The last two weeks have been like hitting a brick wall.  No one expects the Third Trimester to be easy, but I was startled by the new pregnancy issues that showed up seemingly out of nowhere. 

Where did you go, Sleep?

I considered myself lucky for most of my pregnancy, because my sleep would only be interrupted by an occasional bathroom break.  Suddenly, the last two weeks, my sleep is interrupted by everything from my hands aching (carpal tunnel from mild pregnancy swelling - I finally got a prescription for splints from my OB/GYN last week but haven't had a chance to fill it yet) to heartburn (which, I've learned, I can now get off of a single piece of toast) to mild dehydration (it's been hot) to aches and pains to the fact that I rolled over onto one of my son's stuffed animals.  Last night, I woke up seven times.  SEVEN TIMES.  Some people are so good about getting back to sleep, but I am not one of them.  I usually eat a bowl of cereal or drink water, pet my hauspanther, read the Economist or lose a few hours to Pinterest before I can doze off again. 

Grape-Nuts and Cherries

I have absolutely faith in myself to down an entire box of Grape-Nuts and a pound of cherries every single day now.  Considering that my pregnancy cravings have been pretty mild up to this point, I was intrigued.  Well, as it turns out, Grape-Nuts are super high in iron and folate, two of the most valuable nutrients during pregnancy.  Cherries on the other hand - well, what's not to love?!  They are high in antioxidants, which help manage inflammation and melatonin, which helps manage sleep cycles.  They also contain a lot of potassium, which is a super valuable electrolyte to consume during a summer heat wave.  Another wonderful feature of cherries is that for all of their natural sweetness, they don't actually rank all that high on the glycemic index, meaning that indulging doesn't spike my blood sugar too much. 

I just cut my bangs!  What on Earth...?

People devote a lot of energy to expounding on the joys of magical, fast-growing, shiny, healthy pregnancy hair and nails.  I never really noticed much difference.  Then, all of the sudden, I looked like a sheepdog only two weeks after having my bangs trimmed.  The next week, I realized that my nail polish had grown out to the middle of my nails - in three (THREE!?) days.  It's pretty cool.  I feel like Wolverine, like I can just make my body rejuvenate.  I also clogged my bathroom sink drain twice already.

Twice Weekly Fetal Non-Stress Tests

I've continued to go into my OB/GYN's office twice per week for Fetal NST.  I generally get these done on Tuesdays and Fridays.  I've been fortunate to schedule them in the late afternoon so that I can work most of the day and then just leave a little early.  So far, everything has been completely normal and I am so very grateful.   I also had another ultrasound at Thirty-four weeks.  I looked forward to this ultrasound for weeks because I thought I would get to see Baby Girl's profile, or something precious, like her sucking her thumb.  Nope.  I got to see her ear.  One lone ear.  And a femur.  At least she is no longer breech!

Group B Strep Test...well, um, that was...invasive.

I honestly did not remember this test from my first pregnancy at all.  In my mind, I must have vaguely recalled it as a simple vaginal swab.  Well, it's a vaginal AND anal swab to test for Group B Streptococcus.  Women who test positive for Group B must take antibiotics prior to delivery, as this little simple bacteria can cause all kinds of scary issues, the least of which is infection in your newborn.  My Group B Strep Test was immediately followed up by a manual exam to try to evaluate whether my pelvic opening veered on the narrow side (it does).  This was basically as comfortable as someone sticking their hand in your vagina to try to evaluate your spine.  Let's just say my thirty-five week appointment couldn't end soon enough. 

Delivery?  I'm pretty sure it's tomorrow.

I'm four weeks away from my due date.  Once you get that close, I feel like your body and your mind start to work together to narrow your focus to only your pregnancy.  For example, the last week or so, I feel like it it is difficult to concentrate on anything unrelated to the baby.  I also feel like my body's demands for rest have become loud and clear.  Even a couple of weeks ago, waking to an alarm and getting ready for work seemed a thoroughly manageable task, now it often feels Hurculean.  Emotionally, closing the distance of four weeks makes everything feel so imminent!  This last month is going by like a bullet train!

Exercise Program

Here is my typical workout schedule right now. 

Monday:  30 minutes of swimming or "water aerobics" movements, aided by kickboard
Tuesday:  30 minutes of swimming or "water aerobics" movements, aided by kickboard
Wednesday:  30 minute walk
Thursday:  15 to 40 minutes of toning with 3 lb weights  or bodyweight only (like Cardio Barre Arms on the Studio Tone it Up App).
Friday:  Rest Day
Saturday:  Gardening or 30 minutes of swimming; 15-25 minute toning with 3 lb weights or bodyweight only.
Sunday:  Rest Day

As you can see, I'm spending a lot of time in the pool.  My son is just becoming an independent swimmer this year, so a lot of the time, I'm focused on assisting him in the water.  When he has his wings on and I don't feel the need to be right on top of him, I'll do leg lifts, arm circles, skipping, bouncing and anything else to keep me moving in the water.  Gravity and I have been having some disagreements lately, so it feel great to move without additional strain on my body.  I keep it laid back and don't follow any specific workout routine in the water.  I just try to stay in motion! 

I continue to follow the Studio Tone it Up weekly schedules.  That has required a bit of humility lately!  Sometimes, I'll have plans to complete a rigorous workout and tap out after fifteen minutes.  I  just remind myself that this short phase of my life is not about gaining muscle or endurance, but rather about boosting circulation, stretching, maintaining health, managing pregnancy weight gain and just getting a couple of endorphins running around.  Even five minutes of exercise can meet most of those goals, so I try to keep my expectations reasonable. 

MEAL ONE:  A piece of Ezekiel Toast with natural peanut butter and low-sugar, natural jam.  16 oz of infused water (lemon and mint leaves are my favorite).  Sometimes, I'll make a protein smoothie instead (1/2 frozen banana, 1 cup almond milk, 2 cups of frozen berries, 2 dates, 1 scoop of vegan protein powder).

MEAL TWO:  A Tone it Up Protein Bite (my favorite flavor is Snickerdoodle), together with a small apple.  Sometimes, I like to have an entire Tone it Up Protein Bar instead.  My favorite flavor is Birthday Cake.  

MEAL THREE:  I have been focusing a lot on cold salads lately.  I've noticed that it is hard for me to eat meat at this point in my pregnancy, so I try to obtain protein through plant sources.  Today, I had a cold chickpea and veggie salad with olive oil and spices; together with an un-buttered piece of French bread and roasted veggies.  This has been my largest meal of the day for a while, because it doesn't help heartburn to eat a big, substantial dinner.  I have one goal for Meal Three now and that is to pack it solid with as many nutrients as possible, because (as you'll see), I've been struggling to eat much at all for dinner. 

MEAL FOUR:  No lies here.  I have been grabbing a few "mini" pieces of chocolate at this point.  I limit myself to 3 mini chocolates - like the kind you would hand out at Halloween (or about 140 calories). I also like to snack on nuts or seeds at this time, and sometimes throw together my own trail mix at home. 

MEAL FIVE:  Honestly, I can't win.  I've eaten things as bland as banana-strawberry smoothies and still spent the night up multiple times with awful heartburn and stomach pains.  Lately, I've tried to incorporate a small bowl of chickpea pasta with a little olive oil, just to have something more substantial to get through the night.  Sometimes, I down a bowl of yogurt with a spoonful of natural peanut butter and raisins mixed in.  Sometimes, I down a bowl of Grape Nuts or Oatmeal with almond milk.  Sometimes, I eat a Popsicle, nectarine and raid my five year old son's snack drawer for fruit gummies.  It's a victory when I'm motivated enough to make homemade "Nice Cream" or a smoothie. 

Meal Five is a bit of a free-for-all, based on whatever I think I can handle now that my stomach is somewhere around my clavicles.  I definitely can't even look at Mexican food, Indian food, Thai food, pizza, or meat-based dishes, and my significant other is beside himself.  If he wasn't able to eat these foods, he would surely starve, muttering dramatic last words quoted from an episode of Top Chef. 

I definitely can't say that Meal Five has been "TIU Approved."  With that said, I've given it the Old College Try and avoided fried foods, artificial sweeteners, no high fructose corn syrup, and minimal refined breads or pastas.  I'm also committed to staying with five meals per day to keep my energy levels stable. 

I've read that during the last few weeks of pregnancy, the placenta creates as much estrogen in one day as in a single year of not being pregnant.  This seems about right now that I'm crossing into Thirty-seven week territory.

Weight Gain

I've gained 30-35 pounds total with this pregnancy, 38 pounds with my last one.  Strangely, this slight difference seems profound.  I get a lot more comments this time about being "all baby" and "not even looking pregnant" until people see my stomach, and can only attribute that to the fact that I worked out harder and more consistently during this pregnancy and must be carrying a bit differently. 

Women place a lot of importance on their weight gain during pregnancy, but in my experience, that last 10% of total gain has nothing to do with you.  In the last 60 days, I feel like the biggest driver of weight gain is water retention and the baby itself, things that are not impacted all that heavily by diet and exercise (unless your afternoon snack consists of a salt lick.)  I was SO committed to keeping my weight under a certain number this time, and devoted a lot of effort toward that goal, and blamelessly blew right past that number four weeks before my due date.  Pregnancy is a great example of how the whole "calories in, calories out" mythology of weight gain can be shortsighted and misleading. 

Appetite

Almost out of nowhere, my appetite completely changed.  I can honestly say that I've only had ice cream a couple of times during this entire nine month period.  Suddenly, I downed an entire mini-container (850 calories!) in one sitting.  It's funny, because last time, I went into labor on my birthday after eating five pieces of cheesecake.  I'm someone who can make an entire bar of dark chocolate last an entire week, so when I start to crave super high calorie "bombs" I know that my body is trying to stockpile energy for something big. 

Zzzzzzzzzzz

I always wish that I was a napper, but I'm not.  I often lament the fact that even when I'm desperately tired, I just can't fall asleep during the day.  Suddenly, once I hit this Thirty-seven week point, my body started to crash HARD from fatigue.  For example, I had a busy day at the beach on Saturday.  On Sunday, I was awake from 3 AM to 6 AM, when I decided to just lie down and rest a little.  I passed out cold until almost 1 PM, and when I woke up, I was like "Where am I?"  Just like the high calorie food cravings, my body seems to want to stockpile a few extra zzzzzz for the big event.

Hips don't lie

My hips suddenly feel like a game of Jenga, as though all of the parts are not quite fitting together the way that they should.  This sensation arises from a mix of things, primarily the hormone relaxin, repositioning of my center of gravity, the significant weight at the front of my body, and the baby dropping lower into the pelvic region.  Basically, if I roll over in bed, my hips crack or pop in about five places they didn't used to!  Like most women, I also tend to get a bit of back pain or sciatica, especially after walking.  At the recommendation of my doula, I've decided to focus heavily on hip openers. 

I've adopted the following stretches, which I perform daily:

1.  Butterfly asana
2. Wide legged stradle - right leg
3. Wide legged stradle - left leg
4. Wide legged stradle - center (e.g. Russian split)
5. Frog asana (yin yoga)
6. Modified dragon asana (keeping the back leg bent)
7. Pelvic tilts (modified Cat/Cow asana, watching for minimal back extension)
8. Pelvic tilts on an exercise ball
9. Hip circles on an exercise ball
10.  Deep squats, supported by a yoga block
11.  Goddess asana (wide legged "plie" squat) sometimes supported by an exercise ball
12. Lunges
13.  Psoas stretch with modification (low lunge or "foot to opposite knee" pose)

I have been lucky to retain quite a bit of flexibility, so this sequence does not cause pain or discomfort.  Everyone is built differently, so please do not push it if any of these are uncomfortable.  There are a million ways to modify a stretch or asana, and just as many ways to replace it entirely with something new. 

Wrist Splints

My son took a look at my brand new wrist spints and said "it looks like your arms are broken."  I took one look at them and said, "Wow, this is the first time I've been able to feel my fingers when I wake up in the morning in more than a month."  When it became difficult to do simple tasks like button a shirt or open a can of cat food, I knew it was time to just suck it up and get a pair.  Binson's Medical Supply was a joy and helped me find a pair that fit my tiny wrists.  It's amazing how just a tiny bit of swelling was having such a huge impact on my day to day life. 

When I was Twenty-six weeks pregnant, my doctor informed me that my glucose was "+1".  This means that the amount of glucose in my blood stream measured in excess of the accepted normal limit, albeit not by much.  Still, in combination with my advanced maternal age (41), even this single test result earned me a 3.5 hour Glucose Tolerance Test at Twenty-seven weeks. 

A little background:  Adult onset Type II Diabetes exists on both sides of my family.  On my father's side, my grandfather was diagnosed with Type II Diabetes in his late 60s, and managed it through medication.  On my mother's side, my grandmother was diagnosed with Type II Diabetes in her late 70s, although it appeared to be paired with the onset of fairly aggressive dementia.  As early as high school, I figured out that excessive sugar intake was not really my friend.  After passing out cold during cheerleading practice, and suffering from a few other odd symptoms, I had a six hour Glucose Tolerance Test at the age of 16.  I found that while I was not diabetic (phew!), I had a strong tendency toward reactive hypoglycemia.  The test was MISERY, but as a result of it, I made a few permanent lifestyle changes that kept me in great health for the following decades:  I gave up drinking pop.  I never indulged alcohol.  I cut back on candies and other high glycemic index foods, like white breads.  I tried to sneak in a little bit of protein at each meal.  I learned to eat every three hours so that I wouldn't get lightheaded.  This was all in the early 1990s, decades before phrases like "keto" or "Whole 30" or even "plant based" would enter the common vernacular.  For that reason, I had to learn what a healthy "low sugar" diet was on my own, largely by relying on things like the Mayo Clinic's nutritional guidance.   For more than twenty years, I had absolutely no abnormalities.  Getting even this test result was a bit disheartening, as though my decades long run of good luck had finally come to an end.

The 3.5 hour Glucose Tolerance Test came back normal, but believe me, I prepared for it by limiting simple carbohydrates for the entire week preceding it.  Cereal has been one of my pregnancy cravings (probably because it is enriched), so this was not the best week of my life.  I also switched the prenatal that I was taking from Premama Prenatal Drink Mix to Rainbow Light Prenatal One.  Frankly, I can't say that one is better than the other.  I switched for the following reasons: (1) I had tired of the taste of Premama Prenatal Drink Mix after so many days of drinking it and was relying on juice and Mio drops to make it more palatable, something that I worried would influence my test results (Mio contains nominal amounts of sucrose and sucraolose).  (2) I had taken Rainbow Light Prenatal One 35+ during my pregnancy with my son, and knew that I tolerated it well.   I also completely cut out even the tiny amount of caffeine I was consuming each day.  I had a really hard time with even this 3.5 hour test because it requires that you fast for such a long time.  Still, I was grateful for normal results. 

My happiness was a little bit short-lived.  The next week, my routine urine testing returned +2 glucose and +1 protein.  I had also gained four pounds in one week, including a lot of water retention.  Hearing about the protein and weight gain stopped me in my tracks, as these can be the earliest markers for preclampsia, a very serious pregnancy complication.  Certainly, other things can cause a positive protein result as well, such as a mild urinary infection. It is not clear what led to my result, as I did not have (and have not developed) any other symptoms of preclampsia.  However, despite favorable results after that week, I had already earned twice weekly Fetal Non-stress Tests (Fetal NST) for the remainder of my pregnancy. 

Emotionally, I was surprised at how stressful this period was for me.  The minute that I realized that my test results were not completely perfect, I engaged in a bit of catastrophic thinking.  I never engaged in any serious concerns about Baby Girl, because I have complete faith in my health care providers to see to our welfare, and had the benefit of being a bit farther along in my pregnancy.  Still, I had a LOT of concerns about being placed on mandatory bed rest or needing to deliver weeks earlier than my due date.  I was also absolutely terrified to tell my boss that I was going to need to have medical tests performed on the other side of town twice per week for the foreseeable future.  Thankfully, she was exceedingly understanding.  With that said, I could tell that it was a bit of a "wake up call" for both of us, and I immediately went to work on creating a written Maternity Leave Plan and making arrangements - just in case. 

I'm now Thirty-three weeks along, and in the process of submitting my Maternity Leave Plan this week.  I've continued to drastically limit simple carbohydrates (e.g. candy, ice cream) and caffeine. I still work out 3-6 days per week (although, having gained twenty-five pounds, I've been moving those workouts to the pool where possible!) Luckily, the first three Fetal NST tests have been relaxing and demonstrated no abnormalities at all.  I have them each Tuesday and Friday.  During the last one, Baby Girl had the hiccups, which was adorable and hilarious to listen to over the amplified speaker. 

Purpose of Writing the Plan

There are many reasons to put together a written Maternity Leave Plan for your employer.  For me, I really enjoy and appreciate my coworkers, and realize that my extended absence may present them with challenges or changes.  The plan offered me a forum to make things a little easier on them, by answering their likely questions.  These questions ranged from the obvious ("When do you expect to have your last day in the office?  What is your due date?) to the not-so-obvious ("Do you have any recurring meetings set up?")  It also helped me to fulfill a legal requirement - in order to qualify for FMLA leave, you must provide your employer with no less than thirty (30) days prior notice.  I also found that the Maternity Leave Plan helped me to feel more confident about two things: (a) my financial situation during leave, part of which will involve reduced pay and part of which will involve no pay at all; and (b) my general career direction (specifically, it was nice to have solid estimates about when leave would end, because I could predict what kind of projects or activities would be going on at that time. 

Include Key Dates and Contact Information

The first page of my plan includes the following important dates and contact information:
1.  My last day of full time work (I'm taking a week of vacation prior to my due date)
2. My last day in the office (Important for those who may work remotely for a little while)
3. Length of leave (12 weeks)
4. Estimated last day of maternity leave (i.e. last day of FMLA coverage)
5. Estimated date of first "official check-in
6. My OB/GYN's contact information (just in case I go into labor at the office *shrug*)
7. Health Care System/Location of Delivery contact information (see #6)
8. Request for enhanced remote work schedule (for first 6 months post delivery)
9. Personal Contact Information

When I requested an enhanced remote work schedule, this is the exact language I used: "For consideration - Transitional remote work 2x per week through March 2020.  This would be very helpful to navigate the numerous infant pediatrician visits, recovery from surgery (if needed) and establishment of sleep/feeding/care cycles over the first six months.  At Company's discretion." 

As a second time mother, I am now well versed in the fact that humans have ZERO Circadian rhythm until they are at least 4 months old; breastfeeding is an activity that can take 40 minutes up to 6-9X per day for young infants; and recovery from surgery or other medical issues do not always neatly line up with maternity leave timelines.  Also, the gross inadequacy of U.S. parental leave practices is well established at this point, so no one should ever feel ashamed for asking for a concession that will make it easier for them to be a better parent and employee.  

Please note that especially if you are going to have a period of uncompensated leave under FMLA, you really should not be working.  Resist the temptation to be a "people pleaser" and make yourself available for work functions or contact too early during leave.  For one, taking that "one conference call" can impact your legal rights to leave.  For another, especially if you are a first-time parent, I promise you that you are grossly underestimating the physical, emotional and mental resources needed to take care of a newborn and infant.   This is one time in your life to practice strict work versus home boundaries (a skill you'll refine over and over for the next eight-teen years!)

Status of Open Projects or Negotiations

One of the biggest "fears" that your boss and coworkers likely have about your departure is that an open project of some kind will fall through the cracks.  I'm lucky to have had many discussions with my boss about my upcoming leave, and can confirm that this is one of the items that she brings up frequently.  This is nerve-wracking for them because they have to step into the middle of something.  It's like a toddler entering the classroom when they are already doing "morning circle time."  No one ever wants to be caught off-guard!  As a priority, I would ensure that you have a list of all of the things that you are working on at the time of leave, as well as a a plan for who will step in to complete those items if you are unable to do so.

Recurring Meetings

I have an ongoing meeting each week with one of our customers through the next year.  Since I will be absent, it is important to establish what other employees may be able to participate in my stead.  Alternatively, you may consider which recurring meetings can be suspended or cancelled.  For my plan, I included a paragraph setting forth the status of our discussions, all of the participants (including contact information) and flagged any items of urgency.

Outside Support

Everyone's role is different, as are the plans for covering that role during an extended absence.  At many companies, a temporary employee may be brought in to assist.  At other companies, the existing employees may absorb additional work during the leave period.  For me, the latter situation applied.  One of my primary areas of expertise is a bit specialized, so I made sure to include contact information for a third party vendor capable of providing specialized support in this subject area.  I included information about pricing and an overview of past services this vendor has already successfully provided for us.

Inside Support

I think it is important to take initiative to identify those people that can step in and help fill your role during maternity leave, instead of just leaving it up to your boss to figure it out on his or her own.  Your management team is likely busy and lacking in genuine insight into the nuances of your day-to-day (unless they are micromanaging, which would be a completely separate issue!)  By coming to your boss with both external and internal contacts who support you regularly, you are making their life a lot easier.  In business, I often feel like 50% of success is just knowing the right person to reach out to for information. 

Locating Important Information

Since I perform legal activities for my employer, a considerable amount of the work product I generate is not suitable for public (or even company-wide) consumption.  For this reason, I worked with my IT Department for several weeks prior to leave to arrange for two different electronic locations to store my documents, memos and reports during leave.  Our primary goal was to create locations that allowed access by anyone who needed the information, but did not risk improper disclosure of confidential information to unauthorized individuals.  I ended up creating one shared drive accessible only by my boss that contains EVERYTHING (searchable by keyword) and a second shared drive accessible by a select group of peers that contains only a few important folders.  This process involved the transfer of more than 2,000 individual documents.  You probably underestimate how much electronic content you generate at work, so it is never too early to reach out to IT and ask for their guidance about how best to manage it.

E-mail Out of Office Response

This is another item that can be highly variable depending on your role.  For me, I proposed an e-mail automatic Out of Office reply that will direct people to one or two individuals, depending on the nature of their request. 

Annual Functions and Reviews

It can be helpful to identify any key annual functions that may occur while you are out of leave and address them in advance.  For me, I realized that my leave would coincide with our annual performance review process.  By flagging things like this in advance, you are communicating to your employer that you are a forward-thinker and taking a comprehensive approach to planning your leave. 

Human Resources

I know that there are many women who hesitate to inform their employers about their pregnancies early on, for any number of reasons.  However, if you feel comfortable doing so, I encourage you to share the news early.  I told my boss at about 6 weeks, and I believe I informed Human Resources and key coworkers by about 10-12 weeks.  Now that I am well into the third trimester, I'm grateful for this approach because it means that everyone I work with has had plenty of time and notice to address questions, express concerns, assist with planning and mentally prepare for my upcoming leave.  Basically, there should be no surprises when I go out in a couple of weeks, and that provides me with peace of mind.  In addition, I've been able to schedule multiple sessions with Human Resources to review the terms of my maternity leave.  Even with a legal education, this stuff can be confusing!  Be sure to set aside time with Human Resources and don't feel ashamed for asking questions until you really "get it." 

Maternity Leave Impact

Taking maternity leave can be one of the most critical moments of your career.  My first maternity leave experience eventually ended with me settling with the company about two years later after extended disputes over blatant discrimination and harm to my career.  In short, the contract worker they hired to assist during my leave never left.  Over the next couple of years, I found that my work relationships were harmed and my most valuable and important work was siphoned off to her, including several opportunities for advancement. 

Many women have a fantastic experience with maternity leave, and may even have access to mentoring, phased returns to the office, group coaching, well appointed mothers' rooms or on-site childcare, and general support for employees who are also parents.  However, my experience is not a unique one either.  Sometimes women are shocked to find that they return to a culture that does not take them seriously, passes them up for promotions, or fails to express understanding for the challenges of working parents.

Creating your Maternity Leave Plan may present an opportunity to consider your long-term goals in your career and how your current situation supports (or does not support) those goals.  It can give you a wonderful forum to really engage with your boss or coworkers about what you want to accomplish in life. 

Rarely will you be presented with such a clearly delineated break from your chosen career path.  This can be a great time to journal, meditate, explore, and daydream about what kind of parent and professional you want to be.