Tips for Your Third Trimester

By now you should have signed up for a prenatal class, in which you learn what to expect in this final stage of pregnancy and during labor and delivery. Regardless of what type of delivery you're hoping for, it is important that you learn about all options—drug-free, vaginal delivery with pain relief, and cesarean section.

You should also complete all preadmission information at the hospital or birthing center where you hope to deliver. Most offer family tours of the maternity unit, which can help prepare older children for a new sibling.

And don't forget to pack a bag for the hospital or birthing center. Make sure you include a "coming home" outfit for the baby. One other thing: Make sure you have a car seat properly installed in your vehicle. The hospital won't let you take Baby home without it! You can learn more about car seats and their proper use at www.aap.org/family/Carseatguide.htm.

Choosing a Day Care Provider

It's also time to begin planning for after the delivery. If you've decided to return to work after your maternity leave, it's time to arrange for day care. You have numerous options: center-based care, family-based care, hiring a nanny or an au pair. When considering day care, keep the following in mind:

• Do you want a small, intimate family home or a professional day-care center? Both should meet licensing requirements in your state, but a family home situation may offer more individual attention and a more home-like atmosphere. However, it may be less dependable if the caregiver gets sick or takes vacation. The day-care center, which may provide more dependable care and have more resources for training and equipment, may have a high rate of caregiver turnover and a more "institutional feel." Make sure you spend time in each before making any decisions. Also ask the state agency that oversees child-care centers about any problems.
• How much does it cost? After you pay for day care, commuting, taxes, work clothes, etc., is it economically feasible to continue working?
• How far is the center from your work? If your child gets sick in the middle of the day, can you or your partner easily get to her?

When visiting day-care centers, the American Academy of Family Physicians recommends you ask the following questions:

• What is the child-to-staff ratio? Make sure it meets state requirements. The American Academy of Pediatrics recommends one staff person for three to five small children.
• What are the center's policies on discipline and other important issues? Ask for a copy.
• What are the center's emergency policies?
• How does the center care for sick children?
• How is the staff trained? What is the staff turnover rate?

The Nursery and Layette

Contrary to what you may think if you've ever been to a big-box baby supply store, newborns need very little. They need you, the breast or bottle, some simple clothing, diapers, and a safe place to sleep. Of course, that's no fun!

Still, don't go crazy buying things and decorating. If this is your first child, your friends and family will likely throw you a baby shower, and you'll receive many of the items you need then. If you receive hand-me-down equipment like cribs, strollers and car seats, make sure they meet all current consumer safety requirements. You can check out product recalls at www.cpsc.gov. Another good site is www.healthychild.org. Click on "market" to find recommendations of products chosen for their value as well as their environmental friendliness.

Here are the bare necessities you'll need. The amount depends on how often you plan to do laundry. Keep in mind that newborns grow fast. Don't buy too many items in the same size.

Must-Haves

• Newborn diapers
• Onesie T-shirts
• Socks
• Footed coveralls
• Receiving blankets
• Hooded bath towels
• Sleep sacks (can double as blankets in cold weather)
• Burp clothes (cloth diapers are great for this)
• Small tub for bathing baby (although you can use the sink)
• Coat or warm sweater
• Hat
• Stroller
• Car seat
• Bassinet or crib

Pregnant Women Ask…
Can my baby sleep with me?

No. The safest place for your baby to sleep is in your room with you but not in bed with you. You could roll over and crush her or she could smother. Always put your baby to sleep on her back in a safety-approved crib with a firm mattress and fitted sheets.

Time to Deliver

You also need to use this time to prepare for delivery. In addition to learning what to expect during labor and delivery, there are things you can to do to strengthen your body for the hard work ahead. (There's a reason they call it "labor!")

One of the most important steps you can take is to do pelvic floor exercises, or Kegels. Not only will these simple exercises help prevent post-partum incontinence, but by strengthening the pelvic floor muscles, they can make it easier to push the baby out.

Kegels are easy. First, figure out which muscles to target by stopping midstream when urinating. Those are the ones you want to strengthen. Then squeeze those muscles and hold for a count of 10. Relax, then repeat. Perform at least three sets of 10 contractions a day, two to three times a week throughout this trimester. Once the baby is born and you recover from the delivery, continue your Kegels.

Pregnant Women Ask…
How can I avoid an episiotomy during delivery?

An episiotomy is a cut in the perineum (the bridge of tissue between your anus and vagina) to reduce the risk of tearing as the baby exits. It is typically performed in the belief that controlling the tear by cutting reduces the risk of urinary and fecal incontinence. However, the evidence on this is mixed. Overall, there is no evidence for routine use of episiotomy even though many doctors routinely perform them. If you want to avoid one, make sure you tell your doctor (midwives rarely perform episiotomies unless absolutely necessary). You can also use perineal massage and warm compresses to help relax the perineum during labor to reduce the risk of tearing.

When It's Time

How will you know you're in labor? That's a very good question, particularly since you may have been experiencing "false" contractions, known as Braxton Hicks contractions, for weeks.

Pain Management Options

Here's the thing. Labor and delivery hurt. Any woman who tells you they don't either had good medication or has a poor memory. There are numerous medications and other options you can use, most of which are detailed below, to make you as comfortable as possible.

Cesarean Section

The rate of cesarean section in this country has never been higher. Part of the reason is that more women are requesting elective cesarean to avoid the pain of labor. Another is that doctors are more reluctant to let women who had a previous cesarean attempt a vaginal birth, for fear of rupturing the uterus (although the risk of uterine rupture is extremely small). Regardless, there are times when a cesarean is necessary. For instance, if labor has slowed, you experience complications, the baby is in distress or the size of your baby compared to the size of you makes a vaginal birth unlikely.

During a cesarean, the baby is delivered through an incision in the abdominal wall and uterus. Click here for other things you should know.

Cord Blood Storage

When you complete your preadmission paperwork, don't be surprised if you're asked what you want to do with your newborn's cord blood. Cord blood is jammed with valuable cells called stem cells that can be used in transplants for diseases like leukemia and that may one day play a role in "building" new tissue. You can store the blood at a private cord blood "bank," where it will be available for your family only; or you can donate it to a public cord blood bank, which matches stem cells to patients who need transplants. If you choose the latter, the cord blood will not be available to you in the future if you or someone in your family needs it. A major issue is cost; private cord blood banks charge about $2,000 for collection and about $125 a year for storage. Public banks charge nothing for collection or storage. Visit www.cord-blood.org to help you understand cord blood banking.

Circumcision

It's a boy! After choosing a name, you and your partner need to have another discussion: to circumcise or not to circumcise. While there is some evidence that circumcision can prevent certain sexually transmitted infections, particularly the HIV virus, the American Academy of Pediatrics (AAP) does not recommend routine newborn circumcision. If you do decide to circumcise your son, make sure you insist on anesthesia which the AAP notes is "safe and effective in reducing the procedural pain associated with circumcision." Studies find the most effective pain relief is a dorsal penile nerve block, kind of a like an epidural for circumcision. Many hospitals also give newborns a sugary solution to suck on, which studies find can further reduce pain. Also, only healthy infants should be circumcised.

Thing to Watch For

If you experience sudden, rapid weight gain of more than five pounds a week and facial and hand swelling, with or without headache, contact your health care professional immediately. You may be showing signs of preeclampsia, which used to be called pregnancy-induced hypertension. It occurs when your blood pressure suddenly rises after 20 weeks of pregnancy, but typically occurs in your third trimester. Your health care professional should be screening you for it at every prenatal visit by taking your blood pressure and checking for protein in the urine.

Also contact your health care professional immediately if you haven't felt the baby move in 24 hours or if you start bleeding vaginally.

Smart Advice: Do not take aspirin during your third trimester. It could increase the risk of bleeding in you and the baby during labor.