Third
trimester – week 27 to week 40
The guidelines that are
out there for this trimester basically go along with those for the second
trimester. In addition, this trimester, the recommended extra calorie intake is
an additional 450 calories per day, so make sure you are keeping a good calorie
balance with expenditure to ensure you are still getting the extra calories
your baby needs to grow.
The challenges of continued exercise during this trimester:
1. extra body weight = musculoskeletal
pain of all kinds!
2. energy level
3. GI symptoms – return of
nausea, worsening reflux, indigestion, constipation
4. frequent urination
5. Braxton Hicks
contractions
6. Overheating!
7. Anxiety
Some Tips:
1. Cut
back mileage if still running.
2. Short
workouts are your friend! They provide you with energy without taking up too
much of your free time that you
should also spend resting when possible.
3. Try walking and
jogging intermittently to maintain exertion without getting out of that elusive
"moderate" zone.
4. Plan a run with available
pit-stops for those frequent bladder issues.
5. Take up swimming or
water aerobics classes if you haven't already. Weightlessness is heavenly,
especially during pregnancy, and especially towards the end. It's also a good way to stay cool!
6. DRINK water, water,
and more water. (Even though it makes you pee more. Dehydration is not any
athlete’s friend, but it is certainly not a pregnant woman’s! And it worsens
constipation, so DRINK UP!)
7. Listen to your body and take care of your mental health, whether that means exercise or rest ;)
How's it going?
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| 32 weeks, 2 days, first senior 24-hour call in the NICU. Last year at this time I was getting up at 4:30am to run pre-shift. Now I just got up for a strength workout. And baby was happy with the extra sleep! :-P |
So here it is folks—the fun of the third trimester! Just 5 weeks
in, I have to say, I’ll take GERD and indigestion over joint pains any day! I
tried to compare my joint pain while running this pregnant to the pain I
experienced running the marathon portion of an Ironman after wrecking my bike.
I will just say that it’s a different kind of pain now, and I don’t get a medal
for continuing to train through this, which makes my motivation to run a bit
different. It’s not that I need a medal to run through pain, but I do want to
do what’s best for my baby and for my health so I can be a good mom later, and
I’m training for a different kind of race these days ;)
Here are just some of the symptoms that women experience secondary
to the musculoskeletal changes during pregnancy:
- Back pain
- Joint pains
- Muscle strains
- Nerve pain
Back pain –
Most back pain during
pregnancy is due to mechanical factors resulting from altered posture, muscle
weakness, joint laxity, and/or vertebral facet joint irritation. Fluid
retention within connective tissue can also contribute to the pain. Yay. I haven’t tried one
of those pregnancy sleeping pillows yet, but there is a method to the madness,
folks. A pillow to support the weight of the uterus and a pillow between the
legs relieves much of the pressure on the back, and as always, lay on your side
to provide the best blood flow to the baby and to decrease risk of IVC syndrome
as we talked about in the 2nd trimester blog post.
What you can do about it (ACOG recommendations to prevent back
pain):
● Wear low-heeled (but not flat) shoes with good arch support.
● Get help when lifting heavy objects.
● Place a board between the mattress and box spring if your bed is
too soft.
● Squat down, bend knees and keep the back straight when lifting.
● Sit in chairs with good back support, or use a small pillow to
provide support.
● Sleep on the side with pillows between the knees for support.
● Apply heat, cold, or massage to the painful area.
Pain in
joints – pelvis, hips, knees, ankles, shoulders, you name it!
 |
| 30 weeks... a day I thought was my last run during pregnancy, but it wasn't :) |
While
relaxin is to blame for pelvic girdle pain (pain in the 3 joints of the pelvis
including sacroiliac joints—it’s ok, it helps your pelvis open more to deliver
your baby!), laxity in other joints during pregnancy is actually thought to be
due to elevated estradiol and progresterone levels, not relaxin. Along with increased
joint laxity, the force across some joints is increased up to two-fold during
pregnancy. Yowza. As a person with 2 prior knee surgeries and osteoarthritis
from the age of 22, I have to say that I really didn’t expect my knee to make
it this long. It’s starting to hurt in the exact spot that used to during
college ball, and I know it’s the weight gain and the extra force, coupled with
the fact that I haven’t been very dedicated to strength training during
pregnancy, so you guys and cyberland as my witness, I am going to have a goal
to be more dedicated to strength training these last 8 weeks and see how the
joint pain does. It’s partly because of how much
strength I feel like I’ve lost in my legs and partly after hearing my
new-mom-friends speak about how traumatic labor and delivery was for them
because they just felt like their whole bodies were sore for days after labor.
I’m sure a lot of that is all the adrenaline and hormones that it takes to push
a baby out, but I feel like I owe it to myself to find the time for some
strength training to do what little I can for a better delivery for this baby
girl. As it goes
now, I wake up at night with pain in different joints. Maybe it’s time to
finally buy one of those pregnancy pillows? But somehow I feel like it wouldn’t work proportion-wise for a 6’2” woman!
Whatever you choose, remember that moderate exercise, light stretching,
Tylenol, icing, changes in position throughout the day if you have a stationary
job, and time off your feet if you have an active job are all things that are
recommended for joint pains during pregnancy.
Leg Cramps
and Muscle Strains
Daily exercise to improve circulation and stretching is
recommended to prevent leg cramps, but you may get some anyway. Try hot
showers, ice massage, and increased hydration to help. For muscle strains, we
all know that we’ve had them before, but your body is changing and your
technique and form change so much during pregnancy that you are using muscles
in different ways. A significant increase in the
anterior tilt of the pelvis occurs, causing more use of hip extensor, abductor,
and ankle plantar flexor muscles. Stance and gait widen to maintain the movement
of the trunk. And I must be doing the weirdest stride ever because I feel it in my hip flexors! Go figure! What all this means is that you may feel some muscles pulling in weird ways,
and if something goes too far, remember the kind of race you are running
these days- a race for two, not an individual endurance or speed race, and take
time for rest and recovery. Ice and foam-rolling for myofascial release and
decreased inflammation are your friends because anti-inflammatory drugs are off
the market during pregnancy. NSAIDs like ibuprofen are particularly dangerous
for baby kidneys, so avoid these. Tylenol is considered safe for pain during
pregnancy, but let’s be honest, folks, Tylenol does not work that well for
musculoskeletal pain and inflammation, and some studies now link Tylenol use in
pregnancy to Autism. (What isn’t linked with Autism these days? Tylenol is
still a class B drug, so obstetricians are fine with you taking it for pain
during pregnancy if you want to!)
Nerve pain
Numbness and tingling secondary to nerve impingement can be a
worrisome and not fun part of trying to stay active during pregnancy. Some
people experience carpal tunnel syndrome (fluid retention during pregnancy can cause
compression of the median nerve as it enters the carpal tunnel of the wrist)
and De Quervain’s tenosynovitis (similar pathophysiology but this one is the
thumb). Others have issues with sciatica (inflammation and/or compression of the sciatic nerve, usually manifested as low back and buttock pain that radiates down the leg and can causes numbness and tingling in your leg/foot) because of baby’s position or because
of the adjustments the body makes to accommodate the increased weight and
laxity in the pelvis. For the medical folks out there, it’s important to assess
all patients with back pain for any neurological sequelae. Nerve root
irritation can be assessed by muscle tenderness at various levels: S1 (calf
muscles), L5 (extensor hallucis muscles, which affect the toe-walking test), L4
(quadriceps and anterior tibialis, which affect heel-walking with foot
dorsiflexion). Also MDs, check for significant muscle weakness, sensory
impairment, or deep tendon reflex changes that can suggest radiculopathy.
Where
are we going from here?
One of my worries used
to be that I would be post-dates and would not go into labor no matter how much
activity I did. They tell women who are near their due dates to start walking
every day to initiate labor, so my thought was, what do women do to initiate
labor when they have already been running during pregnancy? :-\ I thought I'd need to do some crazy LSD's (long-slow-distance runs, not the psychotropic drug for those of you thinking I'm insane) at 39 weeks to get the baby out. But, I’m not as
worried about this now, mostly because I’m really not certain how much longer
I’ll keep going with this. I feel so much better if I get activity, but it is
getting harder and harder to do work activities and household chores these
days. In short, I am 8 months pregnant...and I'm a resident. Extra sleep might make me change my thoughts on staying active, but sometimes sleep is just more important now. I know, super annoying! At any rate, each time I do head out for a run, when I feel too slow or my running clothes don't fit or I wonder if I am totally destroying my stride and picking up bad habits, I just think that it could be my last chance to run before the baby comes...and about how special it is to share the intimacy and stream-of-consciousness thoughts of my running with her...and I let all my anxieties about the stupid stuff from the day and the worries about tomorrow fade. Yes, I am getting a little awkward these days, but, I’m here, my baby is still growing and
active, and after admitting ex-28-weekers, I can only say that I’m just so glad
she’s still going along for the ride and staying in the incubator for now!
Interesting tid-bits and references:
Ponnapula P, Boberg JS. Lower extremity changes experienced
during pregnancy. J Foot Ankle Surg. 2010 Sept-Oct;49(5):452-8.
Riberiro et al. Static and dynamic biomechanical adaptations
of the lower limbs and gait pattern changes during pregnancy. Womens Health.
2013 Jan;9(1):99-108.
Thein-Nissenbaum JM et al. Low back and hip pain in a
postpartum runner: applying ultrasound imaging and running analysis. J Orthop
Sports Phys Ther. 2012 Jul;42(7):615-24.
Next up: Patellofemoral
Pain Syndrome!
