Welcome to the third trimester! The flutters have turned into strong kicks and your midwife or doctor is now able to assess "which end is up." Your baby's bones are well calcified so his fetal back, butt and head are fairly easy to palpate now. Never mind if baby is breech at this point. Although most babies start out head down and stay that way for the duration of the pregnancy, a breech presentation would not be of concern until 36 weeks. At that time, if baby is still in a head-up presentation, your care provider may request that you come in for an ultrasound and "version" (a procedure to turn the baby in your uterus from the breech position to the head-down vertex position). If baby has his feet up near the ears or crossed on his abdomen and there is lots of fluid and the placenta is not in the way, you may be a candidate for an external cephalic version if your baby is still breech at 36 to 37 weeks.
Bracing to Enter the World
The goal of a fetus in the last trimester is to gain muscle and fat so adaptation to the outside world will involve the least amount of risk and energy. Brain development continues; the wrinkles (convolutions) are getting deeper in order to maximize development of the optimal number of cells. This is no time for mothers to be smoking, cheating on their diets or using mind-altering chemicals or drugs. Baby needs the very best in nutrition, with an emphasis on protein. Maternal intake of protein should be about 60 grams per day. Sources of protein include meats, dairy products, nuts, soybeans, whole grains and beans.
Baby is now a very active and interactive member of the team. The brain is now regulating processes within the tiny body, such as "breathing" (amniotic fluid is "inhaled" and "exhaled"), exchanging oxygen, removing waste products and pumping blood. Hormone production is in full swing, and soon the delicate interplay of maternal and fetal hormones will signal the onset of labor. You may notice distinct sleep and wake cycles now as the baby's neurological system is becoming more mature. Your care provider may recommend "fetal kick counts" starting in this trimester. It is good to observe patterns of movement and notify your doctor or midwife if you notice any change. A healthy baby should move quite a bit when awake.
At your 28-week visit, you may be asked to have an iron (hemoglobin) check and an antibody titer, and, if you are Rh-negative, a shot of Rh o (D) immune globulin (RhoGAM) will be given. Your one-hour glucose challenge results will be discussed. If you were asked to do the three-hour test and this has confirmed gestational diabetes, you will be eating a special diet by now. Such attention to calories and nutrition will safeguard the baby from gaining excess weight. This glycemic regulation will prevent maternal and fetal trauma during the birth and reduce the risk for cesarean birth. Recent research also demonstrates that if the mother is able to keep blood sugars well regulated, baby and the child and adult he will become will have a decreased risk of obesity and becoming diabetic.