Exercise in the Third Trimester: What to Expect and Beyond
The third trimester is the final stretch of this long, but incredible nine month journey. While this is an exciting time, it is also a time where you may start to feel anxious as there are many changes coming soon— one of them being getting your baby out ! haha
It can be confusing because some doctors and/or loved ones may offer misguided advice, suggesting that it is now time to slow down or stop exercising. While you will begin to slow down, I do not recommen stopping! You may start to feel aches and pains in the lower back, pubic area and joints, and even severe swelling, which makes reasons for you to want to back off exercise or stop altogether. You don’t need to be hitting the gym hard at this point but simply taking walks, doing yoga, or taking a fun prenatal group class, it will make a huge impact. I could go on and on, but I am going to share with you why it’s important to stay moving and to prioritize it even when you least feel like it at the end. as well as, main focuses here in the third trimester.
I mentioned it in my previous blog post, but wanted to share it again— research has shown that women who exercise throughout their entire pregnancy experience less weight gain and have a quicker return to pre-pregnancy weight than those who do not exercise (Clapp, 1998). Exercising right up until delivery is extremely beneficial both physically and mentally because it helps to ease the stress and anxiety we feel towards the end and prepare the body for birth and the fourth trimester.
Reasons to Workout in the Third Trimester
Your body is undergoing tremendous changes in the last trimester of pregnancy. Continuing to workout during this time helps you prepare for labor and delivery and keeps your body strong for the demands of motherhood.
Common ailments that can happen in the third trimester (back pain, postural challenges, poor circulation, swelling) can lesson with consistent exercise.
Exercise Can Improve Your Attitude: “women who exercise regularly during pregnancy maintain positive attitudes about themselves, their pregnancies, and their upcoming labor and delivery” (Clapp, 1998).
Effects of Exercise on Labor
During my training through ACE, I got to read a lot of excellent research and here are some highlights on how exercise positively affects labor.
James Clapp found that pregnant women who exercise experience shorter, easier, and faster labors (an average of two hours less). This is such an encouraging finding because although anything can happen and most is out of our control, exercising is one thing that can be controlled!
Clapp’s studies also show that 24% of exercising pregnant women had fewer cesareans and fewer complications than women who did not exercise at all.
In a study in the Journal of Sports Medicine and Physical Fitness, they found that women who are physically fit, perceive labor to be less difficult. On the Borg scale of exertion, fit women registered a lower rating of exertion during labor than less physically fit women. Women who exercise also perceived their labors to be shorter. They mentioned that this may occur because fit women can handle more discomfort because they have participated in regular exercise.
Other noteworthy Clapp study results for pregnant exercisers:
35% reduced need for pain relief
75% decrease in the incidence of maternal exhaustion
50% decrease in the need to artificially rupture membranes (break water sac)
50% decrease in the need to induce or stimulate labor with Pitocin
50% reduction in need to intervene because of abnormal fetal heart rate
50% fewer episiotomies
75% reduction in need for operative intervention (forceps or Cesarean section)
Overall, women who exercise during pregnancy have been shown to experience fewer complications and interventions during delivery. Resulting in shorter hospital stays and a faster return to your pre-pregnancy shape.
Physiological Changes in the Third Trimester
Skeletal and Posture Changes
All of the posture challenges that I discussed in the second trimester continue into the third trimester. With your increased weight gain, growing breast size, and of course the growing baby make good posture ridiculously hard. This strain, the weight gain, and loosening hip joints, begin to affect things like your gate and stride.
During this time, your baby’s head drops (hopefully!) into the birth canal, putting a ton of pressure on your pubic bone which gives many women the classic “waddle”. Walking with constantly turned out hips and legs can cause your glutes, and hamstrings to tighten up causing back pain.
A huge reminder to engage your transverse abdominals-- this is the best thing you can do to prevent or alleviate back pain.
Shortness of Breath
This is no joke haha. For me it starts from the beginning. By 36 weeks, your uterus is 1,000 times its original size (Graves, 1999)—That is insane! As the uterus grows, it pushes your diaphragm up as much as one inch, which in turn reduces the space for your lungs to expand. Although this is true, research shows that women who exercise during their pregnancy have fewer occurrences of breathlessness compared to sedentary women because their lungs become more efficient!
3. Swelling and Numbness
Some women may begin to feel numbness or tingling in their extremities due to swelling or edema. When you’re pregnant, you may see an increase in swelling in the tissue of the hands, wrists, and even the shoulder joints, which places pressure on the nerves, and leads to numbness in the hands, wrists, and arms—it can also occur in the legs and feet. Generally these symptoms are minor and go away after the baby is born
One of the best remedies is exercise and specifically, water workouts . The force exerted by the muscles against the pressure of the water helps to remove the build up of fluid.
One other key to reducing swelling is to hydrate! It may seem counterintuitive to try to flush out fluids with fluids, but drinking eight to ten glasses of water a day will help rid the system of excess sodium and other waste products, minimizing swelling.
*Remember that noticeable swelling in the face and hands may be a warning sign of preeclampsia and you should see their doctor as soon as possible.
4. Sciatica
I suffered from Sciatica during the 3rd trimester of my frist 2 pregnancies. Thankful I had some minor hip pain in the beginning of my thrid pregnancy, but with the help of exercise and yoga, I have been able to so far keep it away! Sciatica causes shooting pains and/or numbness in the lower back, buttocks area, or down the backs of the thighs. They say in pregnancy it is caused by the uterus pressing on the sciatic nerve roots (can also be due to: external rotation of the hips, piriformis muscles entrapping the nerve or poor alignment). A woman has two sciatic nerves that run from her lower back down her legs to her feet.
Sciatica can be severe enough to limit your mobility almost entirely, because it is caused by the position of your baby and sadly there is very little that can be done to relieve the situation until the baby is born. Some may experience symptom relief if baby changes position.
Regular exercise in the first and second trimester and good eating habits pre-pregnancy and in early pregnancy can help you avoid sciatic pain in this third trimester. This is due to better posture and muscle tone!
Avoiding high heels and practicing good pregnancy posture (no slumping at the computer) will head off bouts of sciatica as well.
ACOG guidelines for Avoiding Lower Back Pain: (2003)
Wear low-heeled shoes with good arch support.
Avoid lifting heavy objects.
Bend at the knees to pick things up.
Sit in chairs with good back support, or tuck a small pillow behind the lower back.
Sleep in a side-lying position rather than on the back.
Apply a heating pad using the lowest temperature setting, warm-water bottle, or cold compress to ease the pain.
5. Abdominal Separation
As the baby grows in the thoracic cavity behind the abdominal wall, it pushes the abdominals further out. The linear muscles of the rectus abnominus stretch around the front circumference of the growing belly and the oblique muscles stretch from either side of the belly. If the rectus abdomius reaches the limits of its elasticity and the baby still needs more room to grow, the abdominal wall will separate. This separation occurs along the points of natural weakness, the linea alba (the center vertical line of the abdominals), and the umbilicus (belly button). This abdominal wall separation is called diastatis recti. It is most often seen in third trimester.
Because oblique work puts more pull on the sides of the rectus abdominus at its weakened points, excessive, repetitive oblique exercises should be avoided.
you will want to avoid exercises that repetitively twist, or shorten from hip to shoulder (like a traditional bicycle abdominal exercise).
Instead do abdominal stabilizing exercises, Transverse abdominal work, the act of “hugging the baby” with ab muscles is also a way to limit the severity of Diastsis Recti.
6. Gestational Diabetes
Studies show women who participate in regular exercise in the first 20 weeks of pregnancy have a reduced risk of developing gestational diabetes. However, when it comes to using exercise to manage blood glucose levels in pregnant women already diagnosed with gestational diabetes, the research is less conclusive (Lewis, 2008). So it's best to start exercising from the beginning and staying consistent. For women diagnosed with gestational diabetes, diet and exercise are the main course of treatment. Dr.’s recommend 4 to 5 days a week of regular exercise go lower blood sugar.
The main goals of a pregnant client’s third trimester of exercise should be:
Managing ailments
water aerobics, stretching and yoga, are great at reducing swelling by increasing circulation. These exercises reduce fluid retention, and help get more feeling back in the hands.
Posture damage control
it is important to continue doing multi-joint exercises as long as possible, if posture and form are truly suffering, modifications should be made to avoid further taxing the compromised postural muscles. For example if a squat with an overhead press is causing the body to sway too far out of alignment, the client can sit on a stability ball for the overhead press and use the stability ball against the wall to assist in proper squat executions.
Belly breathing and coordinated pushing
From my ACE training:
How to practice belly breathing for labor:
Belly Breathing is the first abdominal exercise you should do after your baby, so make sure you practice it during pregnancy not only for birth and but also for the first safe abdominal work postpartum..
place your hands on your belly, with your middle fingers touching each other right above your belly button.
then inhale and imagine the breath going all the way down to the baby. while your middle fingers separate.
As you exhale, “hug your baby” with your abs, and bringing your middle fingers back together. Other cues : “pull your baby up and in on the exhale”
How to practice coordinated pushing:
Coordinated pushing can be quite difficult—but with practice it is something that you will get better at. I recommend starting with belly breathing and once you have that down, put it all together.:
On the exhale stage of belly breathing, engage your abdominals, and actively drop or relax your pelvic floor. Your glutes should be relaxed and transverse abdominals contracted. This combination of a relaxed pelvic floor and tight abs is the most effective way to push your baby out.
Helpful phrases “drop,” “lower,” “relax” the pelvic floor, “push with your gut, not with your butt”.
Key Moves in the Third Trimester
1. Pelvic floor exercises/Kegels
2. Flexibility and stretching (Yoga: Cat-Cow, Pigeon Pose, Child's Pose)
3. Belly Breathing and Coordinated Pushing
4. If access to a pool — Water Aerobics (to help alleviate swelling, pelvic pain and back/sciatic pain)
Needing more structure, guidance and accountability?
This is for you ↓
If you feel sharp, hot, or pinpointed pain right over the bony part of your outer hip during pregnancy, it’s very likely you have bursitis. You will be most symptomatic with lying on your side, walking, standing on one leg, or putting any pressure over the bursa.