Are you having back pain with any of the following?
We understand that you are experiencing one or more of the health issues that might be impacting your back pain.
We recommend that you discuss these health issues with your doctor before proceeding with this program.
Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.
We offer many resources to help you and your partner prepare for your baby. Learn about what to expect during and after pregnancy including labor and delivery, breastfeeding, and when to call us.
During the third trimester of pregnancy, from 28 weeks of gestation until your labor and delivery, both you and your baby are going through big changes. The baby is growing and changing in preparation for the transition into the real world. You are changing, both physically and emotionally, to prepare for labor and delivery, and the transition to breastfeeding and caring for your newborn infant. We are here to help you make these transitions safely and smoothly.
As you start your third trimester of pregnancy, your baby weighs 1 to 2 pounds and is 8 to 14 inches long. In this trimester, your baby will gain more than three-quarters of its total birth weight.
The first few weeks after birth are exciting and challenging for both parents and the newborn, who is working hard to achieve a rhythm in his or her new life. We are here to help you make a successful adjustment to being a new parent.
During your pregnancy, there are many kinds of prenatal tests that can help you learn more about your baby's health. We can discuss your options and decide which tests might be a good option for you.
These are tests that we recommend for all pregnancies to check the health and development of your baby. These routine prenatal tests are safe for you and your baby. During your third trimester we may recommend tests for:
We will also recommend a RhoGAM shot if you have an Rh-negative blood type. We do not routinely offer an ultrasound test during your third trimester of pregnancy, but we may recommend one, based on a special medical need.
To protect your newborn from whooping cough, we also recommend that you receive the Tdap vaccine during each pregnancy, preferably between 27 and 36 weeks. The vaccine is safe for pregnant women. Even if you have already been vaccinated for Tdap, we recommend that you have the vaccine again during the end of your pregnancy because it transfers additional protection to your baby.
Certain blood tests can help you find out if you have a higher or lower chance of having a baby with certain birth defects, but they can't make a definitive diagnosis. These are optional prenatal tests, and are safe for you and your baby. Serum-integrated screening, sequential integrated screening, and quad tests are examples of optional screening tests. These tests are most effective when done at a certain stage of fetal development. Depending on which trimester you are in, we can discuss which screenings available for you.
While there is no test that can detect all potential problems, these tests can diagnose certain kinds of birth defects. Prenatal diagnostic tests are more invasive than other prenatal tests, and there is a very small associated risk of miscarriage. Some women choose diagnostic tests based upon their family history, or their age during their pregnancy. Examples of diagnostic tests are amniocentesis and chorionic villus sampling.
Breast milk is the perfect food for your baby. There are many health benefits for you and your baby. According to the American Academy of Pediatrics, breast milk is the only food that your baby will need during the first 6 months of life. We recommend that you continue to breastfeed your baby for up to 1 year if you are able to. Even after you introduce solid foods, you can continue breastfeeding for as long as you wish.
Breastfeeding decreases your baby's risk for many types of infections and allergies. Benefits include:
Benefits to you may include:
There are rare medical conditions where breastfeeding is not advised. We can talk further if this applies to you.
You and your baby will be more successful at breastfeeding if you are prepared. You can begin preparing now and continue throughout the last weeks of pregnancy. Suggestions for how to prepare include:
Take a class, read a book, or read our article on breastfeeding for more information. Talk to women who've had successful breastfeeding experiences. Remember, breastfeeding is a learned skill and takes practice.
To locate classes near you, search our health class directory or contact your local Health Education Center or department.
Breastfeeding does take time, but it is time well spent. You're giving your baby the best possible food, holding your baby close, and making a strong connection. Breast milk is the best food for your baby and has all the nutrition your baby needs for the first 6 months of life. The longer you breastfeed, the greater the benefits will be for you and your baby.
Get phone numbers of hospital lactation consultants, your local Pediatric Department, or members of your local La Leche League. Have these numbers ready so you can call after you and your baby go home from the hospital. For breastfeeding questions, call the 24-hour helpline at 877-4-LALECHE.
Expressing and storing your breast milk allows you to get extra milk from your breasts that can be given to your baby when you're not there.
All new mothers will need help in the beginning, so ask your friends and family to plan to help out. After the baby arrives, they can assist with meals, shopping, and the care of older children. This will allow you to spend plenty of time with your new baby.
Parents choose to feed their babies formula for a variety of reasons. You may even decide to breastfeed your baby while using an occasional bottle. It's important to explore all of the issues related to how you'll feed your baby.
You can choose from 3 types of formula:
Your baby's pediatrician may recommend a specific brand of formula and tell you whether to sterilize or simply wash the bottles and nipples. Many women find that a dishwasher thoroughly cleans both if they are first scrubbed with a brush. Always check the expiration date and preparation instructions before you make your baby's formula. Follow the directions exactly.
Pregnancy hormones cause the digestive tract to relax and function more slowly, which can cause constipation. As your uterus enlarges, this can also cause constipation. What you can do:
Heartburn (sometimes also called reflux) is caused by stomach acid coming up into your esophagus (the tube connecting your mouth to your stomach). Heartburn during pregnancy is caused by a hormone which relaxes the stomach sphincter that keeps the acid out of the esophagus. This same hormone causes a delay in stomach emptying so that more acid builds up. What you can do:
If your heartburn is still a problem, please let us know. There are prescription medications that you can use.
You've probably noticed how easy it is to get off balance and feel very clumsy. This is due partly to a pregnancy hormone called relaxin that softens the cartilage in your joints and pelvis. This is responsible for the pregnancy waddle that most women have when they walk. It's also a result of your center of gravity moving forward as your baby grows. Your baby should be fine even if you fall or bump yourself because a protective cushion of warm amniotic fluid protects the developing child. What you can do:
If you fall, you should call Labor and Delivery right away to see if you should come in to be evaluated.
As pregnancy progresses, leg cramps, breathlessness, contractions, the frequent need to urinate, and an active baby may all interfere with your sleep. You may need to try various options in order to find a comfortable position. What you can do:
Lying on your side is better for you and the baby now that you are in your third trimester. When you are lying on your back, the weight of your uterus and your baby rests on the vena cava, the largest vein in your abdomen. When there is pressure on that vein, your blood pressure can go down and you may feel dizzy or light-headed.
Leg cramps are common in mid to late pregnancy. They usually occur late at night and may wake you up. They may be caused by the pressure of your enlarged uterus on the nerves or blood vessels in your legs, from lack of calcium, or occasionally from too much phosphorus in your diet. What you can do to prevent leg cramps:
What you can do to relieve leg cramps:
As your baby grows, your pregnancy hormones can trigger changes in your skin. These changes should fade away after your pregnancy. These skin changes are not usually treated during pregnancy. If you're worried, talk to us about your concerns.
Your baby may settle into a position that is very uncomfortable for you. Your baby's kicks and twists can be strong and sometimes painful. When your baby drops into the pelvis (called lightening), the kicks will probably be less uncomfortable. If you are having your first baby, lightening can occur several weeks before delivery. For subsequent babies, it usually doesn’t happen until just before labor. What you can do:
Sharp, lower, midline pain is sometimes caused when a joint at the front of the pelvis (symphysis pubis) relaxes in response to pregnancy hormones. You may feel pelvic pressure or pain if your baby's head is low in the pelvis (after lightening occurs). You might have groin discomfort as the round ligaments that support the uterus continue to stretch. What you can do:
As your growing uterus puts pressure on your bladder, you might notice that you leak urine when you laugh or cough. This is common and is called stress incontinence. What you can do:
If you leak enough to need a pad, you might have a leak in your amniotic sac, often called your bag of waters. Call us right away to discuss this.
You may notice that your feet, ankles, hands, and fingers will become swollen, particularly at the end of the day. It's normal to have extra fluid in your tissues during pregnancy. What you can do:
Varicose veins are visible, enlarged blood vessels in your legs. Your calves may ache or throb, even when the veins aren't visible. Most varicose veins will shrink or disappear after birth. What you can do:
Hemorrhoids (dilated, twisted blood vessels in and around the rectum) are common, especially in the last months of pregnancy when the uterus is pushing constantly on the rectal veins. Hemorrhoids can cause pain, itching, and bleeding during a bowel movement, but usually improve without treatment shortly after birth. What you can do:
As your pregnancy progresses, your posture changes to accommodate your expanding uterus, and lower backaches often result. The pelvic joints loosen under the influence of hormones, so they are less supportive. Your lower spine curves more, which might strain your lower back muscles. What you can do:
During pregnancy, you breathe more air in and out of your lungs. Sometimes you may feel as if you can't catch your breath. This feeling comes from your uterus pressing up on your diaphragm and crowding your lungs. Relief usually comes when your baby settles into the pelvis. What you can do:
If you experience sudden, severe shortness of breath with rapid breathing, a rapid pulse, and chest pain, or if you have any blue color around your lips or fingernails, call 911 and get medical help immediately.
The third trimester is the time during pregnancy when we all look forward to the next exciting development: the amazing birth of your baby! There is so much to do to prepare for this arrival and we want this to be a healthy, safe, and beautiful experience for you and your family. The following information may be helpful in knowing what to expect:
After 24 weeks, please call Labor and Delivery if:
During your third trimester, I’ll recommend that you make an appointment to see me each month. Closer to your due date, I’d like to see you every 1 to 2 weeks.
If it is past your due date and you have not started labor, I’ll arrange for fetal monitoring and other appropriate post-term monitoring to ensure that you and your baby are in good health.
I will perform an exam to evaluate your health and the health of your baby. I will test for Group B strep and check for fetal position at around 36 weeks. If you haven’t already attended a childbirth preparation or infant care class, my staff or I will invite you to register.
Subscribe to our Healthy Beginnings newsletter. The newsletter is delivered to your e-mail inbox every week of your pregnancy, and it has information and answers to common questions as your pregnancy progresses.
The following online Emmi programs may help you as you approach your due date:
You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.
Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.
Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay current on your health status and to collaborate with each other as appropriate.
When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.
We will work together to monitor and assess how your medications are working and make adjustments as needed. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.
If refills are needed in the future, you can:
For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.
My specialty colleagues are readily available to assist me if I need additional advice about your condition. In some cases, I may contact them during your visit, so we can discuss your care together. If we decide you need a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.
As part of our commitment to prevention, additional members of our health care team may contact you to come in for a visit or test. We will contact you if you are overdue for cancer screenings or conditions which may require monitoring.
As your personal physician, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.
My Doctor Online is available 24/7 so that you can access and manage your care where and when it is most convenient. From my home page you can:
If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.
This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.