My third trimester started off a bit stressful. At 28 weeks, I failed my one-hour gestational diabetes test. I was stressed about possibly having yet another health complication during pregnancy. I then had to endure a three-hour-long glucose test which I passed, thank goodness!
But the stress of my third trimester was only getting started; I have a lot to share with you about what happened over those nine weeks! Yep, if you’re counting along that means my son was born at 37 weeks. It’s taken me a while to write this post. I’ve been in a bit of an exhausted daze over the past six months (baby is doing great by the way). It’s been very hard but I want to share everything in the hopes that it may help others going through similar situations.
In this post, I’m going to talk about the complications of my lupus, high inflammation levels, and chronic pain during my pregnancy, as well as a new autoimmune diagnosis. I’m also going to cover standard pregnancy issues, high risk care information, and complications I experienced because my son has a rare disease (although we didn’t know that until after he was born).
Cover photo and maternity photos were taken by Leslie Mason Photography.
All about my 3rd trimester.
Third trimester pregnancy symptoms.
With the exception of Braxton Hicks, all these pregnancy symptoms were ongoing (and generally worsening, unfortunately) from my second trimester.
Having a big baby: Even though I passed my three-hour glucose test, the doctors kept asking me to repeat my fasting glucose levels because my baby was just so big! Even though I’m a tall person (nearly 5’9”), my first baby was quite small so my doctors remained concerned about gestational diabetes.
In my opinion, my first baby may have been small because my autoimmune disease(s) and hypertension were not as well-controlled, and this baby was more than likely a more normal size thanks to better disease control (and just the fact that people have different size babies sometimes).
However, the doctors estimated that my baby would be 10 lbs. if I delivered him at 40 weeks and I wasn’t all that happy about the idea. I certainly felt every pound of that sweet and large baby in my belly.
Pelvic joint dysfunction: I started doing physical therapy (PT) twice-weekly at 28 weeks and I did see a large improvement in my pain for a while. However, around 34 weeks the pain flared up pretty badly. My baby was lower in my pelvis at that point and I had not kept up with my exercises due to pure exhaustion. I struggled to find time for my PT appointments because I had so many other pregnancy appointments and ongoing medical issues with my nearly 3-year-old.
I got stuck on the couch a few times as the bones in my pelvis felt like they were going to come apart and were extremely painful. For the last week of my pregnancy, I could not use my hips to walk as my pelvic joints were so loose and painful. I had to do a weird waddle-like thing where I essentially used my lower legs to forcefully propel myself. Unfortunately, this ended up making my leg muscles super tight and caused a ton of cramping throughout the day and night. It was not fun.
Inability to exercise: Even before the pelvic joint dysfunction worsened, I was having a hard time exercising because I was short of breath and would swell if I tried to do too much. I was also having intermittent Braxton Hicks, lots of pressure on my bladder, lightning sensations down low, and was just downright too big and uncomfortable to do much. I suffered for it though, as labor, delivery, and postpartum were all more difficult since I hadn’t been able to keep up my strength and endurance.
Restless legs: I made it to 33 weeks before I stopped sleeping through the night due to my restless legs. I had to start wearing my compression boots all night which made things a little awkward when I would get up three or more times nightly to waddle to the bathroom – with the boots on. (You can see a photo of the boots in my first trimester post).
While my restless legs were horrid and I would never wish them on anyone, it was better than my experience in my first pregnancy (I have written about it was downright torturous during that third trimester). I didn’t have to suffer quite as much this time around because I had access to muscle relaxers and opioids, which I used extremely sparingly and with my doctors’ supervision throughout my third trimester. For the last week of my pregnancy, I took Ambien (prescribed by my OB) every other night so that I could have just barely enough sleep to function. I was able to strike a reasonable balance between controlling my health issues and protecting my baby (he did not go through any withdrawals after birth).
If you’re going through the trenches of restless legs, I wrote more about it and included tips in this article for Lupus.net: Restless Legs and the Endless Search for Rest.
Baby movement: I had good and bad experiences with my baby’s movements in my third trimester. He most often would punch me down low, causing painful lightning sensations. He had a large head and did a lot of wiggling. However, he never really kicked me. I was relieved to an extent because my older son kicked me to the point of tears during my first pregnancy, but, as time went on I became concerned.
Those concerns later became extremely valid – it turned out he was unable to kick because of painful bone growths on his legs (I’ll be covering that in more detail when rare disease day comes around). So, his movements did make me a bit uncomfortable but I would also get concerned frequently because it didn’t seem like his whole body was moving or that he was moving often enough.
A handful of times I began to panic and would drink ice water or juice to get him moving, but he still never kicked during his kick counts. (Technically, any type of movement counts during kick counts, so he passed, but it still was unsettling).
Other issues: I had really bad stomach pain for a while with no easily identifiable cause. I also went through some other gastrointestinal distress that I hoped was an early sign of labor, but now I know it was likely due to IBS-C (which I was diagnosed with when my baby was five-months-old).
My stress was also on an entirely new level towards the end of my pregnancy. I was trying to enroll my three-year-old in our local school program for kids with issues such as pervasive developmental delays. We had been seeing a developmental pediatrician, trying to get blood work done, and go through the autism diagnosis process. We got ripped off to the tune of nearly $800 before we finally found a quality place to have his autism diagnosis – and his final examination ended up being just three days before I had my baby.
The soon-to-be big brother.
There were so many things we were trying to squeeze in before baby was born, which were only made more difficult by my inability to move around much. It was a brutal last 2-4 weeks. We desperately needed to buy a family car, as I have a two-door sports car and my husband has a very small sedan, and that’s one thing we didn’t manage to get before our baby arrived. My husband ended up buying a family car when baby was five days old.
I just want to take a moment here and acknowledge that this post so far has covered many negative topics – things that aren’t all that fun to read about – and I’m just barely getting started. I had many issues with this pregnancy that were out of my control and I was truly miserable for about two-thirds of it. I’m not going to sugarcoat my issues, many of which are commonly experienced by pregnant women. I have many more difficult issues to cover due to my medical complexity as well as issues with poor medical treatment. At times it may seem like I’m complaining (okay, at times I am complaining, but it’s my blog after all). But more importantly, I hope that discussing these difficult issues will ultimately resonate with and provide comfort to people who are going through similar tough time. Additionally, I currently have a thriving six-month-old baby and he was worth it; he’s also not to blame for any of the difficulties I had.
COVID-19 concerns.
I was very concerned about COVID-19 from the moment I heard that it had entered the United States. I knew I was at higher risk due to being immunocompromised. I was further concerned after reports came out that pregnant women had higher risks of hospitalization and severe disease with COVID-19. I didn’t want to do anything to jeopardize my health or the baby’s, so we kept a high level of quarantine until the vaccines were available.
I got my first COVID-19 vaccine (Moderna) at 28 weeks, which ironically turned out to be the same day I was supposed to get my TDAP vaccine. But the COVID-19 vaccine slots were hard to come by and my doctors were okay with delaying the TDAP until after I finished my Moderna shots. I got my second shot at 32 weeks pregnant and had to wait two more weeks after that to get my TDAP. However, I started having non-reactive stress tests (the first sign that my baby might be in distress) and became quite worried that I wouldn’t be able to get my TDAP in time for my baby to be protected before birth. Thankfully, I was able to get my TDAP at 34 weeks which left about three weeks between the shot and my delivery. After my husband and I were vaccinated we still kept pretty strict precautions because I didn’t want even a minor case of COVID-19 interfering with labor, delivery, or the first weeks with my new baby.
As a bonus, we didn’t have to COVID tested at the hospital after showing our vaccine cards! I also gave birth in what I consider to be a “sweet spot” for pregnant women during the pandemic because it happened after the vaccines came out and while cases were lower. Therefore, I didn’t have to wear a mask during delivery or have severe restrictions during my hospital stay. Just a few months later, cases increased and we started to see breakthrough cases for vaccinated people due to variants, and those factors led to more restrictive rules at hospitals. I’m also so grateful my baby likely has some antibodies from my vaccine and that we have remained safe from COVID-19 in our home.
Managing my chronic pain.
When I was unknowingly three weeks pregnant, I had my first Botox injection. I traveled a long, difficult road with my chronic neck pain before finding myself on the other end of a needle filled with Botox, and I was devastated when I thought I would have to stop the injections. My pain levels had been so high for so long; I desperately wanted relief.
As it turns out, Botox injections were approved on an as-needed basis during pregnancy (for issues like chronic migraines and cervical dystonia) just a few months before I became pregnant. This is largely because they are intramuscular and are not expected to enter the bloodstream, but even if Botox ended up in the bloodstream it’s also not expected to cross the placenta. I was immensely relieved to be able to use this pain management so that I could lower my use of muscle relaxers, which do cross the placenta.
I wrote more about my Botox injections for Lupus.net here: My Experience Getting Botox Injections
I also used opioids to manage my joint pain on an as-needed basis, which was usually less than one pill per week. I’m appreciative that I had access to pain management during pregnancy, which is not the case for every chronic pain patient. I’m also grateful that I was able to keep my pain largely under control without jeopardizing my baby.
Every medication I used during pregnancy was weighed in a benefit vs. risk scenario, so I used the lowest amount of medications possible to remain as functional as possible, as too much stress and inactivity would hurt the baby more than the medications. If I had been capable, I would have used physical activity to lower my pain levels whenever possible, but I spent a lot of time in bed during this pregnancy due to nausea and pelvic joint dysfunction.
Third trimester high risk medical care & lupus management.
I’m considered high risk because of my lupus and hypertension, though both were considered to be well managed clinically (aka, only going by available data such as labs) at the time. My hypertension was actually better controlled during this pregnancy than ever; I even gravitated towards borderline low pressure readings towards the end of pregnancy. I’m thankful that I didn’t have to worry about high blood pressure issues complicating my already complicated pregnancy.
As I mentioned in my intro, my third trimester started stressfully with a failed glucose test (though I ultimately passed the second one and didn’t have gestational diabetes). However, the same week as the failed test I also visited a rheumatologist at Duke University who specializes in lupus and pregnancy. That visit didn’t go so well and I ended up spiraling downward into a hole of pain and anxiety before getting help from another doctor a few weeks later
To give you some background, I had to stop taking my immunosuppressant (azathioprine) at the end of my first trimester because my lab results showed signs of liver toxicity. After a few weeks, I was able to continue taking it at half the previous dose, but it wasn’t enough for my symptoms. During my second trimester, around 22 weeks, my joint pain started getting out of control. I could barely use my hands, which tend to be my worst areas for joint pain.
So I took my concerns about joint pain to the specialist and she was not willing to treat me with anything other than Tylenol and an anti-depressant, which upset me greatly. I asked her specifically about starting Cimzia, a biologic, and she said she would never consider that for me unless my joints were huge (meaning, swollen and inflamed). I couldn’t believe that she wouldn’t treat my pain and left the appointment feeling devastated, neglected, and shocked. I also began to feel panicked, how would I function with joint pain this severe – and worsening by the week?
Maternal-fetal medicine to the rescue.
Fortunately, two weeks later I saw my maternal-fetal medicine (MFM) doctor, OB, and rheumatologist. I told the MFM doctor about my concerns and he told me that pain, suffering, and high inflammation levels during pregnancy were much worse for mom and baby than a biologic like Cimzia. He called my rheumatologist that day, and she sent in the script for Cimzia when I saw her two days later.
Both of these doctors were willing to consider my symptoms and poor health over standard guidelines (such as only going by lupus blood work or noticeably inflamed joints). My rheumatologist went one step further by ordering an early Sjögren’s syndrome antibodies panel for me even though I could tell she wasn’t convinced it was needed. But some of the antibodies came back positive! I felt so validated and incredibly grateful that this doctor did not dismiss me. My diagnosis is now considered to be lupus with a Sjögren’s syndrome overlap. That made it easier to get a prescription for Cimzia, which is not typically a drug used for lupus.
I did my first set of Cimiza injections at 32 weeks. I completed my loading doses (which were three sets of injections that were two weeks apart each) a week before I gave birth, and my joints felt so much better! I wrote an article detailing this experience for Lupus.net: My Experience on Cimzia During Pregnancy and Postpartum
I am still on Cimiza and it’s been one of the best medication experiences I’ve ever had. I’ve had no noticeable side effects and a significant improvement in many of my symptoms. It transformed my lupus and Sjögren’s symptoms at the end of my pregnancy – and the beginning of postpartum – and I’m super grateful for the awesome doctors that made it happen for me.
Ramping up pregnancy monitoring.
At 32 weeks I also began having non-stress tests (NSTs) to assess the health of my baby. Things were more complicated compared to my first pregnancy, where I had once-weekly NSTs from 32 weeks until 35 weeks when they began to be twice-weekly and were generally fine. This time the twice-weekly tests started at 33 weeks and I had a ton of them as time when on. I have a more detailed description of NSTs in my post about the third trimester of my first pregnancy for those that are interested.
But my baby kept “being difficult” during the NSTs. These tests passively monitor baby’s heart rate and they need to see a certain amount of heart rate elevations for the baby to pass the test. My baby generally wasn’t passing the tests on his own. At first, this was downplayed and joked about as having an uncooperative or sleepy baby. I was given cold water, a coke, a snack, or they would use a special buzzer on my stomach. One day they used the buzzer a dozen times and my baby still didn’t do what they needed (I later learned that it’s against protocol for them to use it more than one or two times and they should have sent me for an ultrasound instead of continuing the test).
I was frustrated things were chalked up to a sleepy baby, especially once it started happening at every test. I wish I had pushed for them to take the poor results more seriously right away. It reminds me of my experience with high blood pressure as medical staff kept saying my high readings were due to “white coat syndrome” even though I told them that was not the case and I eventually had to force my doctor to take it more seriously.
I had a routine ultrasound at 34 weeks with my MFM, which I thought would be my last one, but nope, at 35+6 my baby failed yet another NST and I was rushed to the MFM. I failed another NST at their office and then had an ultrasound that was on the edge of concerning. Due to my high risk status and the fact that my baby had been having issues with NSTs for weeks, they sent me to the hospital for an overnight stay.
It was my 31st birthday.
It was also the day before my son turned 3 years old. Thankfully, we didn’t have anything big planned – and he didn’t fully understand what it meant that it was his birthday – so there wasn’t any huge disappointment for him. He was happy to be with his grandparents.
My hospital stay was not fun.
I could walk from the tower where my MFM doctor is located over to the hospital, and the staff offered to take me over in a wheelchair. I was hobbling so much that by the time we made it to L&D I wished that I had accepted! We spent a long time in small triage room and my baby did pass the NSTs there. But the doctors decided I should stick around to have more monitoring and to give my baby steroid shots in case we ended up delivering him early.
As I was being admitted I felt stressed because my husband had a cold that our son brought home from preschool. I was so worried that I would catch it and have to deliver while sick or that I’d have to deliver while my husband was quite sick. Somehow, I never caught the cold and didn’t have to deliver during the hospital stay.
Unfortunately, for me, it’s standard policy in L&D to place a saline lock after you’re admitted. This is an IV line that’s inserted and then capped off so that they can use it as needed, especially in case of an emergency. Things didn’t go well. And it was completely unexpected for me because I’ve never had an issue with an IV line being placed before. I later learned that I have very difficult veins, and I can’t help but wonder if the other nurses had always been lucky or if something has changed with me health-wise to make it more difficult.
Anyway, two different nurses attempted to place a saline lock four times and ended up blowing four veins in my hand, arm, and both wrists. They decided to stop and try again later but thankfully no one tried again or needed the IV access. However, these blown veins hurt immensely. Since it happened on both of my wrists, the pain prevented me from using my hands without extreme pain. The bruises looked awful.
I sat in the hospital with bags of ice on my hands, monitoring straps around my belly, a ton of pain from various pregnancy issues, and a fair amount of boredom as my husband had to leave for several hours to pick up our son, take him to the grandparents, and pack an overnight bag for me. We were completely unprepared to go to the hospital from my appointment, so I didn’t even have a phone charger.
Oh, and then I got my steroid shot in my butt.
The steroid shot is to help the baby’s lungs develop in the case of an early delivery. It didn’t really hurt but steroids give me terrible insomnia so I paced the halls until the night nurse finally gave me an Ambien so I could sleep.
The next day my son had an important doctor’s visit, and I was able to join by phone while being monitored in the hospital. The monitoring went well and the staff said it was up to me whether I stayed one more night or went home with instructions to vigilantly monitor baby movements and call if he missed even one kick count session. I chose to go home. Around 3 pm I got my second steroid shot – they have to be 24 hours apart – and went home (with a prescription for Ambien since I really needed to be able to sleep a little).
The final week.
I was released on a Friday afternoon and readmitted on the following Friday in the evening. A lot happened during that week. I also spent the entire week with wicked bruises from my IV lines and was kind of surprised that no one asked me about it.
I had two NSTs, which actually went well, but I was so miserable and concerned about potential issues with my baby that my doctors agreed that I could be induced as soon as I was 37 weeks. It helped that I had the steroid shots, so there was less concern about an early-term delivery. Little did I know, my baby was likely in a lot of danger due to a rare disease that we didn’t learn about until after birth. I’m so grateful to the doctor who erred on the side of caution by allowing an early induction.
My doctor explained that I would be eligible for induction on the day that I was 37 weeks pregnant – beginning at midnight – and I would be called as soon as they had a spot, but it could take up to a week for them to have an opening. My city was having a baby boom and L&D was completely overwhelmed. Once I was 37+6, however, I’d move to top priority status. So I had to be ready and have my phone on me at all times starting at midnight that Friday. I was disappointed that I’d never get to experience a more natural labor (without induction), but things worked out in the end.
Additionally, that week my 3-year-old had a very important evaluation and I was quite relieved that we were able to squeeze it in before delivery! It had been difficult to schedule and was very important timing-wise. I’m grateful we hung in there. I also saw my rheumatologist. Then, on Friday, we had a lovely outdoor lunch with my lupus support group because it was Put on Purple for lupus day!
They showered us with gifts for baby and it was so kind. Then, around 4 pm, we got the call that I could come in for my induction! I was so relieved! But I wasn’t prepared since I’d had such a busy week and had a lot of pain in my neck, pelvis, back, legs, arms (from the IV bruises), and so on. But we scrambled and we made it to the hospital on time – I even managed to get a belly photo before we left.
I’ll have to pause the storytelling here, as what happens next belongs in my birth story. Don’t worry though, I’ll give you a few spoilers.
Four highlights of birth and postpartum.
– It was so emotional trying to soak up all the moments and the “lasts” with my first son while he was still my only, and even more emotional to introduce him to his little brother, but he’s been doing a great job as a big brother.
– Baby’s birth was extremely similar to the birth of my first baby.
– Baby was born at 37+1 with some complications but overall strong and healthy.
– Six months on he’s doing great and he’s quite the chunk. (Yes, it has taken me quite some time to write this, haha!)
Is anyone interested in reading my birth story? As I mentioned it was very similar – eerily similar, actually – to my first birth and, much like that one, I’m a little hesitant to describe and relive the traumatic experience. I may just write a very short version of it so that I’ll have it to look back on in case I ever want to, as these details easily fade over time.
And, a few newborn photos for anyone who’s gotten this far. Thanks for reading my story!
These amazing newborn photos were taken by Leslie Mason Photography when Baby was two weeks old.
My Third Trimester: Hobbling Along and Delivering Early. Click To Tweet
