of sodium. Avoid adding salt to foods and eating too many salty snacks or heavily cured foods.
• Visit your doctor regularly so she can monitor your blood pressure and severity of fluid retention.

During the course of your pregnancy, your body will produce approximately 50 percent more blood and body fluids to meet the needs of your developing baby. The accumulation of these extra fluids accounts for almost 25 percent of a woman's weight gain during pregnancy.

Coping with an Achy Back and Legs

Backaches and leg aches can be very common later in pregnancy, as the baby begins to grow larger. By the second and third trimester, the weight of the baby on the pelvic bone can compress your sciatic nerve and result in pain along your back and legs. In addition to the weight of the baby and uterus, other causes of common aches include poor posture, hormonal changes (which can cause a loosening of the ligaments), and weak abdominal muscles. It is important to practice good posture with your pelvis tucked in and your shoulders back to relieve some of the pressure.

Ways to Relieve the Ache

Other tips that might help relieve the aches include the following:

• Wear low-heeled, but not flat shoes that have a good supportive arch.
• Do not lift heavy objects, such as children. If you have to lift something, bend at the knees, and keep your back straight. Use your legs to lift and not your back.
• Sit in chairs with good back support, or put a small pillow behind the lower part of your back.
• Try to sleep on your side with one or two pillows placed between your legs for support.
• Apply heat or cold to painful areas, or have someone massage them.
• Stay physically active to keep muscles toned and strong. Yoga stretches a few times a week may help relieve back pain, but make sure you learn how to correctly perform the stretches to avoid injury.
• Sleep on a firm mattress.
• Keep your weight under control with proper diet and exercise. Gain only the recommended amount of weight. Gaining too much weight will put even more stress on your legs and back.
• If back and/or leg pain is very bothersome, speak to your doctor. A licensed physical therapist may be able to help you ease your pain through postural awareness and safe exercises.

Dreadful Varicose Veins

Some women may get painful varicose veins during pregnancy, particularly if this problem runs in the family. The increase in blood volume, along with changes in hormone levels, and the increasing size of the baby and uterus can all add to the likelihood of varicose veins. The veins in your legs help to transport blood back to the heart and lungs for reoxygenation. It is a tough job, though, because gravity pulls the blood downward instead of up toward the heart and lungs. The leg muscles try to fight this gravity by contracting. As the muscles contract, blood moves through the veins where valves confine and hold it. If these valves become overwhelmed, which they often do during the later months of pregnancy, blood collects and stretches the vein walls out of shape. The painful result is visually swollen varicose veins. Support pantyhose can help to ease some of the pain. Put your feet up whenever possible, and avoid standing for long periods of time. Take a brisk walk every day to keep increase circulation. If your varicose veins become intensely bothersome and painful, talk with your doctor about other types of treatment.

Nutritional Concerns

Of course, good nutrition and proper weight gain are also essential during your third trimester. Too little or too much weight gain can become a more significant problem in this home stretch. Calcium intake is also crucial because the baby's bones are developing rapidly during the last trimester.

Weight: Walking a Thin line

During these last three months, you can go either way when it comes to weight. The weight of your baby is increasing rapidly. For some women, this might mean that at meals, you feel fuller faster, making it difficult to get the essential calories that are still needed. If that's the case, it is best to try to eat smaller meals more often throughout the day. Snacks in between meals can help boost calorie intake. Choose a variety of snacks that will supply the nutrients that you need. If you have not gained enough weight throughout your entire pregnancy, you may not be able to make up for it all in the last trimester, but you can begin to ensure you are getting all of the calories that you need for a normal weight baby.

The flip side of the coin is gaining too much weight. You should be gaining about 1 pound per week during the third trimester. But by the ninth month, it is really the baby who is plumping up and not you. This is a good thing because the baby needs to be at a healthy weight by delivery. Low birth-weight babies have a harder time thriving and are much more susceptible to health and developmental problems. If by this time you are concerned that you have gained too much weight, discuss it with your doctor. If you feel you are gaining too much weight, do not restrict your caloric intake in hopes of losing a few pounds before the birth of your baby. In your ninth month, it is still important to eat a healthy diet and to pack a nutritional punch at each and every meal and snack. It is never too late to switch to a healthier diet for the proper nourishment of your baby and for a healthier weight gain. Eating a healthier diet can also help provide you with the important energy you will need for the delivery process.

Crucial Calcium

Although calcium is an essential nutrient before, during, and after pregnancy, it is especially crucial in the last three months of pregnancy. This is the time that your baby's bones and teeth are rapidly developing. If the baby can't get enough calcium from your dietary intake, he will take what he needs from your own stores. If your baby is relying on your stores of calcium for his needs, this can be detrimental to your health in the long run-for instance, by increasing your risk of osteoporosis. For this reason, it is vital that you get plenty of calcium through food and supplements in this critical third trimester. Chapters "Planning for a Healthy Baby" and "Nutritional Necessities" can provide you with additional information on calcium.

Keep in mind that you can always overdo too much of a good thing, so watch that you don't abuse calcium supplements. You should not get more than 2,500 mg of calcium per day.