I am officially full-term in my pregnancy (the clinical definition of full-term is now 37-42 weeks gestational age) so I thought I might as well go ahead and write about trimester three. Partly because it could end essentially at any time now, and partly because I have more aggravations I need to vent.
Myths and Expectations?
I don’t know that I have any tri-3 myths to bust. Pretty much everything that I was warned about has happened:
- my back hurts all the time no matter what I do or what position I am in.
- I sprout cankles if I wear the wrong pants, wear the wrong shoes, or stand or sit for too long. (I thought I might be one of the lucky 30% who dodges that bullet since I got to 36 weeks without foot swelling, but no. Weirdly–OR IS IT?–the only thing that seems to make it go away is a cocktail or two. Maybe it’s coincidence, because a tittle is timed with putting my feet up at the end of the day…but putting my feet up alone doesn’t seem to work. My guess is it’s a relaxation of the blood vessels/my nerves thing, but what do I know? I’m no doctor. And the only thing the internet says on the matter is to avoid alcohol because it will dehydrate you, and dehydration makes edema worse).
- My heartburn is out of control.
- My stomach has hit the point of diminishing capacity, where what used to be a normal meal feels like Thanksgiving gluttony and what used to be a snack is now a meal.
- I have started waddling rather than walking, that charming rolling step you do like you’re on the deck of a ship, only it turns out the ship is you.
- At least the only time I feel miserably huge is getting out of bed. That’s hard and, perhaps oddly, the time I most feel the extra weight I am carrying (in the mirror I have done a good job of not putting on much weight but baby and perhaps even losing some fat, but by the scale I am 10+ pounds over what I “should” have put on at the end, much less with 2-4 weeks to go).
- I am exhausted all the time again, almost as badly as I was during the first trimester
- I feel nauseated on a regular basis…like the thought of eating turns my stomach, even when I’m hungry. It’s a different sort of nausea than the first trimester brought, and just feeling “off my feed” is better than feeling carsick all the time, plus this comes and goes.
- Everything south of my waist hurts all the time. If you’ve heard about the “punched in the pussy” feeling…it’s real. Apparently it’s the pubic bone shifting apart/loosening up. I have been blessed with either progressively stronger Braxton Hicks contractions or an extended podromal labor because I’ve had what amount to period cramps for hours on end every day for the last week or more. They aren’t labor pains – I can sleep, talk, work through them, and they are neither occurring in a regular pattern nor getting worse – but they are noticeable enough to make me irritable and distracted.
- I never thought I would be one of “those women” who talks about just being ready for pregnancy to be over, but…I am. Sleep is torture, because there are no comfortable positions, but so is being awake because I have to go about my normal life in mild pain and physical exhaustion. Yeah. Baby can come any time. I’m ready.
The worst part about the end of pregnancy is the insufferable number of visits to the OB and, if you have any sort of “complication,” other support centers. The regular pattern is every 2 weeks from 28-34 weeks and then every week from 35 to the end of pregnancy. For me, having the “high risk” diagnosis of gestational diabetes, the added fun of twice-weekly fetal non-stress-tests (NSTs) was added around week 36. (In a way I have to count myself lucky – some OBs want NST’s done twice weekly from 32 weeks on with GD, or as soon as the condition is diagnosed. God forbid.) The NST center wanted to do an ultrasound every week, as well, which I declined. I am not comfortable having 8+ ultrasounds in one pregnancy, for no good reason (because I am already being monitored so often for fetal movements). IF the NST shows something is abnormal, then an ultrasound is medically indicated and appropriate. I don’t consider multiple precautionary ultrasounds an appropriate course of treatment…especially since they would also tell me (and the doctor) weight estimates of the baby.
The problem I have with the weight estimates is this: they are off by up to 2 pounds in BOTH directions. The u/s estimate is more or less right about a third of the time – AKA the same statistic the doctor would get if s/he were to just guess “small, regular, or big” for each baby. The reason this is problematic is that doctor’s perception of a baby’s size influences their risk assessment/decision-making process in delivery. A woman who is suspected of having a large baby (even when it turns out the baby was not large at all) is more likely to be diagnosed with failure to progress or a too-narrow pelvis and whisked off for an “emergency” c-section than a woman who is assumed to have a normal sized baby (even when it turns out the baby was very large). Since one of my goals is avoiding a section, obviously, I also want to avoid any fodder for the doctor’s fears that my baby will be macrosomic.
This avoidance stems directly from a series of appointments in which my doctor harped on the dangers of delivering big babies and stressed me out to the point of tears over it, because I felt like she was assuming that JUST because I have GD I would automatically have a big baby and that, by her emphasis on it, she would react poorly to any hiccup or stall in labor. While the reality is that I have a higher chance of a big baby because of my GD (apparently even seemingly controlled GD can result in a fat baby), it’s not a guarantee and statistically unlikely. Even with a big baby the chance of shoulder dystocia during birth is, again, statistically unlikely. I brought her a family history from my mother’s side, showing where she and her many sisters delivered all their many babies – a good third of them pushing 9 pounds – vaginally and with no complications. This was also the appointment where we went over my birth plan and I included a note about being familiar with the maneuvers to get a baby unstuck, and after that appointment the OB hasn’t really brought up the big baby thing again. Maybe it’s because that list was a reminder that she assessed me in the beginning as having “birthing hips” (very wide pelvic opening) and that women in my family have no problems with bigger babies, maybe it’s that she is certain I understand the potential risk now, or maybe she just remembers we’ve talked about it now whereas for some of those appointments she forgot that she’d already brought it up. I do feel like, based on our conversation around my birth plan, that we are on the same page and she will not be one of those doctors who panics if the baby seems “stuck” so that is also reassuring.
Anyway, all of this stress and worry and emphasis on my GD has led me to some interesting places in terms of how I view obstetric care. Basically, it seems to me that there is a very real attempt on the part of the medical establishment to pathologize pregnancy – to take it from the realm of a natural process with countless and not-always-understood effects on the mother to a clinical chart, any deviation from which constitutes a problem that must be addressed medically.
For example: There is an interplay between anemia and gestational diabetes. Specifically, mild anemia can sometimes help keep blood sugars in check. So perhaps some explanation for the rising rates of GD is that women are now routinely given (or told to take) prenatal vitamins with iron, and prescribed extra iron if their blood iron level slips below the non-pregnant clinical definition of “normal.” Perhaps during pregnancy women are supposed to be a little bit anemic to help offset some of the effects of the placenta on insulin and blood sugar. If iron levels are artificially boosted back to non-pregnant levels, then the pregnant mother loses the protection afforded by her natural body chemistry. Therefore, treating the lowered iron level as a problem that needs to be addressed actually creates more problems by interfering in the natural bodily processes of gestation.
Obviously the above is just my own speculation, but it makes sense to me that interventions create more problems than they solve…especially when it’s not clear that what’s being “solved” is a problem in the first place. I’ve talked to my mom about when she was pregnant, and they had never HEARD of all the conditions that are routinely diagnosed now, nor was pregnancy monitored so closely, nor was any deviation from “normal” AKA non-pregnant body chemistry considered some sort of fucking crisis. How did the human race survive without all these tests? Oh, what’s that? Because it’s a natural goddamned process that even now most doctors don’t really understand all the effects and intricacies of? What needs to be observed and then treated from are normal pregnancy parameters, not pregnant vs. non-pregnant parameters.
But, hey, the doctors are doing a booming business, and so are the testing services that monitor all these “problems” and so are the pharmacology companies that sell the pills to correct the problems, so who cares if any of it’s truly necessary? If it saves one child it’s worth all the expense and stress and fear that are paid out by the mothers-to-be…right? RIGHT?
Another interesting aspect of GD I have found is who is more at risk for getting it (aside from women who already have diabetes before pregnancy): Asians, Pacific Islanders, Native Americans, Eskimos, and Hispanics (presumably many/most of whom are descended from some of the native peoples of Central/South America). Basically…any ethnic group that is more closely associated with the Mongoloid subgroup of humans. The reason this is interesting to me is because of a book my husband read (and told me all about) that discussed genomic differences between population groups across the globe. One point he made was to posit that the book of Genesis wasn’t actually wrong to say that childbirth became harder for women as a result of knowledge…that changing from a hunter-gatherer wandering society to permanent establishments with farming and a grain-based diet actually changed human physiology. Many of the women who have easier labors and deliveries tend to come from the groups that did NOT experience that physical structural change – AKA all the “native” nomadic peoples like the American Indians and the Mongols, and subsequently the parts of the general populations who descend from them. My mother is from Finnish Laplander stock (basically the Finnish Eskimos) so perhaps that explains why her family make such excellent birthers. It would also put me in a category of elevated risk for GD…that is easily mitigated by ignoring the Western grain-based diet in favor of meat and plants.
I also want to touch on the ridiculous and contradictory advice that gets distributed to pregnant women by the medical establishment. The one that got to me was the weight thing. One of the most common things pregnant women are told is not to try to lose weight while pregnant. BUT when you are told that you should only put on X number of pound – a number that is sometimes lower than the actual physical weight of baby, placenta, amniotic fluid, etc., how are you NOT supposed to lose weight even if the aggregate is a gain? Or, in my case, the diabetes center told me when I was first diagnosed that based on my pre-pregnancy weight and where I was then (32 weeks) that I shouldn’t put on any more pounds for the rest of my pregnancy. You know, during the third trimester when the baby is putting on approximately 1/2 pound per week. So…how was I supposed to avoid putting on weight if I was not also losing weight off my own body to balance what my baby was putting on? How is that not contraindicated? Do you think I am innumerate? Do you think I do not know how to do math, and how to balance equations? Do you think I do not consider these things when examining the medical advice given to me? I am sure every woman gets told equally asinine things to do/not do that, in conjunction with other medical edicts, become completely contradictory. So which are you supposed to follow?
I’ve chosen to do what feels right for me, which is to continue to eat normally, for the most part avoid junk and overeating, and let my body put on what it will. I actually think I look small for 8 1/2 months based on my overall frame and how big I THOUGHT I would get, so even if the scale says I’m a fat pregnant cow, the mirror exposes the lie.
I also want to get into the social aspects of late pregnancy, but this has rambled on long enough so that will be a separate post….