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