When I’m on call, I frequently get phone calls from patients concerning whether or not they are in labor. The two most frequent scenarios are:

A. “My contractions have been every 5 minutes for an hour, so I think this is it. Should I come to the hospital?” says the patient quite calmly.

“Which baby is this for you and how far dilated were you at your last visit?” I inquire.

“First baby,” patient says giggling. ”I was only 1 cm, but I’m just so excited. All the books say to come in when your contractions are 5 minutes apart!”

“Are you having any pain?” I ask, a little skeptical.

“Oh, I definitely felt some ’twinges’ with that last one,” she says with more giggling.

“Why don’t we give it a little longer. Wait until they really hurt, then check back with me,” I say {she can’t see the grin on my face}.

B. “Doctor, I think I’m in labor, but I’m not…… huff, huff, pant… sure…..if I should come in yet,” patient asks in obvious distress.

“How far apart are your contractions?” I inquire.

“They are…. just a second….” I hear phone being put down.

{Insert blood curdling shrieks and moans for the next 60 seconds.}

“…. about 6 minutes apart.”

“Yes, please come in right away!” I reply.

I don’t fault these women for not knowing exactly what is going on in their body. A woman’s first labor is a totally new experience. She can’t possibly know fully what to expect.

TV has also given everyone a warped view of the labor process. There are the cheesy sitcoms, where women have one contraction and then nearly have the baby in the car. On the other hand you have “A Baby Story” where they nicely edit an entire pregnancy and delivery into one half hour show*. Real life is not quite so predictable and usually not so fast.

Latent or early labor refers to the time from when contractions first start until you reach 5 centimeters of dilation. For the first time mom, this time period can be upwards of 24 hours with the average being about 12. Also, many moms will have false starts where their labor will kick in and then putter out over a few hours. After 5 centimeters, active labor thankfully kicks in and dilation happens at closer to 1-2 centimeters per hour.

A good rule of thumb for first time moms is that you should come to the hospital when your contractions are every 5 minutes for a hour and so uncomfortable that you can’t talk through them. When you time your contractions, start from the beginning of one contraction until the beginning of the next.

Women often get concerned about WHERE IN THEIR BELLY they should feel contractions. Are real contractions in the back? Pelvis? Everywhere? In active labor, contractions are usually felt as a total abdominal tightening pain that then causes a severe pressure into the pelvis. Real labor contractions CAN be felt anywhere in the abdomen, though more important than where is the intensity in which they are felt. Labor pain has often been described to me as ‘knife like stabbing pains in your vaginal area’ {often there are also expletives in this description…but I will leave those out}.

“But my cousin knows this girl who knows this other girl whose ex-roomate’s best friend didn’t even know she was in labor and she had her baby in the car on the way to the hospital!” you might say.

Ah yes. Everyone’s biggest fear. While crazy things like that DO happen on occasion, in my 11 years of delivering babies it has never happened with a first time mom.**

Now with additional babies, the rules change. By the time you have your sixth, we usually tell you to come to the hospital if you sneeze. I have had few patients deliver en route with third and fourth babies.

When you reach 35 weeks, usually your doctor will begin examining your cervix at each visit. She will use your dilation, combined with which baby it is for you and how far from the hospital you live to determine how soon you should come to the hospital.

And when in doubt, just call.

*Doctors hate it when you say “This isn’t how they do it on ‘The Baby Story’.”

** Full disclosure: While I’ve never had a patient give birth to her first baby in a car, it did happen to a relative of mine. But it’s really rare, so don’t sweat it.

It’s hard to believe that 4 weeks from now I’ll be in the hospital, induced and finally having this baby boy! That is unless he comes sooner. (Why am I being induced? More on that in another post.)

I used to be the queen of to-do lists. As if writing everything down in my most perfect handwriting gave me greater control of whether or not it got done. Since I’ve become a mom (and was a full time working mom), I’ve written fewer and fewer lists. I suppose being in survival mode caused me to give up on the notion that lists created control. Perhaps not having it written down gave me permission to not get it done. But alas, I am now home every day and as I look towards welcoming another life into my midst for which I will be responsible, I’ve been getting back into the practice of lists.

I made a list the other day with various projects I’d like to see completed before Joshua’s arrival (like this handmade mobile I’ve been trying to start for months). I’ve marked a few items off the list but there are several left to tackle. I’m not sure how I’m going to get to them but having them on the list makes me feel better. Although I have my trusty list, it dawned on me yesterday that there are many more, small-scale, practical things I want to do to get ready for this baby. So I’m compelled to author a (hopefully) comprehensive 3rd trimester to-do list for all of the mommies-to-be that I know read this blog regularly. I advise you starting on this list a bit sooner than I am (4 weeks out) thus the name 3rd Trimester To-Do List.

The Pregnancy Companion 3rd Trimester To-Do List

√     If you haven’t already, begin looking into childcare options (if needed).

√     Select a pediatrician. Take the time to interview a few in your area. There are great tips on choosing a provider in the book.

√     Attend a childbirth and/or breastfeeding class at your hospital/in your area if you have not already.

√     Make sure you know how to use your breast pump.

√     Preregister at your hospital. This will save you lots of time when baby decides it’s time to grace the world.

√     Consider and write down your birth plan.

√     Wash, fold and put away baby’s clothes and linens (don’t forget to use a fragrance free laundry soap).

√     Finish painting/decorating the nursery if you haven’t already (leave time for those paint fumes to disappear).

√     If you are in nesting mode, tackle a couple of small scale organizational projects that will help clear your space (and your head) before baby’s arrival.

√     Schedule last minute appointments such as the dentist or eye doctor. It will be much easier to commit to this “non-essential” maintenance without a newborn vying for your attention.

√     Write and send thank you notes for gifts you’ve received.

√     Finalize your maternity leave plans and begin to wrap up any unfinished projects at work.

√     Plan a special date with your spouse. It might be your last one for a while.

√     Plan a special outing with your kids (if possible, individually) so they have mom all to themselves one last time before baby comes.

√     Schedule a pedicure or prenatal massage and give yourself at least 1/2 the day for “me” time.

√     Get your hair cut a week or two before you are due. Nothing feels better than freshly cut hair. . .especially when you don’t have much time to “do” it.

√     Make sure your fridge, freezer and pantry are stocked. Prepare a few meals that can be easily frozen and then thawed (this is especially helpful if you do not have someone coordinating meals for you after baby arrives).

√     Schedule a thorough cleaning of your house. If you can afford it, splurge and have someone clean for you. If not, ask a friend or two to help you one afternoon. You will feel so much better bringing baby home to a clean house.

√     Take inventory of your household items such as paper goods, toiletries and cleaning supplies to make sure you are stocked for a few months. Who wants to worry about running out of toilet paper AND diapers!

√     Your baby’s closet is likely full of adorable clothes and linens. Are you stocked up on diapers, wipes and baby toiletries as well? Take a last minute inventory of your baby care items to make sure you have all the essentials.

√     Prepay any bills you can so you won’t have to think about it for a few weeks after baby is born.

√     Install baby’s carseat.

√     Pack your hospital bag. There is a great list for what to pack in the book.

√     Make sure you have your most essential cosmetic items on hand. There won’t be much time for a trip to the Clinique counter in the next month or so. I’m planning a post later this month on the Top 10 Makeup Must Haves for New Moms. . .I’ll talk more about this then.

√     Create your labor and delivery music playlist. If your husband is into music, let him do this for you. It’s a great way to involve him in the process.

√     Arrange childcare for siblings. If you do not have a scheduled birth, have a couple of options available as baby may come when it is not convenient for some.

√     Write down your list of people to contact once baby arrives (with phone numbers and email addresses). Give this list to a trusted friend or family member so they can spread the wonderful news. You can also give them access to your Facebook page so they can post pics of your bundle of joy.

√     Have photos taken of your beautiful baby belly. You may not want to remember what it felt like to be 9 months pregnant, but you will likely enjoy seeing it in years to come.

√     Write a letter to your unborn child. Whether you have been journaling your pregnancy or not, now is a great time to record your deepest thoughts and emotions about carrying this little one within your womb for the past 9 months and how excited you are to finally meet them.

Whew! So much to do. I’d better stop writing and get started on this list. I’m so behind!! Have I left anything out? We’d love to hear your additions to this list. Although I really don’t think I could handle one more thing to do!

Happy Nesting Mommies-To-Be,

Jessica

WARNING: This post is not being written by the doctor. BUT, I am pulling from my current, personal experience AND the valuable information actually written by Dr. Rupe in our book. So read with confidence that there are accuracies (infused with a little personal story) here.

Many expectant moms consider entry into their 3rd trimester something to celebrate. Basically 6 months down, 3 to go. The reality of seeing baby in the flesh is so close. It truly is something to celebrate but for many (probably more for 2nd and 3rd time moms-to-be) there is some dread involved. . .because those moms know what’s coming.

3rd trimester symptoms.

Still, it’s not a terrible thing to be a little in the dark heading into the home stretch. Speaking of stretching. . .hang on a sec while I change positions. These leg cramps are killing me.

OK, that’s better. Now where was I? Oh, 3rd trimester symptoms. Actually, many 1st time moms-to-be will not experience the worst of these inconveniences. I know personally, I felt amazing during the last few months of my pregnancy. Although now that I am staring my last 3 months in the face for baby #2, I can honestly say I agree with my girlfriends – subsequent pregnancies are harder. It’s important to remember though that every pregnant woman is different. You may feel wonderful for every day of every pregnancy you have. You may feel great for one pregnancy and miserable the next. The important thing is to be familiar with what you may experience and be ready to do what you can to relieve your symptoms. Eating right and exercising throughout your entire pregnancy will make a huge difference right through delivery.

Give me a minute while I find my Tums, will ya? This heartburn is killing me. Be right back.

OK, much better. Where was I again? Right. Late pregnancy symptoms.

Our book covers symptoms all throughout pregnancy in detail and Dr. Rupe gives some great, simple advice on how to manage them. The more I talk to other moms-to-be the more it seems a few symptoms seem to really dominate the last few months of pregnancy.

Leg Cramps  //  Heartburn  //  Frequent Urination

Ah, man. Just typing the work urination made me have to pee. Hang on another minute while I take another trip to the loo.

OK, seriously that should be the last interruption.

There are probably several more prominent 3rd trimester symptoms but for the sake of your precious time and due to the fact that I’m obviously experiencing these symptoms right now, I will focus on those mentioned above.

Leg Cramps - This one came on a lot sooner for me in my 2nd pregnancy. Leg cramps can occur at any time during the day (especially if you are on your feet for long periods of time) but seem to plague most moms-to-be while they are trying to get their precious sleep. As if it weren’t hard enough to find a comfortable position, it’s miserable to be awakened by a severe charley horse at an ungodly hour. One night I woke up with one and after it passed, another one came and then another. I had to wake up my husband to rub my calf until the pain stopped. Leg cramps may come in the form of a charley horse (which usually follows a quick movement of the leg) or you may experience an aching pain in the hips or legs, even while lying still. Dr. Rupe suggested that I eat a banana before bed (sometime in the evening) as the potassium helps relieve this type of cramping. This simple remedy worked like a charm. I’ve not awakened in the night with a cramp in a couple of weeks.

Heartburn - Yet another symptom that entered the picture for me much earlier this time around. But heartburn always seems to intensify as pregnancy progresses. Simply explained (by Dr. Rupe in the book): your body releases high levels of the hormone progesterone during pregnancy. This brings a relaxing effect to the body and with that to the valve between your stomach and esophagus. This lets the acid in your stomach pass into the sensitive lower esophagus, causing the burning sensation in your chest. Heartburn is exacerbated by the growing uterus pushing up against the stomach. Awesome! The best ways to manage or even avoid heartburn are:

1. Avoid eating up to 2 hours before bedtime.
2. Cut back on fatty and fried foods.
3. Stay upright after eating.
4. If these tricks don’t work, it is safe to take chewable calcium carbonate (Tums, Rolaids) or even Pepcid if needed.

Tums are my best friend right now. I like the Smoothie kind. Yum.

Frequent Urination - You probably became acquainted with this friendly symptom during your 1st trimester. Surprise. He’s back! Did you miss him? 1st trimester frequent urination is caused by hormonal changes. While those changes may still contribute to it’s 3rd trimester return, later in your pregnancy it’s more about your growing baby pushing on your bladder. The frustrating thing about this symptom is that drinking water (which is vital throughout your pregnancy) does not help in the matter. There really is nothing you can do to avoid this symptom. The key is to manage it. Make sure you truly empty your bladder each time you visit the little girls room (gosh, sounds like something I just said to my 3 year old while potty training last week). Although peeing every 5-10 minutes is annoying for me throughout the day, it’s not as invasive as having to go every two hours during the night. To help with this inconvenience, my husband and I switched sides of the bed (his side is closer to the bathroom) during the last trimester of my 1st pregnancy. Last night after I had gotten up twice before 1am he asked, “Is it time to switch sides?” Almost!

I wish all of you mommies-to-be that are in or are entering your 3rd trimester lots of relief and comfort as you encounter these possible inconveniences. Just remember that you are that much closer to seeing the life that makes this all worth it. The frustration of peeing constantly and enduring heartburn will fade once you hold that sweet baby in your arms.

We’d love to hear from current moms-to-be and even you mommies that are past pregnancy out there on what symptoms you experienced most in your 3rd trimester and how you managed them.

Heading back to the bathroom,

Jessica