Healthy YOU Podcast, Episode 19: Pregnancy: What to expect during your third trimester

December 27, 2023

Podcast Episodes Women's Health
Pregnancy: What to expect during your third trimester
Title: Healthy YOU Podcast, Episode 20: Pregnancy: What to expect during your third trimester

Host: Frankye Myers, Chief Nursing Officer for Riverside Health System 

Expert Guest: Neada Kenner-Woodard, Nurse Midwife with Riverside Partners in Women’s Health

[00:00:00] Frankye Myers: From Riverside Health System. This is the Healthy You podcast where we talk about a range of health related topics focused on improving your physical and mental health. We chat with our providers, team members, patients, and caregivers to learn more about how to maintain a healthy lifestyle and improve overall physical and mental health. So let's dive in to learn more about becoming a healthier you.

[00:00:28] Frankye Myers: All righty. I am really excited to have in the Healthy You studio with me today. My guest is Neada Kenner-Woodard. Neada  is a nurse midwife with Riverside Partners in Women's Health. Welcome.

[00:00:44] Neada Kenner-Woodard: Thank you. Thank you for having yes, yes.

[00:00:46] Frankye Myers: So this episode we're going to talk about pregnancy and what to expect during your third trimesters.

In your third trimester, hopefully you won't have multiple of those.

[00:00:56] Neada Kenner-Woodard: Oh, no. One is good enough.

[00:01:00] Frankye Myers: Absolutely.

So tell me a little bit about yourself.

[00:01:07] Neada Kenner-Woodard: So I'm a certified nurse midwife. I've been a midwife since 2016.

I decided to go into this field because I've always been interested in healthcare, and I ended up volunteering at a nurse midwifery center and saw what the midwives did and I thought, this is exactly where I need to be, helping women through one of the most difficult and empowering times of their lives. So I ended up going to midwife preschool. And here we are.

[00:01:35] Frankye Myers: Yes. That is an understatement. I'm having flashbacks right now to my two pregnancies, and I would not have made it without the midwife and providers that supported me during that time. We're continuing our series on pregnancy, and so those stages are so pivotal. So I want to really help our viewers understand what's going on with their bodies during those times and what things they can do.

All right, talk a little bit. You already talked a little bit about why you pursued nurse midwifery.

Sometimes there's some confusion about nurse midwife and should I see a nurse midwife or an Obstetrician?

So would you talk a little bit about the difference? Sure.

[00:02:26] Neada Kenner-Woodard: The difference is in our training and of course, physicians go to medical school, whereas certified nurse midwives are advanced practice registered nurses. So our background is in nursing and we have advanced degrees, master's some doctorates, and that's the essential difference.

[00:02:50] Frankye Myers: Okay, so the training the training the training is different. Okay.

All right.

In our previous episodes in this miniseries on pregnancy, we covered pre pregnancy through the second trimester. And we're going to go in and dive into a little bit more details about the third trimester. So let's start by defining the third trimester. What is the time frame for that third trimester?

[00:03:16] Neada Kenner-Woodard: So the third trimester is the longest trimester. It starts at 28 weeks and ends with delivery, which we know can be 40 or 41 weeks. Okay.

[00:03:31] Frankye Myers: We know that there are several stages and changes are happening. Changes are really happening at that time for mom and baby during this third trimester. Let's chat a little bit about what changes a woman can expect in the body during this time.

[00:03:48] Neada Kenner-Woodard: Okay, so in the third trimester, it's the final stage. So the body is getting ready to deliver. There is an increase in the amount of discomfort a woman may feel in the third trimester.

Things like round ligament, pain and difficulty sleeping are common.

The baby starts to descend into the pelvis, getting ready for birth, and as a result, what ends up happening is there's a lot of hip, can be a lot of hip pain.

And even though in the second trimester, they got a break from that frequent urination, but now it's coming back because of the descent of the baby into the pelvis.

Another thing that they can expect, the body produces a lot of progesterone, and that's a hormone that just helps relax the uterus, but it also relaxes the digestive system. So constipation, heartburn, stomach upset, those things are common, too.

[00:04:52] Frankye Myers: What kind of things can they do to combat some of those things? Because I do think as it relates to constipation, you kind of want to do more natural things. You don't want to use medications.

Are there things or tips that you would give moms in the third trimester that could help with some of the things that we talked about that really start to become a problem for them in the third trimester?

[00:05:17] Neada Kenner-Woodard: Yes. So the foundation is increased water intake, especially for constipation. I tell women that they need to drink at least half their body weight in ounces of water. So that kind of puts things into perspective.

Increasing fiber intake is important as well.

Movement, walking, exercise, those are all good for getting the digestive system moving. And in worst case scenario, there are medications that we can take over the counter like colase and Miralax that will help things move along.

[00:05:56] Frankye Myers: Okay. I can remember that time sleep, just finding a position and getting one of those lumbar pillows because your back is not comfortable, because your weight gain and the baby size at that point is larger.

So that's very helpful. That's very helpful.

As it relates to exercise in that third trimester.

Do you think there are things that they should avoid or be more mindful of during that time frame? I know there's some old wives tales that I remember my mom used to say, well, you can't put your hand over your head or don't bend over. And so I think sometimes people are more cautious because they don't want to hurt the baby, but wanted you just to talk a little bit about that.

[00:06:51] Neada Kenner-Woodard: Okay.

So the thing is that we generally believe that women can do whatever they did outside of pregnancy. They can also do in pregnancy with, of course, some modifications. Keep in mind that the center of gravity has been thrown off substantially because the baby is growing very rapidly, sometimes half a pound to a pound a week. So that throws off a woman's center of gravity. So climbing ladders and running down steps.

[00:07:21] Frankye Myers: Is a little more risky.

[00:07:22] Neada Kenner-Woodard: Right. We need to shy away from that. Another thing is just listen to your body, and your body will tell you things that you shouldn't do because the baby has grown so rapidly, and a lot of energy is going into that. If you're tired, you're tired.

Don't push it.

It's okay.

[00:07:43] Frankye Myers: That's good information.

I know the swelling at that time, and so I know sometimes they think that's because of taking in too much fluid, but I know there are other things going on, especially around the ankle. So talk a little bit about what could potentially be causing that swelling and what are some things they can do to help alleviate that or address that in the last trimester.

[00:08:11] Neada Kenner-Woodard: So swelling is one of those things that we cannot get around, especially in the final trimester.

It can be absolutely normal in pregnancy.

That hormone, again, progesterone, causes relaxation of the vessels. And so it's easier for that extra fluid volume that we carry around in pregnancy to leak out into the tissues. So that causes that edema or swelling. Some of the things that we can do is it's actually counterintuitive, but drinking more fluid to help bring the fluid that has leaked out into the vessel so that you can pee it out.

The other thing is that you can reduce sodium intake. Is that going to lower it substantially? Maybe, especially if you're eating a lot of processed foods that causes to retain water. Another thing is compression stockings.

[00:09:06] Frankye Myers: Okay.

[00:09:08] Neada Kenner-Woodard: That helps force the fluid back into the vessels, so again, you can get rid of it.

[00:09:14] Frankye Myers: Okay.

Very helpful. Leg cramps, is that associated because of the edema or well, is that caused by something else going on in that?

[00:09:25] Neada Kenner-Woodard: It's a lot of things that could cause leg cramps. There could be some electrolyte imbalances that are exacerbated by the shift in fluid, but it can also let's see, what else can I be mainly the electrolytes or dehydration? Carrying a lot of weight around right.

[00:09:49] Frankye Myers: That you historically don't have, right?

[00:09:51] Neada Kenner-Woodard: Yes. Very true. Very true.

Usually when women have a lot of leg cramps, I recommend magnesium, Epsom salt baths. I mean, that's wives tale, but it is effective. We absorb a lot of magnesium transdermally, and that helps a lot with the cramp, late cramps.

[00:10:11] Frankye Myers: And magnesium also helps you relax. You correct sleep?

[00:10:15] Neada Kenner-Woodard: Yes, it does.

[00:10:18] Frankye Myers: Okay. I'm falling back on an old nursing, right?

[00:10:24] Neada Kenner-Woodard: That's right.

[00:10:25] Frankye Myers: And then the Braxton Hicks, I do remember those.

They were false alarms at the first sign of pain. I was on my way to the hospital. So talk a little bit about Braxton Hicks contractions.

[00:10:39] Neada Kenner-Woodard: So Braxton Hicks start to increase in this trimester. Those are like practice contractions. They don't actually make the cervix dilate. But what a woman may start experiencing is some tightening of the abdomen that doesn't necessarily translate to any cramping or any back pain, and then eventually that evolves into translating into lower uterine cramps back pain. And it gets worse and worse until you actually have contractions. Okay, yes.

[00:11:13] Frankye Myers: They didn't feel like practice to me.

[00:11:15] Neada Kenner-Woodard: But they never do. They never do. Until you have a real contraction, you reflect back and like, okay, I guess.

[00:11:22] Frankye Myers: We all have a different pain tolerance.

[00:11:24] Neada Kenner-Woodard: Very true.

[00:11:26] Frankye Myers: And then the dryness, the itchiness, and then the stretch marks.

Are there any tips? I know one thing is keeping your weight in the normal suggested range yes, absolutely helps. But any feedback that you can give around stretch marks, drying itchy skin, some.

[00:11:49] Neada Kenner-Woodard: Of the issue with stretch marks is genetic, so you can't avoid it. But certainly watching the weight gain make sure the skin doesn't stretch rapidly is helpful. The other thing, just for comfort, I like emu oil. I really like emu oil. It has some anti inflammatory properties in it.

And also Aquaphor is really good, so keeping the skin real moisturized to help reduce that itching. And also when you take showers, especially coming up on the winter, you want to make sure that the temperature of the water is not too hot.

[00:12:25] Frankye Myers: Okay.

[00:12:27] Neada Kenner-Woodard: That could be helpful with the dryness. All right.

[00:12:30] Frankye Myers: And then varicose veins.

I know that can be hereditary as well, but talk a little bit about that. Is it more common? Less common.

[00:12:44] Neada Kenner-Woodard: Yes, it can happen more in the third trimester, and it has to do with the increased weight of the woman, but also it can come from the stress on the legs, from the swelling and things like that.

[00:13:01] Frankye Myers: Yeah. And the compression stockings.

[00:13:02] Neada Kenner-Woodard: The compression stockings are as well. Yes.

[00:13:05] Frankye Myers: Great feedback. So now that we've talked a lot about what's going on with the mom, talk a little bit about changes. We can see that's happening with the fetus during this time.

[00:13:18] Neada Kenner-Woodard: Okay, so these are the final stages of development.

Right around the beginning of the third trimester, the baby is about 14 inches long and can weigh about two and a half pounds.

By this time, like around 32 weeks, the baby starts getting normal sleep and wake cycles. And the mom will recognize that because they'll have patterns of movement that are recognizable.

The baby can hear, the baby can see. They start opening their eyes around 30 weeks.

A lot of good things going on.

[00:13:54] Frankye Myers: You make me want to have another baby.

[00:13:55] Neada Kenner-Woodard: Oh my goodness. Come on, do it. No, I wish I could.

[00:13:59] Frankye Myers: I might try it, but it's impossible at this point.

[00:14:03] Neada Kenner-Woodard: I understand.

The other thing is, as far as development goes, usually by 35 weeks, the brain is developed, the kidneys in, and the lungs are developed by 34 weeks. So all the finalization of preparing this baby to be able to live on its own at birth.

[00:14:27] Frankye Myers: Awesome.

That's really great information. I know that. So by 34 weeks, lung maturity should be almost optimal. Are there still some opportunities if you deliver early that there could be some potential lung lack of development? Because there are some that goes into the latter part?

[00:14:53] Neada Kenner-Woodard: Yes.

[00:14:53] Frankye Myers: Outside of that, 34 weeks.

[00:14:55] Neada Kenner-Woodard: Absolutely. And remember, too, like, your due date is plus or minus two weeks. So just because we're calculating 34 weeks, you could be 32 or you could be 36 weeks, right?

[00:15:04] Frankye Myers: Yes.

[00:15:06] Neada Kenner-Woodard: But in the case where we have someone who goes into preterm labor or is threatening preterm labor, there are medications that can help mature the lungs.

[00:15:14] Frankye Myers: Okay.

[00:15:15] Neada Kenner-Woodard: And then let's say someone goes into labor rapidly and the baby is born and there's some respiratory suppression there. There are medications that can begin, like supplemental oxygen and surfactant that can be given to the babies to help them breathe afterwards. Okay, great information. And the neonatal team over there at.

[00:15:37] Frankye Myers: River, we have a great absolutely.

[00:15:40] Neada Kenner-Woodard: Yes.

[00:15:41] Frankye Myers: So as we wrap up today during the second trimester, what should the woman expect during their prenatal visits? I think we have that as a last I mean I'm sorry, the third trimester. I apologize. No problem. It's the third trimester. I'm getting them all back to back here. It's a lot of trimesters. Yes. What should they expect during each visit?

[00:16:07] Neada Kenner-Woodard: Yes. So just like the visits before everyone gets vital signs, we paid very special attention to blood pressure because this is when we start seeing the blood pressure creeping up to pre pregnancy. Normal after that decline in the second trimester, fetal heart tones.

We also do some type of assessment to see how to assess fetal growth. So be that Leopolds where we're feeling the belly.

[00:16:35] Frankye Myers: What's the Leopold pulse?

[00:16:37] Neada Kenner-Woodard: Leopolds maneuver is when we try to figure out the position of the baby through feeling the stomach.

[00:16:48] Frankye Myers: Okay.

[00:16:48] Neada Kenner-Woodard: And we also can try to estimate the size of the baby just through feeling through the abdomen there.

[00:16:58] Frankye Myers: So they'll still do the check with the check the circumference, the funnel height measurement. Okay.

[00:17:04] Neada Kenner-Woodard: Yes, we'll do that. Provided there hasn't been a past discrepancy where it doesn't equal it matches.

[00:17:11] Frankye Myers: You can tell I wasn't a labor and delivery nurse. 

[00:17:18] Neada Kenner-Woodard: All right.

[00:17:18] Frankye Myers: Great information.

Well, Nita, thank you so much for spending time with us and really wrapping up this last trimester in our series and look forward to having you back on in the future. Is there anything you would like to share with our viewers before we conclude? And then more importantly, how can they reach out if they're looking for a midwife or a provider or they're going to start that journey of having babies?

[00:17:45] Neada Kenner-Woodard: Yes. So the main thing I want to hit home is that the third trimester can be challenging, but it is all in preparation for childbirth and parenthood, be patient. Even though the baby is full term at 37 weeks, going the full 40 is important in brain development. Absolutely.

It lowers admissions to the NICU lowers Caesarean section rates. So just be patient with the process. Use the time to pamper yourself and get a plan in place for labor and postpartum. Look into doulas. I'm a big fan of doulas and the support that they offer throughout pregnancy childbirth. Right. It's like a coach, a non medical professional who is there to support you and advocate for you throughout the entire maternal cycle.

[00:18:38] Frankye Myers: I wish that existed when I was having children, because most often you depend on your spouse or your partner, and they may not be best prepared.

[00:18:47] Neada Kenner-Woodard: Correct. They need support, too. They help support the partners, too.

[00:18:52] Frankye Myers: Their support looks a little different. A little different.

[00:18:54] Neada Kenner-Woodard: A little different.

Biggest role is the person in the.

[00:18:58] Frankye Myers: Bed having the baby.

[00:19:00] Neada Kenner-Woodard: Right. Exactly.

[00:19:02] Frankye Myers: Agree. And then at this point, the decision around breastfeeding I know it's something that I did my last pregnancy was very rewarding.

[00:19:13] Neada Kenner-Woodard: Yes, it is.

[00:19:14] Frankye Myers: So any recommendations about how to start exploring that in the last trimester as an option? I think it's one of the best ways right. To support nourishing.

[00:19:28] Neada Kenner-Woodard: Your infant. Yes. So in the third trimester, some of the things you want to make sure that you do is have a breast pump. All insurances cover a breast pump. So go ahead and have that at the house.

Knowledge is power. So look at the there are a lot of resources out there. Talk to us. We'll give you recommendations as far as books and things like that, to educate yourself on breastfeeding and surround yourself with positivity, too.

That's good. Not just for breastfeeding support, but also to get through the remainder of the pregnancy and throughout labor. Just surround yourself with people with positive birth stories, positive experiences. That is everything.

[00:20:23] Frankye Myers: Absolutely. I know if I didn't have that support system, I probably would have given up after a couple of weeks. But it was one of the easiest things I ever did, and it was not only good for the baby, but it was so important to our bonding.

And it was easy. It's just so easy.

[00:20:41] Neada Kenner-Woodard: Yes. And it helps you get back to your pre pregnancy state, too. You burn a lot of calories by making milk and breastfeeding.

[00:20:50] Frankye Myers: I think they said extra 300 plus calories per day. So I did. My waistline was snatched by six months.

[00:20:59] Neada Kenner-Woodard: I love it. Yes. And then that bonding also helps with our mood, too. It elevates our mood. So lower rates of postpartum depression and.

[00:21:11] Frankye Myers: The immunity that baby gets from you.

[00:21:13] Neada Kenner-Woodard: Yes.

[00:21:14] Frankye Myers: You can tell. I did do my research. You did? Even though you're not a lady. But I did do it for that time period. Well, thank you so much.

[00:21:24] Neada Kenner-Woodard: Thank you for having me. This is so important for health, literacy and community engagement. I love it. Agreed.

[00:21:31] Frankye Myers: We'll definitely have you back on again.

[00:21:32] Neada Kenner-Woodard: Please do.

[00:21:33] Frankye Myers: Thank you.

[00:21:34] Neada Kenner-Woodard: All right. Thank you.

[00:21:35] Frankye Myers: Bye bye. Bye bye.

[00:21:37] Frankye Myers: Thank you for listening to this episode of healthy You. We're so glad you were able to join us today and learn more about this topic. If you would like to explore more, go to riversideonline.com.
 

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