the final months of pregnancy
Pregnant women will often describe the third trimester as a time to “tie loose ends”, stay comfortable and prepare for the birth. Hopefully, you are slowing down at work and at home and friends and family are lining up to help you stock your freezer and get ready for baby. If you need extra support, this is a time to ask for it. We are also here to help you access resources and support. Make sure you are eating well, staying hydrated and napping as needed! If you are working hard till that “last minute”, make sure you have some time each day to put your feet up, take some slow breaths and slow down from your hectic day. Short walks daily are proven to help you both physically and emotionally.
How to reach your midwife
At all times, a midwife is on call for you. The central line is: (604) 901-7806
The central number leads to a message that will tell you who is on call and how that midwife can be reached.
FOR NON-URGENT Calls
Leave us a message. We strive to return calls in 24-48 hours. Texting and emailing is not always reliable. Please let us know what the best way to reach you is.
Leave a message for the midwife on call between 9am & 9pm.
- Please respect that after-hours calls are welcome if they are for urgent concerns only.
Anytime: if you have an urgent call, call the midwife on call.
- If you don’t get a response within fifteen minutes, call again.
- If you still don’t get a response within another fifteen minutes, please try the off-call midwife.
- If you have no response from any of us, call Sechelt Hospital Maternity, inform them of your situation and ask for their help: (604) 989-6248.
Daytime (between 9am & 9pm):
- If you suspect you may be in labour, phone the midwife on call. A heads-up call can help us to arrange our day so that we will be available when you need us later.
Nighttime (between 9pm & 9am):
- If you know you are in active labour and/or need a midwife now, please page us urgently!
- If you do not need a midwife immediately, please wait until morning. We appreciate our chances to sleep through the night, and having a perky midwife when labour gets hard may be just what you need.
Lehe Spiegelman: (604) 603-0477
Jules Atkins: (778) 808-2959
In most pregnancies, labor starts between 37 and 42 weeks after the last menstrual period. Labor is considered preterm labor when it starts before the beginning of the 37th week.
Signs of preterm labor
- Noticeable Increase or Change in Vaginal Discharge (enough to make your underwear wet)
- Ruptured Membranes (your “water breaks”)
- Vaginal Bleeding
- Low, Dull Backache (constant OR comes and goes)
- Pelvic Pressure (feels like the baby is pushing down; feels heavy)
- Abdominal cramping (with or without diarrhea)
- Menstrual-like cramps (constant OR come and go)
- Uterine Contractions
If you are noticing uterine contractions, cramping or backache:
- Drink 16 oz. of a non-caffeinated beverage and empty your bladder, then get in a warm bath or lie down, and count the contractions for an hour. Physical and/or emotional stress can increase the number and strength of Braxton-Hicks contractions, so the idea is to relax and de-stress.
- Call your midwife if:
- you have six or more contractions in an hour;
- your contractions/cramps/backache are increasing in frequency, duration or strength
- you have risk factors for preterm labor, such as a personal or family history of preterm delivery
What causes preterm labor?
It is not known exactly what causes labor to start. Hormones produced by both the mother and fetus play a role. Preterm labor may be a normal process that starts early for some reason. Or, it may be started by some other problem, like infection of the uterus or amniotic fluid. In most cases of preterm labor, the exact cause is not known. Half of the women who go into preterm labor have no known risk factors.
Why the concern?
Growth and development in the last part of pregnancy is critical to the baby’s health. If preterm labor is found early enough, delivery can sometimes be prevented or postponed. This will give your baby extra time to grow and mature.
Obviously, the earlier the baby is born, the greater the risk of problems. Preterm birth, especially very preterm delivery before 30 weeks, accounts for about 75% of newborn deaths that are not related to birth defects. Even “late preterm” babies, i.e. born between 34 – 37 weeks, can have problems such as maintaining a normal body temperature. Thus, if you are planning a home birth but find yourself delivering before 37 weeks, it will be recommended that you birth in the hospital.
Diagnosing Preterm Labor
Braxton-Hicks or practice contractions
It can be hard to tell the difference between true labor and strong Braxton-Hicks contractions. Braxton-Hicks start at around 12 weeks of pregnancy, and increase in strength in the third trimester as the uterus gets stronger in preparation for labor. At this time, women may begin to notice that their bellies regularly get hard (especially with movement such as during exercise, or caused by fetal movement). These “practice contractions” may even be painful and regular, but usually go away within an hour or with rest. Braxton-Hicks contractions can also last for extended periods of time, even up to an hour – these are generally reassuring, unlike intermittent contractions that increase in frequency, duration or strength.
True preterm labor
Preterm labor can only be diagnosed by finding changes in the cervix. This can sometimes be done by your careprovider doing an internal exam (inserting two fingers into your vagina to feel the cervix). Other times, in the early stages of preterm labor, ultrasound will need to be used to confirm cervical shortening and/or dilation.
Rising Blood Pressure
Momma health: rest & keep BP down
The following are some ideas about how to de-stress and/or support your body in order to slow or stop the development of clinically high blood pressure. Of course, there is no guarantee that if you do any or all of the following, that you will not still go on to develop Gestational Hypertension.
- 2-3 L water, daily
- Nutritious meals, NO trans fats
- Eat tabouleh (parsley minimizes swelling)
- Moderate exercise, especially if calming such as yoga or walking
- Swimming (hydrostatic pressure minimizes swelling, decreases stress)
- Epsom salts baths … 2 cups in tub, daily
- Lavender essential oil … 3 drops in bath
- Full body massage 1-2x/wk
- Foot massage, evenings
- Quit work
Sometimes continuously high blood pressure can start to have an effect on baby. For this reason we advise:
- Fetal movement counting, daily:
Pick a time of day that baby is normally active and count how long it takes to get 10 movements. If you don’t get 10 movements in two hours, you should call your midwife.
Cervical ripening if >36 wks
The cure for high blood pressure in pregnancy is to birth the baby. When blood pressures get too high, induction is usually advised. For this reason, anything that speeds the ripening process and increases the chance of a natural labour or straightforward induction is positive.
- Evening Primrose oil … 3000mg orally a.m., 1000mg vaginally at bedtime
- Nine-month Tea … 3 cups daily
- Homeopathic Caulophyllum … 200C 4x daily
- Acupuncture labour stimulation
- Cervical sweeps (aka cervical massage, membrane stripping/sweeping)
Further suggestions by your midwife may include:
- More frequent BP checks, possibly including checking your own BP at home
- Calcium … 2mg daily
- Magnesium … 150-200mg 4x daily
- Skullcap tincture… 15 drops, 3x daily
- Hawthorne berry tincture… 15 drops, 3x daily
- Bed rest
- Non Stress Testing
- Ultrasound to measure fetal growth
Taking your BP at home
Normal blood pressure in pregnancy is anywhere between 90/50 to 140/90.
The best time to take your blood pressure is when you are physically and mentally relaxed. Because of this, first thing in the morning while still in bed can be a good time.
Some women’s blood pressure is steadily the same no matter what. Others have wide differences in blood pressure depending on stress, time of day, hunger, etc, so if you find that your pressure is variable, you can be reassured that this is normal.
When to call your midwife
Your midwife may give you more specific instructions, but the following is a list of symptoms or situations that are generally a reason to call your midwife. Although these are symptoms of pre-eclampsia, don’t panic, a number of these symptoms also can be a result of other normal causes, or can just be a reason for increased frequency of monitoring:
- Blood pressure: the top number (systolic pressure) over 140
- Blood pressure: the bottom number (diastolic pressure) is over 90
- Visual disturbances: consistently seeing stars or floaties
- Severe headache, not eased by Tylenol
- Severe upper abdominal pain, in the area under your ribcage
- Sudden and serious swelling, especially of face
- Noticeable decrease in fetal movement – less than 10 movements in two hours
- Nausea with vomiting
From the Best Birth Clinic at BC Women’s Hospital:
Having a cesarean birth leaves a scar on the wall of the uterus. This area is weaker than the rest of the uterus. Because of this, it was once assumed that a woman should always have a cesarean birth with any future births.
However, a large amount of research clearly shows that vaginal birth is a good option for many women who have previously had a cesarean birth. In most cases, a Vaginal Birth After Cesarean (called a VBAC) remains a safe option for both mother and baby. Studies show that 70% to 80% of women who attempt VBAC will be successful at vaginal birth.
VBAC can still be an option after more than one cesarean birth, although the risks are slightly higher. A woman’s medical history or other circumstances may make VBAC a poor choice. In this case, her care provider will recommend a repeat cesarean birth.
If you have had a previous cesarean birth, talk to your care provider about whether you would be a good candidate for VBAC.
You can also download and use our decision aid booklet to get more information and help you decide which choice you prefer. The booklet is available here.
Benefits of VBAC
The benefits of vaginal birth are particularly important for women who already have children at home. With VBAC, you can expect to spend less time in hospital and recover faster than you did with your cesarean birth.
Compared to a cesarean birth, VBAC offers:
- Less blood loss
- Less risk of injury and infection
- No complications associated with surgery
- A shorter hospital stay
- A faster, less painful recovery
- Less risk of breathing difficulties for your baby
- Reduced risk of complications for future pregnancies
Risks of VBAC
Compared to a planned cesarean birth, the risks of VBAC are:
- Uterine rupture in labour (tearing of the uterus at the location of your cesarean scar). While the risk of uterine rupture is very small overall, this complication can be life-threatening for both mother and baby. Research has determined that the risk is increased if your babies are born close together: if you give birth vaginally 18 months or sooner after your previous cesarean, your risk of uterine rupture is slightly higher than if you give birth after 18 months.
- Greater risks associated with having an unplanned cesarean birth, if you are not successful at delivering your baby vaginally for any reason.
Group B Strep (GBS) - What is it?
What is Group B Streptococcus?
Group B Streptococcus has many names: Group B Strep, GBS, Strep B. It is part of the normal bacteria found in the intestinal and/or reproductive tracts of about 30% of healthy people in Vancouver. Under normal circumstances it is part of the balanced system of gut flora that does not cause disease. It is not associated with bad hygiene, nor is it sexually transmitted. GBS may come and go in people’s bodies, so having had it previously does not mean you have it now.
How can GBS affect my baby?
If you have GBS in your vagina when you give birth, your baby obviously will be exposed to it. Mostly this is of no consequence. In fact, of those babies who are exposed only 50% will become carriers of GBS – i.e. they will have GBS on their skin or in their system but it will not have any negative effects on them.
But about 1 in 200 babies who are exposed to GBS will develop a systemic infection. Symptoms can include fever, difficulty feeding, irritability, or lethargy. These babies will need hospitalization and IV antibiotics. Further, of those who do get sick, for 1 in 20 this infection will be fatal. Babies that survive, particularly those who have meningitis, may have long-term problems such as hearing or vision loss, or learning disabilities.
Most GBS infection will be obvious at birth or shortly after, but can develop anytime within the first week. (This is called early onset GBS infection. There is also a late onset GBS disease that begins after the first week, but this is caused by transmission after birth.)
In summary, out of 4000 babies exposed to GBS [see figure 1]:
2000 will become carriers …….. 2000 will not become carriers
20 will become sick …………….. 3980 will not get sick
1 will die ……………………………. 3999 will survive
What might increase my baby’s risk of developing GBS disease?
The following risk factors multiply by 10 the chance of your baby getting sick:
- Previous baby that developed GBS infection
- Bladder infection caused by GBS at any time during this pregnancy
- Preterm birth <37 weeks
- Maternal fever in labour >38OC
- Ruptured membranes >18 hrs
Can I prevent or eliminate GBS from my system?
Although there is little research on this topic, one strategy has been to use dietary supplements to boost your own immune system to fight off GBS so that you don’t become a carrier. These would include focusing on foods high in vitamin C, minimizing refined sugar, and consuming probiotics. It is never too early or too late in pregnancy to start this regime.
What are my options for testing and treatment?
Currently, the community standard is to test women at 35-37 weeks (which is a cotton-swab or “Q-tip” sample from your vagina and anus that you can do yourself). This swab is sent to the lab to be cultured. It usually takes a few days to get results.
The test is done at the end of pregnancy because GBS bacteria can be present in your body temporarily. Testing within 5 weeks of your due date has been shown to be the most accurate way to determine your status at the time of birth.
If your test comes back positive:
- The usual approach is to offer you treatment with IV antibiotics once you are in active labour OR if your water breaks before labor. The drug of choice is Penicillin, but there are other effective options for women who are allergic to Penicillin, or for strains of GBS that are resistant to Penicillin.
- Once started on antibiotics, you will receive a dose every four hours until you have your baby. Ideally, you will receive at least one dose a minimum of one hour before the birth, as this reduces the chance of your baby getting sick to 1 in 4000. Subsequent doses reduce the chance even further.
- If your water breaks before labour starts, you will be offered the choice of inducing labour. The reason for this is to minimize the chance of infection due to prolonged ruptured membranes, which we know may increase the chance that you will pass on GBS to your baby.
- You will not be offered antibiotics unless you develop signs of infection, which would likely be due to organisms other than GBS.
- If you go into labor before test results are available, then you will be offered antibiotics only if you develop any of the risk factors listed above.
If your test comes back negative:
If your GBS status is unknown:
What are the downsides of antibiotic treatment?
The antibiotics are given through an IV in your arm and take about 15 minutes to complete. This can be uncomfortable or painful. Afterwards a saline lock will be placed in the IV catheter to avoid repeating the IV insertion. There is about a 1 in 10,000 chance that you may have a severe allergic reaction requiring emergency treatment to these antibiotics.
Long term effects on baby of early antibiotic exposure are not fully researched.
Are there any alternatives to treatment with antibiotics?
There are no other treatment alternatives that have enough data for us to know whether they are effective.
Some women have a strong wish to avoid antibiotic exposure and have requested an alternative approach to treatment with antibiotics where 1) they are found to be a GBS carrier, and 2) they develop any of the risk factors mentioned above which make it ten times more likely that the baby will get sick. This approach was based on a previous standard of care before universal testing and treatment for positive status was adopted.
Can I prevent or eliminate GBS from my system?
One strategy that has not be proven by research to have an effect but that may is dietary supplements to boost your own immune system to fight off GBS so that you don’t become a carrier. These would include focusing on foods high in vitamin C, minimizing refined sugar, and consuming probiotics. It is never too early or too late in pregnancy to start this regime.
Herbs and teas for pregnancy and labour preparation
All ingredients used in these teas and drinks are nutritive in value. In other words they enhance the natural processes of your body by helping balance and sustain your energy flow. For herbs that allay annoyances or deal with major problems, it is important to work with an experienced herbalist knowledgeable in the childbearing cycle.
|Pregnancy Tea||Labor Prep Tea (from 36+ weeks)|
|4 parts Peppermint/Spearmint3 parts Red Raspberry leaf
3 parts Lemon Balm
2 parts Partridgeberry
2 parts Nettle
1 part Alfalfa leaves
|3 parts Partridgeberry2 parts Red Raspberry leaf
1 part Alfalfa
1 part Lemon Balm
1 part Nettle
|Herbal Healing for Women, Rosemary Gladstar||Care of Beth Ebers, RM|
|If you are fatigued, first of all take the time to rest and relax. Then have some Energy Tea. The recipe is the same as for the Pregnancy Tea, but the Lemon Balm is replaced with ¼ part grated ginger root.Herbal Healing for Women, Rosemary Gladstar|
|Anemia Prevention Tea|
|½ ounce Nettle leaf½ ounce Parsley leaf
½ ounce Comfrey leaf
½ ounce Yellow Dock root
¼ ounce Peppermint leaf
(these are dried weights)
|This brew contains three excellent sources of iron: Nettle, Parsley, and Yellow Dock. It provides folic acid from the Parsley and vitamin B12 from the Comfrey. The green herbs all contribute vitamin C which aids iron absorption. The Mint makes it tasty.|
|Wise Woman Herbal for the Childbearing Year, Susun S. Weed|
|Stress Relief Tea|
|4 parts Lemon Balm2 parts Oat Straw
2 parts Chamomile
½ part Lavender flower
|Great for any occasion: very calming, and pretty too. Excellent for labor support people too!|
|Care of Kat Montgomery, RM|
Other Prenatal Recipes
Labor Preparation Tincture
A tincture is a liquid preparation that uses alcohol and water to extract the constituents of herbs. The following is a blend inspired by the Eclectic physicians (medical herbalists of the 1900s) which contains herbs that may be considered unpleasant to drink in tea form, but have valuable properties that aid in preparing the uterus for labour and birth and in tincture form can be taken in smaller quantity. This blend can be formulated at local herb stores upon request. Do NOT take this tincture if you are regularly drinking a Labor Preparation tea.
From 36+ weeks:
|3 parts Partridgeberry2 parts Black Haw
1 part Black Cohosh
Care of Beth Ebers, RM
Second & Third Trimesters:
|4-6 drops Lavender½ C powdered milk
1-2C Epsom salts
By tripling the recipe, this mix can be made in large quantity and stored in a closed jar.
Care of Kat Montgomery, RM
From 36+ weeks:
|3 drops Frankincense3 drops Lavender
1-2C Epsom Salts
|Frankincense tones the uterus for childbirth, promotes relaxation, and eases feelings of fear or stress
Care of Beth Ebers, RM
From 36+ weeks:
|12c Arnica12c Cimicifuga
|Care of Beth Ebers, RM|