By Dr. Christy Carosello PT, DPT, PCES
Introduction
Ah, the arrival of the third trimester. FINALLY. You feel like this long journey is starting to have a finish line in sight. And with it’s arrival brings a new onset of fatigue (goodbye 2nd Tri energy), aches and pains, and general “let’s get this show on the road”.
In this blog post we’ll delve into understanding the third trimester, the role of pelvic floor health, and general tips to implement before baby’s big arrival.
Understanding the Third Trimester
The third trimester marks the final stage of pregnancy, spanning from week 28 to the birth of your baby. This period is crucial as your body undergoes significant changes to prepare for childbirth. Here's what to expect and how it impacts your pelvic floor health:
Timeline and Key Milestones
Weeks 28-32: Your baby continues to grow rapidly, gaining weight and developing vital organs. You may start feeling more pronounced movements and kicks. Around Week 28 typically marks the glucose tolerance test to screen for gestational diabetes.
Weeks 33-36: The baby's head may begin to move down into the pelvis in preparation for birth, causing increased pressure on the pelvic floor.
Weeks 37-40: You are considered full-term, and labor could start at any time. It's essential to be prepared for childbirth and the postpartum period.
Common Physical and Emotional Changes
Physical Changes:
Increased Weight and Size: The baby's growth and the accompanying increase in amniotic fluid, placenta, and uterine size can add considerable weight and pressure on your body.
Pelvic Pressure: As the baby descends into the pelvis, you might experience increased pressure and discomfort in the pelvic region.
Braxton Hicks Contractions: These "practice" contractions can become more frequent and intense as your body prepares for labor.
Swelling and Fluid Retention: It's common to experience swelling in the legs, ankles, and feet due to fluid retention and increased blood volume.
Diastasis Recti: By 35 weeks nearly 100% of women have a gapping or thinning of the midline connective tissues of the abdominal wall. While this change is normal, it is important to maintain good body mechanics to minute stress in these tissues and maximize recovery postpartum.
Emotional Changes:
Anticipation and Anxiety: As the due date approaches, you may feel a mix of excitement and anxiety about the upcoming birth and parenthood.
Fatigue and Insomnia: Physical discomfort and hormonal changes can lead to increased fatigue and difficulty sleeping.
Importance of Pelvic Floor Health
Maintaining pelvic floor health during the third trimester is important for a comfortable pregnancy, smoother delivery, and faster postpartum recovery. The pelvic floor muscles support your bladder, bowel, and uterus, and they play a key role in urinary and fecal continence, sexual function, and childbirth.
The Pelvic Floor and Its Functions
The pelvic floor is a group of muscles and connective tissues that form a sling across the bottom of the pelvis. These muscles:
Support Pelvic Organs: They hold the bladder, uterus, and rectum in place, preventing them from descending or prolapsing.
Control Continence: They help you control urination and bowel movements by contracting and relaxing appropriately.
Assist in Childbirth: During labor, the pelvic floor muscles stretch to allow the baby to pass through the birth canal.
Common Pelvic Floor Issues During the Third Trimester
As your body prepares for childbirth, the pelvic floor muscles experience increased pressure and strain. This can lead to several common issues:
Urinary Incontinence: The added weight of the baby can weaken the pelvic floor muscles, leading to leakage when you sneeze, cough, or laugh.
Pelvic Pain: The growing baby and hormonal changes can cause discomfort or pain in the pelvic region.
Pelvic Organ Prolapse: Weakened pelvic floor muscles may not adequately support the pelvic organs, causing them to descend and create a bulge in the vaginal area.
Benefits of Maintaining Pelvic Floor Health
Taking care of your pelvic floor during the third trimester offers numerous benefits, including:
Reduced Incontinence: Strengthening and maintaining the pelvic floor can help minimize urinary leakage and improve bladder control.
Eased Pelvic Pain: Proper pelvic floor health can alleviate discomfort and pain in the pelvic region, enhancing your overall comfort during pregnancy.
Smoother Labor and Delivery: A strong and flexible pelvic floor can facilitate an easier childbirth process, reducing the risk of tearing and other complications.
Faster Postpartum Recovery: A well-maintained pelvic floor can help you recover more quickly after delivery, reducing the likelihood of long-term issues such as incontinence or prolapse.
By prioritizing your pelvic floor health, you can enhance your comfort and well-being during the third trimester and set the stage for a smoother, healthier postpartum recovery. In the next section, we'll explore practical tips and exercises to help you maintain a strong, flexible, and healthy pelvic floor.
Tips for Maintaining Pelvic Floor Health
Tip 1: Pelvic Floor Exercises
During labor and delivery the role of the pelvic floor muscles is to “get out of the way”. As the uterus pushes baby out via contractions, the pelvic floor muscles must stretch to accommodate baby passing through the birth canal. If you have been performing kegels to this point for pelvic floor strengthening it is important to modify the frequency of pelvic floor strengthening to allow for pelvic floor mobility.
Here are 3 easy pelvic floor stretches to implement:
Deep Yoga Squat: squat deeply with the feet slightly wider than hip-width apart and the toes pointing slightly outward. Lower hips towards the ground while keeping the spine straight and the chest open. The palms are pressed together in front of the chest in a prayer position, and the elbows gently press against the inner knees to deepen the stretch. During late pregnancy you may need to add a yoga block to the bottom of your deep squat for support. This pose helps to open the hips, stretch the lower back and groin, improve balance and flexibility, and to help prepare the body for labor.
Sidelying Diaphragmatic Breathing: lie on your side with a pillow supporting your head and another between their knees for comfort and alignment. One hand is placed on the ribcage and the other on the abdomen. Focus on deep, slow breaths, inhaling through the nose and allowing the diaphragm and lower rib cage to expand, causing the abdomen to rise. The exhalation is slow and controlled, often through pursed lips, allowing the abdomen to fall.
Modified Child’s Pose: kneel on the floor in front of a chair, couch, or yoga ball. Extend your arms out to rest on the surface in front of you, while sitting your bottom back towards your heels. Focus on deep, while expanding your back and rib cage.
Tip 2: Proper Posture and Body Mechanics
Anatomical changes during pregnancy take a toll on our posture, which in turn impacts various area for each individual, and may contribute to different symptoms such as back, hip, or pelvic pain. Keeping the ribs stacked over the pelvis, standing tall through your torso, and engaging the lower core muscles throughout the day can help maintain good posture.
Being mindful of body mechanics can also help manage pain and set you up for success postpartum:
Squat to lift: use your legs when picking up heavy items or toddlers
Log roll: When getting in/out of bed, keep your legs together and lie down to your side, then roll over as one unit to lie on your back or opposite side.
Utilize a Belly Band: Using a belly band late in pregnancy can help manage back and pelvic pain when standing for long periods of time. One of my favorites is the Bao Bei Pro Bump (code mamas.in.motion.pt for 15% off). Another favorite is the Baby Belly Band.
Tip 3: Staying Active with Safe Exercise
Staying active in the third trimester can help mitigate common discomforts, as well reduce risk of pregnancy complications and help with postpartum recovery.
It is important to listen to your body and modify activities as needed. When exercising, use the Rating of Perceived Exertion Scale to monitor how hard you are working. It is recommended to work at a level of 6-7/10, or working hard enough to break a sweat and breathe a little harder, but still be able to carry on a conversation.
Great activity options for third trimester include, but are not limited to: walking, Yoga, Pilates, and swimming. If you were already active prior to pregnancy and don’t have any complications, it is usually safe to continue what feels comfortable. If you weren’t active before, it’s never too late to start, but you may benefit from specific guidance from a pelvic floor therapist or another healthcare provider.
Tip 4: Hydrate
Staying hydrated during pregnancy should always be a priority. The American College of Obstetrics and Gynecology (ACOG) recommends drinking 8-12 cups of water daily during pregnancy. Water is essential for both maternal and fetal health.
Staying hydrated in the third trimester is especially important, as dehydration can lead to increased muscle tightness, among other issues. Keeping our tissues hydrated may help decrease risk of tearing during a vaginal delivery.
Simple tricks like keeping a water bottle with you to sip throughout the day can help to track water intake. If you’re tired of plain water try adding flavoring with oranges, lemons, or limes.
Increasing electrolytes can also help with hydration. Coconut water or low sugar electrolyte packets such as LMNT are great options during pregnancy.
Conclusion
Maintaining pelvic floor health during the third trimester is essential for ensuring a comfortable pregnancy, facilitating a smoother delivery, and promoting a quicker postpartum recovery. By understanding the changes your body undergoes and the impact on your pelvic floor, you can take proactive steps to support your health during this critical period.
Being aware of when to seek help from a pelvic floor physical therapist can make a significant difference in managing any discomfort or issues that arise.
Prioritizing your pelvic floor health not only benefits you during pregnancy and childbirth but also contributes to your overall well-being as you transition into motherhood. At Mamas in Motion Physical Therapy and Wellness, we are dedicated to supporting you every step of the way with personalized care and expert guidance.
If you have any questions or need additional support, don’t hesitate to reach out to us. Your journey to a healthy, happy pregnancy starts with taking care of yourself and your pelvic floor.
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