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What Happens At My 32 Week Visit?

amidwifenation

32 weeks! The third trimester usually flies by from 28 to 34 weeks. Then the last few weeks seem to drag out. It’s the perfect time to to all the planning for birth and postpartum. And that’s the idea behind this template!

In case you missed the other posts so far…here are the links!

Overwhelmed by all the information about pregnancy? Looking for a checklist to guide to each pregnancy visit? Don’t expect your OB provider to do all the work – take control of your care and get these templates to guide every aspect of your pregnancy visits.

Make the investment in you and your baby here!

What are the components of the 32 week visit?

Let’s break it down!

Review of symptoms or patient concerns

These are symptoms that have occurred since the last visit that the patient desires to discuss with the provider. Here’s an example: “I think I have a yeast infection because there are white chunks coming out of my vagina and it itches.” Or, “I had a yeast infection two weeks ago but I used Monistat over the counter and my symptoms disappeared. Was this okay to do?

Because it’s a routine visit, the review of system questions are targeted to pregnancy unless the woman’s history or questions indicate investigation and follow up. These questions are generally the same at every visit for the rest of pregnancy.

After the routine questions, I have some favorite questions that I like to ask during this visit. These are some of the questions I ask at the 32 week visit:

The Screening

Screenings are usually completed in a number of fashions – sometimes by the tech asks the woman questions or the woman fills out a piece of paper.

Screening for psychosocial factors is an important part of prenatal care. Some risk factors (i.e. homelessness, loss of job, smoking, drinking, moving…) are present before prenatal care and some factors happen during the pregnancy or postpartum. To increase the number of opportunities to provide timely intervention, support or referral, ACOG & AAP (2017) recommend screening on a regular basis during prenatal care and documentation of each screening in the prenatal record.

If the woman has a history of depression or anxiety, reports new symptoms of either depression or anxiety, or is on medication for mood management, a screening is appropriate to assess her mood and risk. ACOG (2015) only recommends screening once during the perinatal period and once a the postpartum period.

Screening tools vary across practices and regions of the world. In the United States, the most common tools used for screening in pregnancy at the EPDS or the PHQ (PHQ-2 or PHQ-9).

It is always appropriate to ask that the provider review your screening results with you. A screening tool is very valuable. And sometimes a woman may feel uncomfortable talking about her mood even though she knows something isn’t feeling quite right. A positive screening is a flag for your provider to ask more questions and also review options for support, counseling or resources.

The Exam, Lab Testing, and Ultrasounds

Exam

Once the pregnancy is established, the exam is limited to checking for normal progression of the pregnancy.

Source
Laboratory testing

Usually, there are not any labs done at the 32 week visit unless 28 week labs were missed or are completed late. Read more about 28 week labs here.

Ultrasound

For the anatomy scan…Read all about the scan on the 20 Week Visit in case you missed it!

At this point, ultrasounds are either completed for assessment of growth, blood flow to/from the baby (also know as dopplers) or as follow up (if the placenta was close to the cervix or some anatomy pictures weren’t seen clearly in a prior scan).

Some high risk pregnancy disorders (chronic hypertension, diabetes, intrauterine growth restriction) continue to have regular ultrasounds throughout the pregnancy to assess the baby’s growth and well-being. Low risk pregnancies tend to only have the dating scan and the anatomy scan – but this varies greatly from practice to practice and city to city.

The Education

The 32 week visit is a welcome mat to the third trimester.

These are the common areas of education, but the sky really is the limit and varies greatly from provider to provider.

These are the ones that I think are best for the gestational age! And regarding the golden hour, although it may be early to start talking about these components of birth, remember that about 10% of births are preterm. So the 32 or 34 week visit may be the last visit the woman has before she goes into labor.

THE GOLDEN HOUR

The Golden Hour is the first hour after the baby is born. These five actions improve bonding, help your baby regulate temperature, and reduce stress levels in the baby and mother:

Some videos about skin to skin are below (these little newborn snuggles are my absolute favorite to watch!):

Make Your Birth Plan

A birth plan is a written set of desires and expectations for a woman and her family during her labor, birth and postpartum period.

There is quite a bit of evidence about birth plans….here’s a recap!

Some evidence shows that women who complete a birth plan report higher satisfaction about their birth experience (Mirghafourvand et al., 2019). Other evidence demonstrates that a birth plan is related to fewer interventions, higher likelihood of natural birth and better outcomes for women and babies (Hidalgo-Lopezosa, 2021). Some birth plan templates can be very outdated or offer options that may not be available at a woman’s place of care. Some templates offer options that require discussions with the provider and should not be viewed as a “checkbox” item. For women, sometimes birth plans paint a pretty picture of birth that may not be realistic depending on their medical history. Other times, the staff on the birth unit may mock or disregard women that present with a birth plan (DeBaets, 2016).

Only one systematic review has examined birth plans. The review looked at 3 trials (n=1132 women) and noted that there was not enough evidence to show that a birth plan can improve the birth experience or satisfaction associated with birth.

These sites offer birth plan templates:

Don’t feel limited by these templates. You can also create your own!

Read more about limiting interventions during labor and birth here (ACOG, 2019).

Whatever method you choose, it is important to review the plan with the provider during your prenatal care and on admission to your birthing unit.

Talking about your birth plan during your prenatal care helps you and and your partner to make informed decisions (this is also known as shared decision-making) while simultaneously building a foundation of trust (DeBaets, 2016).

make your postpartum plan

It’s hard to cover all of this in a post. In fact, to cover everything might actually be a 2 day conference over a weekend. Alas, this will have to do. Consider this a bird’s eye view and dive down to whatever may interest you. For first time mamas, more research and reading might be indicated, but seasoned mamas may just need a quick scan of resources.

I posted a book review on The Fourth Trimester in 2021. Much of what was said in that post is true here.

To start, when you make a postpartum plan, consider these five needs during a postpartum period: an extended rest period, nourishing food, loving touch, the presence of wise women and spiritual companionship and contact with nature (Johnson, 2017).

Know that you are going to be sleep deprived. Sleep deprivation drives a lots of the planning to dos. But the planning really makes all of the difference.

Also consider these tips:

Postpartum Support Virginia’s My Family Postpartum Plan (in Spanish here) does a great job at walking women and their families through each of those five needs and more.

After a basic plan, there are a number of great resources to review.

Planning for this period really does help. It deserves as much attention as planning for the birth!

prepare for breastfeeding

There are some amazing educational opportunities on the web to learn about breastfeeding. These are my favorites:

prepare for birth

Preparing for birth takes a number of months. And it’s best to prepare one thing at a time if you can. With the pandemic, childbirth classes took a sideline. This list is meant to get you started.

Remember too, that about 10% of births occur preterm (less than 37 weeks gestation). So get a head start if you are able or catch up as you can!

what to expect with GBS!

About 1 in 4 women carry a bacteria called GBS (group beta streptococcus) in their body.

Newborn babies are at risk to develop GBS. In the United States, about 2,000 babies get early or late onset GBS disease in the newborn period each year.

Pregnant women are screened for GBS between 36 and 37 weeks of pregnancy.

If a women tests positive for GBS, antibiotics are given during labor to prevent early onset disease. Antibiotics only work during labor.

If a pregnant woman that is GBS positive receives antibiotics in labor, the baby only has a 1 in 4000 chance of developing GBS disease. If antibiotics are not received in labor, the baby has a 1 in 200 chance of developing GBS disease.

The test is completed with a swab of the vagina AND the anus. Either the provider or the patient can collect the swab. See how the swab is collected here (CDC, 2020).

The Follow Up

Whew, we made it through all that information! All of those great sources live permanently on the RESOURCES and BOOKS pages.

The follow up information is just as important as the rest of the visit!

Here’s a list to review with a woman and her family before leaving the clinic!

Other goodies…

For providers and women, the Share with Women Handouts cannot be beat for many discomforts and conditions of pregnancy.

ACOG’s Resources for You (Frequently Asked Questions about pregnancy/women’s health) and Healthychildren.org‘s Prenatal Resources are also excellent resources.

For any recommendations about books to read during pregnancy or breastfeeding, a full list is available on the BOOKS & MORE page!

Whew! That’s a wrap. Remember, this is only a guide for the 32 week visit. Providers and patients should work together to address all patient needs at the time of the visit. And, a lot of prenatal education is reviewed again and again!

Let me know!

Jamie

1 year ago on the blog…A Must Have Handout for Your Birth Plan and Your Birth Team

2 years ago on the blog…Women Ask Wednesday – The Well Woman Visit

Overwhelmed by all the information about pregnancy? Looking for a checklist to guide to each pregnancy visit? Don’t expect your OB provider to do all the work – take control of your care and get these templates to guide every aspect of your pregnancy visits.

Make the investment in you and your baby here!

Links in the post

5 S’s by Dr. Harvey Karp

ACOG’s Approaches to Limit Interventions during Labor and Birth: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/02/approaches-to-limit-intervention-during-labor-and-birth

ACOG’s Resources for You: https://www.acog.org/womens-health/resources-for-you

Birth plan templates: March of Dimes; The Bump; Writing a Birth Plan

Perinatal Mental Health Discussion Tool: https://www.postpartum.net/wp-content/uploads/2019/05/PSI-Perinatal-Mental-Health-Discusion-Tool.pdf

Postpartum resources: The 4th Trimester Project; The Blue Dot Project; Postpartum Support International; Postpartum Education for Parents

Routine Tests in Pregnancy: https://www.acog.org/womens-health/faqs/routine-tests-during-pregnancy

Share with Women handouts: http://www.midwife.org/Share-With-Women

The Period of Purple Crying

Tucson Medical Center (free birthing class, online)

References

American College of Nurse-Midwives. (2011). Vaginal birth after cesarean delivery. http://www.midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000000090/VBAC%20Dec%202011.pdf

American College of Nurse-Midwives. (2019). Preventing iron deficiency anemia during pregnancy. Journal of Midwifery & Women’s Health, 64(1). doi: 10.1111/jmwh.12940

American Academy of Pediatrics, & American College of Obstetricians and Gynecologists. (2017). Guidelines for perinatal care (8th ed.). doi: 10.1002/14651858.CD003519.pub3

Centers for Disease and Control and Prevention. Group b strep. https://www.cdc.gov/groupbstrep/about/fast-facts.html#:~:text=About%201%20in%204%20pregnant,onset%20GBS%20disease%20in%20newborns

DeBaets, A.M. (2016). From birth plan to birth partnership: Enhaving communication in childbirth. American Journal of Obstetrics & Gyneoclogy, 216(1), P31.E1-31.E4. doi: 10.1016/j.acog.2016.09.087

Hidalgo-Lopezosa, P., Cubero-Luna, A. M., Jiménez-Ruz, A., Hidalgo-Maestre, M., Rodríguez-Borrego, M. A., & López-Soto, P. J. (2021). Association between Birth Plan Use and Maternal and Neonatal Outcomes in Southern Spain: A Case-Control Study. International journal of environmental research and public health, 18(2), 456. https://doi.org/10.3390/ijerph18020456

King, T., Brucker, M., Kriebs, J., Fahey, J., Gegor, C., & Varney, H. (2015). Varney’s midwifery (5th ed.). Burlington, Massachusetts: Jones & Bartlett Learning.

Johnson, K.A. (2017). The fourth trimester: A postpartum guide to healing your body, balancing your emotions, and restoring your vitality. Shambhala.

Mirghafourvand, M., Mohammad Alizadeh Charandabi, S., Ghanbari-Homayi, S., Jahangiry, L., Nahaee, J., & Hadian, T. (2019). Effect of birth plans on childbirth experience: A systematic review. International journal of nursing practice, 25(4), e12722. https://doi.org/10.1111/ijn.12722

Neczypor, J., & Holley, S. (2017). Providing evidence-based care during the golden hour. Nursing for Women’s Health, 21(6), 462-472. doi: 10.1016/j.nwh.2017.10.011

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