The Waddle's Not So Cute Anymore

Last Editorial Review: 1/30/2005

Countdown to Baby

WebMD Feature

Reviewed By Charlotte Grayson

It's the final countdown -- fast approaching single-digit weeks -- before you get to meet your baby and coo over those tiny fingers and toes. Unfortunately, tiny isn't the word that comes to mind these days.

The homestretch can be, well, a stretch. Itchy bellies, achy backs, swollen ankles, hemorrhoids -- you name the annoyance, and some expectant mom probably feels it.

The real remedy, of course, is childbirth. But since that option is still a bit premature, we asked an obstetrician, a midwife, and a family practitioner to share their best trade secrets for surviving the common aches and pains of the third trimester.

Our experts: Owen Montgomery, MD, assistant professor of obstetrics and gynecology at University of Pennsylvania School of Medicine in Philadelphia; Stephanie Lowell, a certified nurse midwife in Phoenix, Ariz.; and. Bruce Bagley, MD, a family-practice physician in Latham, N.Y., and former president of the American Academy of Family Physicians.

Make sure to talk to your own provider about your discomforts, especially before trying any over-the-counter treatments. "These remedies are reasonable things that experienced practitioners have used for a long time, but your doctor or midwife may have a different feeling about it," says Montgomery.

Tricks of the Trade

Itchy Skin: As your skin stretches, particularly over your growing belly, it may feel dry and itchy.

Montgomery: If the itching is isolated, Caladryl or topical steroids, such as hydrocortisone (over-the-counter products are available in 1% or 0.5% strengths) may help. If itching is all over your body, Aveeno oatmeal baths or Benadryl (oral or spray) can offer relief. Trim your fingernails to reduce sleep-time scratches.

Lowell: Calamine lotions, such as Caladryl, are helpful. "Keep it refrigerated because it seems to help the itching more if it's cold."

Bagley: Soothing oatmeal or Alpha-Keri baths, moisturizing lotions, or cocoa butter might offer temporary relief.

Hemorrhoids: These swollen veins in the rectal area are caused by extra progesterone and increased blood flow and pressure on the veins in the anus, similar to varicose veins in your legs.

Montgomery: "The best treatment is to avoid them," which means soft, regular bowel movements. Drink at least eight 8-ounce glasses of water a day (refrigerate a 2-liter jug of water to use throughout the day). If necessary, try stool softeners, such as Colace, along with extra fiber (such as Metamucil or Citrucel); topical ointments, such as Preparation H or Anusol; sitz baths; and witch-hazel pads.

Lowell: Caster-oil packs (a piece of cotton flannel soaked in caster oil), plenty of water, and fiber-rich fruit, vegetables, grains, and cereals (or supplements such as Metamucil, if necessary). If those remedies don't work, try stool softeners or topical preparations, such as Preparation H.

Bagley: Keep stools soft by eating plenty of fiber, especially fiber-rich cereals such as Bran or Fiber One. Keep hemorrhoids lubricated with Vaseline or Preparation H.

Swollen Feet and Ankles: Some normal swelling, particularly in the lower body because it's more difficult for your circulation to fight the forces of gravity, occurs because of increased blood and fluid volumes.

Montgomery: Try elevating the foot of your bed with a 2x4 board, or put enough pillows and blankets under your mattress so it's angled and gravity can drain the fluid to the rest of your body. Sleeping on one side also decreases resistance of blood traveling back from your legs. Avoid standing still for long periods. Support stockings may help, too. Significant swelling should be reported immediately to your practitioner because it could be a sign of toxemia (pregnancy-induced high blood pressure).

Lowell: Make sure you get at least 100 grams of protein and a gallon of water per day. Watermelon is another good source of fluid. Walking around or floating in a swimming pool can also help because water resistance acts like a lymphatic massage.

Bagley: Take time each day to put your feet up, either on your lunch break, at your desk, or before starting dinner. Support hose also might help. Don't severely restrict your salt intake, but make sure you're not consuming excessive salt (pregnancy nutrition experts recommend a total of about 3,000 mg.). Sudden weight gain, such as 3 to 5 pounds in a couple of days, may be a sign of toxemia and should be reported to your practitioner.

Heartburn/Indigestion: As your uterus expands, it puts pressure on the stomach, causing acid to back up in the esophagus (the swallowing tube) and leave a burning sensation in the throat and chest.

Montgomery: Eat small, frequent meals and try not to eat meals after 6 p.m. because that's when acid production can be the worst. Over-the-counter antacids also help: Liquids seem to work better because they coat the esophagus, but chewables are easier to carry during the day. If the condition is severe, you may want to talk to your practitioner about taking an acid blocking drug, such as Pepcid.

Lowell: Make sure you eat six small meals per day rather than three large ones. Rather than drinking beverages with your meal, hold the drinks until an hour and a half to two hours after you've finished. Reduce fat intake, which slows digestion. Papaya tablets have a digestive enzyme and can be effective in improving digestion, too, or take antacids, such as Mylanta, Maalox, or Tums.

Bagley: Antacids, particularly liquids, work. (Tums are a good source of extra calcium, too.) Watch out for foods that can exacerbate indigestion, such as coffee and spicy foods, and don't eat close to bedtime. Small, frequent meals also help.

Backaches: Back soreness is caused by shifts in weight and your center of gravity as your uterus gets bigger and heavier.

Montgomery: Try maternity accessories that take the weight off your lower back, like special support bands that fit under your abdomen and across your back, or maternity girdles that start at the midthigh and extend up to your breastbone. Massage, heating pads, and shower massagers can offer some relief. Daily exercise, such as walking, and lower-back exercises, such as the pelvic tilt, can help keep muscles strong.

Lowell: For upper-back problems, do shoulder rolls and make sure that your neck and shoulders are at 90 degrees while you sleep. A good stretch for the lower back is to squat flat-footed while holding the kitchen sink or counter, then lean back. Water resistance by walking or floating in a swimming pool can strengthen back muscles, too.

Bagley: Get good, comfortable shoes (put the heels away for now), and make sure car, work, and home seating offer good lumbar support.

Discomfort in the Lower Pelvis (also known as "lightening"): As your baby drops lower in the abdomen to ready itself for birth, you may feel more pressure or aches in your lower pelvis or groin area.

Montgomery: Taking some breaks to put your feet up might offer some relief, but on the whole, it's a good sign. It means the baby's probably going to fit through the birth canal if it's lower in the abdomen.

Lowell: A maternity support belt helps. When you're lifting things, make sure to squat and let your legs do the lifting, rather than bending at the waist.

Bagley: Stay off your feet or lie down when you feel discomfort. "The one good thing is that it means you're probably going to deliver soon."

Relax, It Goes With the Territory

Sleeplessness: Many women have trouble finding a comfortable sleeping position as they get bigger, especially if they've always slept on their stomachs. Adding to it are more trips to the bathroom and a growing preoccupation with delivery and life changes ahead.

Montgomery: An egg-crate mattress, feather bed, body pillow, or tucking lots of pillows around you will help take pressure off your hips. Before bed, try a cup of chamomile tea or warm milk. Exercise during the day also helps your body tire by nighttime. Sleep aids generally aren't prescribed during pregnancy, although Benadryl may help. The good news? Sleepless nights now help you prepare for sleepless nights with your baby.

Lowell: Make sure you're getting enough exercise during the day (such as a 20-minute walk or swim). Before bedtime, try relaxing in a warm tub, or drink a cup of peppermint or chamomile tea. In bed, try tucking a pillow between your legs.

Bagley: Take a relaxing bath before bed, and try sleeping with a pillow between your knees. Visualization and progressive muscle relaxation exercises may also help.

Frequent Urination: You'll take more trips to the bathroom as the baby gets bigger and starts pushing harder on the bladder.

Montgomery: You don't want to limit the total amount of liquids you're having, but if you drink less before bedtime, then make sure you drink more during the day. You'll still get up a couple of times during the night, but maybe less than before.

Lowell: "When you have a baby standing on its head on top of your bladder, sometimes you have to pee frequently. It goes with the territory. It's preparing you for when you're have to get up at night to feed the baby."

Bagley: Ditto. "There's not much you can do about it, but it helps to know it's normal."

Shortness of Breath: As the baby gets bigger, it puts more pressure on your diaphragm. Progesterone levels also cause you to breathe more deeply, assuring sufficient oxygen to your baby.

Montgomery: "It's normal and nothing to be panicked about."

Lowell: What sometimes helps are arm stretches, where you sit cross-legged and reach each arm alternately over your head.

Bagley: Like frequent urination, some shortness of breath also goes with the territory, but contact your practitioner if you're wheezing or breathless when you're at rest, not just climbing a flight of stairs, because it may be a sign of anemia or another condition.

Plain, Old Feeling Huge: As the baby gets bigger, your clothes are getting snugger and that waddle just doesn't seem cute anymore.

Montgomery: Staying within the recommended 25- to 35-pound weight gain and remaining physically active will help you feel better throughout your pregnancy, especially in the last trimester. But you're supposed to get bigger -- it's even common to feel clumsier and bump into things more because, like an adolescent boy who suddenly grows two shoe sizes, you're not used to having a larger belly.

Lowell: "I tell women to focus on the reason their body is larger and the baby coming: Their tummy is big for the best possible reason."

Bagley: "Everybody struggles with that because most people are used to watching their weight and feeling trim, but it's just impossible to keep doing that when you have 10 pounds of baby in front." Relax, but try to stay within the recommended weight gain.

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