Here are some guidelines for the last month of pregnancy – look at which ones suit your lifestyle and start to incorporate them!
Preparation at this stage can increase the chance of a birth with minimal intervention and tissue damage and help to facilitate your recovery, including bonding with your baby and your ability to breastfeed.
Optimal foetal positioning:
- Avoid bucket seat positions where your pelvis tips under – especially be mindful when driving, at work or when relaxing at home. Try to keep your hips higher than your knees – sit on your birthing ball where possible!
- Sleep on your left side – don’t worry if you move, just start out on your left
- Pelvic mobility exercises in different positions – standing, leaning, on all 4s or on birthing ball. Sways, rocks, tilts, circles, figures of eight
- Exercises I’ve shown you in class to encourage baby into the most favourable position
- Move daily, preferably outdoors
Preparing the pelvic floor and cervix:
- Perineal massage
- Kegels especially focussing on the relaxation phase. You can also try J breathing to help
- Eutonia – sitting on the noodle daily!!
- Intercourse with deep ejaculation (semen softens cervix)
Mental and emotional preparation:
- Visualize your perfect birth – in as much detail as you can, the positions you take, who’s there, how it goes
- Don’t watch/listen to birth horror stories – no One Born Every Minute for now!
- Watch beautiful birth videos (YouTube)
- Verbalize fears – write them down – then work through them
- Read affirmations – eg. “I look forward to meeting my baby”, “I trust my body to birth my baby”, “contractions help to bring my baby to my arms”, “my baby is happy and healthy”. Read more examples on the app In Shape Moms (affirmations are free). Try to write your own!
Prepare tissues and systems with nutrition:
- Avoid processed foods and just eat real food!
- Eat an anti-inflammatory diet – avoid wheat, sugar, dairy, processed foods
- Add more gluten-free carbs to your diet – sweet potato, rice
- Add good fats – coconut milk/oil, avocado, fish, nuts
- Eat foods high in iron – green veg, walnuts, almonds, meat
- Take probiotics
- Eat 4 dates per day – this helps to keep the waters intact which in turn can lessen the pain of contractions
- Stop taking multi-vitamins especially those containing iron – inhibits prostaglandins which help soften cervix
- Stay hydrated – can include raspberry leaf tea now which may help contractions
- Try to establish a regular sleep cycle – this helps regulate hormones
- Take naps where possible
- Reduce stress – use your breathing, soften your face, avoid stressful situations
- Limit social agenda – don’t try to fit everything in
- Prepare for the postnatal period – try to enlist other people’s help for household tasks or else build up a bank of frozen homecooked meals
- Spend time outdoors, preferably in the sun (!!)
- Favour activities that make you happy and so increases oxytocin – massage, music, sex, cuddling
Do what preparation you can beforehand and then when it all starts know that you and your baby are fully prepared for what’s to come – don’t try to control it, go with it!
I have already talked about pain in the front and back of the pelvis and the hips – Pelvic Girdle Pain (PGP) – caused by the hormone relaxin during pregnancy. You can read the original post here. Now here’s another pain in the bum!
Piriformis Syndrome can occur in anyone but it is particularly prevalent in pregnancy. The piriformis is a muscle that connects the thigh bone (femur) to the spine at the sacrum. It also blends into the pelvic floor so can affect the function of the pelvic floor too. It’s quite a small muscle that can be overused and quite tight. Because the sciatic nerve runs through/near it, a tight and spasming piriformis can press on it causing sciatic symptoms – such as pain in the bum and down the leg.
Posture (as ever!) has a lot to do with it. If you walk/stand with your feet facing outwards the piriformis muscle is continually switched on. Try to have your feet facing forwards instead.
Another postural problem is having your bum tucked under constantly. Instead think of your bum sticking out when standing – easier if you’re not pushing your weight into your toes. In seated position try to sit upright on your sit bones instead of slouching back. This is essential in pregnancy anyway, to help keep the pelvic bowl open, creating lots of space for baby. And try not to sit too much – take regular standing breaks if possible.
To ease off the muscle there are a number of stretches you can do. The main one is the figure of 4 stretch. Sit on the edge of a chair, up on your sit bones, feet flat on the floor under your knees. Lift one leg up and place the ankle on top of opposite knee. Allow knee of top leg to rotate down gently. Try to keep ankle straight – having the foot flexed helps. Hold and breathe for a few seconds and then switch legs. This could also be done sat on the floor or lying on your back with the bottom leg up the wall
Sitting on a tennis ball – not suitable in pregnancy. Place a tennis ball under one bum cheek – you can go right on the source of discomfort if it’s not too intense, otherwise place just above or below the trigger point. From there you can just sit and breathe until the discomfort eases or you can make small circles. Also from a seated position with feet flat on the floor allow one knee to drop out slowly then draw back in.
One we often do in Pregnancy Pilates Relaxation class is a hip hinge with feet in a t shape. Place one foot in front of the other so that the instep of the front foot is next to the toes of the back foot. In this position, push the hips back, keeping the back straight. You should feel the stretch in the bum cheek of the front leg.
Just as important as the releases, you also need to strengthen the bum – squats, hip lifts, hip hinges all help. These are key movements in all my classes as a strong bum will also help with posture and strength as well as looks good!!
Pelvic girdle pain (PGP), sometimes known as Symphysis Pubis Dysfunction (SPD) or SI Joint Pain – can be felt in the back, bum, legs and front of pelvis.
It’s a common problem in pregnancy – 20% of pregnant women get it, although it can be as much as 50%. But remember common does not mean normal – so you don’t have to just put up with it!
The good news is that it does tend to clear up after pregnancy – only 7-8% women still have a problem postnatally. But how you deal with it in pregnancy will have a bearing on your recovery
There are various risk factors for the condition including:
- pelvic girdle pain in previous pregnancy
- gaining excessive weight during pregnancy
- lack of core strength
- poor posture
- pelvic misalignment or history of trauma to the pelvis
- hypermobility, connective tissue disorders or laxity in the joints
- expecting a large baby or multiples
- baby’s position
There is also a range in the severity of pain felt and different activities can affect differently – some movements may cause no pain in some women but be excruciating for others. For instance, the classic going up stairs was not a problem for me but turning over in bed was always painful. The general rule of thumb is – if it hurts, don’t do it! There is no benefit in pushing through the pain and you’re more likely to make it worse.
Here are a few ideas to try which may help out with day to day activities:
- Walking – take smaller steps and go slower. Be aware that if you have a small child or a dog pulling on you that will also exacerbate it. Otherwise walking is a great exercise and should be continued as much as possible
- Sitting – don’t cross your legs – either at the ankles or the knees. Sit upright and with both feet on the floor – an upright chair or birthing ball is helpful rather than the sofa. Click here to go to my YouTube channel where there are videos instructions on sitting, standing up and getting up from the floor or bed. Using the Knack on movement will also help.
- In bed – turning over is usually the issue. Keep a pillow between your knees then squeeze your knees, perform the Knack and try to keep your hips stacked as you roll. This can be aided by having a duvet under the bottom sheet. Also reducing friction to turning can help – using silk sheets, a snoozle slide sheet or if you’re desperate, a bin bag!
- In the car – getting in and out is a challenge. Think 1950s and keep your legs still and swivel round! You don’t want the knees to move inwards past hip width, so again a pillow between the knees (or a yoga block) and squeeze and perform the Knack as you swivel. A plastic bag on the chair can help. Also when in the car try sitting on a rolled up towel so that your hips are more in line with your knees.
- Avoid one legged positions – sit down to get dressed and walk upstairs by bringing the second leg up to meet the first before you take the next step. Think of stepping upwards with each step rather than forwards. You may also want to avoid carrying things upstairs. If you need to get down to the floor try to use a squat position and onto all fours instead of a lunge.
- Avoid wide legged positions – anything wider than hip width apart will either cause pain or risk pulling the pubic bones further apart. This also applies to your birthing position – safest position is actually on your side.
- Avoid heavy lifting and pushing – this means vacuuming and shopping trolleys are not good idea. Time to get help where possible.
- Work on your posture and try to keep your pelvis in alignment – get a referral to see a women’s health physiotherapist or a chiropractor for an assessment. They will be able to give you manual therapy and may advise a support belt to help.
- Exercise – it’s important to keep moving if possible. Gentle walking and swimming are good – but avoid breaststroke legs. Pelvic floor and deep abdominal exercises are essential – my pregnancy Pilates classes are ideal for this. Other key exercises we do are those that work on keeping the pelvis both stable and mobile. Try to practice these at home regularly.
Also, make sure it’s written in your notes – mine wasn’t and I ended up in stirrups with a forceps delivery. I was kept in that position a long time after birth too and this made my postnatal recovery from PGP much harder.
For more information the best website to use is
www.pelvicpartnership.org.uk – loads of information there.
If you need any more help feel free to contact me and remember I can always teach you exercises in class that you can use at home.