Third Trimester – Answered by David Priver, MD, FACOG

Q. When I was about six months’ pregnant I had surgery to remove a hemorrhoid. At seven months, my sugar was 140 and I was told I could have gestational diabetes. I did a diet for a week and when I had the test again it came out negative. I’m 6′, and my husband is 6’2″. I’m 34 weeks and the doctor said my baby is probably about 8 lbs and already on the fetal position. Is the baby big because of the gestational diabetes or because we’re tall? I’m afraid this baby will be too big to deliver vaginally. What would be best?

A. What would be best is not worry about this situation. It is clear that you do not have diabetes, if that’s what your test showed. There is nothing surprising about big parents having big babies. Be aware that estimates of fetal weight are notoriously undependable. I have not seen many 6′ tall women who have had trouble delivering their babies.

Q. I’m 33 weeks’ pregnant with fraternal twins. It’s my third pregnancy and everything has gone well so far, as far as my health and the babies. I feel awful and have been in pain for weeks, but that’s to be expected. Yesterday the doctor said I was a 1-2 and 50 percent effaced. Could this mean I’ll have these babies anytime soon? I want to make it to 34 weeks but at the same time I think I’ll die if i had to go until I’m due!

A. 1-2 cm. and 50 percent effaced really don’t mean anything as far as predicting the onset of labor. This being other than your first pregnancy, you actually stand a good chance of going to term, which is best for the babies, even if it’s uncomfortable for you. 36 weeks would be a good goal to shoot for.

Q. I’m 37 weeks’ pregnant. Should I start trying to induce my own labor like natural ways?

A. I am so glad you asked this question, as there is so much misinformation out there about what women at term should be doing to help bring on labor. To begin with, there has long been the false belief that labor is brought on by walking around a lot. While women have tended to buy this because of all the pelvic discomfort that this activity produces, it is completely false. What women should actually do is spend as much time as possible at rest and taking in good amounts of liquids, as this is what will result in increased blood flow to the uterus which brings with it oxygen and nutrients needed to make the uterus contract. If you doubt this, pay attention to what happens when you first get off your feet; you will most likely feel an increase in the contractions we call Braxton-Hicks. That said, there is great benefit to ambulating once labor is established as gravity will help bring the baby down against the cervix and open it up rapidly. However, ambulating does not help to initiate labor and most likely actually tends to inhibit it. There is another approach, albeit a bit controversial and certainly not scientifically tested, which I mention only because I have seen it work many times in my practice. Sexual intercourse results, as we all know, in the deposition of semen onto the cervix. This material is absolutely loaded with a hormone called Prostaglandin, which is know to both soften the cervix and stimulate uterine contractions. Naturally, this particular approach will need to be employed only if comfort permits, which is not always the case. It must also be avoided if there are certain risk factors such as ruptured membranes or placental bleeding problems.

Q. I’m 33 weeks’ pregnant, and my cervix is slightly open. What are possible consequences? Is it safe to deliver at 34 weeks?

A. Your cervix being slightly open does not mean that you are at any increased risk of delivering prematurely, unless, of course, you are having strong and regular contractions as well. In any event, 34-week births do not usually create any serious problems for the newborn.

Q. I am 32 weeks’ pregnant with our second daughter. I am dilated 3 cm, and 75 percent effaced. I’m on bedrest. I have mild sporadic contractions, but the large ones are kept under control by medication every 4 hours. How likely is it that I will deliver her soon? If I do deliver her in the next week or so, will she be okay?

A. Premature birth (prior to 37 weeks) is quite likely here, especially as you are already under treatment to prevent labor. The good news is that with premature newborn care as effective as it is nowadays, healthy survival is the rule and not the exception at your current gestation.

Q. I am having a burning sensation in my upper stomach below my breast. What does it mean? I’m 35-and-a-half weeks’ pregnant.

A. At this gestation, stomach acids have a tendency to back up into the esophagus, causing acid indigestion. Antacids will help a bit, but don’t expect this to clear completely until after the birth.

Q. I’m 37 weeks’ pregnant with my third baby. My left breast, including my nipple, is extremely sore. It feels as if I have a plugged duct and that the nipples are sore from poor latch, although I am not currently nursing. I am planning on nursing this baby but am concerned about what could be going on.

A. It’s not likely to be a plugged duct as that is caused by milk which solidifies in the duct, and significant milk flow does not usually start until after the birth occurs. More likely, there is the beginning of milk production without flow which is causing pain. Ice packs to the area for a few minutes at a time should keep this under control for now.

Q. I’m 32 weeks’ pregnant. I had a very sharp pain in my back that lasted for about one hour. I took a hot bath and it stopped for 30 minutes; then it started back up ten times worse than before. What’s happening?

A. Most of the time, sharp back pains in late pregnancy are caused by pressure upon and stretching of nerves coming from the lumbar area as a result of the dramatic changes in posture that are occurring. Generally, reduced activity will cause this to resolve, but if that doesn’t happen, bring it to your doctor’s attention.

Q. I’m 34-and-a-half weeks’ pregnant. Last night I woke up and vomited about seven times. The midwife said it was just “bugs” in my stomach. Now I’m not urinating much. Am I going to have any problems with the baby? When I was sick the first time, a bit of urine leaked. Did my water break or was it urine?

A. It doesn’t sound like your water broke as that is usually pretty dramatic, continuous, and hard to miss. On the other hand, you need to be sure that the repetitive vomiting hasn’t caused you to become dehydrated, which happens easily during pregnancy. Be sure to report if this level of vomiting happens again.

Q. Is it safe if the umbilical cord is around my fetus’s neck during the 34th week of pregnancy?

A. This is a very common position for the cord and does not subject the fetus to any increased hazards prior to delivery, although it can become a problem in labor if it interferes with adequate blood flow to the baby. Monitoring will nearly always detect if that is becoming a problem.

Q. I am 36 weeks’ pregnant and had a nasty fall last night. I have been having bad cramping. Could being this far into my pregnancy put me into labor?

A. Yes, it could, but this would not be a dangerous thing at this point in the pregnancy. If the fall created bruising of the uterine muscle, this could result in enough irritability to trigger labor. Most likely, what will happen is that the injury would not be enough to cause labor and the cramping will gradually diminish over the next few days.

Q. Is being diabetic and having a kidney infection a reason to delay a C-section at 39 weeks? Is it serious enough for immediate admission to the hospital?

A. Kidney infections at any stage of pregnancy are dangerous and usually do require hospitalization. It would not be advisable to undergo a C-section until the infection is cleared, unless there is no other alternative.

Q. I am 35 weeks’ pregnant with my first child, and I am a half centimeter dilated. Does this mean my baby will come early? I know another expectant mother who is three weeks ahead of me and not dilated, but 50 percent effaced. What’s the difference?

A. Neither of these findings have any bearing whatever on when labor will start. There is no benefit to knowing the status of your cervix unless this information is needed in order to plan some intervention, such as trying to head off a premature birth or inducing labor for some good reason.

Q. I am 39 weeks’ pregnant and I have been losing big globs of my mucus plug over the past three days. Now I am having a bit of light pink spotting but it is not coming with the mucus. What could it be?

A. This is what is called the “bloody show.” It indicates that the cervix is starting to shorten, or efface. It usually means that labor will be starting in the next few days.

Q. I am 32 weeks’ pregnant and I have been feeling numb and hot all over my body. Just wondering what that could be and what I should do.

A. This is a sign of hormonal change which is a common event in the third trimester. These changes cause fluctuations in blood flow to the skin, which causes these symptoms. It is not dangerous and does not need attention.

Q. I’m almost 33 weeks’ pregnant, and I have noticed more frequent contractions over the last three days. They are not regular but I have a dull cramp that doesn’t really go away. I have had small chunks of blood and it feels as though I am starting my period. I’m not quite sure if I should call my doctor or wait until my appointment next week.

A. This is not likely to be of any great importance, but should still be communicated to your doctor if it has not resolved in the next two or three days. Bleeding in pregnancy is never considered normal, but, at a very low level as you describe, usually resolves itself.

Q. I am 80-percent firm and 1 centimeter dilated. My doctor says I am going to have my baby this month, when my due date is May 22. What do you think?

A. There is no possible way for an exam of the cervix be used to predict when someone will deliver, so unless there is some additional information regarding your situation, you may disregard that prediction.

Q. I’m 31 weeks’ pregnant and my baby has dropped and the cervix has opened. Does this mean the baby is coming?

A. No, it doesn’t. The way you will know that your baby is coming is that your labor will start. No other methods can predict when delivery will occur.

Q. I am 38 to 39 weeks’ pregnant and scheduled to have a C-section in ten days. I’m having a LOT of milky-white discharge. Is this normal? This is my second pregnancy,but I have not experienced this before.

A. In the absence of itching, burning or a bad odor, it’s probably nothing more than a combination of cervical mucus and epithelial cells, which is very normal.

Q. I am 35 weeks’ pregnant, and at times I start cramping when I’m urinating, which stops when I finish. Is this normal? Is it Braxton-Hicks contractions?

A. This is normal. In late pregnancy, the uterus will contract whenever there is some sort of postural change. This includes even the slight positional change which occurs when the bladder empties. It does fall within the definition of Braxton-Hicks contractions, so it has nothing to do with actual labor.

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