Pregnant MD: Third Trimester Woes

As always, this post is meant as information and a personal account only and does not replace the advice of your personal healthcare provider. This post contains affiliate links to help you find the products I personally recommend which may provide small compensation for me.

Rounding out this pregnancy-blogging adventure, I have had a rodeo of all the discomforts of third trimester to remind me what to warn other mamas is coming for them. I had forgotten a few of them, so it’s lucky for you all I decided to go for #3 to be truly up to date on all of this (jk). Every woman’s experience of pregnancy is different – you may get none of these, all of them, and then some more – but I’ve tried to hit the most common highlights here for reference.

Braxton-Hicks

These fun semi-contractions may have started earlier for you than 28 weeks, the official kick-off of third trimester. However, if they didn’t, most women will start to get them more noticeably now. You might start to wonder if these are “the real deal” and whether you should worry. In general, the main difference is BH contractions are a tightening not a pushing down sensation. Think a fist squeezing closed around something rather than trying to push down. It’s hard to know the difference until you’ve had the real thing sometimes, but trust me when I say – you’ll know the real ones when they come.

They can range from barely noticeable to quite strong, stopping you in your tracks. Talk with your provider about when to go get checked, but in general if you’re having more than 4 per hour despite resting and being hydrated with an empty bladder (I do realize those last 2 are hard to balance….), you should check in with your person.

Snissing

I learned this fun term in my first pregnancy and have been giggling about it ever since. Snissing is pissing when you sneeze. As that baby pushes more on your bladder and your pelvic floor loosens up more, you may start to lose control with episodes of pressure – aka sneezing, coughing, laughing, having a toddler jump on you…. Doing Kegels regularly through the pregnancy can help avoid this, but for some it’s your anatomy and you’ll just have to make do with wearing pads and prioritizing emptying your bladder very regularly. Hooray!

Hemorrhoids & Constipation

Everyone’s least favorite body part to talk about – your butthole. These are 2 separate issues but very related, so I’ll address together. Some lucky people (ahem, me included) struggle with constipation at baseline and pregnancy hormones make that so much worse. The worse the constipation, the more you might be straining to get that BM out. I mean this 100% literally: I have had multiple poops that were harder to push out than my actual babies. The more you strain the more pressure you put on the veins around your anus and at some point, they can start to bulge out – this, my friends is a hemorrhoid.

Image result for hemorrhoid illustration

What’s a preggo girl to do?? Stay aggressive about constipation management. Aim for 1-2 easy bowel movements per day. Talk to your provider about a regimen you can use, for me it’s been high-fiber diet, hydration with at least 2 liters water a day, Smooth Move tea most days and high-quality pre/probiotics. The best I’ve found are these Prolistic ones by Nerium, not just saying that because I work with the company, they are superior (link is not even for my own business to keep this separate).

Heartburn and Reflux and Vurping, Oh My!

Me after drinking orange juice

Downward pressure has it’s problems as above, but at some point the upward pressure gets to most people as well. Fun fact – the old wives’ tale that babies with more hair cause worse heartburn is for completely unknown reasons statistically true. The safest methods for managing this are natural:

  • Avoid large meals, don’t eat anything more than a few bites of a snack for 2 hours before bed.
  • Avoid acidic foods: coffee, tomato, citrus…
  • Manage constipation (backing up the whole system)
  • Avoid carbonation

Some people also do well with Papaya Enzyme after meals. And up to 6 Tums regular strength tablets a day are safe – but beware!! These can worsen constipation turning into a self-perpetuating issue. If it’s bad beyond that, talk to your provider about other antacids.

Aches and Pains

You can get upper back pain from the weight of belly and breasts, round ligament pain from your growing uterus, and low back pain from basically doing dead-lifts all day long with a 20lb plyo-ball. I read in residency that 80% of women experience back pain in pregnancy. That seems unreasonably low. I have never, ever talked to a woman who didn’t have some degree of back pain by the end of pregnancy. If you’re out there… what’s that like? What are you made of? Are you descended from Amazons? For the rest of us, a few things can help…

  1. Prenatal yoga. Exercise in general is helpful, but prenatal yoga in particular is INCREDIBLY important for the health and comfort of your back.
  2. Prenatal massage. Make sure you’re seeing someone trained in this specifically and with a table set up to accommodate a growing belly.
  3. Topical creams. Distracting the nerves with something tingly can help temporarily. My go-to is BioFreeze because it’s the tingliest (is that a word?).
  4. Belly and hip supports. See if you can get one through your insurance first, if not, the most popular ones are in This NY Magazine Review
  5. Warm showers or baths or heating pad. I say warm, I mean VERY warm. There is no exact temperature cut-off – just stop as soon as you feel “Hey, I’m hot”.
  6. Tylenol. Yep. That’s all you get. Plain tylenol. Always good to double check with your own provider if this is ok for you, but most pregnant women can take this for bad pain.

If your pain goes beyond what can be managed with the above, talk to your health care provider. Some will have you see a specially trained chiropractor who knows Webster technique, work with a physical therapist or use other medication to manage it.

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Labor Scares

We will do a whole post on ‘How to Tell When to Go To The Hospital”, but in short, many women experience bouts of ‘Prodromal labor’ or ‘False labor’ prior to the real deal.

  • Contractions: The Braxton Hicks can get pretty strong and somewhat regular towards the end and as prenatal providers, we get a lot of “When are they labor?”. The general rule is 5-1-1: if you have contractions that stop you from doing what you’re doing every 5 minutes, lasting 1 minute for 1 hour and getting stronger despite resting and hydrating, you should check in with your person.
  • Breaking Water: This seems like it would be straight forward, however, as explained above with Snissing, plus how much vaginal discharge you might have, it can be tricky. It is often not the Hollywood gush of a gallon of fluid that is obvious, but a slower trickle when your water breaks. If you’re not sure, go empty your bladder, put on a clean, dry pad and walk around a bit. If your water is broken, you’ll keep leaking. Still not sure – go get checked.

Cankles and Varicose Veins

It’s a cruel joke of the universe that just when it becomes super awkward to try to put on any socks, much less super tight compression hose, you start getting ankle swelling that is treated by exactly those socks. Do your best to wear them if you know you’ll be on your feet a lot and certainly if you’re traveling where you’ll be stationary in a car or plane for more than an hour at a time. There are lots of options with better breathability and cuter designs these days, these are affordable and the appropriate 20-30mm pressure rating.

Screen Shot 2018-12-14 at 11.23.38 AM

If you are able, also take 20-30 minutes a few times a day to put your feet up at heart level and let gravity help you out here. If you get the ankle, or in particular hand or face swelling that comes on suddenly, go see your provider right away as this can be a sign of pre-eclampsia.

I would be remiss if I didn’t also warn you that you can get swelling and varicose veins everywhere south of your uterus – including your lady parts. Some women have the special experience of these throbbing, painful veins or swelling in the vagina and labia at the end of pregnancy. While there are also some interesting medieval-looking support contraptions that can help with this, the main thing that will make it less-bad is resting on your side or in puppy-dog pose type position for 10-15 minutes throughout the day.

Image result for puppy dog yoga pose

Lightning Crotch and Sciatica

Ever get a reallllly good zinger plugging something in that the wires were a bit stripped or your finger was on the plug? Imaging that in your labia. Welcome to lightning crotch, the fun pregnancy-version of good ol sciatica. Both of these can happen as baby moves lower in your pelvis toward the end of pregnancy. The same things that help with back pain described above can help with these particular issues as well. Some people also find acupuncture very helpful – but again – check with your provider about if and with whom that would be safe to do.

Pregnancy Brain

Yes, you’ve probably had this all along. Scientists have actually figured out that part of this is due to the hormones circulating around. However, with third trimester, your sleep starts to be very disrupted – most people wake 3-6 times a night to change positions and go pee. This makes the fog worse, of course. My own theory though, is that it’s also due to the now much stronger little being inside your squirming around. I told my husband to try to imagine concentrating with a little elf riding around poking you, elbowing you, going, “Hey! Hi! It’s me! Hey-yo!! Yoohoo!! Hi!” allllllll day long. Now… What was I writing about here…? Oh yeah. Help yourself and write things down! Consider a tracking device for keys, make sure “Find My iPhone” is on and maybe slap some GPS watches on your other kids while you’re at it.

When To Get Help

There are 6 main things we never want you sitting at home with:

  1. Bleeding that is any more than spotting
  2. Concern your water has broken (see above)
  3. Persistent contractions (see above)
  4. Feeling less baby movement – there’s no perfect rule for this, if you’re worried, we are worried.
  5. Signs of pre-eclampsia: Persistent pain in the belly or back, headache, blurred vision, sudden increase in swelling of feet/hands/face, or difficulty breathing.
  6. Depressed mood or bad anxiety, or any threatening or abusive behavior from your partner. These all, sadly, go up in pregnancy – don’t stay silent! We can help!

The bottom line on this one is any time something is beyond a minor discomfort, we want to hear about it. Have a low threshold for asking for advice from your healthcare provider – we VERY much would rather you come in for something small than miss something big.

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Now, then… Who’s ready to have a baby??

 Dr. Annie is a family physician and 3 time mama in California.

 

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Real As A M*ther

Four girls became best friends in high school and have stayed together through a whole lot of life. We are now a doctor, a lawyer, a financial advisor and a badass doula slash massage therapist and homesteader and want to share what we've learned as wives, moms, women and in our careers with the world... and entertain you along the way!

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