The third trimester of my pregnancy didn’t have nearly as many sweet spots as the second trimester, unfortunately. It turned out to be quite difficult. Of course, lupus and pregnancy mixed together is never going to be easy. I was able to cope fairly well with most of the issues I encountered until the last two weeks – at that point I was just outright miserable.
In this post I’ll be sharing about my medical care, lupus symptoms, and pregnancy symptoms. In case you missed it, you can check out my posts about the first trimester and second trimester of lupus and pregnancy.
Lupus and Pregnancy: The Third Trimester.
February 25th – May 13th, 2018
Medical care in the third trimester.
My obstetrical care really ramped up in the third trimester. On week 32 I started seeing my OB once a week and having a non-stress test (NST). Then at week 35 we added on a second NST each week, meaning I had to go in twice weekly for my appointment and the tests.
During a NST you have two monitors strapped around your belly, one for the fetal heartbeat and the other for contractions. The fetal monitor is hooked up to a machine with a printer that continuously makes a printout of the heart rate and it also has a speaker so you can hear baby’s heartbeat, which is definitely the best part! There’s also a hand held clicker and you click every time you feel a movement, which gets noted on the printout and hopefully matches up with a heart rate increase from baby.
The doctors are looking for heart rate elevations – times when the baby moves and their heart rate increases while moving – during the NST to make sure the baby is healthy. There are supposed to be a certain number of them per session but when you are only monitoring a baby for 20 minutes out of a 24 hour period then of course you may not catch them. But mom and baby can’t leave until they see enough of those heart rate elevations – so the staff would use a buzzer on my stomach to wake up baby. We often ended up hanging out and sometimes getting buzzed for 30 minutes or more. It was certainly time consuming. I had 13 of these tests during the last weeks of my pregnancy.
Once the third trimester began I was only allowed to take three of my pain pills per week to ensure that my baby wouldn’t go through withdrawal after birth. Ultimately, this meant I dealt with more lupus related pain than usual. Being in pain makes me feel very stressed and makes my blood pressure rise and so I would have these large hypertension fluctuations from one appointment to the next if I had a low pain day followed by a high pain day. The doctors didn’t like this one bit, especially since I was already dealing with lupus and pregnancy. Adding hypertension to the mix stressed them out and made them question if I was suffering from pre-eclampsia.
On week 35 my doctors started having me attend their special clinic for high risk patients each week. This was nice because it meant that I’d have more than one doctor reviewing my status and they would make a joint decision about my care moving forward. My appointments throughout the third trimester were all positive; the doctors were happy that I was doing so well – my only real complaints were about being uncomfortable. The doctors all agreed that my pregnancy should not go past 39 completed weeks because after that time my risk of placental death and other complications was higher than the risk of induction. I wasn’t crazy about being induced, but I was very happy that I successfully carried my baby until 39 weeks.
I also saw my maternal fetal medicine specialist on week 30 and 34. At one of the appointments they performed an anatomy scan, which was weird because the woman didn’t tell me what she was doing and I was very startled to see a little face pop up on the screen. It freaked me out a bit to see my baby in 3D but it was really cool to have an idea of what he looked like.
Third trimester pregnancy symptoms.
Shortness of breath: My baby got all up in my ribs and made it very hard to breathe right at the beginning of the third trimester. He loved to stretch out and would squish my lungs with each stretch. He squished my stomach too. I had to eat small meals since I didn’t have room to fill my stomach up much.
From my baby shower at 32 weeks.
Fatigue: The fatigue came back with a vengeance around week 30. As bad as it was, it got a whole lot worse towards the end of the third trimester because I was only sleeping maybe three to five hours at night. I’m used to dealing with lupus related fatigue, but lupus and pregnancy together made it go to a whole new level. It became very difficult to concentrate and the extreme fatigue led me to avoid driving whenever possible (a big thanks to my husband and my sister in law who drove me to appointments).
Pain: So many different types of pregnancy pain showed up during my third trimester. I had hip pain, cramp-like pain, baby pressing on my bladder pain, lupus pain, baby kicking and punching me internally pain, pelvic pain, muscle pain – the list goes on (and on and on). My sciatica pain, which started in the second trimester, continued and became intense enough that it was difficult to walk and bend over.
Fetal movement: Man, did my baby like to kick. He kicked me so hard I would wake up in the middle of the night with a gasp. He shook my bath water with his kicks and made me flinch while I was driving (another reason why I stopped driving). He kicked me hard enough to interrupt conversations. I remember once I was trying to order a coffee and it went something like, “I’d like to have a HAZEL [groan], uh, hazelnut cofFEE, please. Ouch.”
Even as he grew and had less space to maneuver he would stick kick and punch (but mostly kick) with frightening intensity. About a week before he was born he kicked and something popped really loudly – in fact, I thought he had broken my water. Although it was really painful and frustrating (especially when I was trying to rest), I’m very glad that he had strong and frequent fetal movement. I never went more than an hour without feeling him move, which meant I didn’t have to worry that he might be in distress. And those kicks continued after he was born; when he was one day old he kicked off the oxygen monitor on his foot and at two weeks old he would lie in his bassinet kicking hard enough to make it move.
Extra hair: Having lovely hair is one of the well-known perks of pregnancy. But did you know that it’s not just on your head that the hair grows? My entire body got strangely hairy. The weirdest part was having long hairs on my belly, I could feel them moving in the breeze sometimes when I would change my shirt.
Getting big: During the last two or three weeks of my pregnancy it was very difficult to pick things up off the floor and put on pants or shoes because of my belly. I tried to take some photos of our little in-room nursery and ended up throwing out my back for a few days. I didn’t think I was all that big (it helped that I’m tall) but apparently my back muscles were not prepared for my bending and straining with the extra weight.
From the photo session that threw out my back.
Restless Legs: I’ve had issues with restless legs for years, especially when I sit or lie down for too long, but pregnancy brought this problem to a new extreme. I would lie down to go to sleep and just as I was drifting off to sleep my legs and ankles would start to hurt. It’s hard to describe how they hurt, but the pain would build until my legs would kick involuntarily or I would kick them on purpose because it was the only thing that relieved the pain.
After I got the pain to calm down I would start to fall asleep again… until the pain came back just as bad or worse. This cycle – of being on the verge of sleep and suddenly being ripped from potential slumber by pain – would just keep repeating and last for HOURS every night for the last two or three weeks. I would only get three or four hours of sleep once I was finally able to successfully sleep. It was the most torturous thing I have ever experienced and hands down the worst part of my pregnancy. I hope I never have to go through that again.
Overall: I really just ran out of steam towards the end. Being in that much pain without being able to take adequate pain medication wasn’t a new experience for me (I’ve had intense pain for years) but it was uniquely frustrating. It is really hard to share your body with another person for so long – especially a tiny, vulnerable person that can’t be exposed to some of the medications that you really need.
I was in pure survival mode after about 36 weeks. Which shouldn’t have come as a surprise, I suppose, after I read this really interesting article about how the end of pregnancy actually pushes a woman to her metabolic limit and the only reason that humans are born around 40 weeks is that the mother cannot physically sustain them any longer.
My survival mode experience reminded me a bit of finals week in college since I was so tired, eating out a lot, not sleeping much, and seemed to always have a headache. This time, however, I knew there was no hope of lots of freedom and relaxation after it was over. On the contrary, the hard work had hardly begun. I was also very afraid of the trauma that my body was about to go through and all the potential complications of giving birth. I alternated between working on a (very loose) birth plan and trying my best not to think about my impending labor.
Third trimester lupus activity.
It was very difficult to share my body with both lupus and a baby. Thankfully I had a new rheumatologist who was very helpful in managing my lupus and pregnancy. My lupus remained inactive throughout the third trimester despite me being very symptomatic (which I’ve recently learned is actually normal – inactive lupus means that you aren’t likely having organ damage but doesn’t stop other symptoms).
My lupus symptoms during pregnancy were the same ones I’ve always experienced. I had joint pain, pleurisy, fatigue, swollen extremities, muscle pain, and rashes on my face, neck, and chest. I also suffer from chronic dry eye – likely due to lupus – which became unbearable in the third trimester. It’s actually common for pregnant women to have dry eye so that’s likely why mine was exacerbated. I had eye plugs put in which helped a lot and I’m still grateful for them several months later.
38 weeks pregnant.
A few times my lupus symptoms flared up to the point that I would take a round of prednisone. In addition to my opioid pain medicine, which I previously mentioned that I could take three times a week, I could take Tylenol, but it wasn’t very effective and more than two a day would give me awful rebound headaches. I really missed being able to take anti-inflammatories and my muscle relaxer – both are a no-no during pregnancy. I did stay on plaquenil and as low a dose of imuran as possible. When I was 33 weeks along my pharmacist freaked out about me taking imuran during pregnancy (it’s a category D) and I had to give her the name of my MFM doctor in order to get my medication – another sad case of a pharmacist second guessing a decision that a doctor already made with great consideration.
Overall, I got a ton of excellent medical care throughout my third trimester. While I had pain induced hypertension, some lupus symptoms, and a few mini flares, I didn’t have any truly concerning or damaging medical issues. I also received a ton of support from family and friends throughout that time. Though there were some really stressful moments when I worried about if we were prepared mentally, physically, and financially, everything worked out in the end!
Next up: have a read about my birth story.
Thanks for reading! Do you have any third trimester stories? Please share in the comments.
Lupus and Pregnancy in the Third Trimester. Share on X
Thanks for sharing. As a Lupus patient myself who wants to get pregnant hopefully in future, this is a very important and useful resource. Thank you!
You’re very welcome! I hope you can have a successful pregnancy ❤️
Hi there! I’ve been wondering when this post was going to come around. I was so curious about how you were doing. A lupus pregnancy sounds like quite a ride, but I’m glad you had good medical care and, based on the few hints dropped about your little boy, that the birth went well (if the word “well” can even be used to describe something that is so physically traumatizing at the best of times!). I look forward to reading the birth story!
It went about as well as it could have, I suppose. Well, you can read for yourself once that one finally comes around. 🙂 It’s hard for me to re-live at times. I definitely don’t want to do it again. Thanks for thinking of me!
I am a lupus patient and currently 34 weeks pregnant. It has become increasingly difficult to just get out of the bed. I can barely walk because the vaginal pressure causes flare ups in my hips knees and ankles. Braxton Hicks causes extreme migraines and head pressure so I sit in my bed in the dark with shades on. Many days I just want to cry. I know it will be over soon so I’m just trying to hang in there.
I’m so sorry Bre. I understand that feeling of desperation with the physical unwellness and wanting the pregnancy to be over. Is there anything else your doctors can do for you? That sounds really rough. I hope the time can pass as painlessly and quickly as possible for you until your little one is here! Hang in there, I’m here for you.