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Getting Ready for Baby: A Midwife's Third Trimester Guide · Meaningful Medicine with Novant Health

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  Gina Kaye (Host): Meaningful Medicine is a Novant podcast bringing you
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  access to leading doctors who answer questions they wish you would ask.
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  From routine care to rare conditions, our physicians offer tips to navigate medical
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  decisions and build a healthier future.
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  I'm your host, Gina Kaye.
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  And today, we're sitting down with Jess Bentley, a certified nurse-midwife,
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  to explore the exciting topic of the third trimester welcome, Jess.
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  It's great to have you.
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  Jessica Bentley, CNM: Thank you.
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  It's wonderful to be here.
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  Host: Great.
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  So to start with, let's talk about what changes moms can
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  expect during the third trimester.
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  Jessica Bentley, CNM: Sure.
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  So, I always try to tell patients the third trimester is very similar to the
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  first trimester in that you have rapid changes and you have that fatigue, you
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  have that nausea come back, but it's also the most exciting trimester because
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  you're so close to your end goal.
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  Host: What are the biggest milestones that happen between week 28 and 40?
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  Jessica Bentley, CNM: During that third trimester, mom averages about
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  a pound a week for weight gain.
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  we have some pretty important tests that we do in the 28th week, we will
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  do a gestational diabetes screen, because gestational diabetes, you know,
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  people think of diabetes, "Oh, I have had a poor diet or a family history."
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  But really, it's how your placenta is creating an
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  environment of insulin resistance.
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  So, we do the glucose screening.
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  And then, we do start to see you more frequently.
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  We see you every two weeks.
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  And then, we see you till 36 weeks, we see you every week because
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  things are rapidly changing.
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  You are at a risk for things like hypertension, preeclampsia, and then
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  the diabetes that we just talked about.
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  Host: Let's talk a little bit then about symptoms.
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  What symptoms are normal during the third trimester, and is it normal
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  to start feeling a bit tired?
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  Jessica Bentley, CNM: Our center of gravity changes significantly, right?
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  Because we have such a large growth with baby, so it's important that
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  you have good supportive shoes.
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  This is where moms tend to have that lower back pain or sciatica.
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  So, we recommend yoga and stretching and, chiropractic care.
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  Wearing good supporting shoes.
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  Our legs tend to swell in the third trimester.
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  You take the heat and just the nature of having the most blood volume in your body.
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  So, compression stockings, resting when you can.
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  And the fatigue is real, and just reminding yourself you're growing
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  a whole human, it's a lot of work, and it's okay to take a nap.
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  Host: It's a lot of work.
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  So, speaking of those compression socks, what causes swelling in the
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  feet and ankles, and is that maybe one of those tricks that really help?
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  Jessica Bentley, CNM: Sure.
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  So, compression stockings and good supportive shoes are probably
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  the number one thing we can do to help with that swelling.
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  Every pregnant woman's going to have a little bit of an element of swelling
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  because of all that blood volume.
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  Keeping a low sodium diet, getting your hydration.
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  It seems, "Oh, I have swelling in my legs, I shouldn't drink as much."
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  But really, we want you to still have that goal of 120 to
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  140 ounces of fluid every day.
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  Host: Something about Braxton Hicks contractions.
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  What should patients look out for?
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  Jessica Bentley, CNM: So when it comes to Braxton Hicks, I like to tell patients
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  that they're your practice contractions.
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  They're the warm-up.
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  Our body is trying to figure out what's going on.
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  If this is the second, third, fourth baby, our body has muscle memory.
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  And so, your body's going to remember those practice
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  contractions a little bit more.
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  They're super common.
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  However, preterm labor does still exist.
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  We still don't know why it happens.
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  You have to be aware of your body.
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  And if you're having those Braxton Hicks or you feel like you have menstrual
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  cramps, if you're having five, six, seven an hour, they don't go away with
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  rest, hydration, emptying your bladder, those are times we want you to come in to
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  see your provider, whether it be in the office or in labor and delivery triage.
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  Host: How about the first signs of labor?
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  What are we looking for?
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  Jessica Bentley, CNM: Yeah.
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  So, the first signs of labor are, of course, the fatigue and/or a burst
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  of energy, that true nesting feeling.
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  Not everyone gets that nesting feeling, but that's definitely where it starts.
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  Your vaginal discharge can change a little bit.
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  It might be really thin.
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  It might be a little bit creamy in consistency, but you're definitely
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  going to notice some more discharge.
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  You may notice that your baby drops some.
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  All of a sudden you go, "Gosh, I can take a nice deep breath."
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  Or a patient will say, "I ate a whole meal last night, and it was
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  wonderful because I could breathe throughout the entire thing."
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  And so, those are kind of those starting signs.
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  And of course, those little contractions.
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  It's sort of like when water boils on the stove.
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  You have a few bubbles, a few contractions, then a few more
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  bubbles, and then a few more bubbles.
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  And then, it ramps up to full-blown contractions.
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  Host: So, we've talked about the first signs of labor.
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  Now, let's talk about when should a patient in labor
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  actually go to the hospital?
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  Jessica Bentley, CNM: Sure.
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  So, every patient is going to have a little bit different comfort level.
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  As soon as one person has a contraction, they start to get a little bit nervous
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  and they want to go, and that's fine.
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  As well as everyone's level of pain is different.
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  But our general rule of thumb is it's instead of 911, it's 511.
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  Five contractions in an hour, and each contraction is
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  lasting approximately a minute.
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  Now, at any time, if you don't want to be at home, like, I always say
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  this is when we really listen to our maternal sixth sense, because
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  you'll know when you want to go.
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  Your partners usually want to go a little bit sooner than you do, and that's fine.
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  It's really whenever you're comfortable, but that 511 rule of thumb is
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  really a good standard to go by.
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  Host: I was going to say, I think that sounds really helpful.
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  Jessica Bentley, CNM: It's a great just sort of, "Hey, I'm having them.
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  Oh, but they are only 30 seconds," and then they kind of fizzle out.
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  But if they're lasting a whole minute and they're going to increase
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  in intensity, like that boiling water, that really is a good rule.
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  Host: Let's focus on prenatal care in the final weeks of pregnancy.
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  What discussions typically happen as labor approaches?
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  Jessica Bentley, CNM: Yeah.
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  So, we start to see you every week starting at 36 weeks because you have
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  risks of things like preeclampsia.
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  We want to check you for group B strep, which is a natural bacteria
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  that we have in our digestive system, but it can be harmful to babies.
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  So, if you're a carrier, you do not have to be treated, but you have to be
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  treated in labor, so we want that test.
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  And then, preeclampsia is kind of one of those things where you can be fine in
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  the morning and not fine in the evening, so we do keep that closer eye on you.
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  We also want to start talking to you about what is your birth plan.
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  You know, what are your wishes while you're there?
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  Who do you want to be there for your birthday party?
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  I mean, we are so blessed to be part of these birthday parties, to
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  keep you and baby safe and healthy.
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  But we want to also facilitate how you would like your care, because
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  it really is a team effort.
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  Host: What is the one thing, and I know there are a lot of
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  things, but the one thing every mom should do before her due date?
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  Jessica Bentley, CNM: Well, I have two.
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  But the very number one thing every mom should do, have a self-care day.
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  Have a day that is just about you.
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  If you like to go shopping, if you like ice cream, if you like walking on the
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  beach, if you like getting a pedicure, whatever it is, if you want to lay on the
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  sofa and watch a TV show, whatever you want, that day is dedicated to just you.
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  Because as moms, right, something in our brain changes a little bit, and
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  we tend to put ourselves a little farther and farther down on the list.
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  So, this really is your opportunity for that real self-care day.
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  And then, just be excited.
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  Let us know how you're feeling.
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  If you're scared, it's okay.
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  If you're scared and you think, "Oh, I don't want to bother somebody
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  with this question," please do.
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  We're there for you, and we're there to help you, and we
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  want you to reach out to us.
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  Host: Those are fantastic.
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  And we all know that once that baby comes, your self-care kind
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  of goes to the side for a bit.
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  Jessica Bentley, CNM: It does.
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  It sure does.
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  Host: So as we prepare to close, I want to ask, what drew you
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  to serve as a nurse midwife?
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  Jessica Bentley, CNM: So, I was an ICU nurse when I was very first in nursing.
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  And I started to go to Haiti, and went to Haiti for many years.
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  I was in the earthquake in Haiti.
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  And at that point, I was a labor and delivery nurse, but I just saw the
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  need for a voice, not just for women in Haiti, but women in the United States.
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  And being a midwife, we have this special role where we're still nurses,
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  we're still nurses at heart, we're still bedside nurses, but we have
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  the ability to be a larger advocate.
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  We can be a larger voice for our patients, and really being that
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  go-to—I mean, the definition, right?
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  Middle provider—and then midwife with women, so to be able to be
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  that voice for the women that I serve and the women that I've seen,
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  and women I will continue to see.
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  Host: Jess, thank you so much for joining us today and
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  especially for doing what you do.
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  Are there any, closing thoughts you'd like to share with our listeners?
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  Jessica Bentley, CNM: Don't be afraid.
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  No question is silly.
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  Like, we want you to ask all the questions.
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  We love it when you bring a list for us to go through.
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  And enjoy every moment of pregnancy.
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  Host: Very well stated.
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  Thank you.
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  Jessica Bentley, CNM: Thank you.
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  Host: To find a physician, please visit novanthealth.org.
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  For more health and wellness information from our experts,
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  visit healthyheadlines.org.
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  And if you enjoyed this podcast, please share it on
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  your own social media channels.
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  This has been Meaningful Medicine from Novant Health.
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  Thanks for listening.