Your healthcare provider is a hugely valuable resource for you as you head down the homestretch of pregnancy – make sure you get your questions ready!
3rd Trimester, 1st Appointment (Week 28)
Now that you’re in the third trimester, the frequency of your prenatal visits will increase from once every four weeks, to one 15-minute appointment every two weeks, just so your healthcare provider can make sure that all is going smoothly with Baby’s development. As always, your healthcare provider is going to want to check your weight, blood pressure, and have you leave a urine sample to test for the elevated presence of protein or sugar. In addition, he or she will measure your uterus to get a sense of how Baby is growing, and take their heart rate with a fetal doppler. Your healthcare provider will probably also start asking about Baby’s movement from appointment-to-appointment as a good indicator of their health.
And remember how you were tested for your Rh factor way back at your first appointment? If your test came back Rh-, and your partner is either Rh or unsure, Week 28 is generally when your healthcare provider will administer a Rhogam shot, a medicine that prevents Rh- women from producing antibodies to Baby’s potentially Rh blood. If you tested Rh- back at your first appointment, it’s imperative that you get this injection, otherwise Baby could develop erythroblastosis fetalis, a disorder in which your antibodies will deplete their red blood cell count.
3rd Trimester, 2nd Appointment (Week 30)
Now that you are solidly ¾ of the way through pregnancy, your healthcare provider has started having you schedule your 15-minute check-ups for every two weeks rather than four, as the due date approaches. Per usual, your healthcare provider will measure your weight, blood pressure, and have you leave a urine sample that will be scoured for elevated levels of protein and sugar. He or she will also measure your uterus to get a good sense of how Baby is growing, and take their heart rate with a fetal doppler, as well as asking about their movements, and if their frequency or intensity has changed since your last visit.
With most of the diagnostic testing behind you, and the pre-labor testing still to come, these appointments will mostly be based around any questions you have for your healthcare provider about symptoms, or delivery, or anything else that you feel needs addressing.
3rd Trimester, 3rd Appointment (Week 32)
Ready for another 15-minute check-in? Now that you’re quite the prenatal professional, you probably are getting the gist of the routine. Your healthcare provider will take your weight, blood, pressure, and have you give a urine sample that will be tested to check for elevated levels of protein and sugar. In addition, the healthcare provider is also going to do the standard baby check-up, measuring the height of your womb to see how big Baby is, checking their heart rate with a fetal doppler, and discussing the frequency of their movements with you.
Your healthcare provider will also continue to guide you through any questions or concerns you may have, and can advise you about your pregnancy diet or symptoms, which are more important than ever, now that you’ve reached the later stages of pregnancy.
3rd Trimester, 4th Appointment (Week 34)
It’s almost time for those weekly appointments as your due date draws closer and closer, but not quite yet. This will be another one of those routine 15-minute visits, simply to make sure that all is running smoothly with you and Baby, and allow you the opportunity to ask your healthcare provider any questions you may have. Like always, your healthcare provider will take your weight, blood pressure, and have you provide a urine sample that will be screened for elevated levels of protein and sugar. He or she will also record Baby’s heart beat with a fetal doppler, measure your womb to get a good gauge on Baby’s size, and discuss the frequency and intensity of their movements with you.
As you approach your due date, your healthcare provider will also check to make sure that Baby is turning themself headfirst towards the birth canal. Although most babies will make the turn toward the headfirst delivery position (and can still even if they have not yet), some will remain in a vertical, bottom-down posture. Vaginal deliveries are possible for moms of breech babies, but very much more often than not they will require a C-section to keep baby and mom as healthy as can be.
3rd Trimester, 5th Appointment (Week 36)
Now that you’re within just a few short weeks of BABY!, you’ll start visiting your healthcare provider for prenatal appointments once a week. Baby is considered near-term next week, so it certainly doesn’t hurt to see your healthcare provider with increased frequency. This will be another 15-minute visit, in which your healthcare provider will measure your weight, blood pressure, and have you provide a urine sample which will be tested for elevated levels of sugar and protein. He or she will also discuss Baby’s movement over the past two weeks with you, measure your womb to get a good read on their size, and take their heart rate with a fetal doppler. If they were still in breech position at your last appointment, your healthcare provider will also check to see if they have made any progress in orienting herself towards the proper, head-down delivery position.
At the week 36 appointment, your healthcare provider will also test you for Group B Streptococcus (GBS). GBS is a pretty common bacterium found in the body, and doesn’t make adults sick, but exposure and infection for Baby could prove very dangerous. Your healthcare provider will swab your vagina and rectum and test the cultures for GBS. If you are GBS-positive, you’ll need antibiotics administered during delivery in order to make sure that baby does not pick up the bacteria.
3rd Trimester, 6th Appointment (Week 37)
Provided you and Baby are in tip-top shape, this will be another one of those quick and easy, but super helpful 15-minute appointments. The healthcare provider will take your weight, blood pressure, and ask you to provide a urine sample, which they will screen for elevated levels of protein and sugar. Your healthcare provider will also discuss Baby’s movements with you, measure the size of your womb to get a sense of how big they are, and measure their heart rate with a fetal doppler. And now that they are near-term, it’s really time to start thinking very seriously about delivery. If they are still in breech position, beginning at week 37 your healthcare provider may perform an External Cephalic Version (ECV) to retain the option of a vaginal delivery even if Baby does not turn on his own.
An ECV involves your healthcare provider pushing down on your womb and manipulating Baby to turn towards the proper, head-down delivery position. Because the procedure involves a slight but possible risk for Baby, and the possibility of discomfort for you, your healthcare provider will take many precautions before performing this procedure. These may include:
- Fetal ultrasound: Your healthcare provider needs to know exactly where Baby and the placenta are in your belly, and he or she almost must be able to determine the amount of amniotic fluid.
- Fetal heart rate: Baby’s heart rate should increase a bit when coaxed into moving, so your healthcare provider will want to make sure that the slightly elevated rate is there.
- Terbutaline: A drug that is normally dispensed to prevent pre-term labor, but acts by reducing the frequency of contractions, terbutaline is often given to women who are undergoing an ECV, as contractions can lead to complications for the breeched baby due to the positioning of the umbilical cord.
- Epidural: An initial failed attempt to turn baby might lead to another try. However, ECVs can be quite painful for women, so an epidural may be given to lessen any ECV-related pain.
An unsuccessful ECV is far from a disaster, it simply means that Baby may have to be a C-section.
3rd Trimester, 7th Appointment (Week 38)
With the end in sight, your healthcare provider will begin making his or her way down the pre-delivery medical checklist. Usually just a 15-minute appointment, your healthcare provider will, as always, take your weight, blood pressure, and have you provide a urine sample that will be screened for elevated levels of sugar and protein. He or she will also record Baby’s heart rate using a fetal doppler, discuss their movements with you, and measure your womb to get an accurate read on their size. With due date close in sight, your healthcare provider may begin checking your cervical dilation (opening) and effacement (thinning) to see how your body is preparing for delivery. Your cervix will open and thin more before Baby is ready to come out, so your healthcare provider might check from week-to-week how the cervical developments are progressing, though this is not universal.
If you haven’t had an ultrasound in a while (Week 20 for a lot of women), your healthcare provider may also perform a Non-Stress Test (NST), in which healthcare providers will monitor Baby’s heart rate, movement, and your contractions. Baby’s heart rate should positively correlate with her movements, as a person’s heart rate increases in periods of activity. If the correlation is not observed, it could be a sign that they are not getting enough oxygen, as sufficient oxygen is needed to keep their heart rate within a safe range.
3rd Trimester, 8th Appointment (Week 39)
No new testing at this appointment, just a routine, 15-minute, twilight of pregnancy check-up. Lots of moms will have already given birth by now, so your provider may measure your cervical effacement and dilation, and compare it relative to last week to get an accurate sense of your timetable until labor and delivery.
As always, your healthcare provider is going to want to check your weight, blood pressure, and have you provide a urine sample that will be screened for elevated levels of sugar and protein. In addition, he or she will measure your womb to get a good sense of how Baby is growing, discuss the frequency and intensity of their movements relative to last week, and take their heart rate using a fetal doppler.
3rd Trimester, 9th Appointment (Week 40)
Although this is your last anticipated prenatal visit, many moms-to-be will have either already given birth and moved to the postpartum area of gynecological medicine, or have belly tenants who may stay in for a couple more weeks, requiring a couple more visits. This is another 15-minute check-up, and as always, your healthcare provider will take your weight, blood pressure, and have you provide a urine sample which will be tested for elevated levels of sugar and protein. Your healthcare provider will also take Baby’s heart rate with a fetal doppler, measure your womb to get a sense of their growth, and discuss their week-to-week movements with you.
Your healthcare provider may keep looking for and measuring your cervical dilation and effacement to get as accurate as possible a read on when Baby will be born. Your cervix will expand from the most-of-pregnancy 0 cm, to about 5-6 cm during labor, and then finally to about 10 cm when baby is finally ready to come out.
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Sources
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- Andrew S. Coco, M.D., M.S., Stephanie Silverman, M.D. “External Cephalic Version.” American Family Physician. 58(3):731-738. Web. 9/1/1998.
- Mayo Clinic Staff. “Biophysical Profile.” Mayo Clinic. Mayo Clinic, 3/5/2015. Web.
- Mayo Clinic Staff. “Third trimester pregnancy: What to expect.” Mayo Clinic. Mayo Clinic, 5/5/2014. Web.
- “Body changes and discomforts.” Womenshealth.gov. U.S. Department of Health & Human Services, 9/27/2010. Web.
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- “Prenatal care in your third trimeser.” U.S National Library of Medicine. MedlinePlus, 6/11/2014. Web.
- Mayo Clinic Staff. “Prenatal care: 3rd trimester visits.” Mayo Clinic. Mayo Clinic, 7/30/2015. Web.
- Committee on Obstetric Practice. “Analgesia and Cesarean Delivery Rates: Committe Opinion Number 339.” ACOG. American College of Obstetricians and Gynecologists, 6/6/2015. Web.
