What to expect when you're expecting (124 page)

Size (you may get a rough weight estimate) and position of the fetus, by palpation (feeling from the outside)

Feet and hands for swelling, and legs for varicose veins

Group B strep test

Symptoms you have been experiencing, especially unusual ones

Questions and problems you want to discuss—have a list ready

“Every once in a while my uterus seems to bunch up and harden. What’s going on?”

It’s practicing. With delivery right around the corner, your body is warming up for the big day by flexing its muscles—literally. Those uterine calisthenics you’re feeling are called Braxton Hicks contractions—practice-for-labor contractions that usually begin sometime after the 20th week of pregnancy (though they’re more noticeable in the last few months of pregnancy). These rehearsal contractions (typically experienced earlier and with more intensity in women who’ve had a previous pregnancy) feel like a tightening sensation that begins at the top of your uterus and then spreads downward, lasting from 15 to 30 seconds, though they can sometimes last as long as two minutes or more. If you check out your belly while you’re having a Braxton Hicks, you might even be able to see what you’re feeling; your usually round abdomen might appear pointy or strangely bunched up. Weird to watch, but normal.

Though Braxton Hicks contractions are not true labor, they may be difficult to distinguish from real labor—especially as they become more intense, which they often do as pregnancy draws to a close. And though they’re not efficient enough to deliver your baby (even when they get really uncomfortable), they may give you a leg up on labor by getting effacement and early dilation of the cervix started when the time is right.

To relieve any discomfort you may feel during these contractions, try changing your position—lying down and relaxing if you’ve been on your feet, or getting up and walking around if you’ve been sitting. Be sure, too, that you’re getting enough to drink. Dehydration (even minor dehydration) can sometimes
cause contractions, including these practice ones. You can also use this labor rehearsal to practice your breathing exercises and the various other childbirth techniques you’ve learned, which can make it easier to deal with the real contractions when they do arrive.

If the contractions don’t subside with a change in activity, and if they become progressively stronger and more regular, you may be in real labor, so be sure to put in a call to your practitioner. A good rule of thumb: If you have more than four Braxton Hicks in an hour, call your practitioner and let him or her know. If you’re having a hard time distinguishing Braxton Hicks contractions from the real thing—especially if this is your first pregnancy and you’ve never experienced the real thing—read up about the different kinds of contractions on
page 359
and give your practitioner a call, being sure to describe exactly what you’re feeling.

“It feels as though my baby has his feet jammed up into my rib cage, and it really hurts.”

In the later months, when fetuses run out of stretching room in their cramped quarters, the resourceful little creatures often do seem to find a snug niche for their feet between their mother’s ribs, and that’s one kind of rib tickling that doesn’t tickle. Changing your own position may convince your baby to change his or hers. A gentle nudge from you or a few pelvic tilts may dislodge him. Or try relocating him with this exercise: Take a deep breath while you raise one arm over your head, then exhale while you drop your arm; repeat a few times with each arm.

If none of these tactics works, hang in there. When your little pain-in-the-ribs engages, or drops into your pelvis, which usually happens two or three weeks before delivery in first pregnancies (though often not until labor begins in subsequent ones), he probably won’t be able to stretch his toes quite so high up.

Another reason for rib cage pain that you can’t blame on your baby—at least not directly—comes from a loosening of the joints in the area, courtesy of pregnancy hormones. Acetaminophen (Tylenol) can help ease the ache, but also avoid heavy lifting, which can make it worse (and which you shouldn’t be doing now anyway).

“Sometimes I have trouble breathing, even when I’m not exerting any energy. Why is that happening to me? And does it mean my baby isn’t getting enough oxygen?”

It’s not surprising you’re feeling a little spare on air these days. Your ever-expanding uterus is now crowding out all your other internal organs in an effort to provide spacious-enough accommodations for your ever-growing baby. Among those organs feeling the crunch are your lungs, which your uterus has compressed, limiting their ability to expand fully when you take a breath. This, teamed with the extra progesterone that has already been leaving you breathless for months, explains why a trip upstairs these days can make you feel as if you’ve just run a marathon (winded, big time). Fortunately, while this shortness of breath may feel very uncomfortable to you, it doesn’t bother your baby in the least. He or she is kept well stocked with all the oxygen he or she needs through the placenta.

Choosing a Pediatrician

Choosing a pediatrician (or a family practitioner) is one of the most important decisions you’ll make as a parent—and actually, you shouldn’t wait until you become a parent to make it. Sifting through your choices and making your selection now, before your baby starts crying inexplicably at 3 a.m., will ensure that your transition to parenthood will be that much easier. It will also allow for an informed—not hasty—decision.

If you’re not sure where to begin your search, ask your practitioner (if you’ve been happy with his or her care) or friends, neighbors, or coworkers who have young children for recommendations. Or contact the hospital or birthing center where you’ll be delivering (you can call the labor and delivery floor or pediatrics, and ask a nurse on duty for some suggestions; no one gets a better look at doctors than nurses do). Of course, if you’re on a health insurance plan that limits your choices, you’ll have to choose from that list.

Once you’ve narrowed your choices down to two or three, call for consultations; most pediatricians or family practitioners will oblige. Bring a list of questions about issues that are important to you, such as office protocol (for instance, whether there are call-in hours for parents or when you can expect calls to be returned), breastfeeding support, circumcision, the use of antibiotics, whether the doctor handles all well-baby visits or whether they are typically handled by nurse-practitioners in the practice. Also important to know: Is the doctor board certified? Which hospital is the doctor affiliated with, and will he or she be able to care for the newborn in the hospital? For more questions to ask and issues to consider, check out the
What to Expect Pregnancy Journal and Organizer.

Relief from that winded feeling usually arrives toward the end of pregnancy, when your baby drops into your pelvis in preparation for birth (in first pregnancies this generally occurs two to three weeks before delivery, in subsequent deliveries often not until labor begins). Until then, you may find it easier to breathe if you sit straight up instead of slumped over and sleep in a semi-propped-up position, bolstered by two or three pillows.

Sometimes breathlessness can be a sign that iron stores are low, so check in with your practitioner about it. Call immediately (or head to the ER) if shortness of breath is severe and accompanied by rapid breathing, blueness of the lips and fingertips, chest pain, and/or rapid pulse.

“I watched a funny movie last night and I seemed to be leaking urine every time I laughed. Why is that?”

As if frequent bathroom runs weren’t annoying enough lately, the third trimester has added another bladder issue to the mix: stress incontinence. This lack of bladder control—causing you to spring a small leak when you cough, sneeze, lift something heavy, or even laugh (though there’s nothing funny about that)—is the result of the mounting pressure of the growing uterus on the bladder. Some women also experience urge incontinence, the sudden,
overwhelming need to urinate (gotta go
now!
) during late pregnancy. Try these tips to help prevent or control stress or urge incontinence:

Empty your bladder as completely as possible each time you pee by leaning forward.