$Unique_ID{PAR00437} $Pretitle{} $Title{Pregnancy: The Third Trimester: Coping With the Changes} $Subtitle{} $Author{ Editors of Consumer Guide Ellis, Jeffrey W Ellis, Maria} $Subject{Third Trimester Coping Changes physical emotional stress conscientious diet childbirth preparation classes employment child care infant feeding health care Discomfort Discomforts Breath Shortness enlarged uterus lungs Varicose Veins blood vessels Dizzy Dizziness Light-headed Light-headedness Stand sit rise hypoglycemia Hemorrhoids constipation Swelling Legs Feet Ankles Aches Vagina Groin Hips loosening joints ligaments pelvis hormone Vision Psychological anticipation attention anxiety fatherhood Sexual Relations large abdomen swollen breasts increased vaginal secretions skin pigmentation unattractive embarrassed sexuality sex intercourse Orgasm Orgasms amniotic sac Health drugs toxic chemicals radiation infection infections nutritional deficiency deficiencies diet fall falling Comfort Sleep Exercise exercising Travel traveling} $Log{ When Resting or Sleeping*0043701.tif To Prevent Dizziness (Caption)*0043702.tif To Prevent Dizziness (Image)*0043702a.tif Getting Up from Floor*0043703.tif Comfortable Night's Sleep*0043704.tif} Miracle of Birth The Third Trimester: Coping With the Changes Keeping up the Good Work Throughout pregnancy, you are confronted with many physical and emotional changes. You may also experience stress caused by your feelings about your changing body and your future role as a parent. During these last three months of your pregnancy, when you're probably just plain tired of being pregnant, it may be encouraging to remember that most of these physical and emotional changes are quite normal and that they'll be quickly overshadowed by the joy you feel when you give birth. Practical Matters in the Third Trimester As you get ready for the birth of your baby, you will need to continue to be conscientious about your diet and be sure to get plenty of rest. At the same time, however, you'll probably also need to take childbirth preparation classes; make decisions about employment, child care, infant feeding, and health care for your baby; and prepare the baby's space and equipment. If they have not already done so, this is when most couples take a good look at their financial situation and figure out the impact that the birth of the baby will have. There may be a loss of income for a while, extra bills associated with the birth, other expenses for the baby's needs, and more. It is best to try to prepare yourself for these financial changes as much as possible so that you are not caught in a financial bind when your baby is born. Common Discomforts of the Third Trimester Shortness of Breath As the uterus continues to enlarge during the last three months of pregnancy, it will push up on your lungs, and you may experience shortness of breath. The best way to relieve this sensation is to maintain an upright position as often as possible and avoid lying flat on your back. The flatter your position, the greater the pressure of the uterus on your lungs. It may be easy to remain upright during the day, but at bedtime, it will take some preparation. Before you go to sleep, place two pillows under your head and one under your back so that your body is at a slight angle, thus helping to relieve the pressure on your lungs. If you ever suddenly experience shortness of breath, especially if it is not relieved by standing up or resting, call your doctor, since this could be a sign of a more serious condition such as pneumonia. Varicose Veins These are common side effects of pregnancy, and they tend to become more severe with each subsequent pregnancy. Varicose veins are caused by the pressure that the enlarging uterus places on blood vessels in the abdomen that carry blood from the legs back up to the heart. The walls of the veins in the legs weaken as a result of being overfilled with blood. This eventually causes the veins directly below the skin of the legs to bulge and ache. The following suggestions may help you relieve some of the discomfort of varicose veins and may prevent them from getting worse. - Elevate your legs on a stool, if possible, while you are sitting. - Avoid prolonged standing. - Avoid sitting with your knees crossed or sitting in one position for a long period of time. - If it is possible during the day, take frequent rest periods and lie down with your head and shoulders raised slightly and your feet propped up on a low stool or several pillows. - Avoid wearing clothing that may constrict the blood vessels in your legs, such as tight slacks, knee-high stockings, or girdles. - Nonconstricting support stockings may be worn during the day. Be certain to put them on in the morning before you get out of bed. If you stand up first, which allows the varicose veins to bulge, the support stockings will be less effective. - Elevate the foot of your bed with six- to eight-inch blocks. This will raise your legs at night and reduce the pressure on the walls of the leg veins. - When you are sleeping, lie on your left side. This will help to move the uterus off of the veins in the abdomen and thereby reduce the pressure in the leg veins. If you ever experience severe pain or tenderness in your legs or notice redness over a leg vein, call your doctor immediately. This may be a sign of a blood clot. Dizziness and Light-headedness Other problems caused by the pressure of the growing uterus on blood vessels in the abdomen include dizziness and light-headedness. Since this pressure tends to make the blood pool in your legs, less blood is available for your heart to pump up to the brain. These discomforts usually occur if you rise suddenly from a sitting or reclining position, because the heart cannot compensate quickly enough for your new position. Until the heart can compensate by pumping harder, you may experience dizziness and a sensation of light-headedness. To prevent this from happening, make certain that you avoid sudden changes in your position. Stand or sit up slowly. For example, when you rise from bed in the morning, use your arms to push yourself up slowly to a sitting position. Remain seated for a minute or two, and then slowly stand up. A low blood sugar level--called hypoglycemia--may also cause dizziness. Since the baby is constantly taking sugar from your blood, your blood sugar level may drop at certain times of the day, usually between meals. To relieve this, always carry a high-carbohydrate snack, such as crackers or an apple. At the first sign of light-headedness, eat the snack. This will usually relieve symptoms within a few minutes. You may also want to eat several smaller meals throughout the day instead of three large meals, since this will also help to keep your blood sugar level from dropping too low. Hemorrhoids This problem is also caused by the pressure that the enlarging uterus puts on the veins in the abdomen. The following suggestions may help you relieve hemorrhoids. - First, try to relieve any constipation (see The First Trimester: Coping with the Changes), since straining to have a bowel movement may cause hemorrhoids to develop and will make existing ones larger. - Avoid prolonged standing and sitting. Lie down whenever you can. - For relief, place witch-hazel pads, which you can purchase at a drugstore, directly on the hemorrhoids. You may do this three or four times a day as needed. - Soak in a warm bath whenever possible. If these simple measures fail to bring relief, your doctor can prescribe safe medications, such as stool softeners and pain-relieving hemorrhoid creams and suppositories, for you to use. If extreme pain develops in the rectal area or if you experience any rectal bleeding, notify your doctor. Swelling of the Legs, Feet, and Ankles This common problem is also caused by the heavy weight of the uterus pressing on blood vessels in the abdomen. It is usually most apparent after you have been standing or sitting for a long period of time. The following suggestions may help you relieve this swelling. - Try to lie down or sit with your feet elevated as often as possible. - Do not wear constricting stockings, panties, or girdles. - Sleep on your left side with your feet slightly elevated on pillows. This will help to move the uterus off the blood vessels in the abdomen and will aid circulation in the legs. - Salt in your diet may cause you to retain fluid, which will contribute to swelling. While you should not severely restrict your salt intake, you may want to avoid heavily salted foods. You might also try cutting back on the use of salt at the table if you add salt while cooking. Consult your doctor if you have any questions about salt in your diet. While swelling of the legs is common during pregnancy, swelling of the hands or face may be a sign of preeclampsia. If you ever experience swelling of the hands or face, or if your feet, ankles, or legs swell suddenly, notify your doctor immediately. Aches in the Vagina, Groin, and Hips These discomforts are caused by the pressure of the enlarging uterus and the loosening of the joints and ligaments in the pelvis caused by your changing hormone levels. The best remedy is to avoid activities that may strain these joints and ligaments. Move carefully and avoid sudden twisting or bending. Also, turn over slowly when you are in bed or getting up. Practicing the pelvic tilt exercise (see The Second Trimester, For You and Your Baby) may also help to relieve these discomforts. Vision Problems Women who wear glasses or contact lenses may find that their vision during pregnancy is not as good as it was prior to pregnancy. Vision changes may occur if the shape of the eyeball changes slightly due to increased fluid in the tissues. (Some women experience similar vision changes five to seven days before their menstrual period when they are not pregnant.) If you do have this problem, it may be necessary to have your lens prescription changed during pregnancy. Talk to your eye doctor about this. Be sure to notify your doctor immediately if you experience blurred or double vision, since these may be signs of preeclampsia. Psychological Changes The third trimester is a time of anticipation. Soon, your baby will be born. During these final months of pregnancy, the baby will begin to take on an identity of her own. This is usually when parents-to-be set up the nursery and discuss names for their child. Usually, by the time the third trimester has arrived, any ambivalent feelings about the pregnancy have been resolved. During this time, you may feel very special. If you had difficulty becoming pregnant in the first place, the last weeks of pregnancy may take on even more significance. During this time, you may find that you need extra attention from your husband, your family, and your friends. You may need reassurance regarding your appearance and your ability to be a good parent. First-time mothers often experience a great deal of anxiety at this time about whether they will know when labor has begun. In women who have had children before, Braxton Hicks contractions may be so strong that they may not know when real labor has started. Childbirth classes, which are usually attended in the seventh or eighth month of pregnancy, are very helpful in educating parents-to-be about what they can expect and in relieving many common fears about childbirth. For your husband, impending fatherhood may trigger memories and emotions concerning his childhood relationship with his own father. For some men, becoming a father means giving up the idea of being a son. It also means reconciling childhood experiences with the reality of becoming a father. In some men, it seems that these feelings are stronger during the latter weeks of pregnancy than they are after birth. Even if a man has fathered children before, his wife's pregnancy may elicit a variety of emotions and thoughts. He may think about the kind of father he has been to the children that he has, and he may worry about the additional responsibilities he will be facing. If the father-to-be is proud of his fathering experience, he will probably be excited about the upcoming birth. Just as it was assumed in the 1950s that no father could adequately participate in the labor and delivery experience, it is now assumed that most fathers will. If your husband plans to attend the birth, he may be concerned about his ability to act as your coach during labor, especially if this is your first baby. Talking to other men who have gone through the experience may be helpful. Often, childbirth preparation classes provide the perfect opportunity for this type of discussion. If your husband feels that he will not be able to participate in labor and delivery, this should be discussed and resolved prior to the event. You and your husband should not feel that this decision is in any way wrong or abnormal. It is very important during the third trimester for you and your husband to communicate your needs, fears, and concerns openly and to provide each other with support and reassurance. Childbirth preparation classes can also be a great source of reassurance and will increase your knowledge and decrease your fears about the events ahead. You may find it comforting to be able to talk to other couples and may find that they share many of the same emotions and concerns. Sexual Relations How couples feel about sexual relations during the last few months of pregnancy varies greatly. Some couples may experience a renewal of the romantic bond that may have been missing during the previous few months. However, other couples may have a decline in sexual interest and may limit their sexual activity. Some women feel quite self-conscious about their bodies during the last months of pregnancy. A large abdomen, swollen breasts, increased vaginal secretions, and increased skin pigmentation may cause a woman to feel unattractive and even embarrassed. This can affect her relationship with her husband. On the other hand, some women may feel that these changes enhance their sexuality, and they may have an increased desire for sex. Men, too, will have feelings about their partner's changing body. Some men will take great delight in feeling the baby's movements and massaging the abdomen. Others, however, maybe uncomfortable with their partner's physical appearance or may fear that they will hurt the baby during sexual intercourse. During the last few months of a normal pregnancy, sexual intercourse poses little threat of infection to the baby as long as the amniotic sac has not ruptured. Orgasm can initiate labor contractions only if the woman is near her due date. The erect penis will not hurt the baby and is unlikely to rupture the amniotic sac. If you have developed any complications during your current pregnancy or if you experienced complications in a previous pregnancy, however, be sure to discuss with your doctor any limits that might be placed on sexual activity. Likewise, if you have any concerns about safe sexual activity during pregnancy, consult your doctor. It is important that you communicate with your partner and discuss how you feel about sexual relations. Your increasing size may necessitate some experimentation with positions for intercourse. You may, for example, want to try intercourse lying side by side or with you on top. The important point is to find a position that is comfortable for both of you and that does not place too much stress on your body. If having intercourse during these last months of pregnancy makes either of you uncomfortable or if your doctor has advised that you abstain for medical reasons, keep in mind that there are other ways of expressing your love for one another, such as touching, kissing, and cuddling. For many couples expecting their first child, the impending birth may make them acutely aware that they will never be simply a couple again--they will also be parents. This may lead to fears that they will be unable to experience the intimacy that they enjoyed before the baby. Other parents-to-be try to convince themselves that life will be unchanged after their child is born. Neither view is realistic. The birth of a child will bring with it multiple changes, both in the couple's relationship and in their daily activities and plans. It is critical that expectant parents discuss these issues before the birth of their child. Expectant parents who have convinced themselves that nothing will change will be in for a great many disappointments and frustrations. The idea that they are in control of so profound an experience will be a disappointing fantasy once the baby is brought home from the hospital. On the other hand, those who have realistic expectations about the pregnancy and about life with a newborn will be more likely to cope well and perhaps even enjoy many of the changes. Safeguarding Your Baby's Health During the third trimester, your baby remains vulnerable to the effects of drugs, toxic chemicals, radiation, and infection. Since this is also a time of rapid growth, your baby may be severely affected by any nutritional deficiencies in your diet. Even though she is protected by the amniotic fluid and your abdominal wall, your baby can still be injured if you have an accident in which you suffer trauma to the abdomen. Rupture of the membranes, separation of the placenta from the wall of the uterus, and even physical injury to the baby can occur if you have a serious accident. For these reasons, you need to be especially careful during the third trimester to avoid situations in which there is potential for injury. For example, you may wish to stop driving a car if your enlarged abdomen has made it difficult for you to maneuver the steering wheel or reach the pedals. You should avoid standing on ladders or chairs, since you may easily lose your balance and fall. You should also avoid any sporting activity in which you may either lose your balance or get hit by a ball or a teammate. It is also important that you keep in mind the signs and symptoms that may indicate that a problem is developing in your pregnancy (see The Fifth Month: Ask the Doctor). If you ever feel that you are developing any of these signs, call your doctor immediately. For Your Comfort Sleep During the last few months of your pregnancy, you may find it difficult to find a comfortable position for sleeping. Many factors contribute to this, including shortness of breath, leg cramps, backache, movement of the baby, and the large size of your abdomen. You may sleep in any position that you find comfortable, since it is not possible for you to harm the baby by compressing or rolling onto your uterus. The use of several pillows positioned beneath your head and back and between your legs may help you to get comfortable. If you are experiencing shortness of breath, you may wish to use more pillows under your head and back so that you are in a semireclining position. A heating pad or hot-water bottle under your back or legs may also be helpful. Never use sleeping pills during pregnancy, since their effects on the baby are not entirely known. A short walk in the open air, a glass of warm milk, or a warm shower or bath will often help to relieve insomnia. Exercise During the last few weeks of pregnancy, it is best to avoid most forms of strenuous exercise, including jogging and tennis, since you will become out of breath easily and your balance may be affected by the size and weight of your uterus. Walking and swimming remain excellent forms of exercise during the latter months of pregnancy, since they are safe activities, and they will help maintain good circulation in your legs and good muscle tone in your legs and abdomen. Travel During the last month of pregnancy, it is best to travel no farther than one hour's distance from the hospital in which you intend to deliver.