48. Baby’s First Movements, Tips for Sleeping Discomforts in Pregnancy, and Choosing a Pediatrician Before Baby is Born

If you’re ready to answer some of the most asked questions of the mid-second trimester to help you feel confident in your body during pregnancy and informed when making decisions for your baby before they are even born, then this episode is for you! 

The 3 questions answered in this episode are:

• When should I expect to start feeling my baby? What do those first movements feel like? 
• Can you lie on your back to sleep during pregnancy? Tips for pregnancy insomnia and pregnancy sleep challenges.
• When should I start looking for a pediatrician during pregnancy? Will my pediatirican come to the hospital, or how does this process even work?

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Welcome, friends! I am Beth, a certified nurse midwife, doula, and childbirth educator. My philosophy is rooted in autonomy, informed decision making, and positive mindset to help expecting parents plan for a beautiful, stress-free birth. I am here to provide value to YOU through tips and practical advice, either to guide you through pregnancy or to help you prepare for childbirth, postpartum and beyond. There’s no fluff here - only info that adds to your positive experience and saves you stress and uncertainty.

Transcript

Hello everyone and welcome back to Episode 48 of Your Birth Bestie podcast. I apologize right off the bat for my voice, maybe one day I’ll sound better, but I have been sick for 3 weeks and hoping eventually this will be behind me, but today is I guess not the day. Today we are going to be doing a 3 in 15 kind of episode, where I answer 3 questions in 15 minutes. These are all mid-second trimester questions from moms which is also where I am at in my own pregnacy right now. I hit the halfway mark yesterday which is super fun and crazy how fast everything has been going this time around, but I’m excited to continue this journey with you. So, let’s get right into the first question.

And the question is, what do baby’s first movement feel like and when should I expect to start feeling baby?

And many people explain those first flutters, because they are not really kicks right now, as “butterflies” or “gas bubbles”. It can be super subtle and make you guess if what you are feeling is baby or not, so that’s super normal. Your baby is like a half of a pound at this point, so super tiny still and doesn’t have much power to even feel much. But it’s really a unique experience to every person. Then of course as baby gets bigger there is a gradual progression of more distinct kicks and punches, literally being able to see baby’s arm or foot dragging across your belly. Feeling the movements are probably one of my favorite things about pregnancy, but also the strangest thing to think about too sometimes. Movements can also be really gentle and sweet or a really startling kick to the ribs or crotch, aka lightening crotch which is common as well. 

The more babies you have, the more you know what to expect too and usually the earlier you are able to notice these little feelings. Typically moms are able to start to feel baby move around 18 to 25 weeks, but it depends on a few things too such as baby’s positions, mom’s body composition, and the position of the placenta. If you find out at your anatomy ultrasound which we talked about last week, that you have an anterior placenta, you may feel more muffled movements or it might take longer to feel those initial movements. This can be a bummer for some expecting moms and even be a cause for worry because you aren’t feeling what you think you “should” be, but getting in tune with your body and baby the best you can and knowing what’s normal for baby is hopefully reassuring. You also would know the reasoning behind the less intense kicking feelings so hopefully would be helpful as well. 

And as a side note too, my first baby had a posterior placenta which I felt lots of movement, so when I was told my second had an anterior placenta I was shocked because movements felt pretty much the same. The further along I got in my second pregnancy, the more intense movements I felt and it was so surprising feeling more with an anterior placenta than I did with a posterior one. I also swear it had to do with their differences in personalities or something, because my second is definitely much more wild than her old sister, so that maybe started in they womb too, who knows! 

Movement patterns of baby will also change throughout the day depending on their sleep-wake cycle, how active you are, what and when you’re eating, things like that. But you’ll get to learn active times of the day and be the movement should be reassuring of your baby’s well-being, which your provider will recommend around 28 weeks certain things to look for regarding kick counts and any reasons for concern. I’ll also be dedicating a whole podcast to fetal kick counts and fetal well being in a few weeks, so you can look forward to that as well if you’re interested when the time comes!

The next question is all about sleeping in pregnancy, specifically can you lie on your back when pregnant to sleep and tips for insomnia and other sleep discomforts.

The best sleeping position after 20 weeks of pregnancy is usually lying on either side, and this is because as your belly gets bigger and heavier from your growing uterus and baby, they can actually compress major blood vessels, including the vena cava, which can reduce blood flow to your heart and your uterus. This could cause dizziness, shortness of breath, and fainting as well, also restricting blood flow to your baby which isn’t good. These symptoms don’t happen to everyone and everyone’s experience is unique, so if you try your best to fall asleep on your side and wake up in the morning on your back, don’t worry too much about it, you can only do the best you can and aren’t always able to control for this. No need for added stress, but definitely reach out to your provider if you have further concerns.

But in general, I recommend lying on your side with a pillow between your knees, one tucked in behind your back, and then something like a small towel rolled or folded under your belly bump in the front. They have special pregnancy pillows for this which are also great, but I don’t think they are totally necessary unless you’re really struggling at bedtime and are desperate for something more. 

Other common complaints about sleep in pregnnacy are insomnia, restless legs, and of course increased urination waking moms up at night. 

If you’re having a hard time falling asleep or stay asleep, this is due to hormonal changes usually, physical discomfort, and just anticipation and maybe some anxiety about motherhood or pregnancy and birth. What you can do is create a relaxing bedtime routine to basically train your body to know it’s time to wind down, just like we do with kids too. You might enjoy things like reading, taking a warm bath, or practicing relaxation such as deep breathing or meditation. Make sure youre bedding and pillow setup is as comfy as possible. Breathable fabrics, appropriate pillows for support on how you’re wanting to sleep. Try to keep your bedroom cool, dark, and quiet to promote better sleep as well. I love my blackout curtains for daytime sleeping when I’m up all night at a birth, so definitely recommend those, and I also use a white noise machine with a relaxating sound to drown out any other noises around. It has absolutely changed my sleep quality after long overnight shifts, but also in pregnancy it’s a bonus to have that setup already in place too. 

And then the last thing to promote better sleep is limit stimulants and screen time, which I know you already know, but I have to include it. I’m terrible at this one myself because it’s so tempting to want to scroll and look on my phone when I’m relaxed in bed, kid-free, but it’s pointless and doesn’t help my sleep either, so I’m trying to improve this too. The idea is to avoid things like caffeine and stimulating activities right before bedtime. Also, no screens in the 30-60 minutes before bed because the blue light can actually interfere with your body’s natural sleep-wake cycle which is so important. But I get it, it’s a work in progress for many, but something to try if you’re struggling.

As far as restless legs and frequent urination…. Restless legs are really frustruating and usually are worse at night. Things you can try are walking, yoga, or gentle stretching before bed, warm baths or massages, and magnesium supplementation can also help as well. Your provider can also offer personalized advice to help you, if this is a persistent problem that is very uncomfortable.

For frequent urination, this is also frustrating becuase you’re trying all the things to get good rest, but then your bladder doesn’t cooperate. You definitely want to stay hydrated, but reducing fluids in the evening maybe a few hours befor bedtime could help lessen the need to wake up at night. Pelvic floor exercises can help support bladder health and function allowing you to imrove your control and reduce any urgency or frequency with urination. A pelvic floor physical therapist would who I would recommend you getting more personalized support from. I could say strengthen with Kegels, but this is not the advice that is helpful or appropriate for everyone, so I’m not going to support that advice that maybe you have heard before.

And then of course using the bathroom right before bed, practicing those good sleep habits we just talked about so your body knows it’s time to sleep and to get in that restful state, hopefully promoting uninterrupted sleep, and then you can even experiment with different sleeping positions that limit pressure on your bladder. Lying on your left side can alleviate pressure on your bladder so a subtle adjustment to try if you need.

The last question, is about choosing a pediatrician. Basically what moms will often as is when should I look for a pediatrician and how does establishing care work if baby isn’t even born yet?

These are all great questions and I will help explain it to you a bit further in a general sense, because many practices do it differently in different places. But basically I recommend looking for a pediatirian right around 20-24 weeks and committing to someone around 28 weeks. This just ensures that if you were to go into labor early, you’ve already done your research on an important part of your baby’s care, which is who you trust to care for your baby after they are discharged from the hospital. 

What I first recommend is calling your insurance company using the member services number on the back of your insurance card and learning more about your benefits, which providers near you are in-network, and then which ones are actually taking new patients. You might get a long list of providers, so it’s up to you to figure out who will be the best fit for you. 

If you have no clue where to start once you have the list, I don’t blame you I was the same way with my first baby, but what is helpful is to join local facebook groups for moms and make a post, or search for old posts, about looking for a pediatrician and what their thoughts are about who is fantastic and about maybe who to avoid if they didn’t have a good experience. This is where I found out a lot of good information because I didn’t have family or friends that had babies before I did in the same area, so I had no real recommendations to work from. 

You’ll probably see a pattern of what people are saying and maybe narrow down your list to 5 or 10 providers at the most.  You could go into their provider “about me” on their websites, watch their intro videos if they have one and read about their specialities and experience, things like that to get a better idea of who seems like a good fit for you. Once you narrow it down to 5 or less you could call the clinics and tell them your due date and ask if that provider is taking new clients around that time. You could also ask for more information about the clinic if you have specific quesitons. Things like who covers for the provider if they’re unavailable, what are the clinics views on vaccinations if that’s a concern for you, how are sick visits handled, are telehealth services available, whatever questions you might have. 

Once you decide on your pediatrician, usually you don’t schedule anything ahead of time because of course you don’t know when your baby will be born. Some clinics will make you preregister so they have your information when the time comes, but otherwise when you have your baby, you call to notify them and then schedule whatever follow up visits are recommended by whoever is caring for your child at birth. Typically a day or two after you discharge, you’ll have a follow-up visit if you delivered at a hospital, and then your pediatirican will make recommendations from there.

Also, you’ll want to ask if you’re wondering who sees your baby in the hospital when you deliver. Usually, at least where I’m from, it’s a hospital-staff pediatrician who cares for all the babies on the unit, but does not see them outpatient for follow-up when they leave. The records will be transferred and the pediatrician you chose will be your contact point from then on. In some cases, the pediatiican from the clinic you choose as your main doctor for your baby, will actually go to the hospital and assess baby and meet you, and then follow up with you in the clinic after you and baby discharge. Every practice is different, every hospital system is different, sometimes it varies by practitioners too, so is a good question to ask if you’re curious.

Thank you so much for tuning into the podcast today. If you enjoy the show, please hit the follow button so you are notified of new episodes every Tuesday and leave a rating or review for the show wherever it is you listen. This is the best way to support the show and help other moms with these same questions find this episode and hopefully lead them to a more informed and empowered pregnancy and birth experience. That is exactly why I am here, to help pregnant moms like you take control of their experience with education and continuous support, so again thank you so much for being here, I hope this was helpful and I will see you again next Tuesday. Bye everyone!