My 4th Third-Trimester

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Pregnancy is a time riddled with unsolicited advice that creates a monstrous list of “shoulds” for expecting women who likely already have a full plate of responsibilities. I remember the amount of times during each of my pregnancies where I felt like I was not measuring up and meeting all the lofty expectations I placed on myself. After going through a complete pregnancy journey three times already and completing certification programs and course-work in prenatal health and wellness, I have a much more flexible, realistic and comprehensive list of pregnancy suggestions that have helped make pregnancy more pleasant and postpartum smoother. I am currently about 26 weeks pregnant with my fourth child and I have been compiling my priorities for a healthy third trimester, labor & delivery and postpartum. I hope that this list feels both manageable and approachable and has the empathetic tone that many pregnancy health & wellness resources are lacking. This list is also not exhaustive but includes what is realistic for me in my current season. As you adapt this list to your own journey, please feel EMPOWERED to add or to simplify. 

SLEEP: Please, please, please, give your pregnant body a chance to rest! As many as ⅔ of pregnant women experience third-trimester insomnia with drivers including “anxiety, depression, disturbed dreams, nighttime awakening, fetal kicking/ movement, physical discomfort,” frequent bathroom trips and lower back pain (Pacheco & Calendar, 2024, p.1). Other causes of disrupted sleep include restless leg syndrome which 1 in 3 women experience & heartburn. Sleep disturbances are associated with higher risks of preeclampsia, preterm birth, excessively long labors, emergency C-sections and gestational diabetes (Pacheco & Calendar, 2024, p.1). 

Some tips for improving nighttime sleep include sleeping on your left side to promote blood flow, utilizing pillows and wedges to support your belly & lower back and stretching/ taking a warm bath before getting in bed (Pacheco & Calendar, 2024). If sleep is still elusive after a reasonable amount of time, it is better to get up and find something relaxing to do “such as reading or taking a bath,” (Pacheco & Calendar, 2024, p.2). Worrying about sleep is counterproductive, can “make you associate bedtime with stress,” and is related to a higher incidence of postpartum depression Pacheco & Calendar, 2024, p.2). I have found that with little ones waking up throughout the night and pregnancy related insomnia described above, night-time sleep becomes quite elusive and frustrating. During my first pregnancy, this anxiety about sleep made the last two months of pregnancy miserable. Now, if I am unable to fall asleep within 30 minutes, I try a pregnancy meditation/ sleep story. If I am still not able to sleep after this, I either read to relax or write if I have something on my mind (like labor) that is making me anxious. If I still do not feel sleepy, I try a warm bath and gentle prenatal stretch. After meditating, reading/ writing, taking a bath and stretching, I am almost always able to go back to sleep. 

If all else fails, I rely on short naps during the day. I am usually not a fan of naps but, daytime sleep often feels easier in the third trimester. Daytime naps can provide energy, stress relief and can help counteract nighttime sleep disruption (Glover, 2024). Additionally, “pregnant women who regularly nap are less likely to have a baby with low birth weight,” (Glover, 2024, p.1). In addition to daytime naps, I allow myself to fall asleep earlier and get up later than I usually would. I enjoy a solid morning routine before my kids wake up, but during the third trimester sleep is the priority and I allow myself to sleep until I wake up naturally whenever possible. Finally, I utilize passive hobbies like crocheting, writing poetry, reading and embroidering to encourage rest breaks throughout the day. This provides time for my body and mind to relax even when naps are not a realistic option. 

MINDFULNESS/ SPIRITUAL PRACTICES: Meditation is the practice of focusing the attention on the present moment which often elicits a peaceful state. There are many benefits to meditation in all seasons of life including during the third trimester. First, it can reduce stress and anxiety by “reducing the body's stress response and helping to bring down cortisol levels,” (Nurtured Birth, n.d., p.1). Second, it can lower heart rate, lower blood pressure and reduce inflammation (Nurtured Birth, n.d.). Third, It can also foster psychological resilience or the ability “to adapt to stress and adversity,” (Nurtured Birth, n.d., p.2).  Fourth, it can help you foster a “connection with your baby,” which can be a “powerful tool you can use in labor,” as you “work with your body and baby,” (Nurtured Birth, n.d., p.2) Fifth, it can foster body awareness which can be helpful during labor to focus your attention away from being overwhelmed (Nurtured Birth, n.d.). Finally, it can provide the opportunity to “uncover your fears and bring awareness of your body and its capabilities,” (Nurtured Birth, n.d., p. 3). 

In addition to regularly meditating, positive affirmations during pregnancy can also be very beneficial. Positive affirmations are “short mantras that you can recite to yourself,” which have been shown to “help boost confidence, positively affect mental health and improve your ability to find gratitude,” (Aggarwal, 2023, p.1). Pregnancy affirmations in particular help “reduce anxiety, fear and even postnatal blues,” (Aggarwal, 2023, p.1).

Finally, I find prayer very helpful at all times but especially during uncertain times like the third trimester. According to the Tork et al. (2020), prayer can improve a mother's mental health, provide emotional support and reduce anxiety and depression. Additionally, prayer can provide a deeper sense of purpose and meaning during pregnancy (Tork et al., 2020). Prayer and faith in a higher power can help mothers feel confident in their ability to overcome pregnancy and labor challenges (Tork et al., 2020). I find that morning prayer helps me feel prepared for the day ahead and evening prayer helps me practice gratitude and prepare for a good night's sleep. 

MINDFUL MOVEMENT, NUTRITION & HYDRATION: There are many benefits to movement during pregnancy. First, regular exercise is associated with a decreased risk of gestational diabetes and an improved ability to manage gestational diabetes (Hinman et al., 2015). Regular exercise is also associated with a lower risk of developing gestational hypertension (Hinman et al., 2015). Women who exercise regularly during pregnancy have placentas with a greater “total vascular volume and capillary surface area,” (Hinman et al., 2015, p.2). Regular exercise has been found to “shorten the duration of labor and reduce the risk of C-section and operative-assisted vaginal delivery,” due to improved “tone of abdominal and pelvic floor musculature and aerobic fitness,” (Hinman et al., 2015, p.3) Finally, regular exercise is associated with clinically significant reductions in rates of postnatal depression (Hinman et al., 2015).

During the third trimester, I aim to move 30-45 minutes per day 6-7 days per week. On one to two of these days, I walk to improve aerobic fitness, stabilize my pelvis and open my pelvic floor. On two to three of these days, I focus on prenatal yoga/ pilates to cope with the aches and pains of pregnancy and prepare my body for delivery. On two to three of these days, I focus on pregnancy safe weight lifting with a focus on back, glute and quad strength and core/ pelvic floor integrity. This program includes at least 300 minutes of movement daily with a focus on aerobic capacity, functional strength and labor-related flexibility/ mobility. 

Mindful nutrition during pregnancy is also very beneficial. Poor maternal nutrition status is associated with low birth weight, small for gestational age and large for gestational age babies all of which are associated with increased “risks of developing childhood and adult chronic diseases,” (Marshall et al., 2022, p.1). A diet with balanced macronutrient intake is associated with reduced risks of “gestational diabetes, preterm birth, obesity-related complications, preeclampsia and gestational hypertension,” (Marshall et al., 2022, p.1). A balanced diet consists of “ample quantities of vegetables, fruits, whole grains, nuts, legumes, fish, oils, fiber,” with lower quantities of refined grains, simple sugars, processed foods and trans/ saturated fats (Marshall et al., 2022, p. 3). With all that being said, what if you are struggling with hyperemesis gravidarum (like I have been), severe nausea or food aversions? The goal then is to make the best choices with what your body is allowing you to eat. Some food is always better than no food in these situations so when all else fails, ensure that you are maintaining an adequate calorie intake for you and your growing baby. Incorporating protein with each meal, eating smaller meals and doing everything you can to get some fruits/ vegetables in for the vitamin and mineral content are my best recommendations. I am sorry if you are experiencing this and it is common to feel guilty when you are not able to feed your body as you hoped or as you are used to. As with everything, just keep trying your best mama!

Mindful hydration is also extremely important during pregnancy. Drinking fluids during pregnancy can “ease potential constipation and possible hemorrhoids,” “can soften dry skin,” “helps to reduce edema,” and “decreases your risk of urinary tract infections and preterm labor,” (Delaware Valley OBGYN & Princeton Midwifery, 2019, p.1). The goal is to drink about 10 cups of water or about 80oz per day (Delaware Valley OBGYN & Princeton Midwifery, 2019). Starting the day with a glass of water, drinking water throughout the day, consuming plenty of fruits/ veggies and flavoring your water with fruits or electrolytes are all ways to increase fluid intake. It is a good idea to avoid drinking lots of fluids before bed to prevent frequent night-time bathroom trips.  

SELF DEVELOPMENT: Self-development consists of improving your self-awareness, skills and talents to enhance your quality of life. There are benefits to self-development in all seasons especially during the uncertain and selfless season of pregnancy. Self-development during pregnancy is “crucial for a mother’s mental and physical well-being,” by “allowing her to better manage the challenges of pregnancy, foster a positive connection with her baby,” “reducing stress, enhancing positive coping mechanisms and promoting healthy habits,” (Divecha, 2018, p.1). It “lays the foundation for a healthy pregnancy and positive postpartum experience,” by providing women an opportunity to explore interests, foster passion and focus on something outside of the parenting sphere (Divecha, 2018, p.1) 

During each pregnancy I have taken on a new challenge. During my first pregnancy I obtained my personal training certification and resumed my undergraduate degree. During my second pregnancy I completed my undergraduate degree and began my master’s degree. During my third pregnancy I continued working on my master’s degree and completed it shortly after he arrived. During this pregnancy, I have decided to take on the challenge of starting my own holistic women's wellness company, completing a Quickbooks certification and completing a 200-hour yoga teacher training. Continuing to pursue my goals outside of motherhood has helped me to maintain my own sense of self and has provided an outlet for me to pursue my interests and passions. 

PREPARING OUR FAMILY: With the promise of a new baby, each of our older children has needed attention and affirmation as well as additional responsibility and some focus on troublesome behaviors. When I am expecting, I focus on providing each of my children with extra individual love and attention so that they know how important they are. This has prevented any fear surrounding their role in the family with the new baby coming. I also affirm all of the beautiful qualities that each child has often and proudly so that they know they are special and important. 

In addition to positive affirmations and extra affection, I use the third trimester as an opportunity to provide my older kids with additional responsibilities in the form of household chores. Not only do I benefit from having less on my plate but they benefit from additional ownership in our home. Chores provide the opportunity for my kids to help me in age appropriate ways that help them feel needed and provides a clear way to help me during the fourth trimester. This is also a great time to work on any lingering tasks you had hoped to work through such as frequently nighttime waking, potty training, trading bottles for cups etc. Aim for progress over perfection though and be prepared for regressions when the baby arrives. 

BIRTH PREP: Birth preparation is extremely important because it “empowers expectant parents with knowledge about the labor and delivery process, allows them to make informed decisions, manage anxiety, and feel more confident in their ability to navigate childbirth, ultimately leading to potentially more positive birthing experiences by understanding what to expect and how to cope with potential challenges,” (Alizadeh-Dibazari et al., 2024, p.1). Birth preparation varies greatly but I would recommend that EVERYONE seeks out information related to their care providers options and their own preferences. After giving birth vaginally three times, I feel confident and comfortable with my birth options and birth process but I would recommend that all first time moms and anyone that does not feel fully informed to take childbirth classes and seek out all literature that your care provider has available. 

I am focusing on: 

• Pelvic Floor Relaxation: kegels or pelvic floor engagement are great for postpartum recovery but for labor preparation, relaxation is the most important component. The pelvic floor NEEDS to relax to allow the baby to rotate and exit the vaginal canal appropriately. Practice by closing your eyes and envision a flower opening for 5 seconds as you relax your pelvic floor. Complete this at least 10 times per day throughout the third trimester adding more time as you become more comfortable. 

• Hug the Baby: diaphragmatic breaths consist of filling your belly and relaxing your pelvic floor as you breathe in and then engaging through your core like a corset and lifting through your pelvic floor as you exhale. This maintains core integrity and promotes a speedier postpartum recovery. 

• Breathwork: in addition to breathwork during meditation, I focus on breathwork that can be used to manage pain during labor. First, I utilize extended inhales and exhales or long-slow inhales and exhales during early labor. Second, alternate nostril breathing can be used to calm the body between contractions. Third, j breaths that utilize diaphragmatic breathing can be practiced while using the bathroom to help to breath the baby out during delivery. 

• Labor Playlist/ Meditation List: having a playlist of positive affirmations, labor meditations and uplifting music readily available is so helpful to help focus the mind during labor. Used in conjunction with breathwork, this is the most effective pain management technique I have found. 

• Pelvic Floor PT: a pelvic floor therapist is able to help you work on relaxing your pelvic floor, appropriate engagement and relaxation during labor and postpartum recovery. I would recommend that every pregnant woman utilizes pelvic floor PT for birth prep and postpartum recovery! 

Main Takeaways 

1. Unsolicited advice during pregnancy is common and can make even the smallest decisions overwhelming and confusing. 

   1. If it is unkind, ignore it. I can not tell you why everyone decides that pregnancy is a good time to comment on a woman’s body and choices. 

   2. When in doubt, ask your care provider and remember that you know your baby and body best. 

2. Sleep & Rest: try your best to get a goodnight sleep by having earlier bedtimes, flexible wakeup times, and practicing sleep hygiene. 

   1. If you can’t sleep, try relaxing activities to quiet your mind. 

   2. Rest throughout the day especially if you are struggling with insomnia. 

   3. Engage in restful hobbies that allow your body to relax and your mind to unwind during the day. 

3. Meditation, Positive Affirmations & Prayer: 

   1. Meditation offers many physical and mental benefits including labor preparation. 

   2. Positive affirmations can positively impact mental health and reduce anxiety surrounding pregnancy, labor, delivery, postpartum and motherhood. 

   3. Prayer can have mental health benefits and can provide a sense of purpose and meaning during pregnancy and labor challenges. 

4. Mindful Movement, Nutrition & Hydration: 

   1. Regular exercise consisting of aerobic, strength training and flexibility/mobility training has many mental and physical benefits for both mother and baby. 30-45 minutes most days of the week consisting of walking, prenatal yoga/ pilates and functional prenatal strength workouts is a comprehensive training program to prepare for labor, delivery and the fourth trimester. 

   2. Aim for a balanced diet focusing on fruits, vegetables, protein and whole grains. When pregnancy makes eating difficult, focus on adequate calorie consumption, small meals, protein and some fiber from fruits and veggies. 

   3. Aim to drink 10 cups or 80oz of water throughout the day for physical benefits and to help prevent preterm labor. Aim to drink most fluids earlier in the day and try adding flavoring or electrolytes if water consumption is difficult. 

5. Self Development: 

   1. It is important to enhance self-awareness, skills and talents during pregnancy and is important for a mothers' mental and physical well being. 

   2. It helps lay the foundation for practicing healthy coping mechanisms postpartum and throughout motherhood. 

6. Preparing Older Children: 

   1. Remember that pregnancy can be overwhelming for your other kiddos. Try not to let the guilt take over, you are giving them a built-in playmate and friend for life!

   2. Focus on quality time and positive affirmations to affirm that each child is special and has an important role in the family. 

   3. This is also a great time to begin adding chores and working on behaviors that promote personal responsibility and give your child a sense of ownership in your family. 

7. Birth Prep: My focus after three other deliveries is on…

   1. Pelvic floor relaxation

   2. Diaphragmatic (hug the baby) breaths

   3. Breath-work and a birth playlist for pain management

   4. Pelvic floor PT

I recommend you seek out as much information as possible during your pregnancy to make informed decisions for yourself and your baby!!!

References

Aggarwal, N. (2023). 22 empowering affirmations to recite during pregnancy. TheBump. https://www.thebump.com/a/pregnancy-affirmations 

Alizadeh-Dibazari, Z., Abbasalizadeh, F., Mohammah-Alizadeh-Charandabi, S. J., & Mirghafourvand, M. (2024). Childbirth preparation and its facilitating and inhibiting factors from the perspective pregnant and postpartum women in Tabriz-Iran: a qualitative study. Reproductive Health, 21(106). https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-024-01844-8#:~:text=Participation%20in%20childbirth%20preparation%20classes,boosting%20confidence%20in%20natural%20childbirth. 

Delaware Valley OBGYN & Princeton Midwifery (2019). Tips for a hydrated pregnancy. Delaware Valley OBGYN & Princeton Midwifery https://delvalobgyn.com/tips-for-a-hydrated-pregnancy/#:~:text=It%20helps%20to%20reduce%20edema,you%20probably%20need%20even%20more. 

Divecha, D. (2018). Can a pregnant woman’s experience influence her baby’s temperament? Developmental Science. https://www.developmentalscience.com/blog/2018/10/1/can-a-pregnant-womans-experience-influence-her-babys-temperament#:~:text=But%20research%20confirms%20that%20although,Examining%20how%20you%20were%20parented) 

Glover, E. (2024). The scientific reason why pregnant women should nap. Motherly. https://www.mother.ly/pregnancy/pregnant-mamas-go-ahead-and-take-a-nap-science-shows-its-good-for-your-baby/ 

Hinman, S. K., Smith, K. B., Quillen, D. M., & Smith, M. S. (2015). Exercise in Pregnancy: A Clinical Review. Sports health, 7(6), 527–531. https://doi.org/10.1177/1941738115599358

Levin, J.S., Lyons, J.S. & Larson, D.B. (1993). Prayer and health during pregnancy: Findings from the Valveston Low Birthweight Survey. South Med J, 86(9), 1022-7. https://pubmed.ncbi.nlm.nih.gov/8367747/ 

Marshall, N. E., Abrams, B., Barbour, L. A., Catalano, P., Christian, P., Friedman, J. E., Hay, W. W., Jr, Hernandez, T. L., Krebs, N. F., Oken, E., Purnell, J. Q., Roberts, J. M., Soltani, H., Wallace, J., & Thornburg, K. L. (2022). The importance of nutrition in pregnancy and lactation: lifelong consequences. American journal of obstetrics and gynecology, 226(5), 607–632. https://doi.org/10.1016/j.ajog.2021.12.035 

Nurtured Birth (n.d.). 7 benefits of meditation during pregnancy. Nurtured Birth. https://nurturedbirth.com.au/7-benefits-of-meditation-during-pregnancy/#:~:text=Meditation%20and%20mindfulness%20during%20pregnancy,with%20their%20birth%20experience%20after. 

Pacheco, D. & Callender, E. (2024). Sleeping while pregnant: Third trimester. Sleep Foundation. https://www.sleepfoundation.org/pregnancy/sleeping-during-3rd-trimester#:~:text=Poor%20sleep%20during%20the%20third,Source%20during%20pregnancy%20and%20postpartum. 

Tork Zahrani, S., Haji Rafiei, E., Hajian, S., Alavi Majd, H., & Izadi, A. (2020). The Correlation between Spiritual Health and Maternal-Fetal Attachment Behaviors in Pregnant Women Referring to the Health Centers in Qazvin, Iran. International journal of community based nursing and midwifery, 8(1), 84–91. https://doi.org/10.30476/IJCBNM.2019.81668.0