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12.60 MB | 31:38 Min
Leslie Ludka is a Certified Nurse-Midwife who graduated from the midwifery program at the Yale University School of Nursing. After a year of providing full scope midwifery care to native Hawaiian and rural community women on the island of Molokai, Leslie returned to Boston, where she spent nine years at Brigham and Women’s Hospital, the primary teaching facility for Harvard Medical School. Since leaving that position, Leslie has been self employed with LML Consulting, providing full-scope clinical midwifery both nationally and internationally.
Welcome to your Pea in the Podcast, I’m Bonnie Petrie with everything you need to know about your body, your baby and the big changes ahead in your life as you begin your journey to becoming a mommy.
This week it’s all about the third trimester.
From the way you look…
“Well I have this big, beautiful belly I feel kind of like Earth Mother.”
To the way you feel…
“You get the cervix twinges which are you know it feels like someone is shoving a hot poker down there and it’s like oh ah.”
To the big day…
“They’re the type of contractions that are strong enough to make your eyes water, and your nose run and your toes curl.”
We’ll talk to a wonderful Certified Nurse Midwife and mom who has been in the third trimester so long she is overdue in this Pea in the Podcast.
You’re in the home stretch now, the third trimester. It’s time to revel in your beauty. You are a fertility goddess after all.
“It’s like wow I have this big beautiful belly, I feel kind of like Earth Mother like all women hope to feel when they get pregnant. You get this big round belly and it’s like wow it’s so beautiful.”
That’s Brandy. She is 3 days past due and can still enjoy this particular portion of her pregnancy. She loves her look, in part, because it took so long for her to get here.
“Because I’m a plus size girl I started showing a lot later according to everyone else, and no one else can tell I kind of got this little secret and around 28-30 weeks I was finally starting to pop out and people were finally starting to notice and it just made me so happy.”
But along with this beautiful belly comes aches and pains and irritations, Certified Nurse-Midwife Leslie Ludka runs down a few discomforts for you.
“Pelvic pressure, heartburn and joint pain are the three that come right to the top of my mind and then lack of sleep, a lot of women are just all of those discomforts cause lack of sleep which causes fatigue.”
Brandy has experienced all of these things, starting with terrible heartburn.
“It was pretty bad, I couldn’t eat anything that you would ever think would give you heartburn like mashed potatoes or bananas or something really simple and kind of you know soft would just tear me up completely.”
Ludka says you can deal with this by eating smaller meals more frequently, staying upright after eating and sleeping propped up on a pillow. Avoid those foods that give you trouble, of course. Try chewing gum after meals too. Talk to your doc about over the counter antacids that may help you and if those don’t work don’t hesitate to talk to your doc about prescription medications that may help you.
Okay. Joint pain.
“Toward the end of your pregnancy your hormones want to loosen things up so the baby can pass through the birth canal more easily so that things can sort of move aside is how I think of it. And so yes hip pain is common, all joint pain is common and another pain that many women perceive or feel is pubic pain because we think of the pubic bone as one bone all the way across well it isn’t really, there is cartilage in between it at the front and so that often loosens up a little bit and many women experience discomfort there. So I recommend that people are very careful of things like stepping in and out of the shower, anything that would cause you to do what we term as splits in gymnastics. We want to be very careful of that area. Extremely careful on ice if you’re in an area where you get snow, anything that might make you slip walking up and down the stairs you just want to be really careful of that sort of thing.”
All of this pain and discomfort can interfere with your sleep.
“I’ve got a lot of back pain and actually my second trimester I had some hip pain but I guess the baby just positioned weirdly and he got off that nerve or what not but so far it’s just been the back pain. Whenever I’m laying in bed sometimes one of my hips, whichever I am laying on will get very sore and I have to wake up completely to start all over because rolling over is this huge production and it’s so hard. You roll over to the other side just to wake up an hour later to wake up with that hip hurting.”
And for most third trimester moms-to-be sleep is the Holy Grail. How do you get a good night’s sleep?
“A nice back massage and real quiet and have a very comfortable bed and just make sure that they haven’t eaten a heavy meal before they go to bed and just try as best they can to make themselves comfortable in whatever way she can.”
Brandy, like many mom- to-be. does find a nest of pillows helps.
“I do sleep best with a ton of pillows, especially the one that goes between my legs. And then of course there is no room for my husband but he’s been pretty good about it.”
You may find your sleep is disturbed by vivid dreams.
“I’ve had a lot of birth dreams like dreams about I’d be giving birth like in my van in the backyard or my mother-in-law would be driving me crazy while I was in labor. This afternoon during my nap I had a dream that the baby was already here and my husband was playing with it only it was a little girl baby, which is not what I’m supposed to be having so we’ll see.”
You may have a lot of sexy dreams, too, and some upsetting ones. They’re all normal and they may be a further impediment to getting good sleep. You may be peeing more often, make sure you empty your bladder as best you can before bed. Your baby is getting bigger and pressing on your bladder.
You also may be finding yourself suffering from — yippee! — constipation.
“Everybody pretty much knows what makes them go. If it’s prunes, apricots, green leafy vegetables, people typically know and so I really recommend that they make sure that they get plenty of fiber in their diet and drink a lot of fluid so that they don’t get constipated because constipation in addition to being very uncomfortable can also cause you to strain when you’re moving your bowels and that can cause an aggravation of hemorrhoids which has its own discomfort level.”
Yes it does. So if you get hemorrhoids, and a lot of moms-to-be do, what then? Midwife Leslie Ludka…
“There are some products that can be used that your healthcare provider can recommend to you to ease the discomfort of those hemorrhoids and there are some pelvic floor exercises that you can do to try to tighten up those muscles because a hemorrhoid is just really a varicose vein that is protruding outside the rectum.”
Most third trimester moms will also deal with some degree of swelling, which you do need to pay attention to. It most often is nothing to worry about but it can indicate a problem.
“There is swelling that is pretty typical in pregnancy and that is ankle swelling and that ankle swelling can be quite impressive, impressive enough so that you’re not wearing your own shoes anymore. You have to wear somebody else’s shoes or you can’t get into anything but sandals. That is pretty common in pregnancy and what you can do about that is increase the amount of protein in your diet and in the old days we used to say look at salt in-take and I sort of still do say look at your salt in-take. If you’re eating a bag of potato chips everyday and having salty foods at dinner at night you are going to hold more fluid. So that type of swelling in your ankles is something that if you rest with your feet up, drink fluids and watch the salt and eat good protein then you can usually manage it somewhat. But that type of ankle swelling is not harmful to your pregnancy.”
The kind of swelling you want to watch out for is sudden swelling in your face, in your hands. If this happens you want to give your doc a heads up. They’ll probably want to check your blood pressure and look for protein in your urine, they’ll check for these things at every prenatal appointment anyway but you do want to keep an eye on it. Brandy, who did have significant and dangerous swelling during her first pregnancy, has good news to report.
“My ankles are still the same size, my fingers are still the same size, my nose actually has gotten swollen some though. But I remember that happening with my first and it goes away so that makes me very happy.”
Yes, for some people you’ll find your nose does grow a little bit during pregnancy. I did. I don’t think it was probably noticeable to anyone else but it was to me. I was glad to see that go after my baby was born.
In fact, your nose may present a whole host of problems in addition to hormonal changes causing swelling of mucus membranes. You may experience a constant stuffy nose, post nasal drip and nose bleeds. Your allergies may also get worse, that’s always fun.
As your pregnancy progresses, your cravings may continue. Brandy’s have.
“I’ve been craving a lot of protein this time so I’ve been going crazy eating chicken breast, well actually chicken is my main craving lately but with my first I had cravings for apples and caramel dip. And I went crazy because I was kind of trying to hint at my husband to go out and buy some, and every time, because I didn’t come out directly and say it, he would say oh I’m not really an apple person. Well then I called my mom and was like mom I need apples and caramel and she said I’ll be there in 10 minutes.”
Mom’s been there, she gets it.
But even though your growing belly may make it seem like you don’t have to think about diet or exercise anymore, you do. Even if you’re just walking.
“We go walking all of the time especially now that I am overdue. My diet has been pretty strict because I am already a type II diabetic so I’ve had to keep my blood sugars in control but they have been doing really well and just eating healthy and walking is the main exercise that I do.”
As the baby gets bigger you may feel what is called round ligament pain. You may have experienced that already. It’s that brief stabbing pain you may feel in your lower abdomen, particularly as you move quickly, or it also could be a dull ache as those ligaments down there stretch. You may also feel pain as your baby kicks and punches in various places.
“You get the cervix twinges which are, you know, it feels like someone is shoving a hot poker, you know, down there, and it’s like oh! ah! and everyone looks at like you like you’re crazy because they don’t understand what you’re feeling at that point in time. And then there’s, you know, the ones where it makes you feel like you want to like do a backspin because you’re stretching so far.”
In this trimester it does become important to keep track of your baby’s movement. Midwife Leslie Ludka says your doctor or midwife may even tell you to monitor it with something called kick counts.
“The point of is that mothers paying attention to the movements of the baby every day and baby should be moving about the same amount that it has been moving all along and that is really the key.”
So how do you do kick counts? Ludka says there are a couple of ways to do it, and this is what she suggests to her patients.
“Eat a meal, any meal, it doesn’t matter which meal. I want her to lie down on her left side, I want her to put her hand on the baby, I want her to look at the clock and I want her to count every single time the baby moves until the baby has moved 10 times. Once the baby has moved 10 times then she can stop counting, look at the clock again and see how long did it take baby to move 10 times. Any movement counts, kick, roll over, elbow, everything counts. Baby should move 10 times in less than 2 hours.”
If your baby doesn’t, call your doctor. In fact, fetal movement is so important as you approach your due date, if you’re worried at all…
“She should absolutely call her healthcare provider. We would really want to hear about that and maybe even invite her in so that we could all listen to the baby so that we are all reassured that baby is doing fine.”
Sometimes your baby will move less than at other times, which can be scary.
“There’s times of course he scares the crap out of me when he’s like taking a nap or something and I’m like shaking my belly and I’m like move for mommy.”
So do your kick counts and keep your caregiver informed.
You’ll be in pretty close touch with your doctor or midwife as this trimester progresses.
“At 28 weeks we usually like to start seeing people every 2 weeks as long as everything is normal every 2 weeks is usually pretty fine and then once a woman gets to 36 weeks then we like to start to see mother every week.”
During these appointments your caregiver will check your blood pressure and your weight. They’ll make you pee in a cup so they can check your protein and they can look for excess sugar. They’ll measure your belly and give your baby’s heartbeat a listen. They’ll look you over as they talk to you to check for swelling and that kind of thing. As you approach your due date they may check your cervix for dilation, and during these appointments…speak up!
“Talk with your healthcare provider about everything that is of concern to you. Dispel any concerns that you have. It’s better to call your healthcare provider and ask a question that you perceive as silly and your healthcare provider will be very pleased that you called and discussed it with them so that they can dispel your fears and that you don’t have to worry. Pregnancy should be a time in your life that you can enjoy it as much as you possibly can.”
If you do have questions write them down as you think of them. Inevitably when you see that white coat your questions will fly out of your head until you’re in the car on the way home, but if they’re written down you’re all set.
Okay sex, are you still going to want to do it? Certified Nurse-Midwife Leslie Ludka says….maybe…
“It’s very individual and women who do enjoy having sex in the third trimester should definitely have sex in the third trimester and if it’s positioning that needs to be experimented with well then that’s what they should do, is try different positions.”
Many men will feel uncomfortable having sex with their very pregnant partners. If you want to have sex, Ludka says talk to your partner, and if they still don’t feel comfortable have them talk to your caregiver.
“They come in to see us and we have a long discussion about how wonderful sex is and if it is something that the woman wants to do and the male partner is interested as well it’s not something they should be fearful of.”
Brandy and her husband have been sexually active throughout much of the trimester.
“Early in the third trimester, you know you just got to be creative with position but then after the baby drops it’s kind of like he’s hitting, he’s hitting my cervix more and it’s really uncomfortable.”
The baby will drop into your pelvis as your body prepares for labor, but even though sex has become uncomfortable for Brandy and her husband, they’re still doing it. Why? Because she is overdue and she wants the baby to be born. Midwife Leslie Ludka explains what sex has to do with that…
“There is a chemical in sperm that does have the component of one of the chemicals we use to stimulate labor so I have recommended to women if they are past their due date and they are trying to roll into labor that they do have sex that sometimes sperm on the cervix does push a woman to labor.”
Your baby will technically be considered full-term at 37 weeks. You can expect, if left on your own, to go into labor between 38 and 42 weeks. Your estimated due date will be set right in the middle right there at 40 weeks, and after that you will be considered over due. This is not a big deal, although it may feel like one to you. Brandy says she is not surprised she is overdue.
“Well I’ve been counting down the days since I was in early pregnancy, oh I have 280 days left and then I was like oh I have 14 days left and then it’s like well now that I’ve been counting the days down all of this time I’ll probably be one of those women that go over and lo and behold here I am 3 days after.”
And being more than 40 weeks pregnant is for sure uncomfortable.
“You know it is kind of hard when you’re walking around you have to waddle because the baby is so low in your pelvis and you know bending over and cleaning your house and all of the normal things you take for granted are suddenly in fact harder.”
When you’re overdue you may be willing to try all kinds of things to go into labor.
“I’ve tried nipple stimulation which makes contractions happen but they just kind of stop when I’m done nipple stimulating. We walk around a lot which is of course supposed to help. My husband bought me castor oil today but I have not tested it because I’m kind of — it’s a little too involved for me — like I said babies come when they’re ready and I think doing castor oil or something like that would be a little too much pushing.”
Yeah. Castor oil. Lots of people suggest it and lots of other people will say it’s a bad idea. It causes diarrhea and intestinal cramping which is obviously not very much fun and it can lead to dehydration and is no way in which to give birth. I would never tell any of my friends to do it. Also, generally labor does begin when a baby is ready to be born, so barring some medical reason for inducing labor — which is between you and your healthcare provider — I’d wait until the baby decides it’s done baking. Don’t worry,you won’t be pregnant forever. Promise.
“In this country now there’s really a movement to not let people go past 42 weeks and in some practices they even want women to have their babies earlier than that between 40 and 41 weeks. That’s something that you would want to talk over with your healthcare provider and would be a good question to ask when you’re interviewing healthcare providers.”
As the days pass and you remain pregnant you may get overly eager, and you may not take care of yourself as well. Well don’t stop doing that now! Midwife Leslie Ludka agrees…
“Make sure that you’re well rested and you’re well fed because this will happen.”
That’s right, labor is inevitable. You can’t get out of this pregnancy without having a baby. So how do you prepare? Well a childbirth class of some sort is helpful.
“Your healthcare provider is someone who should be able to help direct you to all of the different options that are available to you in your area. Also you may want to consider whether it is covered by your health insurance or not. Some are completely covered by health insurance. Others you have to pay some money.”
The hospital at which you plan to give birth probably does off a childbirth class. You can also look at more involved classes like Lamaze classes or Bradley classes that will teach you more about relaxation and help your partner be more actively involved in your birth. I took the childbirth classes offered by my hospital, found it really wasn’t enough for me. In the future, if I have another baby I will likely take a more in-depth class.
Another thing you can do in preparation for labor is put together a birth plan. Certified Nurse-Midwife Leslie Ludka is a fan of birth plans.
“I really want to know what you want for this birth experience. I really want to know what your expectations are and what you’re hoping for and if you let me know ahead of time with a birth plan then we’re on the same page and I can try to help you formulate your birth plan so that you can have the experience that you’re looking for. Now the qualifier is of course some things don’t always go according to plan and I do ask people to be flexible and I do say that if we need to change the plan I will explain exactly why we need to change the plan and ask your permission to change the plan because all of the decisions are yours.”
So if you do a birth plan, like she says, remember to be flexible. I wrote one, I am very glad I did even though just about nothing I planned actually occurred. My planned drug free birth ended in a c-section, but my birth plan did help me become more aware of the options available to me and gave me a language with which I could talk to my doctor about it. If you do write a birth plan, do talk about it with your caregiver well before you’re actually in labor. They don’t like these things sprung on them, and remember this conversation is on-going. If your doctor sees a need to deviate from your plan at any point be willing to listen to them. Again, it is so important I’ll say it again, be flexible.
In addition to preparing for the physical aspect of labor you’ll likely spend this trimester preparing your life for your new arrival.
“Of course I’ve got the crib ready which is right beside my bed so it’s kind of like a little co-sleeper because it is attached to my bed. And I actually made a blanket for him, an oh so sweet blanket and you know got all of the diapers washed and got all of the clothes washed and folded and everything. I got the carseat installed; I’ve had everything ready since 35 weeks.”
Brandy is also planning to breastfeed her baby so she has customized her own plan to prepare for that.
“I’ve not bought any bottles or formula so that way it’s kind of like put your nose to the grindstone, just do it. Just put your baby on your boob and don’t worry about anything else. I’ve read books, the one thing that I haven’t done that I do think I should do very soon is get in contact with La Leche League and see you know what support is available in my area just in case if problems do arise then I can have that back up.”
And soon enough you will go into labor. Midwife Leslie Ludka tells you what to look for.
“What you’re doing is you’re waiting for consistent contractions. You’re waiting for contractions that are coming every 5 minutes or closer for at least an hour or 2 and they’re the type of contractions that are strong enough to make your eyes water and your nose run and your toes curl.”
You may have been having some kind of contractions for a while now. Many women feel what are called Braxton Hicks throughout their pregnancy.
“I had some of those like especially when I was working because I was on my feet a lot and it seemed like my belly would get really, really tight and then when I would stop and rest it would stop.”
Some people refer to these as practice contractions, contractions that prepare your body for the labor ahead. Earlier in your pregnancy they may be sporadic and painless, later they become more intense. They should remain irregular though, and painless. As labor actually approaches it may start to feel a little painful and fool you into thinking that you’re actually going into labor, but Braxton Hicks contractions don’t grow longer, stronger or closer together like real labor contractions do. They call this false labor, and Brandy has experienced this too.
“It actually started exactly a week ago which was I was 39 weeks and I guess 3 days because I am 40 weeks and 3 days now and I was cooking dinner when they started and so I went to sleep that night and they were pretty mild through the night and the next morning they were still there and I thought of yes this is the real thing but of course like I said it just kind of stopped.”
This may happen to you several times, and it is no fun.
“It’s extremely frustrating because you know you’re already looking for all of these signs and everything and it just kind of blows your mind completely off course and you’re paying attention to every single little twinge and every single little discomfort and you’re like: is this it? Is this it? Is this it? And you know of course you have to be very patient because babies come when they’re ready, not when you want them to.”
Those other signs that you will be watching for include the loss of your mucus plug.
“I’ve been losing mine like parts and pieces for a week now. It kind of looks like well for me it has been like clear goby kind of like my vagina blew its nose kind of thing.”
The loss of your mucus plug is also associated with what is called the “bloody show” where you may see some blood mixed with that mucus. And you may not want to hear this, but losing your mucus plug, while pleasant of course, may not mean that you are about to go into labor any second. It does indicate your cervix is changing, but it still may be a while before baby makes its appearance.
You also may be waiting for your water to break in a dramatic whoosh like you see in the movies, starting your labor. More likely you’ll be well into your labor and nearly fully dilated before your water breaks on its own, if it does. In fact, many never do and your caregiver will have to rupture your membranes with a tool that looks quite a bit like a knitting needle. I have had this done to me; it’s not as bad as it sounds. Honestly. Some moms-to-be though will spring a leak and it will be difficult to tell if you’re urinating, experiencing pre-labor increase in vaginal discharge, or if you are leaking amniotic fluid. Call your healthcare provider if you’re wondering, and they can help you figure it out.
Okay back to contractions…
“When you get contractions that are strong enough to stop you in your tracks every 5 minutes consistently, they are very consistent you can set your watch by them or closer you know every 2 or 3 or 4 minutes. If they are coming every 5 minutes for an hour call your healthcare provider let us know what is going on. It would be much better to talk to us on the phone so that you know that is okay to stay home or let you know that we think it’s time that you come in.”
When else should you call your healthcare provider?
“If you break your bag of water we want to hear from you. If you’re having bleeding a little bit of spotting, a tiny little bit of spotting when contractions start are pretty typical but again if you’re concerned about it call your healthcare provider we would much rather hear from you. If your baby has not been moving as much as normal that is a really important thing to call your healthcare provider about.”
Many people want to labor at home for as long as possible because they are more comfortable there and they are more free to manage their pain by walking or using a tub or bouncing on birth ball, but some of you will have to go to the hospital or birthing center when real contractions start. That’s because you will have tested positive sometime after 35 weeks for Group Beta Strep.
“Well that is there is a bacteria that some women carry in their body and I think it’s about 30% of women carry it and you’ve heard of Group Beta strep because you’ve heard of strep throat. Well we have it in our body, it’s there, nobody really cares, if you have strep throat we care and we treat that but strep in other parts of the body it just happens to be there. And one of the places about 30% of women have it is in the vagina. We don’t even care that it is there, we never look for it, it’s just a bacteria, lots of good and bacteria in our body and so we don’t worry about it unless a woman is pregnant. Then if the baby is coming down the birth canal there is a small possibility that that baby could pick up the Group Beta strep if it’s there. We don’t like babies to get Group Beta strep because they can get very, very sick from Group B strep.”
So when you go into labor you will be given IV antibiotics to keep the strep away from your baby. This should not change your birth plan or inhibit your ability to nurse after your baby is born but it could save your baby’s life.
Of course you know labor hurts, but you may still decide to do it without pain medication, including an epidural. There are many good reasons for avoiding pain meds in labor, and Midwife Leslie Ludka says for some that works out well.
“Some women that’s enough for them that they can get right through labor and have their baby without any medication or any other type of intervention. Other women, they’re needs are greater than that. They try the relaxation and it doesn’t work for them and so they ask for some help, some kind of pain relief, and so we talk before the woman goes into labor about what those options are so that when she’s in labor they are familiar to her. And I will listen, and a healthcare provider will listen to what that woman is telling her, because no one knows what your labor feels like except you. I can be the person standing beside you and listen to you but I am not the person feeling the pain and I will try my very best to honor what you’re telling me. And so there may come a time when you say you know the relaxation was great and that pain medication you gave me was great, too, but now I need something more than that. And then we’re talk about an epidural.”
No shame in that. I, personally, did not plan to have an epidural, but because of my c-section I did have one in order to avoid general anesthesia. With an epidural an anesthesiologist will insert a needle into a numbed area that surrounds the spinal cord and they will thread a small tube into the epidural space. The catheter will remain in place in your back there for as long as you need the pain relief. I was able to move my legs with my epidural, and was kind of surprised by that, actually, but it’s pretty common. More than 50% of moms who have their baby at the hospital do get the epidural. But Midwife Leslie Ludka says the key to a positive birth experience — whether you use pain medication or not — is still relaxing.
“Because really the most ideal thing that we could do is to let out bodies float like we’re on a cloud, like we’re floating on a wave at the beach and just let everything drain out so that mother nature can do and our body can do what it needs to do and I sort of think of it as getting out of the way. It’s something that we just want to try to relax as much as possible and there are many different ways that people relax. Some people like music, some people like walking, some people like to sit in the shower or sit in the tub or sit in the Jacuzzi, some people like to rock in a chair. It varies from person to person and I recommend that people think long and hard before they go into labor about what are the things that help them to relax. Some people tried to learn yoga before they go into labor or try to meditate so all of those things are very helpful.”
But Ludka stresses while you’re looking ahead and preparing for your baby’s birthday — very important things for you to do — but she doesn’t want you to forget to enjoy right now.
“The best advice that I can give to women in terms of getting ready for this baby to come is to take really good care of yourself and to really think about this time that you have because it’s the last time that it will be just you and your partner or you and your partner and other children you have in the house so enjoy that. A wonderful event is going to happen and an amazing new addition is going to come to the family but never again will that couple be just themselves together. So I say enjoy that time together, really, really relish that time together.”
Great advice, your pregnancy is almost over and very soon you will meet your little girl, or little boy.
We hope you’ve enjoyed this Pea in the Podcast: The Third Trimester. Please visit our website PeaInThePodcast.com for more information about our experts, to find links and transcripts and to register to get tailored week by week shows for each week and stage of your pregnancy. It’s everything you need to know about your body, your baby and the big changes ahead in your life in your journey to becoming a mommy. For Pea in the Podcast, I’m Bonnie Petrie. Thanks for listening.
A Special Thanks To…
Brandy in Ohio for sharing her third trimester journey with us for this podcast.