Third trimester pregnancy

Human gestation is niftily divided into three major growth segments, or trimesters, of about twelve weeks. The final three months of a textbook full term pregnancy is referred to as the third trimester.

By this point most women are more than well aware that they are pregnant, with all and sundry asking when they are due and how do they feel? While many women appear to breeze through pregnancy, by the 28th week the growth of the baby is noticeable. While the best thing to do at this time is to continue suitable forms of exercise such as walking, yoga, pilates, swimming etc, eating well and getting adequate sleep (which may not always be as easy as it sounds) – complementary therapies may be useful to help with some of the common health issue of this time.

Cramps and restless legs

While this often occurs in the later stages of pregnancy, a frequent cause is really no big mystery (as some popular texts allude). As the baby has been getting first dibs on the mother’s nutrition over the last six or so months, at this point if supply is not meeting demand, deficiency symptoms occur. Cramps and restless legs are often a sign of not having enough magnesium. So much of the information about calcium directs women to eat more dairy products, which are comparatively low in magnesium. Low magnesium is sometimes a factor in pre-eclampsia.

Good sources of magnesium include: nuts, avocado, bran, unrefined grains (eg, brown rice) and bananas. The celloid or tissue salt form of magnesium phosphate (MP, mag phos), a cross between a homoeopathic and mineral dose, is one of the safest forms of magnesium to take in pregnancy. Take two tablets before bed.

Other deficiencies can also cause restless legs – especially iron and zinc (see the link above for more details).

Backache

While niggling aches and pains are common in pregnancy it doesn’t mean there is nothing you can do to help ease them. Sciatica (a shooting pain, often from the buttocks down the legs) and other musculo-skeletal discomfort can be helped with a couple of osteopathic treatments, acupuncture, physiotherapy or pilates. (For more information and links about these therapies go to the show on aches and pains). Yoga and pilates can also help prevent and treat some back problems. Unless you are advised not to, keep as active as possible throughout this stage of pregnancy.

Try to be aware of your posture as the baby grows. Slumping on the couch not only increases your chance of musculo-skeletal problems but many midwives connect this with a higher chance of a posterior presentation at birth (this is where the baby is head down but facing towards the mother’s spine, so the largest part of the head is prominent.) This often leads to a longer labour.

Swelling/Fluid retention

Standing on your feet all day or being in a warm environment can make the struggling circulation system leak fluid into the tissues. This might present as rings becoming too tight to wear on the usual fingers or swollen ankles, legs or feet. As this can also be a symptom of pre-eclampsia, it is important that your blood pressure is being monitored as well.

For simple fluid retention avoid unnecessary salt. This means cutting out processed foods, avoiding pre-made and restaurant meals and keeping away from the saltshaker. Fresh vegetables, brown rice and steamed or baked fish make a great basic diet, especially if your blood pressure is starting to rise.

If you are working with a herbalist who is helping you with your pregnancy, it is usually safe to have a couple of simple, nutritive diuretic herbs. The two favoured in traditional herbalism are nettle and dandelion leaves (not roots). Half to one teaspoon each per cup, three cups a day is the dosage. Always choose organic, loose-leaf green herbs.

Keeping your legs cool also helps – sitting with your feet in a tub of cool water or using a cold compress gives a little, instant relief.

Varicose veins and haemorrhoids

Cool water can also help raised or bulging veins. Using a shower attachment, spray cold water on the area twice a day.

For haemorrhoids (enlarged, sometimes protruding, swollen veins in the rectum) keeping the bowels working well is an absolute priority. Make sure you drink at least 2 litres of water a day, avoid caffeine and soft drinks and try to get more than the required 5 serves of vegetables and 2 fruits a day. Brown rice, beans, figs, prunes and kiwi fruit are also great to include but pull back on dairy, bread and red meat.

A cream or ointment made from witch hazel, applied to the area, may also be effective.

”Partus Prep”

For centuries traditional herbalists have used plants that help ‘prepare’ for birth. These are herbs that don’t necessarily make stronger contractions, rather they encourage the uterus to contract and relax properly.

Raspberry leaf is the most well known. Research suggests that it has a paradoxical relationship with the smooth muscle of the uterus – astringing it (helping it tighten or contract) as well as relaxing the fibres. This may aid recovery between contractions, helping an active birth.

A “partus prep” is best prescribed by a well trained herbalist, however good quality, organic raspberry leaf tea can be taken at one teaspoon per cup, three times a day from week 28.

More birth preparation

As it is now not unusual for a woman to head into having her first child having never been present at a birth before, it is not unusual that the fear factor can start to grow. We all need mentors in life and having witnessed a positive birthing is useful preparation, as is having a support group around you of people you trust. If you are unable to have a close friend or mother who makes you feel strong and calm with you, consider working with a doula (a professional birth support person).

Hypnosis for a calm, active birth is becoming increasingly popular. One form of training is “hypnobirthing” but others forms exist. As this is a growing, unregistered industry ask around and speak to a few practitioners if you are interested. If interested in hypnotherapy for birth it is often recommended you start as early as possible in pregnancy to get the best results.

Certainly talking through your concerns or fears is important for some women. Midwives are your ally in pregnancy, birth and beyond so get to know who you will be working with. They are the experts, so make use of them during your prenatal check ups. If you are seeing a private obstetrician, you can hire your own midwife or ask to speak to one in the practice if you wish.

Birth preparation classes are usually held in most public and private hospitals. There are also some other excellent private providers, like Lina Clerk who now works in the UK, as well as Melbourne.

Breech presentation

By about weeks 36-37 the baby has settled into position for the last bit of its gestation. If the head is not down, there is a small window of opportunity at this point to try to encourage it to turn around. Increasingly few obstetricians offer manual turning now. If this is not an option or seems risky, try acupuncture and moxibustion. In Victoria you can search for a registered Chinese medicine practitioner at the registration board website

Homoeopathy for birth

Homoeopathic remedies are safe to take to help instigate labour, through the birthing process and after a vaginal delivery or caesarean. The biggest issue is knowing what to take and this requires some knowledge for the birth partner (rather than the woman in labour). A useful guide is available from the Society of Homoeopaths (UK).

If nothing else, the all-purpose remedy is arnica (at a 30 c or higher potency). This helps ease bruising like pain and is useful during and after birth. It is also used for shock.

Planned and emergency caesareans

While complementary medicine aims to support active, natural births – this is not always possible. Sometimes a C-Section is planned as it is the best option for both mother and child, for a wide variety of medical reasons. At other times the baby is in distress or the labour too long for it to safely continue. When you know in advance that a caesarean is planned there are things you can do to help. Certainly pack the homoeopathic arnica and continue to eat well. A multi-vitamin may also be useful.

When a C-Section is unplanned some women experience shock, for which the flower essence formula Rescue Remedy may be useful.

There are some great suggestions about making a caesarean a postive experience at the CARES (SA) site.

While the first six weeks of care post partum is crucial for all women after birth, it is even more so when combined with major surgery. All women should avoid exercise until their ligaments have returned to normal. Post-caeser all abdominal strength is lost, so more hands on help is needed for lifting, doing the washing and so many aspects of daily life. This is even more reason to ask for help from those who are practical and to put a sign on the door to not be disturbed when you and the baby are sleeping during the day. It is normal to be tired, listen to your body and say no to extra activities until you feel ready.

…and some help for the non-pregnant parent

At this time it is not unusual for the non-pregnant parent to have a few of their own health issues, something I tend to think of as “Third Trimester Father Syndrome”. The non-pregnant partner (be it a man or woman) may also be experiencing some stresses and fears, which naturopathy can help support. I’ve written a short article with lots of links, that may be useful.

Gay and lesbian parenting is booming. Rainbow families is the peak support group and offers a range of resources.


For more pregnancy resources check out this previous show, which includes some links to local midwives and doulas.

Muscles aches and pains

Muscle pain: Spasm or contraction in a muscle can happen for many reasons such as a soft tissue injury or a malalignment of the skeleton onto which the muscles and tendons attach. If you are prone to back or neck pain part of your prevention program should include appropriate exercise such as walking, pilates, yoga or stretching. Be aware though, that if you are doing any repetitive exercises incorrectly (such as not breathing from alternate sides when swimming freestyle) you may compound your condition. Being inactive, having a sedentary job, bad posture or lying on the couch while watching TV are common causes of chronic muscular problems.

Acute muscle pain: Heat encourages blood flow, so a hot pack often gives some slight relief. Seek appropriate remedial therapy as soon as possible (see below) – for me the most effective I have found is osteopathy (both conventional and cranial osteopathy), while for others it may be acupuncture, physiotherapy or chiropractic help. For temporary relief, magnesium supplementation (acute dose: 300 – 500 mg 2-3 x a day), natural muscle relaxing herbs such as skullcap and passionflower and a hot bath with Epsom salts can be helpful.

Cramps: Number one muscle remedy is Magnesium and cramps are a dead give away you could be low in this mineral। Foods containing magnesium include: egg yolks, almonds, sesame seeds, brewers yeast and kelp.

As we need a ratio of 2 parts calcium to 1 part magnesium to utilise either mineral – too much or too little calcium can affect your magnesium levels. Plant foods tend to have a better ca:mg balance than dairy foods. Alcohol, animal fats, caffeine and carbonated drinks can also affect the availability or utilisation of magnesium.

Being low in Vitamin E, calcium, sodium and potassium are other potential nutritional causes of cramping. “Restless Legs Syndrome” responds well to supplementation of magnesium and zinc.

Interestingly the heart, which is another type of muscle, has been shown to be low in magnesium when autopsied from people with heart disease.

Fibromyalgia: is characterised by chronic muscle pain and fatigue. A little like Chronic Fatigue Syndrome it is more common in women, may be initially triggered by a virus or infection and no overriding cause or treatment has been identified yet. A good diet (you know what I mean by that – high in plant foods and fish, low in hydrogenated fats, alcohol and caffeine), appropriate low impact exercise, magnesium supplementation and remedial therapies have been most useful to the clients that I have worked with who have this condition. Interestingly, most people diagnosed with fibromyalgia also have Irritable Bowel Syndrome, which most naturopaths would consider to be possible food allergies or intolerances. In such cases, working to find an appropriate diet is important. If your digestive system is ‘unhappy’, the rest of the body is not happy either.


Do you stop building muscle as you age? The latest research shows that even someone in their 90’s can benefit from appropriate weight training/resistance work. They mightn’t be entering Iron Man competitions but they will decrease their chances of falls and osteoporosis.


Creatine: is formed from 3 amino acids and is common in body building powders, creatine helps the body supply energy to muscle and nerve cells. It has been investigated to see if it can increase strength in people with degenerative muscle conditions. Meta-analysis of relevant studies shows some promising results. However the whole issue of amino acids and creatine in body building remains controversial. It is also contraindicated in someone with kidney dysfunction.

Creatine is found in meat, fish and other animal products. I’d suggest a safer alternative to body building powders is taking 1 raw, organic egg in a smoothie.

Prevention and maintainance:Exercise and rest are the most important tools to manage chronic musculo-skeletal problems. While overtraining or doing exercises incorrectly are a common cause of muscle problems, appropriate exercise is both a prevention and a cure. There is no one perfect type but if nothing else walk in correct walking shoes for at least half an hour every day. Yoga, pilates, swimming, marital arts and gym-based work are common favourites. Always get expert guidance when attempting a new form of exercise.

A Rough Guide to Remedial Therapies

Osteopathy: “is a “whole body" system of manual therapy, based on unique biomechanical principles, which uses a wide range of techniques to treat musculo-skeletal problems and other functional disorders of the body.

The AOA website explains what this means by the following example:
“To take a simple example, if you go to an Osteopath with a knee injury, the Osteopath will do much more than just examine and treat your knee. They will want to know exactly how the injury occurred in order to assess not just which tissues in the knee are injured, but also whether there may be any involvement of other areas with a mechanical relationship to the knee, such as the foot, hip, low back and pelvis, and the associated soft tissues. They will then want to analyze any possible secondary effects. For instance, you may be "avoiding" the bad knee and putting more weight on the other side. Over a period of time, this may lead to problems developing in the low back or the "good" knee. The Osteopath will then use this information to prescribe a treatment plan that addresses not just the knee, but all of the other areas of the body and associated tissues that may be involved. The plan will include attention not just to the joints and their associated soft tissues, but also to the blood supply to the affected areas, the lymphatic drainage, the nerve supply etc., in order to include all those factors which will affect the success of healing. It is this "whole body, multi-system" approach that has been the basis of Osteopathy’s success over the last century.”

Australian Osteopathic Association1800 4 OSTEO (1800 467 836)

Physiotherapy: uses some of the following techniques to enhance mobility - joint mobilisation and manipulation, therapeutic exercise and stretches, electrophysical agents (such as hot packs, ice & ultrasound), soft tissue massage, breathing exercises & techniques.

Australian Physiotherapy Association

Chiropractic: focuses on spinal manipulation. The CAA website describes it as: “The moving bones of the spine protect the vulnerable communication pathways of the spinal cord and nerve roots. If the nervous system is impaired, it can cause malfunction of the tissue and organs throughout the body. Chiropractic doctors call this the Vertebral Subluxation Complex. Vertebral, meaning the bones of the spine. Subluxation, meaning the less than a total dislocation, and Complex, meaning consisting of more than one part. Chiropractic is the science of locating offending spinal structures, the art of reducing their impact to the nervous system, and a philosophy of natural health care based on your inborn potential to be healthy.”

Chiropractors’ Association of Australia

Feldenkrais: focuses on movement, posture and breathing to improve flexibility and co-ordination, as well as general wellbeing.

Australian Feldenkrais Guild

Alexander Technique: is a favourite of actors and performers, with it’s roots in the founder’s self discovery of how to treat his vocal loss. This one-on-one technique largely focuses on subtle changes to posture for a wide variety of musculo-skeletal and even occupational issues.

The Australian Society of Teachers of the Alexander Technique
Alexander Technique Association

Acupuncture is a branch of Traditional Chinese Medicine (TCM), though there is also Japanese acupuncture that is relative shiatsu treatment. An experienced practitioner uses fine needles to balance energy or qi flowing through meridians in the body. Other than for a variety of other medical conditions, acupuncture is a common Complementary Treatment for both acute and chronic musculo-skeletal injuries.

TCM is regulated in this State by the Chinese Medicine Registration Board of Victoria. See the Board’s website to find a qualified practitioner. Note, though many medical doctors offer acupuncture, while researching regulation it was discovered that the greatest amount of adverse reactions in acupuncture occurred when being treated by these types of practitioners. (Source).

Remedial Massage: While most of us like a relaxing massage, which in itself can help prevent some muscular problems, in an acute situation a remedial massage therapist who can work more deeply is most applicable. This usually involves at least a second year of training.

Australian Association of Massage Therapists is the peak body for massage therapists in this country and membership for remedial therapists requires not only appropriate education but also a practical test by the Association.

Note: many massage therapists are also naturopaths and may belong to other associations such as ANTA or ATMS instead.

Orthopedic Surgeons – are your savior if you have broken a bone. In my experience as a Naturopath however, I’d suggest you always get a second opinion from a Osteopath before going ahead with any other kind of orthopedic surgery for chronic musculo-skeletal pain. While some people will still require surgery, in the majority of cases treatment through osteopathy, pilates, Alexander Technique etc has averted this for many.