Third Trimester 1 The document provides information for expectant mothers in their third trimester, including: 1. Common physical and emotional changes such as back pain, varicose veins, shortness of breath, Braxton Hicks contractions, increased urination, and breast changes. 2. Recommended classes such as childbirth preparation, breastfeeding, infant care, sibling preparation, and hospital tours. 3. Signs that labor has begun, including regular contractions, loss of the mucus plug, and water breaking. Mothers should contact their provider if preterm labor is suspected.

1. Third Trimester 1
Third Trimester Teaching
Sheets
INFORMATION ABOUT
PREGNANCY:
THIRD TRIMESTER
WEEKS 27 – 40
Be sure mom gets the video (which includes a tour of Women’s Hospital Birth Center, care of newborn…except
remind them of “back to sleep” and not to have baby propped on side as the video suggests, and postpartum care).
Mom should also get the anesthesia pamphlet. References for listed page numbers are at the end of these sheets.
ABOUT MAKING LIFESTYLE CHANGES AND ADAPTING TO PREGNANCY
1. I have information about handling common physical and emotional changes of later pregnancy:
a. Backache
 Common in pregnant women because of postural changes. During pregnancy the uterus tilts the pelvis
forward, shifting the center of gravity forward with it. This affects the pelvic joints and increases the
lumbar sacral curve (the curve in the lower back) causing a sway back (lordosis). Increased breast size can
also contribute to back pain by weighing down the front of the body, causing the shoulders to become
stooped.
 Prevention or relief of back pain
o Use good body mechanics
o Wear low-heeled shoes
o Watch diet and weight gain
o Continue exercising (with permission from provider); stretching exercises work well for
alleviating back pain.
o Pelvic tilt exercises
o Get adequate rest; avoid fatigue
o Sleep on side, on firm mattress
o Avoid excessive exercise, walking, bending, lifting or standing
o Apply heat or cold to sore area

2. Third Trimester 2
o Some analgesics may be acceptable to take with approval from provider
o Consider Pregnancy & Back Pain Class sponsored by U/M Spine program ~ See handout
o *If pain becomes severe or constant contact provider. Back pain is also a symptom of
pyelonephritis (kidney infection), kidney stones or possibly pre-term labor.
L&P, p. 425, 433
b. Varicose Veins
 Varicose veins can range from just a blemish to being painful and bulging.
 The amount of blood circulating throughout your body during pregnancy continues to increase, hormones
cause vasodilatation and relaxation
 Increased pressure from the uterus on the iliac veins and inferior vena cava cause increased pressure on the
perineum and leg veins
 Varicose veins are strongly inherited, and unfortunately there is little you can do to prevent them. However,
things you can do to keep them from getting worse and from aching are:
o Lie on your side or with hips and legs elevated whenever possible
o Do not cross your legs (this cuts off circulation and can aggravate the problem)
o Exercise regularly
o Move around after sitting or standing for a period of time
o Wear support hose every day (consult your provider first)
o Wear clothing that doesn’t restrict circulation
o Avoid excess weight gain
L&P, p. 433
c. Shortness of Breath
o Common in the third trimester due to the growing uterus
o Uterus presses up on diaphragm and makes it difficult to catch one’s breath
o After lightening (“baby dropping”, occurs ~2 weeks before labor onset in nulliparous women), it is
easier to breath
o Things to help: maintain good posture, eat smaller meals, sleep with pillows to keep head
elevated; stop smoking
o Contact health care provider if symptoms worsen to rule out anemia, emphysema, and asthma
L&P, p. 434
d. Braxton Hicks Contractions
o Contractions that occur on and off for days or weeks before true labor
o Often felt in the front of the abdomen; contractions do not increase in intensity and are not
rhythmic
o May be relieved by rest, change of position, effleurage
o Practice breathing techniques when contractions are bothersome
L&P, p. 336, 351-352, 434, 987
e. Increased frequency of urination
o Occurs in the third trimester because of the pressure of the growing baby “sitting” on the bladder
o Especially increases after the baby drops (lightening)
o For relief of frequency try: empty bladder regularly, Kegel exercises, drink fluids earlier in day,
limit fluid intake before bedtime, wear perineal pad
o Contact health care provider for pain or burning sensation
L&P, 361, 431, 434
f. Interest in/safety of sexual activity
 There is a wide range of sexual responses, interest and frequency of intercourse
 It is safe to continue to have and enjoy consensual sex during pregnancy
 Sexual desire may change, or it may remain unchanged
 Women in the3rd trimester have decreased desire due to discomfort and fatigue
 Side-lying position, female superior or vaginal rear entry may be more comfortable intercourse
positions in later pregnancy

3. Third Trimester 3
 Orgasms maybe be more intense followed by cramping during last weeks of pregnancy
 Intercourse should be restricted and physician notified if:
o Bleeding occurs
o Rupture of membranes occurs
o Partner has a sexually transmitted infection
o Hx of miscarriages or shows signs of miscarriage
o Hx of premature labor or experience signs of premature labor
L&P, p. 435-437
g. Hands and feet swelling
o It is important to determine if it is normal pregnancy swelling or if it’s pathological some edema
occurs with pregnancy because of hormonal and structural changes.
o If it’s in the lower extremities it can be relieved by foot elevation, lying on your side, increasing
water intake, and reducing the amount of standing time, avoid crossing legs, ankle exercises,
maintain balanced nutrition
o Extreme finger swelling may be an indicator of pregnancy-induced hypertension.
L&P, p. 361, 434, 840, 845
h. Breasts leaking colostrum
o Normal during third trimester.
o Body is preparing itself for the baby’s nutritional demands.
o Wearing absorbent pads in bra can help elevate staining clothing.
L&P, p. 356, 616, 758, 764
i. Fatigue/Activity intolerance
o The level of fatigue and activity intolerance increases as the fetus grows and carrying the
expanding uterus becomes difficult and the weight of the fetus increases.
o The blood and nutritional demands are increased by the fetus, causing the mother to be easily
fatigued.
o Mother may be anemic
o Daily activities may become increasingly difficult i.e. bending, stooping, and squatting
o Treatment ideas
o Practice relaxation. Take time out for yourself.
o Get enough sleep: Have a routine. Go to bed at the same time every night.
o Avoid coffee, tea, or caffeinated drinks at bedtime
L&P, p. 431
2. I have information about the following class offerings (give her a handout, refer to local paper or
Women’s Resource Center. Classes fill up quickly. It is wise to sign up early!)
a. Childbirth preparation (Natural Childbirth, Prepared Childbirth, Lamaze, Bradley, other)
o Childbirth education classes offer the opportunity to learn about pregnancy and childbirth. They
often will help you prepare for labor and delivery as well as inform you about things you can do to
have a healthy and happy pregnancy.
o There are many different options in childbirth preparation classes for you to choose from (i.e.
Lamaze, Bradley, Birthworks etc.) depending on what you would like to gain from these classes.
o Your provider may be able to provide you with a list of local classes. You may wish to check with
your insurance company to see if they cover the cost of this class. If they do, they may have a
specific provider you need to take the class through.
 Lamaze Childbirth Preparation Association of Ann Arbor (734-973-1014)
 Bradley Method of Husband-Coached Birth (734-475-0022)
 Brighton Community Education – Lamaze, Childbirth Preparation Refresher (810-229-
1419 or 810-231-2820)
 Plymouth Childbirth Education Association (Lamaze) (734-459-7477)
 North Campus Nursing Center at the University of Michigan – Childbirth preparation
(734-747-1636)
L&P, p. 451-454

4. Third Trimester 4
b. Breastfeeding
o A breastfeeding class is designed to teach women techniques that will help promote breastfeeding
of their newborn.
o Breastfeeding requires effort and patience and a class may give women more confidence.
o These classes typically cover material such as latch on, positions, pumping, pacifier and
supplemental bottle use, advantages of breastfeeding, hunger cues, nutrition, potential problems
and common mistakes and misunderstandings.
o Your provider may be able to provide you with a list of local classes. You may wish to check with
your insurance company to see if they cover the cost of this class. If they do, they may have a
specific provider you need to take the class through.
o La Leche League (734-994-0113)
o Breastfeeding Class, North Campus (734-747-1636)
o Breastfeeding Class, Plymouth Childbirth Education (734-459-7477)
o Breastfeeding Class, Livingston County Department of Public Health (517-546-9850)
L&P, p. 761-769
c. Infant Care
o Infant care classes teach parents how to care for their newborns
o Topics often covered: umbilical cord care, bulb syringe use, feeding cues, breast & bottle feeding
basics, newborn adaptation to extrauterine life, bathing, car seat use, newborn complications, etc
 Infant Massage Classes (734-741-9706
 Baby Care Class, North Campus (734-747-1636)
 Newborn Class, Plymouth Childbirth Ed. Assoc. (734-459-7477)
YYB&U, p. 53-57
d. Parenting classes
o Classes may cover expectations of self and others, emotional adjustments, coping strategies,
expression of intimacy
o Anticipatory guidance of new roles
e. Hospital Tour (sign up at Taubman OB clinic check out desk)
o These tours can be beneficial to both you and your partner because you will feel more comfortable
with your surrounding. It will be helpful during labor for your partner to know where to find
refreshments, the waiting room, a pay phone etc. You will also likely appreciate seeing the
facility before delivery and knowing what amenities they have available (whirlpool, shower,
squatting bar etc.)
o Tours are offered weekly. They take place in the early evening and last 60 – 90 minutes.
o A walking tour of Women’s Hospital Birth Center, followed by a question & answer session
o The tour is also included on videotape
o Register at Taubman Center’s OB-Gyn Clinic (at check out) or call 734-763-6295
YYB&U, p. 21
f. Sibling preparation for new baby
Sibling classes are designed for children who are expecting a new sibling. They will teach the children
about what to expect with the new infant with emphasis on them still being important. Some classes may
teach older siblings how to help care for the infant so they feel more involved. Your provider may be able
to provider you with a list of local classes.
YYB&U, p. 22-24
g. What is available in my community
3. I am satisfied that I can manage job/career/school/parenting responsibilities
o Recognize that you can’t be “superwoman” ~ you can’t do it all, especially in the beginning
o Decide on what your priorities are; what things will work best for YOUR family

5. Third Trimester 5
o Learn to compromise: if job, husband and baby are top priorities, an immaculate house may not be
the top priority
o Learn to ask for and accept help (from dad, baby’s grandparents, other relatives, play groups, etc)
o May need to make job adjustments as abdomen enlarges with growing baby (i.e. decrease heavy
lifting, minimize prolonged standing
L&P, p. 672
4. I understand that the following could be signs of labor:
a. Contractions
b. Loss of mucus plug/bloody show
c. water breaking
 Term labor occurs after 37 weeks.
o Labor is preceded by lightening, nesting instinct (burst of energy)
o Contractions are regular and at closer intervals, progressing to 5 minutes apart, lasting 40 – 60
seconds
o Contractions progress in frequency and intensity
o Discomfort begins in back, radiates to abdomen
o Activity such as walking increases contractions; contractions continue when sleeping
o Progressive effacement and dilatation of cervix
o Bloody show usually present
L&P, p.480-481
 Preterm labor is when there are consistent uterine contractions that result in effacement and dilation of the
cervix after 20 weeks but before 38 weeks.
 Assessment is critical! Some risk factors for preterm birth: African-American; <17 years; > 34 years; hx of
preterm births; smoking; alcohol use; poor nutrition and low weight gain; multiple gestation pregnancy;
infection; incompetent cervix; domestic violence
 A common screening tool for preterm labor is cervical length assessment
o Cervical length is assessed via vaginal ultrasound
o Cervical length of < 30mm may predict preterm labor
 Call provider immediately if any of the following s/sx of preterm labor are present:
o Uterine cramping (menstrual-like cramps which are intermittent or constant)
o Uterine contractions (10-15 min apart, or more often)
o Low abdominal pressure or pelvic pressure
o Dull low backache (constant or intermittent)
o Increase or change in vaginal discharge
o Feeling that baby is pushing down
o Abdominal cramping
o Diarrhea
 If sx of preterm labor occur, stop what she is doing, lie down on left side, drink 2 – 3 glasses of water or
juice, wait 1 hour. If sx persist, call health care provider immediately. If in doubt…call health care
provider!
L&P, p. 435-436
o
5. I know what to expect of 3rd trimester care:
a. Appointments with a physician, midwife, or nurse practioner every 2 (28 – 36 weeks gestation) and
every week after 36 weeks weeks plus extra visits is my health or my baby’s health requires them
b. If I have Rh negative blood type, I should receive an injection of RhoGam at about 26 - 28 weeks of
pregnancy, and also if I have any episodes of bleeding
 Maternal Rh negative blood and a negative ABS titer is an indication for prophylactic Rhogam at
26 - 28 weeks gestation
L&P, p. 1085-1086
c. Complete blood count and screening test for diabetes at about 26-28 weeks of pregnancy.

6. Third Trimester 6
Complete Blood Count
Hgb (normal) 2nd & 3rd trimester >11 g/dl (at sea level)
Hct (normal) 2nd & 3rd trimester >33 %
WBC (normal) < 15,000/cc
L&P, p. 358, 918
Blood Group and Rh Factor
Grouped to be A, B, O, and AB
Rh factor is either negative or positive [The Rh factor is positive if the Rh D antigen is present on
the surface of the woman’s RBCs—LMH]
L&P, p. 1083, 1084
Antibody Screening Test (if the woman has a negative Rh factor)
o An Antibody Screen (ABS) [also called an indirect Coombs test—LMH] is done before
RhoGam is given (at 26 - 28 weeks)
o If the ABS is negative, then the mother has not made antibodies to Rh antigens, which are
present on the RBCs of an Rh positive fetus. If the ABS is positive, the mother’s
immune reaction will hemolyze fetal RBCs and may cause intrauterine fetal death
(IUFD); successive antibody titers are drawn to determine if the antibody levels are
rising. If antibody titers have been rising, intrauterine transfusion or early delivery may
be indicated.
L&P, p. 1085-1086
Oral Glucose Tolerance Test (OGTT)
 1-hour post-Glucola test is done at 24 - 28 weeks gestation to screen for gestational diabetes.
[“Glucola” is the Trade name for the glucose drink that is made by one particular company; there
are glucose drinks made by other companies that have different names—LMH]
 1-hour oral glucose test: Drink 50 grams of glucose within 5 minutes. Blood is drawn 1 hour later
o A glucose level > 140mg/dL is a positive screen (elevated)
 3-hour oral glucose tolerance test is done if 1-hour glucose is elevated, to determine if the patient
does indeed have gestational diabetes (diagnostic)
 3-hour OGTT: Fast for 8 hours. FBS done. Drink 100g glucose. Blood drawn at 1, 2, and 3-hour
intervals.
 The woman is diagnosed with gestational diabetes if 2 or more values are met or exceeded.
L&P, p. 895-897
Diagnostic Criteria for GDM
100g
glucose
Threshold glucose levels
Fasting  95 mg/dL
1 hour  180 mg/dL
2 hours  155 mg/dL
3 hours  140 mg/dL
(American Diabetes Association, 2003, as in L&P, 2004)
f. Group B Streptococcus test
Group B cultures done at the recto-vaginal orifices at 35-37 weeks gestation.
Women who are + for GBS need to have intravenous antibiotic prophylaxis (IAP) during labor in order to
reduce the risk to their newborn of acquiring the disease. Babies who are born to mothers with +GBS may
require additional assessment after birth. Women’s Hospital Birth Center puts babies on “36 hour
observation.”
L&P, p. 209, 1069
e. Other tests as necessary to evaluate my health or my baby’s

7. Third Trimester 7
Urine Dip Stick
Urine is tested for glucose, albumin (protein), nitrites and leukocytes at each prenatal visit. The presence of
these may indicate possible complications (e.g., renal disease, pre-eclampsia, infection, diabetes, weight loss,
inadequate nutrition, infection, etc.) and should be reported to the physician. Should patient complain of nausea
and vomiting, urine is checked for ketones.
Glucose--many women have glucose in their urine and it is considered normal unless the glucose reading is >
1+.
Protein--many women will have a trace of protein in their urine. However, protein is considered a very
sensitive indicator of pregnancy induced hypertension which is seen after 20 weeks gestation. It is important to
know what the protein was on the very first visit, which is a baseline. If the protein is a trace, it probably
represents contamination of the urine by cervical or vaginal secretions, especially if it is present in the first and
second trimester. If the patient develops protein in the urine beyond the baseline, then pregnancy-induced
hypertension must be considered. (Bleeding is ruled out)
Nitrites--are a break down of gram negative rods. Positive nitrites mean the presence of bacteria and urine
cultures need be to be sent to the lab to determine which bacteria are present.
Leukocytes--WBC's, positive mean leukocytes are present, in 3rd trimester is normal but if positive when
nitrites are positive, a urinary tract infection is suggested. UTI’s aren’t always related to gram (-) rods. Large
number of leukocytes with or without symptoms may indicate a UTI. Send culture.
L&P, p. 361-362, 564, 840
Ultrasound done to detect structural abnormalities of the developing fetus. Size of the fetus, dating, amount of
amniotic fluid, lung and cardiac activity, and fetal movement can be assessed.
The following tests may be done to assess fetal activity for at-risk patients. When indicated they are usually
initiated at 32 to 34 weeks.
L&P, p. 818-824
Non-Stress Test is an external monitor of the fetus's average heart rate. Fetal Heart Rate should increase 15
beats above the baseline and last for 15 seconds when the fetus moves. The test reactive test is when 2
movements and heart rate acceleration occurs in 20 minutes. This finding suggests that the fetus is well
oxygenated. A test is said to be nonreactive when no acceleration or movement occurs. Further testing needs to
be done.
L&P, p. 829-830
A biophysical profile is done when a fetus is considered compromised by maternal or fetal disease based on
five dimensions: movement, breathing movements, amniotic fluid volume, NST, and fetal tone. It gives
information about fetal oxygenation or asphyxia.
L&P, p. 822-823
Oxytocin challenge (or stress test) test. Tests for fetal oxygen reserves (i.e., his/her ability to withstand the
stress of labor). In this test the pregnant women is made to contract and heart rate is accessed with relationship
to the contraction. Negative means that heart rate did not decrease and suggest fetal well being. Positive means
the heart rate did decrease, the fetus is thought to be jeopardized.
L&P, p. 830-831
Amniotic Fluid Index: AFI< 5 = oligohydramnios: cong. abnormalities, growth restriction, fetal distress; AFI 5
– 19 = normal; AFI > 20 = polyhydramnios: neural tube defects, obstructed fetal GI tract, multi fetus
L&P, p. 822
6. I have information about what to expect of my baby’s movement and activity
 During the third trimester your baby will have active periods and periods of sleep. The movement should
be more regular.
 Kick Counts: Do kick counts every day

8. Third Trimester 8
o Do kick counts after eating or drinking water juice or milk; walking for 5 minutes or during
your baby’s active time of the day
o Write down the time you start. Make a check each time your baby kicks, twists or turns
o After baby has moved 10 times, write down the time again
o Most healthy babies move at least 10 times in 4 hours
L&P, p. 817-818
7. I have information about preparing the baby’s birth certificate
o Worksheet on page 26 of “You, Your baby & us”
o Begin the worksheet now; you can fill out a lot of the information while you are still pregnant
o You will have to complete the birth certificate worksheet after you deliver
o If you want to claim paternity (for single parents), both parents will need to complete and sign an
“affidavit of parentage form.”
YYB&U p. 25, insert after 26
6. I have chosen a physician to take care of my baby and have scheduled a prenatal visit with that physician
o This is an important decision that should be made before the baby is born
o Pediatrician, family physician, pediatric nurse parishioners all provide care for babies
o Ask friends and family for recommendations
o Think about what is important to you in a physician (breastfeeding support, circumcision, call in
hours, emergencies, antibiotic use, beliefs on immunizations, hospital affiliations, if the office has
a sick and well area waiting room, how long to wait for an appointment etc.)
o Call office ahead of time and request a consultation, bring a list of questions
o Ask how the consultation with the baby’s health care provider went
YYB&U, p. 21
9. I have the information I need to make a decision about circumcising a male baby
o Circumcision is the surgical removal of the foreskin from the glands of the penis
o Refer to the American Academy of Pediatrician website: http://www.aap.org/family/circ.html;
AAP does not support circumcision as a routine practice
o Little evidence to support circumcision. May have some decreased urinary tract infections
(Relative Risk of UTI is higher in uncircumcised males; risk is only 1%), may also be culturally,
ethnically or religious tradition, risk of penile cancer is less (however, penile cancer is extremely
rare!)
o Potential disadvantages could include infection, bleeding, penile damage (rare); complications
occur in 1:200 to 1:500 infants. Circumcision is generally safe
o It is the parents’ decision; help them make an informed decision
o Describe post-circumcision care: Vaseline applied for several days so penis doesn’t stick to diaper;
penis may be red and swollen for a couple days; yellow exudates appears which is part of normal
healing. Clean the newly circumcised penis with warm water. The nursing staff will observe the
penis after the procedure to be sure there isn’t excessive bleeding or signs of other complications
o Describe care of uncircumcised penis: never retract a newborns foreskin. Cleanse the penis with
mild soap and water. The foreskin can be retracted when the natural adhesions decrease around 3
years of age
L&P, p. 746-751
10. In preparation for going home after my baby’s birth, I have reviewed the “Information and Skills
Checklist for Going Home” which is in You, Your Baby & Us (p. 46-48)
ABOUT BUILDING EMOTIONAL ATTACHMENTS
11. I have the information and help I need to deal with my emotions and feelings about pregnancy
 Hormonal shifts continue to influence psychological state.
 Emotional changes continue this trimester
 During the 3rd
trimester, mom may have increased apprehension about motherhood, her baby’s
health and about impending labor and birth

9. Third Trimester 9
 She may have more dreaming and fantasizing about the baby
 Weariness of the pregnancy may occur, and mom is ready to be done being pregnant
 May become absentminded
 May become irritable and oversensitive
 May become impatient and restless
 May become excited that the baby will be here soon
 Talk to trusted friend or relative, partner
 Talk to health care provider if you need additional assistance; referral to social services or a mental
health facility may be appropriate
L&P, 398-402, 431-434
12. My partner and I have the information and help we need to deal with our adjustment to pregnancy
 Mom may begin “nesting”
 Mom may need help in identifying anxious or stressful conditions
 Partner adjustment to pregnancy
o Feeling left out
o Attend monthly visit with spouse
o Participate in exercise with wife, give up junk food, stop smoking, and give up alcohol with
wife
o Attend childbirth classes with wife also father to be class.
o Couvade behaviors: partner experiences health symptoms similar to what the mother is
experience
 Spouse mood swings
o Patience, not a permanent condition
 Talk to health care provider if you need additional assistance; referral to social services or a mental
health facility may be appropriate
L&P, p. 402-405
13. I have information about my baby’s growth, development, and behavior both before and after birth
End of 7th
month:
o ~ 3 lbs.,
o fat begins to deposit
o may suck thumb, hiccup, cry
o can taste sweet/sour; responds to stimuli, pain, light, sound
o fetus born between 28 – 31 wks has immature lungs; but has a good chance of survival out of utero (with NICU
support)
L&P, p. 344
End of 8th
month:
o ~ 18 inches, ~ 5 lbs.
o growth is great; weight gain is steady
o can see, hear; most systems well developed
o lungs still immature
o excellent chance of survival out of utero
L&P, p. 344
End of 9th
month:
o Lungs mature
o adds 2 more inches and 2.5 more lbs.
o space is more confined; may be less active
o subcutaneous fat builds
o skull is fully developed
o both testes have descended in the male
L&P, p. 344

10. Third Trimester 10
Newborn Behavior ~ Six Behavioral States
o deep sleep – few jerky movements, rhythmic breathing, difficult to arouse
o light sleep – REM, varied breathing, may be able to arouse to wakeful state with stimulation
o drowsy – sluggish, may open eyes, may be able to arouse to wakeful state easily
o alert – awake, quiet
o active alert – moves entire body in response to stimuli
o crying
L&P, p. 698
14. I have information about how to comfort and console a newborn baby
o feed/burp
o change diaper
o check clothing for comfort/warmth
o swaddle baby
o hold baby close to chest so baby can hear heartbeat
o rock baby
o walk with baby
o decrease environmental stimulation (lights low, decreased noise)
o try a baby swing
o play soothing music
o let baby listen to the sound of running water
o baby massage
o Place in car seat and go for a car ride
o Try a stroller ride
L&P, p. 770
15. I have information about preparing my other children for a new baby.
o Multiple ways to prepare siblings for a baby: sibling classes, visitation on the postpartum unit, reading
books about babies, attend prenatal visits, involvement in the preparation for baby, feeling the baby
kick, talking about what the baby will be like
o Other suggestions:
 Talk about the baby as “our baby”
 Let older child help pick name, make birth announcements, choose baby’s homecoming outfit
 Talk about what a baby does: won’t smile, can’t talk, no teeth, different “belly button”
 Make major room changes far in advance of the birth, especially if you plan to use the older
child’s crib, room
 Make arrangements for who will care for the older child while you are in the hospital
 Prepare child that you will be away from them a few days
 Consider a gift exchange between the older sibling and the baby
 Purchase some inexpensive gifts for the older child so s/he won’t feel left out when visitors
bring gifts to the baby
L&P, p. 405, 461-462, 580, 674-675
ABOUT PROVIDING A SAFE ENVIRONMENT FOR ME AND MY BABY
16. I know how to use a seatbelt during pregnancy.
o Always wear seatbelt
o Lap belt snug across upper thighs, under growing belly
o Shoulder strap positioned between breasts
L&P, p. 428
17. I know that tobacco, street drugs and alcohol are harmful during pregnancy and should be avoided.
o Avoid alcohol during pregnancy (Fetal Alcohol Syndrome)

11. Third Trimester 11
o Quit smoking; or at the least, cut down since tobacco use effects are dose related (SGA, apnea, SIDS,);
second hand smoke dangers
o Avoid street drugs ~ harmful effects to growing fetus, miscarriage, early birth
L&P, p. 430, 964-967
18. I have reviewed with my caregivers the drugs/medication I take to determine what is safe to take during
pregnancy (Ask patient what medications she is taking and have physician aware of the medications so s/he can
describe side effects, teratogens with use during pregnancy.)
19. I know that I should avoid using hot tubs and saunas during pregnancy.
o Refrain from long stays in hot tub
o Anything that raises body temp over 102 degrees is potentially dangerous to baby
o It usually takes about 10 minutes for body to raise to high temps
o Recommend keeping belly out of water; soak feet & legs
o Most U.S. experts recommend avoiding the sauna
20. I have information about finding and choosing infant day care
o Consider who & where you want your baby to be cared for (your home, friend or relative home, licensed
day care provider, day care facility)
o Ask for recommendations from friends
o Question the staff-child ratio
o Consider nurturing qualities of caregivers, consistency of staff
o Safety and cleanliness of the facility
o Schedule of activities: nap, eating, outdoor activity, structured play, etc.
o Ask for references
o Visit your prospective care provider during the hours you would need to leave your baby there
21. I have made arrangements to have an approved infant car seat for my baby
o Car seat program: 734-764-6893 (8a – 5 p, M – F)
o State law requires baby to be in a car seat when transported in automobile
o Infants should be placed in a rear facing seat
o Safest place is in the middle of the back seat
o Practice securing the seat without the baby in it!
o Follow manufactures instructions for securing seat to auto seat belt
o Harness should fit snug; on a newborn, shoulder straps should be in lowest slots; retainer clip should be
level with armpits
o Do not put the baby in a seat equipped with an air bag
o For additional information contact the National Auto Safety Hotline: 800-424-9393
L&P, p. 789, 793, 796, 797
22. I can identify the following problems (danger signs) and report them to my care provider:
a. Persistent, severe vomiting lasting more than 24 hours (hyperemesis, dehydration)
b. Vaginal bleeding, with or without pain (miscarriage)
c. Burning, pain and/or bleeding when I urinate (UTI)
d. Temperature about 100.6 degrees F (infection)
e. Abdominal pain, or painful and persistent abdominal cramping
f. Severe, continuous headache (pre-eclampsia, migraine)
g. Changes in eyesight, such as blurred vision or seeing spots (pre-eclampsia, migraine)
h. Consistent, persistent heartburn-like pain (pre-eclampsia)
i. Sudden swelling of my face & hands; weight gain > 5 lbs/wk ( pre-eclampsia)
j. Decreased or absent fetal movement
k. Trauma
L&P, p. 438-439, 817-818, 870-872, 874-876
23. I can identify resources/help for protecting my physical and emotional safety.

12. Third Trimester 12
 Questions to screen for abuse (If she answers “yes” even once, her partner is abusive!):
o Does your partner put you down and make you feel ashamed?
o Does your partner tell you what to do and who you can see?
o Has your partner ever threatened to hurt you or your family?
o Has your partner ever pushed or hit your, or forced you to have sex?
 Should screen with each visit. Pregnancy puts women at increased risk for domestic violence
 Places to call for help:
o The Domestic Violence Project/SAFE House (Washtenaw County) ~ 24 hour crisis line number is
734-995-5444
o The UM Sexual Assault Prevention and Awareness Center ~ 24 hour crisis line number is 734-
936-3333
o LACASA (Livingston County) ~ 517-548-1350
o National Domestic Violence Hotline ~ 1-800-799-7233 or 1800-787-3224 (TTY)
o Women’s shelter ~ 734-665-6955
L&P, p. 112-114, 152
24. I have made arrangements for help at home after I deliver
o Support from extended family, the father of the baby and friends can be associated with feelings of
competence and decreased stress
o Sometimes social networks can be a source of conflict
o Encourage mom to accept all offers of help; especially with household chores, laundry and meal
preparation
o Provide anticipatory guidance: is father of baby able to be home for a week or two to help out
during the initial adjustment period?
L&P, p. 637, 670-671
Lowdermilk, D. L., & Perry, S. E. (2004). Maternity & women’s health care (8th
ed.). St. Louis, MO: Mosby, Inc.
(L&P, abbreviation for citing in above text)
The Regents of the University of Michigan. (2003). You, your baby & us. Ann Arbor, MI: Women’s Health
Program. (YYB&U, abbreviation for citing in above text)
Prepared by Trudy Esch, MS, RN
Spring 2003
Revised by Linda Hawkins, RNC, BSN [LMH]
Fall 2004

13. Third Trimester 13
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