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Third Trimester Pregnancy Guidelines


The third trimester may be the most important time during your prenatal clients pregnancy that she continues training with you. This is the time to really help prepare her body for the main event – that’s right, the exercises you teach her can contribute and help her push her baby out, when the time comes that is, plus can help tremendously with her recovery after. In this article you will learn the focus for training your prenatal client during her third trimester, key modifications, recommended exercises and tips to give her right after she has her baby. Be sure to read through trimester one and trimester two articles as this trimester three article continues to build upon those and can give you a better overall understanding for training her during the third trimester.

Learning Objectives:

  1. Learn why it’s important to focus more towards relaxing exercises in the third trimester.
  2. Understand possible modifications and what to expect for a prenatal client in her third trimester.
  3. Discover recommended exercises and exercise modifications to include in a prenatal client’s exercise program during her third trimester.

1st Trimester: Week 1 through Week 12

2nd Trimester: Week 13 through Week 26

3rd Trimester: Week 27 through Week 40

Beginning an Exercise Program in Her Third Trimester

Just like if she were in her second trimester she can begin a light exercise program now in her third trimester as long as her physician has given her the okay. Here are some guidelines for those beginning to exercise in the third trimester:

Continue Deep Core Focused Strengthening

In a study by Kjell A. Salvesen looking at strengthening pelvic floor muscles during pregnancy found that structured exercise programs including exercises that focus on strengthening the pelvic floor (and her deep core from my experience), “is associated with fewer cases of active pushing in the second stage of labour lasting longer than 60 minutes.” Continue reading below about encouraging her to relax towards the end of pregnancy, the combination of the two I believe can even decrease that pushing phase for many to 30 minutes or less.

Keep Her Stress-free

Anxiety during pregnancy has been related to outcomes such as fetal distress, premature labor, low birth weight, and possible childhood problems. This is a big reason why I encourage you keep her workouts stress-free, you want her to leave feeling more energized and empowered then when she walked in.

This will vary depending on your client as some clients need a more intense workout to relieve their stress but many, especially as they near the end of their pregnancy will find it more of a stress release if you choose exercises that help her feel better, such as the recommended ones in this article (and trimester two article exercises) and executing each repetition in a slow breath-focused manner.

Posture and Low Back Pain

Continue those tips from trimester two article on encouraging good posture and include exercises such as Cat Cows, Forward Rolls, Squats + Rotations, Squats, Reach + Curl, and the simple reminder to sit and stand tall by gently engaging her deep core.

Encourage Her to Keep Working Out

Many expecting mom’s find that exercise gets harder as pregnancy progresses, you may find her starting to show up less and less for her scheduled workouts. Two things:

  1. Re-evaluate and discuss with her about her workouts, remember having a good open communication with her is key.
  2. Remind and continue to encourage her why she should continue with her workouts during her third trimester. It is still recommended that she continue to exercise a minimum of 30 minutes most days of the week.

Remind Her the Benefits of Exercising

Awareness is a majority of the exercise battle for many prenatal moms, as stated in a study by B. Melton that looked at the link between physical activity and maternal health and how physical activity declines during pregnancy and that “fifty two percent of participants perceived that activity would decrease energy levels, 37.5% did not know that exercise could decrease the risk of gestational diabetes, and 47.6% were unaware that a mother who is overweight is more likely to have an overweight child.”

While to us these stats may seem really high and we see first hand that working out can actually increase her energy, this study shows the reality of what is perceived by many expecting women. This is also why I highly recommend keeping the line of communication open and adjusting her workouts accordingly. You may know she is capable of working out harder but at this stage in her pregnancy she may not feel comfortable doing so, so you must follow her lead but continue to encourage her to keep working out.

Also in a new study just out from the Obstetrics and Gynecology Journal which states what I have professionally noticed since training prenatal women for 10 years, that a structured prenatal exercise program can reduce maternal weight gain and “odds of a cesarean delivery” and “reduces the risk of having a large newborn without a change in the risk of having a small newborn”. This is why I also encourage you to teach her how to engage her deep core muscles and now to relax as she nears her delivery date.

Decrease Intensity and Encourage Relaxation

While you can continue to train your prenatal clients according to what she was doing in her second trimester, as she progresses into her third trimester you may need to decrease her intensity. You will probably notice that she gets tired more easily, that some exercises just aren’t working for her now – so cut those out. Include exercises that help her feel better, the recommended exercises in this article are good choices because they are gentle yet effective.

As she nears the end of her pregnancy between 34 and 36 weeks start teaching her to relax, specifically her pelvic floor muscles. I find many strong women may tend to grip their pelvic floor muscles, especially when in pain, so it’s important now to encourage her thinking about relaxing and preparing for baby to come. Try the “Belly Breathing” exercise to teach her find and relax her pelvic floor muscles.

What to Do Right after Baby is Born

I believe it’s important to give your prenatal clients prior to having her baby, some simple guidelines for exercise postpartum. While it’s important for her to have clearance from her doctor to begin an exercise program again after birth (typically 6 weeks), it’s also important to encourage her to:

More on the specifics of training your postpartum clients coming in the final article of this series, “Training Your Prenatal Clients”.

3rd Trimester Recommended Exercises

She can continue to do squats, lunges, and upper body exercises she was doing during her second trimester as long as they feel good for her and you do not see any “coning” of her belly. Here are 5 additional exercises that are all gentle yet effective for your prenatal clients during the third trimester and also can be taught earlier on, and again as she gets back to exercise in the postpartum stage.

Cat Cows

A wonderful exercise for your prenatal clients  to help stretch her back, strengthen her core and encourage relaxing her pelvic floor after 34 weeks of pregnancy. Do 5 to 10 of these slowly.

Cat Cow 1

Cat Cow 2

  1. On hands and knees, exhale to tuck her hips and round her spine, “hugging her baby”.
  2. Inhale as she slightly arches her back to lengthen her spine.

Side Lying Leg Presses

Side lying leg exercises are an easy go-to exercise during the third trimester because they are gentle, yet effective and there are almost not limitations for a prenatal client to do them. If she feels any pulling in her belly try placing a small pillow under her belly when laying on her side. Do 10 to 10 reps then switch sides.

Side Lying Leg Presses 1

Side Lying Leg Presses 2

  1. Lying on one side, hips stacked, knees slightly bent, exhale to reach the top leg out and away, pressing through the heel.
  2. Inhale to slowly lower her top knee down towards her bottom knee.

Reach + Curl

A good option to gently strengthen and stretch her core and back. Do 10 reps then switch sides.

Reach + Curl 1

Reach + Curl 2

  1. On hands and knees, exhale to extend one arm out in front and the opposite leg back.
  2. Inhale to round her spine and draw her opposite elbow and knee towards each other.

Mermaid Stretch

A good choice to help stretch her tight hips and belly.  If it’s challenging for her to sit directly on the ground, grab a pillow and place it under her hips. This will make it easier for her to sit in this mermaid position. Do 3 to 5 reps then switch sides.

A good option to gently strengthen and stretch her core and back. Do 10 reps then switch sides.

Mermaid Stretch 1

Mermaid Stretch 2

  1. Seated with the right leg bent in front and left leg tucked behind, right hand on the ground behind her body. Exhale as she reaches her left hand overhead, pressing her hips up, bringing her up onto her knees.
  2. Inhale to lower down placing her hips back on the ground.

Relaxed Belly Position

Encourage her to hold this position for a couple of minutes, breathing into her belly and allowing her body and pelvic floor to relax.

Relaxed Belly Position

  1. Sit in a kneeling position with knees out wide enough to allow room for her belly.
  2. Relax the upper body into the ball as she takes slow deep breathes and relaxes her pelvic floor muscles.

For more instruction on recommended exercises for your client in her third trimester, watch the video below:

Conclusion

Now you understand what the focus needs to be, possible modifications, the importance of keeping her stress-free and encouraging relaxation towards the end of her pregnancy, all while encouraging her to continue to workout, even if her workouts are occurring less and are less intense. Continue to encourage her to move often and incorporate a few of these exercises each day to help her relax effectively and prepare her body for the main event.

References

ACOG Committee opinion. Number 267, January 202: exercise during pregnancy and the postpartum period. Obstetrics and Gynecology 2002, 1:171-3

Barakat, R. Pelaez, M. Montejo, R. Refoyo, I. Coteron, J. Exercise throughout pregnancy does not cause preterm delivery: a randomized, controlled trial. J. Physical Activity and Health 2014, 5:1012-7

Melton, B. Marshal, E. Bland, H. Schmidt, M. Guion, WK. American rural women’s self-efficacy and awareness of exercise benefits and safety during pregnancy. Nursing Health Science. 2013 dec;15(4):468-73

Ramirez-Velez R. Bustamante J. Czernicyzniec A. Aguilar de Plata AC. Lores-Arnais S. Effect of exercise training on eNOS expression, NO production and oxygen metabolism in human placenta. 2013 Nov 14;8(11):e80225

Salvesen, Kjell. Morkved, Siv. Randomized controlled trial of pelvic floor muscle training during pregnancy. BMJ 2004, 329(7462):378-380

Teixeria, JM. Fisk, NM. Glover, V. Association between maternal anxiety in pregnancy and increased uterine artery resistance index: cohort based study. BMJ 1999, 318:153-157

Wiebe, HW. Boule, NG. Chari, R. Davenport, MH. The effect of supervised prenatal exercise on fetal growth: A Meta-analysis. Obstretics and Gynecology Journal. 2015 May;125(5):1185-94

Yan, CF. Hung, YC. Gau, ML. Lin, KC. Effects of stability ball exercise programme on low back pain and daily life interference during pregnancy. 2014 April;30 (4):41209