In your third trimester, usually between weeks 35–37, your doctor will take a sample from your vagina and rectum to check for Group B streptococcus (GBS). While GBS does not usually pose a health danger to you, it can be passed to your baby during birth and can cause a serious infection. If you test positive for GBS, you will be treated with antibiotics during labor to help prevent the bacteria from being passed to your baby.

From 36 weeks and on, you will have weekly prenatal visits to Clinic Sofia. This weekly visit will include a cervix check to see if your cervix has softened, effaced (thinned) or dilated, or if your baby’s head is dipping into your pelvis.

During your pregnancy, we will discuss fetal movement at each clinic visit. First-time moms usually feel the baby move at 19–20 weeks. For subsequent pregnancies, moms might feel the baby move earlier.

Generally, by 28–30 weeks the baby has a pattern of movement between sleep periods. Paying attention to and counting baby movements will help you notice any changes and may serve as an early warning for fetal problems.

To count movements, choose an hour when the baby is active. The baby should move ten times during a busy hour. If the baby hasn’t moved or has moved only minimally all day, call Clinic Sofia for further testing.

The Rh factor is a type of protein on the red blood cells. Most people have an Rh factor, or are Rh positive. If your blood lacks the Rh antigen, it is Rh negative. A blood test performed during your pregnancy will determine if you are Rh positive or negative. While the Rh factor does not affect a person’s general health, it may cause problems during pregnancy in Rh-negative women who are carrying an Rh-positive baby. To prevent problems, Rh-negative women will be given Rhogam or Rh immunoglobulin around the 28th week of pregnancy.

When their water breaks, some women hear a pop with fluid leakage, and some find they have fluid running down their legs after emptying the bladder. It may be hard to tell if your water has broken so we recommend putting on a pad and walking around to see if more fluid releases. If in doubt, call Clinic Sofia. If the leaking fluid is discolored, such as red, brown or green, call Clinic Sofia right away.

When in labor, keep an open mind about pain medication. You have a choice of IV narcotics, an epidural or a walking epidural (ITN). An epidural can help labor advance by relaxing the muscles of the pelvis and speeding dilation. The ITN lasts about two hours, making it a good option if your labor or delivery is short. Some women find that IV narcotics help to take the edge off of contractions but don’t last. Some say it causes their minds to be fuzzy.

As members of your birth team, our goal is to help you find the most comfort while looking out for the safety of you and your child.

As you await the arrival of your baby, you can make some final preparations to help your labor go more smoothly. Most families take a birth class to learn what will happen during the hospital stay. Discuss the following with your health care team:

• When should I call my doctor? Who do I call if it’s after office hours?
• Should I go directly to the hospital or call the office first?
• Are there any special steps I should follow when I think I’m in labor?

• Distance and time to the hospital, including during rush hours
• Your transportation to the hospital
• Home arrangements for other children, pets, etc.
• Work arrangements

In preparing a birth plan, consider:

• Who you want in the room during delivery
• Whether you will use pain medication during labor
• Whether you’d like to begin breastfeeding right away or later or if you’d prefer to bottle feed
• If it’s a boy, whether you’d like to have him circumcised
• Whether you’d like to have the baby vaccinated

Signs that you are approaching labor:

• Lightening is a feeling that the baby has dropped lower. This means the baby’s head has settled deep into your pelvis and labor may begin anywhere from a few weeks to a few hours.
• Bloody show is an increase in vaginal discharge that is clear, pink or slightly bloody. This happens when the thick mucous plug that has accumulated at the cervix is pushed into the vagina as the cervix begins to dilate. It can happen several days before labor or at the onset of labor.
• Water breaking is a discharge (can be a trickle or a gush) of watery fluid from your vagina. It means that the fluid-filled sac surrounding the baby has ruptured. This can happen several hours before labor begins to any time during labor.
• Contractions include a regular pattern of pressure in the vagina, discharge and pain moving from the front to the back or vice versa. This indicates the onset of labor. During contractions, the uterus tightens, causing the abdomen to become hard. Between contractions the uterus relaxes and becomes soft.

There are many reasons why a cesarean birth may be used to deliver your baby. It may be the best approach for you and your baby, or it may be planned in advance when certain conditions are known. In some instances, the decision is made during labor. After a cesarean, most women stay in the hospital for 2–4 days. It may take a few weeks for your abdomen to heal and you may experience symptoms such as cramping, bleeding or pain at the incision. It is important that you allow yourself time to recover before returning to normal activities.

All deliveries for Clinic Sofia patients are done at Fairview Southdale Hospital. During your third trimester you will need to pre-register for your delivery and hospitalization through Fairview Southdale Hospital.

Picking a pediatrician is a big decision. You will likely partner with the doctor in your child’s care for the next 18 years or more. We recommend our patients start looking for a family doctor or pediatrician during weeks 28–36 of your pregnancy. Family members and friends are often a good place to find a referral, or you can contact us for our recommendation.

You can get a good feel for a doctor’s office by setting up a new patient appointment to meet the doctor. Before the meeting, create a list of questions you’d like to ask.

Afterwards, decide if you felt listened to and able to communicate openly with the physician. Think about the general atmosphere—how the office looks, how you were treated and how the staff operates—and decide if it meets your needs.