Pregnancy: the last three months

pregnancy_final_monthsThe baby’s rapid growth during the last three months of pregnancy is vital for a healthy birth. We explain what’s happening – and what you can do.

As the mother-to-be enters the last three months of her pregnancy, further changes take place. Throughout the seventh and eighth months, the uterus continues to rise until it finally reaches a point just below the breast bone. In this position, it compresses the lungs and the diaphragm, and some women experience problems of breathlessness when lying down.

Although uncomfortable, this is usually nothing to worry about, as a chat to a doctor will confirm. At this stage a bra with front fastenings can be useful as lower fastenings can be undone, as required, to avoid restriction.

The long wait

As the long awaited birth comes nearer, the last few weeks of pregnancy often seem to go very slowly.

As mother and baby both increase in size, finding a comfortable sleeping position can be a problem. Lying sideways with a pillow beneath the abdomen to support the weight of the uterus helps. When resting during the day, the legs should be raised, and the head and neck well supported.

Niggling problems

In later pregnancy, some women experience puffiness in their hands, fingers, wrists and ankles, this is normally due to fluid retention and is carefully monitored at the antenatal clinic. When combined with protein in the urine and raised blood pressure, puffiness can sometimes be a symptom of pre-eclamsia, a high blood pressure disorder, sometimes causing fits.

Most puffiness disappears soon after the baby is born, but it helps to avoid salt and salty foods.

Backache is another problem often experienced during late pregnancy. Remembering to ‘walk tall’ without slumping, and ensuring the back is always well supported when sitting can minimize the problem.

Another irritant of late pregnancy that some woman experience is cystitis. A doctor may prescribe medication to deal with it, and the sufferer should drink plenty of clear fluids to help flush out the infection. Wearing cotton pants and stockings lowers the risk of infection.

Mothers often find that they suffer from heartburn towards the end of pregnancy. It happens when semi-digested, acidic fluid comes back up the gullet causing a burning sensation in the chest.

Eating small, frequent meals at regular intervals can help – and if the heartburn is really troublesome, late meals should be avoided.

A good diet, based on a variety of fresh foods and whole grains, will help to prevent constipation and its consequent risk of piles. These are swollen veins around the anus and they can be very painful. Special cream – prescribed by the doctor – can ease the discomfort.

Varicose veins in the legs, or more uncomfortably in the vulva, are another possibility in late pregnancy and should be seen by a doctor. The hormone, progesterone, relaxes the walls of the blood vessels making the circulation sluggish at times. Extra weight causes pressure, and distended veins. The area with the varicose veins may be uncomfortable and itchy, or even slightly tender, and the legs will feel tired. Special support tights or stockings will bring a great deal of relief. For varicose veins in the vulva, wearing a pad, held closely and firmly in place, will help.

Routine investigation

At the beginning of the ninth month, after the head is engaged, or is apparently on its way there, many doctors give an internal examination to check for disproportion. This happens in a few otherwise normal pregnancies, when the size and shape of the pelvis, and the position and size of the baby’s head, are less than ideally matched.

When the disproportion is marked, a Caesarean section is sometimes considered the best course of action. This avoids the risk of a long, traumatic labour with the possibility of the baby becoming stuck, when an emergency Caesarean would be the only option.

The final stages

If, during the last month of pregnancy, mild contractions begin, it does not mean the baby is on its way. Unless the contractions are regular, frequent and lasting at least 30 seconds, they are probably Braxton-Hicks contractions. These are ‘limbering up’ contractions which allow the uterus to practise hardening and then relaxing ready for labour. It is also quite normal for the breasts to leak colostrum in late pregnancy. If this does happen, any dried colostrums should be washed off with plain water -and soft breast pads should be worn to protect clothing.

If any bleeding is experienced from the vagina, the hospital or doctor should be contacted immediately. It could mean the placenta is detaching slightly from the wall of the womb. This is an uncommon occurrence, but one needing prompt medical attention.

The baby

During the last three months of pregnancy, the baby grows rapidly, increasing in weight by as much as two kilograms during the final four weeks. At seven months the baby is red and wrinkled with little fat, but fat deposits are laid down from 35 or 36 weeks onwards so it becomes plumper and pinker as the subcutaneous fat hides the blood vessels which were formerly visible through the thin fetal skin.

Sex and internal organs

If the foetus is male, the testes usually start to descend at the beginning of the seventh month, a process which is usually completed in about four weeks when they reach the scrotum.

At the 30th week, the baby’s heart can be heard quite well. The rate varies between 120 and 180 beats a minute. By the 34th week the kidneys are fully mature and the lungs nearly so.

The lungs are not fully developed until after the 36th week, which can lead to major problems with very premature babies. These tiny babies experience respiratory distress syndrome, into which a great deal of research is still being done to conquer the problem.

Some premature babies also have difficulty feeding as the sucking reflex does not develop until quite late. Initially, these babies are tube-fed which conserves their energy for breathing. Later, the mother will require a great deal of patience while the baby adjusts to feeding.

Today, with careful medical and nursing care, the majority of babies born after 28 weeks stand an excellent chance of survival provided they are born without serious physical handicaps or disabilities.

The baby’s movements

Throughout the last two months of pregnancy, the baby is very active – sometimes the mother can even distinguish between kicks and punches. These movements tend to slow down in the very last weeks because there is less room in the uterus. During this period, however, if the movements cease for 24

hours, it is wise to contact the antenatal clinic. The chances are that the baby is fine, but the clinic can confirm this by tracing the heartbeat on a monitor.

By about the 36th week, the baby has taken up the final position in the uterus. Up until this time most babies are positioned with their feet or bottom facing downwards. The majority eventually turn round so that they are facing head down. About three per cent of babies fail to turn, which results in a breech

birth, and they may need to be delivered by Gaesarean section.

Stretch marks

Stretch marks are caused when underlying skin tissue is stretched beyond its normal elasticity, and they often appear during pregnancy on the woman’s abdomen, breasts and thighs. Whether or not stretch marks develop at this time depends on the proportion of elastic to non-elastic fibres in the epidemis or middle layer of skin – the higher the proportion of elastic fibres, the less likelihood there is of stretch marks. When the skin is stretched a little, the elastic fibres extend and the non-elastic fibres straighten, but extreme or prolonged stretching will tear the non-elastic fibres, so that bleeding occurs and appears as bluish-red lines in the skin which later fade to silvery white.

To help prevent stretch marks, take care of your skin by drinking plenty of water and eating a balanced and varied, healthy diet. Massaging the stretched areas, to stimulate blood flow, and moisturising also help.

Posted in Health, Pregnancy and Childbirth