Doctor's Corner - Third trimester: the home straight
During the third trimester, most women can’t wait to meet their baby and this stage of the pregnancy can be quite emotional as the mother starts questioning her maternal abilities. The reality of motherhood is also setting in. This article will look at this exciting stage; touch on labour and the immediate post delivery period.
The third trimester is marked by the descent of the presenting part, significant discomfort as a result of the pressure on surrounding structure (bladder, bowel, etc), and for a fair proportion of women, swelling of the legs and occasionally, most of the body. In most of cases, it is just a normal physiological adaptation of pregnancy. When swelling occurs, it is important to be more careful and blood pressure should be checked to exclude pre-eclampsia. The leading causes of maternal deaths in South Africa are non pregnancy related infections, bleeding, and high blood pressure complications.
The end of the third trimester involves the delivery of a beautiful baby and placenta.
Most women gain between 10kg to 15kg during their pregnancy, but some may gain less and a few women much more. Often weight gain is not a medical problem and by the six week check-up most women would have returned to their pre-pregnancy weight. Returning to normal activity and light exercise, walking, swimming and just taking care of the baby will help to speed up weight loss.
Post partum blues
As many as 70-80% of women may develop post partum blues. This condition is characterized by tearfulness, emotional instability while feeling inadequate and extremely lonely. In most cases, this will pass. The more serious condition termed postpartum depression/psychosis affects a much smaller group of women. It is often missed or wrongly diagnosed as baby blues. The initiation of treatment is very important and may include therapy and medication. Mothers at higher risk for this condition may be single, young with poor support structures, multiple births, sickly or small babies, low socio-economic backgrounds, history of depression or mental disease, difficult pregnancies or deliveries, as well as other factors. This is far more serious as it can lead to attempts to injure the baby, or suicidal ideation and/ or actions.
Complications with the delivery can include emergency procedures, like cesarean section, assisted deliveries, prolonged second stage of labour associated with difficult presentations and occasional injuries to babies. Bleeding from various causes, retained placenta and sometimes lacerations that needs to be repaired in theater.
There are long term complications associated with cesarean sections and from assisted deliveries (vacuum and forceps extractions).
Bundle of joy
The birth of your baby is always a wonderful occasion and after nine months of pregnancy you are rewarded with a gift for life. Remember that breast is best and family spacing is important. The decision to have another baby should be made by both partners and it should not compromise the health of the mother or the baby. In the absence of breastfeeding, ovulation can take place as soon as 25 days after delivery. So please contact your doctor for advice on the best method of contraception for you.
Your six week check-up is very important. A pap smear will be performed to exclude potential abnormal cells that can develop into cervical cancer. The frequency of pap smears vary according to the test result and other health factors. The follow-up with your bundle of joy needs to be discussed with a pediatrician and there are routine vaccines and developmental tests that need to be done.
Women with a mobility impairment should consult a gynecologist (obstetrician) as soon as they suspect that they may be pregnant. This is to confirm pregnancy and exclude some pregnancy complications at an early stage and assess the potential risks. In many cases, pregnancy is uneventful and will require very few adjustments, other than the regular follow-up visits to the doctor.