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Approaching your Guesstimated date;
- Hayley Leonard
- Jul 28
- 6 min read
Medical hazards of the third trimester
As you approach 40 weeks, it's inevitable that you will hear the overwhelming ticking of an invisible clock. A clock that we have been conditioned to fear by modern maternity care, but also a clock to which we must measure our body and all of its functions against.
Sometimes it is whispered in the tirade of unrelenting text messages of “have you had your baby yet?” or the glances at your bump and insinuation that its size and shape is out of control, or the comparison to a loaf of bread in an oven - over cooking
On one hand, your baby is going to grow HUGE the longer you are pregnant, and yet on the other hand you're told that your placenta will stop working adequately (so which one is it hey?!)
The appointments come thick and fast, the surveillance increases and the fear is fed, by third trimester ultrasound and then the barrage of extra monitoring that is recommended as you hit that magical and “scary” 41 weeks (even 40 weeks by some care provider fears)
Instead of catching the fear, get ahead of it by boning up on some really important topics which will prepare you to make some really important decisions, if you do indeed traverse the 40 weeks milestone. Don't get me wrong, I am not anti-intervention. I am just sick of seeing unnecessary intervention! Here are some threads for you to pull as you approach your third trimester…
INFORMED DECISION MAKING
First, know that EVERYTHING in medical care, ALL medical care is optional. It is entirely up to you what you decide to accept and reject. Please start here with a podcast episode on decision making in maternity care;
DUE DATE MYTH
The first concept to grapple is the ‘due date’ or guesstimated date;
CTG MONITORING; In pregnancy
You may also be offered (I say offered but it is usually coerced) into having regular CTG monitoring, once you hit 40-41 weeks. Your body is being treated like it’s a timebomb ready to detonate, so this monitoring is seen to be keeping you under close surveillance. This is not some innocuous monitoring, the machine creates a legal document that they are obligated to act upon if there is a blip or some non reassuring feature. Unfortunately this monitoring is not without it’s failings, so please have a listen before you decide to undertake CTG monitoring, just because you reached an arbitrary gestation
STRETCH & SWEEP
The next concept that may be introduced at your appointments as you approach 40 weeks is the stretch & sweep procedure - it too, seems fairly innocuous but as with every invasive procedure it needs to be considered along with any potential pitfalls;
BIG BABY PERCEPTION
Estimated baby size (most often the “big baby” card comes out) is one of the reasons that intervention may be suggested in the lead up to your birth. They may look at you, then look at your tall partner and make the assumption that you baby will be the size of a mini rugby player - totally discounting the fact that your body is actually built to birth either way. Even if your baby is perceived to be on one of the higher centiles for estimated weight, it says NOTHING about the ability of your pelvis to flex and open, or how incredibly the many bones of your baby's skull can overlap to fit through whatever space is available
Once there is a hint of “your baby could be huge” then a third trimester ‘growth and wellbeing’ scan may be suggested. It is here that an algorithm takes all of the baby's measurements and it spits out an estimation of their weight. And that's what it is - an estimation. More often than not it is waaaay off. I have personally seen it over 800g off! Here are some links to more information;
THE AGING PLACENTA, BABY WELLBEING & Biophysical Profile Ultrasound (BPP)
The other assumption, which totally contradicts the narrative that your baby will grow exponentially - is that your placenta will most likely just stop working as it “ages.” This may mean that blood flow to the baby through the placenta can become impaired, impacting oxygenation and growth. The Great Birth Rebellion and Sara Wickham cover this topic here;
The medical model then goes on to suggest that at that stage, the baby may be better off out of the dangerous environment and to assess such dangerous terrain, an ultrasound is often suggested. A BPP looks at a few different elements of baby's growth, development, blood flow through the uterus and placenta, amniotic fluid levels and features of baby's movements - here is a breakdown of what is involved
I had a BPP during my first pregnancy, as my fundal measurement was always a little lower than my gestation, which suggests that there may be a problem with my baby’s growth. The results of this were apparently reassuring, although if I had my time again, I would want to ask a lot of questions (especially if they were to be suggesting that there was an issue with the results). I have seen many interventions that have been set into motion simply from the suggestion that something maybe wasn’t ideal - when in fact it was mostly reassuring and waiting was a perfectly acceptable option. I would want to know what the score was, and what if anything was not reassuring. This would help me during the decision making process, as there are a number of potential intervention points that may arise from this scan;
First is amniotic fluid levels - maybe you have low levels or maybe more than expected;
Baby size; Baby big (refer back to above) Baby seen to be small for gestational age or growth restricted - these are two very different things
INDUCTION OF LABOUR
The culmination of all of this is that often it is recommended that an induction of labour is booked. That in and of itself is a whooooole novel of information and would add another 5 pages to this blog so instead I will leave these below, for those keen to know more;
Part 1
Part 2
THE RIGHT SUPPORT & PREPARATION IS CRUCIAL!
If you are birthing in a medical model of care, you cannot leave it to chance if you want to try avoid the unnecessary intervention, you need to prepare to meet the system, be it by attaining information and in knowing that you are the soul decision maker (it isn’t “shared” with a Doctor or Midwife), and you deserve to have enough information to make decisions which feel right to you. The other is to hire a Doula! It is like walking into the room with a body guard and space protector. A doula is a symbol of autonomy, they represent someone who has made an investment in the kind of birth experience they desire, someone who knows what they want (and what they do not want) and I find that staff are often much more mindful when you have a doula in your birth space. Staff tend to explain things in more detail and realise that they can’t get away with just talking to talk and pushing you onto the birth production line. More about why you should consider a doula here;
I know this is a lot of information, but unfortunately what we do know from the most recent Mother and Baby report, is that there are less women going into spontaneous labour, there are exponentially increasing interventions and surgical births but the outcomes are not any better for it. Link here for a summation of the latest report;
In fact, up to 30% of women are reporting that their birth experience was traumatic. Something has to seriously change here and unfortunately the system is the last thing to evolve! Change comes with every decision that is made by you, for you. If you have made it this far, well done! I know it is a minefield, and this is in no way medical advice - but well worth taking the time to look at all of your options, according to your own individual circumstances. Pull at any thread you find - there is an abundance of information at your fingertips
Hayley xx
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