28 Weeks - Birth
The third trimester brings many changes to your body; you will need to urinate frequently and your belly looks like it’s ready to explode. Now is the time to start taking childbirth and breastfeeding classes. The finishing touches are being placed on your baby, and the two of you are looking forward to delivery day!
You have now entered your third trimester and your visits will now be every two weeks until you reach 36 weeks. Once 36 weeks is reached your visits will be weekly. At this time it is important to be aware of fetal movement. Your baby should move four to ten times between meals. Kick counts should be done after meals and at a time when you will be able to concentrate on your baby’s movement. If you are concerned about the movement of your baby please call, do not wait.
You can expect blood tests for gestational diabetes (1 hr glucose tolerance test) and anemia (hemoglobin and hematocrit) around this time. The test for gestational diabetes involves drinking a drink with 50 grams of glucose (sugar) and having your blood drawn an hour later to see how your body is able to handle the glucose load and what your resulting blood glucose is. This test does not need to be done fasting, but if your blood glucose level is too high you will be asked to perform a follow up diagnostic test while fasting. Your blood will be tested for anemia with the same blood draw, so that means only one needle stick.
If you are Rh negative and your antibody screen is negative, you will receive a Rhogam injection around this time as well. This will keep you from developing antibodies that could potentially harm the fetus in a future pregnancy. After delivery, if your baby is found to be Rh positive, you will receive a second rhogam injection in the hospital.
The last scheduled screening test will be done at 36 weeks and is a culture of the vaginal and rectal areas for Group B Strep (GBS). If you test positive for this bacteria, and you are planning a vaginal delivery, you will be given antibiotic prophylaxis in the IV during labor. There is no need to treat this earlier than labor secondary to the fact that most cultures only represent a carrier state and not a true infection. If you treat too early than there is a chance the bacteria could return prior to the onset of labor and may have developed antibiotic resistance. The baby does not become exposed to GBS until your amniotic membranes have ruptured (when the water breaks). Therefore it is important to go the hospital soon after your water breaks if you test positive for GBS.
Also at this time, it is important for you, as an observer and participant in your obstetric care, to monitor the baby’s activity. Expectant mothers that are aware of fetal movements are much better predictors of fetal well being than objective observers. Please do daily fetal kick counts. Your baby should move 10 times in a 2-4 hour period. If the baby does not move four times in one hour, please drink something cool, prop your feet up, put your hands on your abdomen and concentrate on the baby’s movements. If you are concerned about fetal movement, please go to Methodist Stone Oak Hospital’s Labor and Delivery for fetal monitoring if movement does not occur.
Between 24 and 35 weeks, we are concerned about premature labor. Some women will have early contractions, which do not change their cervix and are therefore not premature labor. Some women will develop premature labor and it is much easier for us to intervene if we catch it early. If you should have low back cramping or pain that radiates from the back to the front, or any cyclic or rhythmic discomfort, change in vaginal discharge (especially bleeding), or watery fluid, these may be signs of preterm labor. If you notice that your stomach is hard and soft in a rhythmic manner every 10 minutes for an hour, please get off your feet, prop your feet up, hydrate with cool liquids and rest. If this persists for another hour, please don’t call and go to Methodist Stone Oak Hospital’s Labor and Delivery as soon as possible.
Premature labor occurs in about 8% of pregnancies and in most cases cannot be predicted. Once 37 weeks is reached and labor occurs most babies will go home with the mom. Prior to this time, if delivery occurs, your baby may require a stay in the NICU, which is the intensive care unit for neonates. Most babies born after 32 weeks gestation will go home without any long-term problems. Consequently, it is important to be aware of premature contractions, which may lead to premature delivery prior to 35 weeks. If you notice any rhythmic pain that occurs more than 4 to 5 times and hour it is important that you lie down and remain hydrated. If this rhythmic pain persists for more than 30-60 minutes after lying down then please call.
High Blood Pressure of Pregnancy
Another potential but unlikely problem is preeclampsia or high blood pressure of pregnancy. This is defined as an elevation in blood pressure along with urine protein and a significant weight gain which is usually accompanied by swelling. Swelling alone in pregnancy is not uncommon and may be lessened by avoiding salt or foods which may lead to water retention. Support hose and elevation of the legs may also be of benefit. If you notice more than a 10 pound weight gain, a severe headache, which does not resolve with Tylenol or severe abdominal pain please call.
Labor is defined as painful uterine contractions with dilatation of the cervix. You should call if your bag of water breaks, if there is vaginal bleeding which is heavier than a period or in most cases when your contractions are occurring every 2 to 3 minutes for about an hour and are uncomfortable. If your pregnancy has been uncomplicated you may stay home during early labor as long as your bag of water has not broken and your baby is moving well. During this time it is important to stay well hydrated and avoid anything heavy to eat. You may also give yourself an enema if you desire to do this before coming to the hospital or an enema may be given at the hospital. Don’t worry if you do not want an enema that is fine. Some women desire an enema to avoid excessive stool while pushing. You may lose your mucous plug hours to weeks before your delivery this is not predictive of labor. You do not need to notify the office unless this occurs prior to 34 weeks. Once you arrive at the hospital your nurse will obtain a copy of your prenatal information. Please remember to bring your prenatal card. If you are in labor an IV will be started and your baby will be monitored. Pain management will be discussed during your visit between 34 and 36 weeks. You will also discuss this in your prenatal classes. If you have any questions please bring them to your next appointment.
* Please note that most labor takes a considerable length of time from onset (usually many hours). Therefore, driving carefully and following the speed limit is highly encouraged. You should have plenty of time to arrive safely at the hospital.
Reasons to go to the Hospital:
- Rigid Abdomen that is painful and does not relax.
- Heavy Vaginal Bleeding.
- Lack of Fetal Movement, even in labor your baby should move some.
- Your bag of water breaks
- You experience sudden swelling in hands and face with blurred vision and serve headache
- Painful regular contractions, in “true” labor contractions increase in frequency and strength, they are not relived by activity or position