Emotional Changes
Physical Changes
Fluid Accumulation: What's Normal, What's Not
7 Ways to Boost Breathing in Pregnancy
Ways to Reduce the Discomforts of Swelling
Backache
10 Common Annoyances in Third Trimester
How Your Baby is Growing

Braxton-Hicks contractions or premature labor?
6 Ways to Reduce the Risk of Premature Delivery
When to Call the Doctor: 3 Signs of Premature Labor
Explaining a High-Risk Pregnancy
8 Factors to Consider if Children Will Attend the Birth
Coping with Confinement: When Complications Put You to Bed
9 Ways to Make the Best of Bed Rest
Enjoying Late Pregnancy Sex
9 Benefits of Using a Labor Support Person

The middle trimester is over, the final trimester begins, and your thoughts turn toward giving birth. During this month your baby gains at least a pound. You may gain anywhere from 3 to 5 pounds, and your uterus grows to midway between your navel and your rib cage. Naturally, your bigger baby makes herself felt in a bigger way. You may be awakened by a punch to the ribs, or find yourself staring in awe at the basketball-like hump where your abdomen used to be. By the seventh month, your body demands you make lifestyle changes, whether you want to or not. You are simply too pregnant to go about your business at your previous pace. The waddle so characteristic of pregnant women creeps into your walk. Bending over to tie your shoes grows difficult, and putting on pantyhose becomes an exercise in gymnastics.

The third trimester is an emotionally easier time. By now you have learned that pregnancy can be both unspeakably wonderful and incredibly challenging, and you have become used to handling these mixed emotions. Thus, many of the emotional and physical "growing pains" of pregnancy are now behind you, and the emotions that lie ahead are mainly those directly involved with delivering a baby. Here are some typical feelings women may experience in the seventh month:

You may experience a natural high quite unlike anything you've ever felt, a combination of feeling special and proud, and wanting the whole world to acknowledge how important you are. Savor every moment of these worry-free times. Sooner or later a thump in the ribs, a stitch in the side, an irritating itch somewhere, or an attack of heartburn will pull you out of pregnancy heaven down to earth-mother reality.

Preoccupation with your pregnancy and the approaching birth causes many women to be a bit spacey and prone to daydreaming. You may forget important events, such as birthdays and appointments. You may stop in the middle of a sentence, unable to remember the point you were trying to make, and what's even more amazing, you don't care because the point you were trying to make doesn't seem that important anyway. You may have to consult your calendar hourly, or post notes to yourself in places where you can't miss them, such as the steering wheel of your car, the refrigerator, or the bathroom mirror.

You've been through a lot and still have a lot of work ahead of you. You are not a "bad" mother for wanting time out. Think of them as rehearsals for the low points of parenthood, the days when you will feel like resigning, even though that's not really an option (and one you wouldn't take if it were offered).

Many women feel a renewed desire this month to tie up loose ends at work, organize the photo albums, clean out closets, or catch up on social obligations. Often the nesting instinct, the desire to wallpaper the nursery and scrub the house for the baby, kicks in this month, though others do not show this obsession with getting things in order until the eighth or ninth month. While it's true you have more energy now than in the last two months, don't overdo it. Remember, your first priority is making sure you have the energy you need to take care of yourself and grow your baby. To do this, you will need to become good at delegating. You might as well begin delegating responsibilities to your mate now; in the first few weeks after the baby arrives, his help will be crucial to your survival.

You may be halfway through your series of childbirth classes before you think seriously about your birth philosophy and begin to consider the many birthing options available to you. It's easy to be confused by all these choices and to feel burdened by the pressure to make them.

HEART-POUNDING
Throughout your pregnancy, as you already know, blood volume steadily increases to accommodate the body's increasing need for oxygen and nourishment. By the third trimester you have forty-five percent more blood than you started with. Your heart has to work harder to pump this extra fluid: your heart rate increases by around ten beats per minute and the heart pumps about thirty percent more blood with each beat. These changes peak during mid-pregnancy when you may be able to feel your heart working harder; many women feel "heart-pounding" sensations during the second half of pregnancy, especially when they exercise or change position suddenly.

The heart's occasional pounding is a normal response to the major circulatory changes that take place during pregnancy. Yet, it is also a signal that your heart, at the moment, is working too hard. The more fit you are, the better your heart adjusts to the extra demands of pregnancy. If the pounding increases noticeably during exercise, slow down. Rise from lying to sitting, or from sitting to standing more slowly. These heart-pounding sensations will disappear within a few weeks after birth, as your heart rate slows and your circulatory system returns to its pre-pregnant state.

During pregnancy the circulatory system, like the respiratory system, is incredibly efficient, ensuring that both you and your baby receive the extra-oxygenated blood you need. Your lung capacity increases, and you may actually add a few inches to the size of your rib cage. While you may notice that you breathe slightly faster while pregnant, you may not know that you are breathing more efficiently, exhaling and inhaling more air during each breath. At times during your pregnancy you may feel short of breath. These feelings of breathlessness do not mean that you or your baby is lacking oxygen. It just means there is less room for your lungs to expand and your body is protesting this aggravation a bit. Most of the time you are not even conscious that you are breathing more deeply, but sometimes you may catch yourself sighing, which is another way, your body helps you take an extra deep breath.

Most women with healthy pregnancies will notice some fluid accumulation, especially in the third trimester. Anytime from the fifth or sixth month onward, you can expect to lug around heavier hands, legs, and feet, the areas where gravity causes fluid to settle by the end of the day. Add to the effects of gravity the fact that a growing uterus slows the circulation in the legs, and it's no surprise many women gain a shoe size by the end of the day.

What's Normal, What's Not? Some women retain more fluid during their pregnancy than others. Basically, if you are feeling fine and both your body and your baby are growing normally, your body is carrying just the right amount of extra fluid for you and your baby.

Signs that swelling is normal:

• The swelling shifts with gravity, with different areas of your body being swollen at different times of the day. (This is called gravity edema.) And the swelling in your legs and ankles lessens after elevating your feet for an hour.
• You are gaining weight normally. A sudden, unexplained weight gain might indicate a problem (see below).
• Your diet is adequate and balanced.
• Your blood pressure is within normal limits.
• Urine checks at your healthcare provider's office do not show protein in the urine.

Signs that swelling is not normal:

• Fluid retention that is excessive and builds up rapidly may be a sign of a problem, such as toxemia or preeclampsia, especially if it's accompanied by these signs:
• The swelling in your legs is excessive – pressing on the swollen areas with a finger leaves a noticeable dent (called pitting edema), and the swelling doesn't lessen after elevating your legs for an hour.
• You are gaining too much weight too fast.
• Your blood pressure is high.
• Your diet is inadequate.
• Your urine shows excessive protein.
• You are generally feeling unwell and/or your baby is not growing normally.

Normal swelling can be a nuisance and contribute to fatigue at the end of the day, especially tired legs and feet. Try these tips:

• Avoid standing or sitting for long periods of time. If you need to stand or sit for more than an hour at a stretch, exercise your legs and feet. Don't cross your legs when you sit, as this can restrict circulation in your legs.
• Elevate swollen feet for an hour, especially at the end of the day; the swelling should diminish a bit.
• Relax in a rocking chair while flexing your feet against a footstool. This movement promotes circulation in your legs. A rocking chair will be on your "must have" list for when the baby arrives, so you might as well get it now and start enjoying it.
• Walk, swim, or ride a stationary bike. All three are excellent for increasing circulation to your arms and legs.
• Avoid sleeping on your back. Sleeping on your side takes the pressure of your weighty uterus off the major blood vessels and promotes better blood return from your legs.
• Wear loose clothing. Avoid tight bands on pants, socks, or any other clothing, as they can restrict circulation.
• Elevate your feet on a stool during the day and on a pillow at night.
• Elevate your hands when sitting.
• Enjoy a healthy diet. Drink at least eight 8-ounce glasses of liquid daily, especially in hot, humid weather.

Make sure that you have adequate amounts of protein in your diet, and use salt to taste. Do not go on a fluid- or salt-restricted diet unless your healthcare provider advises because you have a specific medical indication. Drinking less fluid will not alleviate the swelling, and your body needs salt for a healthy pregnancy. To check if you are drinking enough water each day, notice the color of your urine. If your urine is almost colorless or slightly yellow, chances are you are drinking enough fluid. If your urine is concentrated to a darker color, like apple juice, this may be a sign of underhydration.

During the third trimester breathlessness increases in both frequency and intensity as your expanding uterus limits the ability of your lungs to expand with each breath. To compensate for cramping your breathing space from below, pregnancy hormones stimulate you to breathe more often and more efficiently, just to make sure you and your baby are getting the oxygen you need. Here are seven ways to increase the efficiency and capacity of your breathing and to cope with feelings of breathlessness during the third trimester:

1. Change position as soon as you feel breathless.

2. Slow down when you feel short of breath. Listen to your body's signals that you are exceeding your limits.

3. Try breathing exercises to raise your rib cage and promote more chest breathing (deep abdominal breathing obviously becomes more difficult as your uterus grows).

• Stand up (this will relieve some of the pressure on your diaphragm):
• Inhale deeply while raising your arms outward to the sides and upward.
• Exhale slowly as you bring your arms back down to your sides.
• Raise and lower your head as you inhale and exhale.
• To be sure you are breathing more into your chest than down into the abdomen, check for rib cage expansion by placing your hands on the sides of your rib cage.
• Make your ribs push out against your hands as you inhale deeply. Focus on how this deep chest breathing feels so that you can switch to it whenever the crowding of your uterus on your lungs makes abdominal breathing more difficult.

4. Practice breathing for labor: slow, deep, relaxed breathing rather than shallow panting. (This is the type of breathing used throughout labor if you are learning the Bradley method. If you are using the Lamaze method this is the type of breathing you'll be doing throughout much of the active stage of labor.)

5. Exercise regularly. Aerobic exercise, began early in your pregnancy, improves the efficiency of both the respiratory and the circulatory systems.

6. Experiment with sitting and sleeping positions that help you breathe more easily. Sitting in a straight chair using correct posture – chest lifted, shoulders back – is easier on the lungs than sitting slumped over in a recliner. Sleep semi-reclined, propped up on pillows. Or try elevating your head with an extra pillow while sleeping in the side-lying position.

7. Know when to seek help. If you experience sudden, severe shortness of breath accompanied by chest pain, rapid breathing, or a much more rapid pulse, or severe chest pain while taking a deep breath, seek medical attention immediately. This could be a signal that a blood clot has dislodged and settled in your lungs – a rare, but serious problem.

More than 50 percent of moms-to-be complain of back pain in the last half of pregnancy. Back muscles get a triple whammy during pregnancy: your ligaments, which are relaxing to allow for easier passage of the baby through the pelvis, are looser all over, putting more strain on your muscles, especially those supporting your spine; your overstretched abdominal muscles force you to rely more on your back to support your weight; and the change in your posture and the curvature of your spine as you compensate for your front-heavy body creates still more work for the back muscles. In the third trimester especially, these overworked muscles and back ligaments will protest in pain.

1. Perform simple low-impact aerobic exercises such as swimming and biking to strengthen abdominal and lower back muscles.

2. Wear sensible shoes. Both high heels and totally flat shoes can strain back muscles. Try shoes with wide, medium-height heels (no higher than two inches) for dress, and walking shoes for casual wear.

3. Avoid jogging on hard surfaces, such as concrete or asphalt, which can be jarring to the spine. Instead of jogging try fast walking, and on natural surfaces like grass, earth or sand, which are easier on the muscles and joints than pounding a hard surface.

4. Don't twist your spine. When you stand or sleep be sure your shoulders and hips are aligned. Avoid awkward reaches, such as getting a heavy box down from the top of a closet or lifting a sleeping toddler from a car seat. If you must under undertake activities that call for awkward lifting, see if you can rethink the job. Consider unbuckling a toddler's car seat, for example, and turning the seat toward you before you lift your child out.

5. Avoid sitting or standing for long periods of time. When you do sit, use a footstool to raise your knees a bit higher than your hips and take pressure off your lower back. If you must stand in one position for a while, put one foot forward and place most of your weight on it for a few minutes, then switch your weight to the other foot. Better yet, prop the forward foot up on a stool, telephone book, drawer, or cabinet ledge.

6. Sleep on your side, and frequently shift sleeping positions.

1. Rest. Usually, simply resting strained muscles will ease the pain.

2. Soak in warm water. Try soaking in warm water or standing in the shower with a jet of warm water focused on the painful area.

3. Pack the back. Many mothers swear by a hot or cold pack (or alternating both) on the painful area. If baby pressing against your spine seems to be the cause of pain, as is common during the final month, try the knee-chest position for a while.

4. Massage it. Ask your mate to give you a back massage. Practice these back massages now so he can later become a useful masseur to help ease the pain of back labor.

1. Frequent urination. As your growing uterus increases pressure on your bladder, you will need to urinate more frequently. Be sure to urinate as often as you feel the urge and completely empty your bladder. Do not hold your urine in, as this may increase your chances of developing a urinary tract infection or even trigger premature contractions.

2. More breast changes. Your breasts continue to enlarge and you may start leaking a thick, yellowish milk, called colostrum.

3. Vaginal pain. An occasional sharp pain in your vaginal area is normal due to the pressure on your cervix.

4. Pelvic pains. You may experience sharp pains and a feeling of pressure in your pelvic area, especially when you lift your leg up to get out of bed or put on your underwear. These are most likely due to the shifting of your pelvic bones and the loosening of the ligaments attached to these bones in preparation for the little passenger that will soon be coming through. The more pregnancies you have, the more you may experience these pelvic sensations.

5. Groin pain. You may notice a sudden sharp pain when you laugh, cough, sneeze, twist, change position, or reach for something. This is caused by stretching of the ligaments that attach your uterus to your pelvis. Adjusting and changing position will ease this pain.

6. Frequent thirst. This is your body's signal that you need to drink a lot of water to keep up with your body's increased fluid demands this trimester. Drink to your thirst's content, and then some.

7. Feeling faint. After you have been standing or active for a long time, or when you rise too quickly, you may experience a faint or dizzy feeling similar to what you felt in the first trimester. Sit or lie down immediately. Low blood sugar can contribute to this light-headed feeling, so be sure to snack frequently. Resting, eating nutritious food, and avoiding sudden moves to the upright position will lessen faintness.

8. More vaginal discharge. Expect more whitish, vaginal discharge, enough to necessitate the use of panty liners.

9. Frequent heartburn. During the second trimester you may have had a reprieve from the heartburn of the first few months, but now that burning feeling reappears. This trimester it is more the result of upward pressure of the growing uterus than of pregnancy hormones. Propping yourself upright during sleep; eating small, frequent meals; and keeping yourself upright after a meal should help.

10. Constipation. Your enlarging uterus and its growing occupant seem to push your intestines aside, contributing to constipation. Your increasing need for water elsewhere in your body may steal needed fluid from your intestines, also leading to constipation. Be sure you drink at least eight 8- ounce glasses of water a day.

However, mothers with no risk factors can go into premature labor without a known cause. Many times this premature labor can be stopped with medication. Even if you do deliver your baby prematurely, modern advances in newborn intensive care mean the chances are good that a baby of at least 28 weeks gestation will survive and thrive.

1. Avail yourself of good prenatal care.

2. Don't smoke. Quit before conception if you can.

3. Avoid alcohol consumption.

4. Eat nutritiously and gain the right amount of weight for you.

5. Avoid illegal drug use and use of over-the-counter medications not approved by your healthcare provider.

6. Avoid chronic, unresolved stress throughout your pregnancy.

1. Your membranes rupture and amniotic fluid either trickles or gushes from your vagina.

2. Contractions that you may have previously thought were normal Braxton- Hicks contractions now become more intense and more regular.

3. Sudden onset of low back pain or crampy pressure in your pelvic area; a feeling that you have not felt before.

High risk is just a medical term that obstetricians use to describe mothers who have a higher than average risk of having health problems during their pregnancy or birth, or of delivering a baby with problems. Common risk factors are insulin-dependent diabetes, high blood pressure, or signs of premature labor. This term only reflects a statistical probability that a problem may occur in your pregnancy or with your baby; it is not an absolute prediction, and you, in fact, may have no problems at all.

We prefer the term "high-responsibility" pregnancy. Our term means more than using specialized, more attentive medical care and a high-tech hospital; it implies that you must take greater responsibility for your own care and for your own birth decisions. Instead of resigning yourself to the high-risk label by becoming a passive patient and leaving all the birth decisions up to your doctor, become a high responsibility mother. Take an even more active part in the birth partnership. You need to be more informed, more responsible, and more involved in decision-making than the average mother, and you need to take better care of yourself.

The first question you should ask your doctor after you are classified as "high risk" is what specific things should you do to lower your risk.

1. The age of your child. In our experience, children over three can understand the emotions of labor and respect the dignity of birth. For some children under three the intensity of birth may be more than they can understand or cope with. Younger children do fine at home birth because they are in their familiar environment and can more freely come and go.

2. The temperament of your child. Only you know how much raw emotion your child can take. Will your child be frightened by the normal theatrics of labor – your groans, your red face, your bleeding, and the fact that mommy appears to be unhappy and in distress? How will your child cope with the restrictions of the hospital or other birthplace?

3. Your ability to tune out your child and focus on your birth. You must be allowed to concentrate on delivering a baby and not be distracted by the demands of other children. Will you be able to ignore the distractions of having your child there and focus on your labor? (If your child is attending your birth and is diverting some of your energy away from the work you need to do, by all means have him escorted out of the delivery room.)

4. Provide familiar caregivers for your children (other than your partner) so that each child is someone else's only responsibility.

5. Tell your children ahead of time what the birthing room rules will be, and what behavior you expect of them. Impress upon them how you want them there, but also how you need them to behave so that "mommy can do her hard work to push our baby out."

6. You'll need a plan for where your child will be cared for throughout labor, which could be quite a long time by three-year-old standards. One way to solve this dilemma is to stay home for most of your labor. Once things are moving along you go ahead to the hospital. Then have your child and the child's caregiver come after you've been assessed and are settled.

7. Prepare your children for what they can expect to see, and in terms they can understand: "Mommy may yell or cry, and you may hear some groaning noises that you've never heard before (demonstrate some of these noises). It's okay, the noise just means mommy's working real hard to push our baby out."

8. Prepare your children for being bored during periods in labor when nothing seems to be happening. You may want to bring them in only toward the end of labor.

Complications that banish a pregnant woman to bed in the first half of pregnancy are unexplained bleeding and the threat of an impending miscarriage; in the second half of pregnancy the most common reason for bed rest is the threat of preterm labor. Other reasons for prescribed bed rest later in pregnancy are high blood pressure, preeclampsia, incompetent cervix, premature rupture of membranes, and chronic heart disease.

Doctors prescribe bed rest for problem pregnancies for a number of reasons. The less active mother is likely to have a less active uterus. Bed rest decreases the pressure of baby on the cervix, thus reducing the likelihood of premature cervical stretching and contractions. Rest increases blood flow to the placenta, and thus improves the delivery of nutrients and oxygen to baby. Rest is likely to reduce a mother's high blood pressure.

Around 20 percent of mothers are confined to a week or more in bed at some time during their pregnancy. In many cases, being ordered to bed comes as a shock neither a woman nor her employer is prepared for. Following a visit or call to your doctor, your whole agenda is put on hold for days, weeks, or months. Even if you are in the middle of a household move or a big project at work, you go to bed because the stakes are so high.

1. Know exactly what you may and may not do. Be sure you understand what your healthcare provider means by bed rest. There's nothing worse than spending half the morning wondering if you can take a shower. You can pretty much figure that bed rest means refraining from the more "active" activities that go on in bed – no sex, no orgasm. But check to be sure you know whether your doctor recommends total bed rest, which means sponge baths in bed and bedpans, or whether you get the luxury of bathroom privileges and an occasional walk to the kitchen. Ask if you can slowly walk up and down stairs, or if you are confined to one floor. Bear in mind that most doctors over prescribe the degree of bed rest, realizing that most human beings do not easily adapt to such drastic changes in lifestyle and will occasionally cheat. Find out if your doctor thinks mental stress is a problem. Can you deal with office work over the phone? While you won't want jumping children using your bed as a trampoline, can they stay in the room with you for much of the day?

2. Set up a comfortable nest. If you have to stay in bed you might as well create a bed you like to stay in. Have your bed placed near or facing a window so you have fresh air and a view. Put anything you'll need within arms' reach on a table next to your bed. Use a cordless phone or one with a long cord if the phone jack isn't near your bed. Keep address books, phone books, your journal and all kinds of reading material on an adjacent table. Move the television or the stereo into the bedroom. Buy or rent a small refrigerator for your bedside snacks. Be kind to your recumbent body. Place a foam egg-crate contoured pad on top of your mattress.

3. Think positively. Rather than dwell on what you're missing, think about what you are enjoying. Even if you find yourself feeling bored and depressed, these feelings will eventually subside, and you will have happy days again. Focus on what you are doing for your baby, and on the benefits to you of resting and relaxing. The good thing about the emotions of pregnancy is that downs are usually followed by ups.

4. Realize your feelings are normal. With so much time to just sit and think, your emotions are likely to run wild. You may worry about the baby's health and survival, fret about how your husband and kids are coping, be bored with too little to do, feel anxious about things you should be doing, and dislike feeling dependent. You may feel angry and disappointed about the course of your pregnancy. You grow impatient, as the days get longer. You'll probably feel tempted to cheat. Each day in bed will bring on new emotions to work through, yet continuing to focus on the goal of your pregnancy will overcome these anxieties and keep you in bed as long as you need to stay there.

5. Seek your mate's help. This may be the first time in your life that your mate waits on you and seems to get very little in return – except, of course, that you are growing his baby. Prolonged bed rest during pregnancy can bring couples together or tear them apart. Abstaining from sex and curtailing the activities that you usually do together doesn't help a marriage that may already be stressed. Expect stress on your marriage for these reasons and because your husband is now holding down two jobs: taking care of you, and bringing home the bacon. Yet, if you are creative, a lot of bedside romance can take place: candlelight dinners followed by a video movie, breakfast in bed, and daily massages that promote circulation, and feel so good. Being cared for by a sensitive mate can add a new depth to your relationship. And for a spouse turned waiter, masseur, entertainer, and cook, this could be the first time in his life that he has had to put someone else's needs ahead of his own – good preparation for becoming a father.

6. Keep fit while in bed. With your doctor's okay, you could do some exercises in bed, such as leg lifts, calf stretches, and upper arm exercises with light weights. Exercising helps promote circulation, as well as keeping your muscles (including your heart) in shape.

7. Pamper yourself. Staying in bed does not mean denying yourself all the pleasures of life. Hire a massage therapist (or ask a friend) to give you a head to toe massage at least once a week. See if your hairdresser will come to your bedside.

8. Bond with your baby. Many women on prolonged bed rest face a dilemma: though this would seem an ideal time to contemplate the miracle of pregnancy and to really bond with the baby, the usual reason for being on prolonged bed rest is the very real possibility of losing the baby. So some women find that even though they have plenty of time to think about and plan for the baby, they have difficulty doing so because of their fear of losing the baby. Remember that the vast majority of women who are confined to bed go on to deliver babies who survive and thrive. And the few who don't, never regret loving the little person who was briefly part of their lives.

9. Get support. Ask your practitioner to give you the phone numbers of other mothers similarly confined to bed. Sometimes you can talk each other through a particularly dull day. Or contact a support group called Sidelines (714-497-2265), which maintains a national hotline of volunteers who offer support and match you with other bedridden moms-to-be. This group is the brainchild of a California mother who was confined to bed during her high-risk pregnancies and figured out a way to use her free time for the good of other women in her circumstances. Ask these experienced bedresters for practical suggestions on what helped them cope. Mothers who have laid in bed for six straight weeks or more will give you ideas on how to pass the time.

Your sex life changes again in late pregnancy. In the third trimester a woman is often preoccupied with her imminent birthing and mothering role. Her husband may find that his own feelings are undergoing a metamorphosis; his wife's body is not just exciting and different – it is the harbinger of imminent change. Women focus on birthing and nurturing the baby; men focus on their new roles as father and (at least temporarily) sole breadwinner. Your mate may be worried that he's losing you to motherhood. Both of you may experience ambivalence about the changes ahead. All these anxieties can get both your minds temporarily off sex.

Nevertheless, couples do engage in sex late in pregnancy. As you grow, your sexual relations will out of physical necessity become more creative. Desire can be the mother (or perhaps, in this case, the father) of invention. You will have to experiment with workable and comfortable positions for intercourse. The man-on-top position is usually the most awkward –- it is difficult, literally, to get over the hump – and least comfortable; penetration is deepest in this position and the man's weight on the woman's abdomen and breasts, while not harmful for baby, is uncomfortable for mother. Besides, in the last few months, women are often uncomfortable lying on their backs for anything. Experiment with these alternatives that allow the woman to control the depth of penetration and the amount of weight she bears.

• Woman on top
• Man on top, but with his weight supported on his arms
• Couple side-lying front-to-front or back-to-front (woman raises her upper leg and supports it with pillows)
• Rear entry (woman on hands and knees with partner behind her)

Use whatever position pleasures you both the most. Expect sex in the last months to be less passionate, less frequent, less athletic, but more inventive. If the desire for sex overrides your physical discomforts and your mental distractions, you will discover new ways of coming together.

Most dads aren't cut out to be labor coaches. So, who provides the missing link? Consider a labor support person. This woman, and probably a mother herself, brings the relaxed, natural approach of the midwife to a traditional hospital birth. Her presence means a mother does not have to rely solely on her husband for help in dealing with pain – she can instead enjoy his emotional support and love at a time that is special, but stressful, for them both.

Though a friend can certainly be a labor support person, mothers typically have the best results when they hire a professional labor assistant (or PLA, also called a labor support doula or a monitrice). Here are the benefits of using a labor support person:

• PLA provides comfort and companionship to the laboring mother.
• PLA has special obstetrical training, either as a midwife, obstetrical nurse, or educated laywoman
• Her knowledge of and experience with birthing, and her sole focus on the mother's needs make her a unique and, to our minds, indispensable part of a hospital birthing team.
• The PLA coaches, counsels, supports, and anchors a laboring woman, helping the process move more quickly and comfortably.
• She, along with the hospital staff, acts as an advocate for the parents' wishes, freeing mom and dad to focus on the labor and impending birth.
• Woman-supported labors are shorter (by as much as 50 percent) and more natural than non-supported hospital labors. (In one study 18 percent of unsupported but only 8 percent of supported mothers had cesareans; fewer supported mothers had epidurals, episiotomies, and perineal tears.)
• PLA's are often instrumental if mothers choose to avoid interventions (such as I.V.'s, epidurals, and internal fetal monitoring).
• PLA's are especially valuable in high-risk pregnancies where the necessary use of such technology makes natural methods of pain control much harder to use.

The downside of using a PLA, is you may end up paying for this service yourself – fees ranging from $500 to $700. Negotiate with your insurance carrier if you can, but don't hesitate to take the money out of savings if you have to.

Your hospital or obstetrician may have a list of PLA's for you to call, but most mothers find their PLA's through childbirth educators, local La Leche League groups, and the recommendations of friends. A resource for PLA's: Doulas of North America (DONA),
PO Box 626 Jasper, IN  47547;
(888)788-DONA
Fax: (812)634-1491
Doula@DONA.org