The 3rd Trimester…Home stretch!

The 3rd trimester. Hopefully you are feeling fine. You may be a little tired, or you could be full of energy and vibrant. Normal gestation is considered 38-42 weeks and you are more than likely counting down the days until you see this amazing baby or babies.

During this time:
1. Your OB appointments increase
2. You may begin to experience a little more discomfort as the baby continues to grow
3. It may start to get more uncomfortable at night, either finding a comfortable position to sleep or even just having difficulty sleeping in general.
4. For others there may be a feeling of constant fatigue
5. Heartburn/ Reflux

Things to remember:
1. Posture is important. Continue to be mindful of your posture.
2. Breathing is very helpful, not only for relaxation but being in tuned with your breath can help in future with your delivery process.
3. Eat smaller portions to accommodate for any heartburn or indigestion you may be feeling. Be cautious of foods that might exacerbate this (spicy foods, citrus foods)
4. Continue to be as mobile as possible. If you are tired, then rest, but on the days when you have a little more energy then go ahead and try to move as much as you can- walking, maybe cleaning with a little music on (I have had some of my best workouts dancing while cleaning).
5. Be mindful of breath holding and also “doming” at the abdomen with activity.

In a previous article I spoke about DRA (diastasis rectus abdominus), something that according to current research literature is present within 100% of pregnant women. This is a stretching of the connective tissue in the abdominal wall and makes sense as the abdomen is growing and needs to accommodate the baby. The important thing here is to be mindful of activity and the things listed above #3 and 4.

Now is a great time, if you haven’t already, to reach out to a pelvic floor therapist. Not only can they work on strengthening and mobility exercises and strategies to prepare you for delivery but also efficient positions for laboring in, especially in lieu of any orthopedic issues or pains that you may be having. They can educate you on any type of supports that may be helpful at this time to better alleviate pain and assist with keeping you as mobile as possible during this phase. In addition, they prepare you for the fourth trimester, or the phase immediately after labor, with exercises to strengthen the pelvic floor, education on proper posture for breast feeding, lifting/ carrying your baby and for functional tasks at home.

As with all the other phases of your pregnancy, your nutrition remains very important. Balance is key. For most persons, they are no longer nauseated at the site or the odor of food. If you feel that you are unable to eat adequately adding a nutritional shake can be helpful to ensure that you get the proper nutrients and calories needed.

As the countdown continues, continue to enjoy this time. Make some time for ‘mama’ because soon your focus will change somewhat and that is perfectly normal. Allow your ‘tribe’ to help where they can and take the opportunity to rest and rejuvenate.

Congratulations!!!!!!

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Round Ligament Pain

The round ligament is a ligament that attaches the uterus to the pelvis.

As pregnancy progresses and the fetus grows, so does the uterus, causing stretching of this ligament and discomfort usually at either side of the abdomen and underneath. This typically occurs from the 2nd trimester.

Pain typically lasts only for a short time but can persist even longer in some cases. It can be felt when rolling or changing positions, such as when attempting to get out of bed, with coughing, sneezing or quick movements.

How can therapy help?

There are several interventions that can be performed to address round ligament pain. These include:

  • Manual Therapy
  • Taping/ bracing either with the use of tape or with the use of maternity belts. It is best that you speak to a women’s health therapist who can recommend what belt is best, if one is needed as there are several on the market and this can save you both time, money and the possibility of no relief from having the wrong belt.
  • Exercises to address the muscles within the surrounding areas for improved support.
  • Moist heat to decrease discomfort as tolerated
  • Strategies to improve pain when present including proper movement techniques
  • Therapy may also be necessary to distinguish this pain from something else.

As always if you are pregnant and have any concerns, speak to your health professional. There is no such thing as a silly question and it is best that any concerns be addressed.

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5 Foods to Alleviate Constipation In The Pregnant Woman

One of the problems that can plague the pregnant woman is constipation, affecting up to 40% of women.  As if you didn’t have enough going on “in your middle” already! This in part is due to increased progesterone causing smooth muscle relaxation and a decrease in gastrointestinal (GI) function. In addition, dehydration  due to nausea/ morning sickness, the growing uterus and it’s stress on abdominal structures and the iron in your prenatal vitamins may also be to responsible.

That being said here are a few things to help with those stubborn bowels:

  1. Drink more water. Re-hydrate your system and get things flowing better.
  2. Coconut oil. Take one teaspoon in the morning and another in the evening. If you have stubborn bowels, you may need to increase to one tablespoon. Coconut oil contains medium-chain fatty acids (MCFAs). They are easy for your body to digest and act as a source of quick energy for the cells that line your intestines, thereby increasing metabolism and stimulating your bowel movements.
  3. Chia seeds also help with bowel motility. Add 1tbsp to a glass of water, let it rest a few minutes and then drink. Chia pudding can be made using vanilla or even chocolate almond milk, 1 tbsp to 1/3 cup of milk. Feel free to add to the blender for a smoother consistency.
  4. High fiber fruit and veggies including figs, dates and prunes.
  5. Probiotics. Try capsules or powder to add to your beverages, cereals or other foods. Try kombucha or products such as ‘Good Belly’.

This list is not exhaustive as there are other foods that you may add based on your preference, culture and diet, for example, grains for those not on a gluten free or paleo diet. Many cultures and traditions stress the need for drinking warm liquids, specific teas, tisanes and herbs during this time to aid with hydration and bowel function.

In addition to these foods please do not forget the importance of MOVING! That’s right… EXERCISE. Walking, yoga, dancing… whatever you prefer. Try to move at least 20-30 minutes daily. The benefits are amazing!

 

What teas or foods did you consume during pregnancy? Comment below to share.

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Why Post-partum Physical Therapy Should Be The New Standard of Care

So… you had a baby. Congratulations!

You got pregnant and watched your body go through these AMAZING changes over a period of 9 months. There were even changes that you did not see. These included:
– the stretching of the linea alba as the abdominal muscles and connective tissues stretches to accommodate your growing stomach
– the relaxation of pelvic ligaments to accommodate for growth of the baby by also labor
– stretching of muscles to accommodate for the above
– slight separation of your pubic bones, up to which 2-4mm is considered normal, to accommodate for passage of the baby during labor
– orthopedic issues including SI jt dysfunction, lumbosacral, thoracolumbar and even sometimes cervical issues due to postural changes.
– decreased muscle tone based on your ability to remain active throughout your pregnancy. Remember not everyone is able to actively participate in some type of fitness although it is highly recommended. There are women on bedrest with precautions and there are many more who don’t have access to or know where to find good instruction for safe activity during pregnancy and as a result opt to “be safe rather than sorry” and not do anything. Then there are those who continue their sedentary lifestyle throughout.

Now depending on the type of birth you might have had, whether you labored for a long time, whether you had a vaginal or a cesarean, there might have been even more changes. These may include: tearing of your perineum (the area between the vaginal entry/ introitus and the anus; disruption of pelvic floor muscles depending on forcefulness, speed of birth and length of labor; disruption of connective tissues if a cesarean and sometimes even with a vaginal birth.

So how does one check at 6 weeks help?!!?!?!?! A peek at the uterus and a papsmear. Maybe you had a physician who asked about breast feeding and or asked a few questions to screen for post-partum depression (or maybe you didn’t). It all seems insufficient as far as postpartum care goes. Somehow the focus post birth seems to be on the baby… and don’t get me wrong, it should… but you know the saying “If momma ain’t happy, ain’t nobody happy!” and I think that has never been truer. If moms are in pain, unable to move and function, have diastasis recti, have abdominal pain, adhesions due to scarring, unable to control urine and feces, unable to have sex, fractures of tailbones and so on, we are not only talking about physical implications, but we are now talking about a lot of psychosocial issues that impact this female and by extension her family and can as a result have an impact of her ability to function optimally even as a mom in some cases.

Research has shown that approximately 50% of women have diastasis recti after giving birth which goes unresolved after 8 weeks. Among American women, about 1 in every 4 have some type of pelvic floor dysfunction. Among new mothers, 58% of moms who delivered vaginally have a pelvic floor dysfunction, as well as 42% of those who have delivered via cesarean.

So, talk to your OB/GYN today. In many states in the US physical therapists (PT) have direct access which means that they can evaluate you and even treat you for a specific period of time without a prescription from your MD. In some states direct access is such that there is no time restriction. Find a PT near you that specializes in pregnancy, post-partum and women’s health that can help you address any issues you may be having as a result of pregnancy.

Let’s take care of ‘momma’!

Take a look at this article from an American living in France with access to post-partum therapy. In France, as a part of their care, women get 10-20 customary post-partum visits with a therapist to ensure that they can address any issues they may have.

http://www.slate.com/articles/life/family/2012/02/postnatal_care_in_france_vagina_exercises_and_video_games.single.html

References:
Benjamin DR, van de Water ATM, Peiris CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy. 2014;100(1):1-8.

Sahakian J, Woodward S. Stress incontinence and pelvic floor excercises in pregnancy. Br J Nurs. 2012;21(18):S10-S15.

Yamaguchi M, Morino S. Comparison of Pelvic Alignment among Never-Pregnant Women,Pregnant Women, and Postpartum Women (Pelvic Alignment and Pregnancy). J Women’s Health Care. 2016;05(01). doi:10.4172/2167-0420.1000294.

Madill S. Differences in pelvic floor muscle activation and functional output between women with and without stress urinary incontinence. September 2009.

Miller JM, Low LK, Zielinski R, Smith AR, DeLancey JOL, Brandon C. Evaluating maternal recovery from labor and delivery: bone and levator ani injuries. Am J Obstet Gynecol. 2015;213(2):188–e11. doi:10.1016/j.ajog.2015.05.001.

Larson-Meyer E. The effects of regular postpartum exercise on mother and child: review article. Int SportMed J. 2003;4(6):1-14.

Norman E, Sherburn M, Osborne RH. An Exercise and Education Program Improves Well-Being of New Mothers: A Randomized Controlled Trial. Phys Ther. 2010;90(3):348-355.

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