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The 2nd trimester…What’s in store?

physical therapy Feb 20, 2019

Congratulations! You have passed the infamous 13-week mark. You are excited because maybe your morning sickness has ended (or maybe not). In a few weeks you get to find out the sex of your baby- how awesome!

The 2nd trimester is interesting because your body continues to undergo many changes but here is where some of those changes become visible. As such, there are a few things that we need to be mindful of.

  1. Your posture. Due to the growing weight of the fetus, your center of gravity shifts. Why is this important you ask? It’s because one of the most common complaints for many women during pregnancy is back pain. The weight of your breasts and stomach start to pull you forward and your body tries to counter. This results in an increase low back “arch”, which is usually the location of most people’s pain. While back pain is certainly common because of the changes that your body undergoes, know that it is not normal and there are ways to alleviate this.
  2. Difficulty breathing. Your stomach is getting so much bigger and it is not uncommon for some women to say they feel slightly winded. One of the ways to address this is to try to maintain some level of cardiovascular fitness throughout. Know that pregnancy does not mean that you have to be inactive. You can continue to work out at the same intensity as prior to your pregnancy. Strength training can be performed, but it is advised that you do so under the eye of a trainer or therapist who specializes with the pregnant population- be cautious with new programs or increasing weight if this is not something you partook of prior to pregnancy as we want to avoid straining. Walking is a wonderful exercise when pregnant, start with a few minutes at a comfortable pace- maybe 10 minutes daily and increase as tolerated. Do not over exert yourself. If you can hold a conversation while participating in activity then you likely are not over doing it.
  3. You may start noticing, depending on the size of your stomach, that your belly button is more prominent. In addition, you may feel some separation just above or below your belly button. This separation is one of the connective tissue, or the linea alba that is located between your rectus abdominus muscles (otherwise known as the ‘6 pack’ muscles). This is known as diastasis rectus abdominus and is more noticeable (when present) in the 3rd trimester and post-partum. Please note that the stretching of the tissues is needed to accommodate the growing fetus. The key here is being mindful of postures and to avoid “bearing down” or valsalva maneuvers which could exacerbate this and cause “doming” as well (more on this in future posts).
  4. Aches and pains! During this time a lot of women begin to notice pain at the lateral and lower aspects of the abdomen. This is more than likely round ligament pain, stemming from the stretching of this ligament due to the growth of the fetus and subsequently the abdomen. Other complaints may include but are not limited to: back pain, groin pain, headaches, jaw pain, neck pain.

Other things to consider include:

  1. Your positions. Usually it is recommended by most OBs to avoid the supine position (lying on your back) for sleeping at least by mid-second trimester. The reason for this is because the growing weight of the baby can press on the vena cava or main vein bringing blood from your extremities. Left side lying is preferred. In addition, when exercises, be mindful of positioning and as your start to grow in size you will need to modify exercises to avoid supine. There are plenty of exercises and modifications you can do, so no worries.
  2. Be mindful of what you eat. Wholesome and nutritious foods- fresh fruits and vegetables are always recommended. Smaller portions are preferred as it can be uncomfortable to eat larger meals at this time.
  3. One of the things that can help during this and really any other time is meditation and breathing exercises. As your body undergoes these changes, it can be a bit overwhelming for some and that is ok! You are not alone!

What can PT do to help?

  1. Education and increasing awareness of what occurs during this time, especially for new mothers who may be unaware of what to expect.
  2. Many women are not in tuned to their breathe, nor are they aware of its connection to the pelvic floor. Education related to this is important and linked to postural training for not only relaxation but also for increased awareness of the pelvic floor muscles and optimization of function.
  3. Postural Training. A lot of the time improved postural awareness and corrections can improve some of the issues that women deal with at this time.
  4. Exercises including strengthening and stretching to improve mobility and function and help with preparation for labor.
  5. Manual techniques, taping and belts/ braces and other therapeutic interventions as needed and as appropriate, depending on the client.

As always, talk to your health professional. Although many women report discomfort when pregnant, they may or may not be referred to physical therapy or a pelvic health/ women’s health specialist. Know that although some things are common, this does not mean they are normal. There are many resources out there for you and solutions to address any issues that you may have during this time.


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