Growing pains: pregnancy during the third trimester

Pamela Wilson
Monday, September 19, 2005
There is a mantra commonly spoken by pregnant women reaching their due date: "Get this baby out". In the first trimester, most women barely feel the physical presence of the baby, while the second trimester is often marked with the growth of a cute, round bump and fluttering sensations when the baby moves. The third trimester, however, can be trying time with some women experiencing increased discomfort as the baby grows to the size of a watermelon.

But, if we consider how clever a pregnant body is, we can see that even these minor discomforts can be a positive thing. As Belmont Birthing Service Midwifery Manager Carolyn Hastie points out, this increased discomfort is supposed to happen. "The mother has to move from that whole concept of being her own person to being a mother, and it is a fabulous transformational process", says Hastie. "This process starts to help women move from being really happy about being pregnant to start to want the baby to be born. You are meant to start to think 'I have had enough of this' because that is part of the signalling to let the hormonal flows happen."

Hannah Dahlen, secretary of the NSW Midwives Association, agrees that hormones — namely progesterone and relaxin — play a big role in preparing the body for birth. "Both hormones are basically designed to relax your uterus so you don't go into labour early, but they also relax all of the joints and ligaments around your pelvis so that when you do go into labour your baby will pass more easily through the pelvis", explains Dahlen. "The problem is they relax a lot of other things like your bowel, so they make you a bit more sluggish and can, therefore, make you more likely to have constipation, for example."

Dahlen also points out that the third trimester of pregnancy is when the greatest amount of growth is occurring, so it is normal to feel more tired, heavier and uncomfortable. But she urges pregnant women to see their doctor or caregiver if they experience any persistent pain, their uterus is going hard and soft, they have a vaginal discharge or they are simply worried about something.

Hastie adds that any bleeding other than a small show with some mucus close to the due date should be investigated. A persistent headache in the middle of the forehead, persistent indigestion-like pain in the middle of the upper abdomen and visual disturbances can all be signs of pre-eclampsia and should also be investigated immediately.

Here are six common health concerns of later pregnancy and the simple solutions you can try to ease them.

Constipation and haemorrhoids
The key to preventing these two conditions is to eat a healthy, balanced diet with plenty of fibre, fruit and vegetables and wholegrain foods. Regular, gentle exercise and eight glasses of water a day is also vital. Dahlen suggests eating bran and prunes, or drinking Metamucil to ease constipation, but warns against strong laxatives as they can trigger off labour.

Constipation can lead to haemorrhoids, so that is extra motivation to keep yourself regular. There are pharmaceutical creams available to treat haemorrhoids, but Dahlen advises pregnant women to discuss the use of these with their doctor first.

Varicose veins
Dahlen explains that the relaxin hormone relaxes all the vessels and, therefore, the blood vessels can dilate and protrude to form varicose veins. Unfortunately, some women are simply more prone to these and find them difficult to prevent, but there are simple measures that may help. Don't stand for too long in one position and put your feet up and rest whenever you can. There are specially designed support stockings to prevent the pooling of blood, and the use of these can be discussed with your doctor.

Sore and itchy skin
As the skin stretches with the growth of the baby, it can cause itchiness and pain. The best thing to do is prevent the skin drying out too much, and regularly apply sorbolene cream to the abdomen. Some women may find they get pain around existing scars, but this is perfectly normal and can be also remedied with moisturising cream. Dahlen says there is no real prevention or treatment of stretch marks, but not gaining too much excess weight during pregnancy can help.

Abdominal or pelvic pain
Pains in these areas are very normal, particular in the last few weeks of pregnancy, but if there is persistent pain, bleeding or any water coming away from the vagina, contact your caregiver. Braxton Hicks contractions can start as early as 20 weeks in some women. They are practice contractions and don't have a rhythm like true labour contractions.

Shortness of breath
Dahlen explains this is very common because the hormones increase your blood supply so your heart is working a lot harder. Also, the uterus is growing and pushing up into your lungs, which is reducing the capacity for your air entry. The best thing to do is rest and breathe calmly. However, if shortness of breath has a very sudden and sharp onset, and you feel unwell, it can be a sign of the rare condition where a clot has formed in the lungs, so don't hesitate to contact your doctor. Iron-deficiency anaemia may also develop towards the end of the second trimester, and treatment for this should definitely be sought from your GP or caregiver.

Sleeping difficulties
This is nature's clever way of getting you ready for the reality that you will sleep in a half-aware state for the next few years while your child is young, says Dahlen. She says the pregnancy hormones can cause women to be quite restless, and the extra heat generated by your body can increase discomfort in bed. However, if you find the sleeplessness is due to excessive worry, depression or concerns about the future, it can be a sign of increasing depression and needs to be assessed.

* Belmont Birthing Service, located at Belmont District Hospital near Newcastle in New South Wales, is Australia’s second government-funded midwife-led birthing clinic.

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