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Third trimester visit

During the third trimester, you will be seen every 1-2 weeks. During this time, we will be monitoring your blood pressure, watching your weight gain, and assessing you for signs of labor. You and your partner should be preparing for the birth process.

Make sure you have signed up for prenatal classes and/or a tour, chosen a pediatrician and have everything ready that you need for baby. We will discuss options for pain control during labor. If you would like to follow a birth plan for labor, please bring this in for your physician to review with you. If you are going to have a scheduled cesarean section, we will schedule it for you.

Working while pregnant

Most women can continue to work safely up until the time of delivery. This depends mostly on the woman, the type of work that she does, and any complications of pregnancy she may be experiencing. In general, we recommend taking breaks every couple of hours, drinking plenty of fluids, and varying work positions. It is safe to continue some lifting during pregnancy. If you are exposed to chemicals or potentially dangerous substances during pregnancy, please consult with your physician.

Choosing a pediatrician

There are many excellent pediatricians throughout the Charlotte region who are accepting new patients Friends and family with children are good references as is your physician.  Many pediatric groups, like South Park Pediatrics, will meet with you during pregnancy to educate you about their office. For more information about Novant pediatricians in the area, click here.

Signs and symptoms of labor

If you are in your last three weeks of pregnancy, you are considered full-term. When you have regular, painful contractions every 3-5 minutes that have persisted for an hour, you may be in labor. Please contact us for evaluation. You should also call if you think your water is broken, even if not contracting. Also call if you have vaginal bleeding more than scant spotting or if your baby is not moving well.

Cord blood banking

Umbilical cord blood is a rich source of stem cells that has been used to treat a variety of genetic and hematologic (blood) disorders. There are benefits to the use of cord blood as a source for stem cells as opposed to sources such as bone marrow. Due to recent advances in stem-cell transplantation, there are now many for-profit and not-for-profit cord blood-banking programs.

The Carolinas Cord Blood Bank is a part of the Duke University School of Medicine. It was established in 1998 and is one of the largest and most respected cord blood banks worldwide. Cord blood donated to the CCBB are listed on the National Marrow Donor Program and the Be the Match Registry. The CCBB has distributed cord blood units for several thousand patients since 1999. All physicians at Providence OB/GYN are certified in cord blood collection for the CCBB. For more information about donating your cord blood, please see the CCBB website.

A large number of private for-profit companies are available for parents who choose to bank their umbilical cord blood for directed donor use (for use by that child or for use by a family member). We recommend caution in interpreting data presented by these companies. The potential for children needing their own cord blood stem cells remains a controversial topic and there is no scientifically proven number (estimates range between a 1:1000 and a 1:200,000 range).

There is no evidence of the safety of cord blood transplants ‘self-donated’ for the treatment of malignant neoplasm and these transplants are specifically avoided in diseases such as leukemia. This remains an intense focus of research and the number of diseases treated by cord blood transplantation is certain to increase in the years to come. Diabetes, brain injury, and cerebral palsy are amongst the diseases being studied currently.

If you decide to pursue private cord-blood banking, you should be aware of the ‘fine-print’ not highlighted in marketing material:

  • While cord blood has been demonstrated to treat more than 80 diseases, most of these diseases cannot be treated with the patient’s own cord blood
  • Cord blood may most often be used for treatment of a sibling, but there is only a 25% chance that siblings will match.
  • A cord blood collection rarely has enough cells to treat an adult. Most adult transplants with cord blood are from multiple donors (usually from public banking).

If you are considering private cord blood banking, the Parent’s Guide to Cord Blood Foundation is a helpful resource in learning about the process and private banks available.

Vaccinations during pregnancy

Immunizations are amongst our greatest public health achievements. Appropriate vaccination before and during pregnancy provides the optimal protection for both you and your unborn child. Currently there are two vaccines that we will recommend during your pregnancy:

Influenza (flu), seasonal

The Flu vaccine remains an important part of your prenatal care. Pregnant women are at significantly increased risk of serious illness from influenza relative to the rest of the population. In other words, pregnant women are much more likely to become seriously ill or die from the influenza virus. They are also at higher risk of medical complications of the flu virus, such as pneumonia. Women with other medical conditions like asthma are at especially high risk.

The inactivated flu vaccine is well studied and poses no risk to your pregnancy. While numerous studies have now confirmed no risk to thimerosal as a preservative in vaccines (found in multi-dose vials), we continue to offer single-dose vials of the flu vaccine that contain no preservative.

Tetanus, diphtheria and pertussis Vaccine (Tdap)

Every pregnant woman is now recommended to have a Tdap vaccination in every pregnancy. This vaccination is for the safety of your unborn child in the first few months after birth. Children ages 0-3 months are particularly vulnerable to whooping cough. Of the roughly 2000 infants in this age range that contracted pertussis in 2012, 15 of the affected babies died from the illness. Unfortunately, most of those infections were contracted from the mother.

The optimal timing of the vaccine is in the third trimester of pregnancy. However, if you are exposed to someone with pertussis, then the vaccine can and should be given as soon as possible. Women who are not vaccinated during the pregnancy should be given the vaccine in the hospital at the time of delivery.

The CDC Advisory Committee on Immunization Practice recommends that everyone in close contact with your infant have an up to date Tdap vaccine. This concept is called “cocooning” and will further protect your baby from this infection.

If you are interested in further information about the Tdap vaccine during pregnancy, click here.

Vaccine safety

While vaccination has been our most effective tool against the spread of disease, there have been safety concerns raised in recent years. Numerous studies involving tens of thousands of children and adults have since further confirmed the safety of vaccinations. Unfortunately a lack of knowledge of the purpose, mechanism, side effects, and benefits of immunization has allowed for continued skepticism about vaccinations.

The American College of OB/GYN has a website devoted to the benefits of vaccines and their safety. If you have concerns, we encourage you to take time to review the resources below and become better educated about the safety and benefit of vaccines:

Pain control options

There are a variety of pain control options for women during labor. This is often a very personal choice for women. Some women choose to go “natural” or without analgesics, while others prefer to have an epidural.

Natural labor: This is a safe option for most women if they choose it. Women use a variety of techniques to help with the pain, including walking, different positioning, and breathing techniques. The Bradley Method is a technique some women choose to study. Some women use a doula, a nonmedical person who assists before, during, or after childbirth, when undergoing a natural labor; others use their spouses/partners as their support person.

Intravenous (IV) pain medication: IV pain medications can take “the edge off of the pain” and can be very helpful for many women. These medications can be sedating both to mom and baby and therefore we try to avoid their use immediately prior to delivery.

Epidural: This is a procedure performed by an anesthesiologist that blocks pain from the waist down. The epidural often greatly, or completely, reduces pain. Most women still have some pressure sensation at times. Once the epidural is placed, the medication is continued until the time of delivery. Because of the numbness, the woman stays in bed once the epidural is placed until a few hours after delivery. Epidurals are very safe and the risk of a serious complication is low.

For more information about our obstetric services, or to set up an appointment, please call our Providence office at 704-372-4000 or our Steelecroft office at 704-384-7900, or visit MyChart.

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