Nutrition in Pregnancy + Beyond: The Third Trimester

The Third Trimester (also known as: the home stretch)

As I write this, I'm in the thick of the third trimester (read: no rose-colored glasses here!).  Accompanied by a basketball-sized belly and an increasingly noticeable waddle, the third trimester promises a tinge of heartburn, a few (dozen) restless nights, and a flood of emotions, followed, of course, by the arrival of your sweet baby!  With an increase in backaches, bathroom trips, and inexplicable (yet oh so explicable) fatigue, I'm working my way towards the light (baby!) while doing my best to remain mindful and appreciative of these last few weeks of pregnancy.    

THE ISSUES*

  1. "You look great!"  Really? Because just this morning I split my pants, and my feet are too swollen to fit into my shoes!  Are you sure you're seeing what I'm seeing?   
  2. "'Feel the burn' has taken on a new meaning."  As in, feeling the heartburn.  Big meals, late night snacks, looking at food the wrong way...they all seem to cause heartburn these days!  I thought I escaped it this pregnancy, but as the baby grows bigger and stronger (yay!), I'm battling heartburn on a regular basis (not yay!).     
  3. "Everything aches, always."  One of the many exaggerated statements that I've uttered in the past few weeks (woe is me!).  Of course everything doesn't always ache, but somedays it feels like that.  Like when I get a shooting pain in my back that leaves me stranded on the ground (why, oh why, did I sit on the ground in the first place!?).  Or when I've walked a few miles and my legs feel as wobbly and sore as they did after running a marathon.  I swear I was a Division 1 athlete not long ago! 
  4. "I'm so tired."  "Go to bed."  "But I can't sleep." This is a typical evening conversation between my husband and me (riveting, I know).  The aforementioned aches + pains coupled with an average of 3-4 bathroom breaks per night really deter a good night's rest.  I can make a few adjustments to improve my sleep, but I'm primarily focusing on practicing gratitude for the sleep I do get, as I suspect even more restless nights during the 4th trimester (AKA baby's first 3 months).  

THE STRATEGIES

Maybe your pregnancy flew by or maybe these last couple months have felt more like years.  I've experienced a mixture of both during my second pregnancy, wishing for time to slow down or speed up depending on the day.  Whatever boat you're in, here are a few strategies to power through the third trimester.**  

On appearances: While well aware of the changes to physical appearance that accompany pregnancy (namely, a growing baby bump along with stretch marks, increased cup size, and overall puffiness), it can be difficult, scary, or uncomfortable to see those changes play out (especially with a vocal audience!).  Of course you're eager and excited about your baby (and the baby's health), but feeling comfortable with your pregnant body doesn't always come naturally (and that's ok!).  One day in my third trimester, I actually did rip my (maternity) jeans while squatting to pick up my toddler.  Before a teardrop could run down my cheek, my husband started laughing (probably a little too hard), and soon I was laughing too.  I quickly changed pants, blamed the rip on "poor fabric quality," and continued along with my day.  Pregnancy, like parenthood, is messy.  I don't always feel like my best self, but I try to stay positive by maintaining a good sense of humor and surrounding myself with an encouraging support team (some of whom occasionally laugh at me).    

On heartburn:  Throughout the entirety of my first pregnancy, I experienced piercing heartburn.  While luckier this time around, I've still encountered the common third trimester heartburn when I consume larger meals or eat too close to bedtime.  If you're dealing with pregnancy-related heartburn (regardless of the trimester), try these techniques to prevent it:

  1. With increased energy needs (+450 calories in the third trimester compared to pre-pregnancy requirements), try focusing on eating frequent, small meals rather than piling on the food in the standard breakfast/lunch/dinner structure.  
  2. Avoid trigger foods, which can vary by person but often include spicy and/or greasy options as well as caffeine.  While dining out, ask for mild dishes and opt for a meal that is grilled, steamed, or baked rather than fried.  Avoid heavy sauces and condiments along with high fat foods (looking at you, mayo-smothered cheeseburger!), which can also contribute to heartburn.    
  3. Go for a light walk after meals rather than sitting down, and try to leave a few hours between your last meal and bedtime.  If you do need a snack before bed, keep it light (read: skip the ice cream, cookies, and pizza).  A few whole grain crackers or a piece of fruit should do the trick, but beware of citrus fruits as these might exacerbate heartburn.  Add in protein with a small amount of yogurt or cottage cheese if you're feeling extra hungry.  

On aches, pains, and energy:  First, try to distinguish between the more serious call-your-doctor aches + pains from the this-hurts-but-I-can-deal aches + pains.  For the former, call your doctor!  For the latter, try to identify the causes and make adjustments accordingly.  I noticed that the less I moved throughout the day, the more my back ached.  Solution: start walking more often throughout the day (full disclosure: I also splurged on a prenatal massage, which didn't hurt).  Increasing my activity level improved my back pain and aided in the quality of my sleep, leaving me less restless on the more active days.  To further boost your energy, review your food choices.  Those calorie-dense and nutrient-poor foods will likely leave you feeling extra sluggish.  And while it's tempting to indulge a bit more than usual towards the end of pregnancy, try to resist!  In addition to improved energy, you'll find it easier to lose weight postpartum if you stick to the recommended weight gain during pregnancy (25-35 pounds for those with a normal pre-pregnancy BMI).  Keep looking to the healthy staples (fruits, veggies, whole grains, lean protein, low fat dairy, nuts + nut butters) to provide the bulk of your calories and nutrients.  And if you want to treat yourself, try to do so with an activity that doesn't involve food!  Go for a relaxing pedicure or prenatal massage, plan a fun date with your partner, or simply cozy up with a good book.     

To those in the final months of pregnancy, I hope these tips help you to overcome the challenges you're experiencing.  At the very least, I hope the stories that I've shared give you a good laugh and the feeling that you are not alone.  And as always, congratulations, mama! You can do this! 

Side notes:

*I recognize how blessed I am to experience two healthy pregnancies. While pregnancy comes with challenges in many forms, those that I faced were absolutely minor and pale in comparison to the joys associated with becoming a mother.  

**As a dietitian, I work to employ evidence-based nutrition practices while recognizing and understanding the unique circumstances of the individual.  If you're interested in personalized prenatal or postpartum nutrition services, please contact me