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Dos and Don’ts for Optimal Baby Positioning in the 3rd Trimester.

If you are just coming across my blog for the first time I’m 33 weeks today with my second and feeling it… physically this pregnancy has been much more challenging than my last, which I’m sure is the case for so many mamas out there.

This blog post is super important and something I talk to almost all my pregnant patients about in the office. Simply, the do’s and don’ts for the third trimester in-terms of how you sit, rest and move!

When you hit the third trimester a few things happen…

One – your healthcare provider probably talks to you about baby movement. Lots will recommend a movement tracker (just a sheet to tick off to make sure you feel babe moving a certain amount of times per hour). In my case this pregnancy this baby is wild! I feel movement constantly… fairly aggressive at times. I’ll just mention here that I pay attention more to WHERE I feel the kicks and movements. It gives me a bit of an idea of how the baby is lying in my belly.

Two – your healthcare provider probably starts to comment on the position of the baby at this stage as well. Like I mentioned on Instagram @drgilliansawyer last week, up until 33-35 weeks-ish you’d expect the babe to flip and flop before they settle into a head-down (hopefully) position for the final stretch of pregnancy to prepare for labor. On that note there are so many variations of normal, this is just a common trend I find in practice. Many, many women come in around the 30-32 week mark mentioning that their doc or midwife thinks the baby may be breech. That’s what happened to me in BOTH pregnancies. This can be super stressful for sure as the options for delivery change a bit when the baby is not head down. I’ll mention here too there are a few neat things you can pay attention to at your appointments to give you an idea perhaps about where baby is sitting. Where are they finding the heart beat typically? For me there was a consistent trend, when babe was head down with the spine along the left side of my belly the doppler always picked up the heat beat on that side down in the lower quadrant of my abdomen. For about a month or so when this little one was sitting breech, the heart rate was consistently being found on the other side and upper quadrant of my belly. Another side note here is when the babe was thought to be head down I’d feel hiccups down low in my pelvic floor. When babe was sitting breech this was not the case. Another thing I noticed was my ability to breathe. I find for myself when babe is head down I get way more space underneath the front of my rib cage… hence more room for expansion and to breathe. When baby was bum down, it seemed to sit higher in my belly and really restrict my breathing. As mentioned above I noticed kicks and movement in different places as well. When breech there was a bulb (the head) sitting up under my ribs on the right and now that babe is head down I can feel a little heel up under my ribs in the spot on the right side and a solid bum on the left side (and the heart beat on this last midwife apt was again left side). Now this may not be everyone’s experience but I just thought these observations were interesting and worth noting!

Third – your physical symptoms…. oh boy, the second time around I am noticing a huge pattern here (the first pregnancy I had nothing to compare to so many of my aches and pains I just chalked up to being part of pregnancy). Some observations I think are worth noting here too as clinically there seems to be a pattern with most women. Of course this won’t apply to everyone. So the pelvis, hips, sciatic nerve, SI joints, pubic symphysis are GRUMPY right now! I find that heading into the 3rd trimester around the 28-30 week mark this seems to be a common theme. Lots of growth happening at this stage, the body is trying its best to keep up and accommodate. The baby is bigger and moving A LOT (flipping in my case from head down to breech and back again). And if it’s not your first pregnancy the body seems to have a muscle memory and the stability of this area of the body is not great. Also good to note here the relaxin hormone ramps up in the third trimester to help prepare your body for labor which is fantastic for labor, just not the most comfy while you are pregnant :(. There is a silver lining here… If the babe does get itself head down and starts to settle down in the pelvis I find clinically for many women including myself that the baby’s head can act as a great stabilizer of the pelvic joints. There are so many women that will say they feel better 35 weeks + then they did at 28-34 weeks. So hang in there is you are feeling terrible right now 😉

So what to do with all this information?!?!?!?!

Here are my fav tips – Do’s and Don’ts heading into the 3rd trimester! (Both for your comfort mamas and for balance in the pelvis to allow the baby to hangout in the best possible position).

DO’S – try to incorporate these when you can!

Keep the PELVIS MOBILE! One of the worst things is to let those joints/muscles seize or tighten up. Because of how directly connected the pelvic structures are to the uterus this is super critical. Keep moving within your tolerance because there is definitely a grey area here, too much activity will make you feel worse symptomatically for sure. If its light walking, gentle yoga or pelvic floor/girdle alignment/exercises, continue to do what feels good for you here. Get your pelvis checked! For alignment, mobility and balanced. I’ve been getting adjusted weekly for symptom relief and for function/balance since my symptoms flared up around 28 weeks and babe was noted to be breech around the same time. Chiropractic wise the Webster technique is meant to do just this. I’ve also been working with my acupuncturist, craniosacral and massage therapists as needed.

Be mindful of the positions you are in.

-whether its your work positions (I’m always working on one side of the table when I treat patients, causing me to be bent forward and rotated. I’ve had to be very mindful of this. Try to keep symmetry as best you can when work. If your job is more at a desk take note of the next point.

–sitting positions… stay FORWARD, sit on your sits bones when seated, sit cross legged on the floor, prop a bolster/pillow/rolled under your butt when on the couch or in the car (See DIY blog post series for a visual on these). This will give you a bit of a forward tilt, which helps keep babe forward. Hang out on a exercise ball, do some pelvic rocks and figure-8s to keep things mobile.

–standing positions… correct your alignment (see DIY guide on the blog), stay balanced with weight in both feet, carry your little ones mid-line when possible.

–sleep positions… side-lying with pillows from knee ALL the way to foot to keep pelvis from tilting, rolling or tugging on the glutes. I flip from side to side through the night (I’m not super strick on always lying on the left because I think the balance is important). But your body may feel better on one side so do what feels best for you.

Try hanging out on all fours, while playing with you kiddos/ gardening (or when spreading mulch while nesting…. see instagram this week 🙂 Add some cat/cows, modified child’s pose if it feels good. If you know your babe is head down the deep squat position is great to open the pelvis and give them space to move down and potentially engage in the pelvis.

DON’TS – these are so important to be mindful of!

-Don’t cross your legs when seated

-Don’t carry your little one on one hip

-Don’t stand with your weight to one side with your hip jutting out

–Don’t LOUNGE or SLOUCH on the couch *** this is huge! You really don’t want the baby’s weight (spine) to sink into your spine with gravity in this position… this would make a posterior baby comfy which is not ideal (posterior position (sunny-side up)) can lend to back labor… not great. And if your babe is breech you want to avoid their little bum from sinking into the pelvis!

So just to summarize in the last month or so when I knew the baby was breech I followed the above. I was mindful of certain positions, kept my pelvis mobile (with movement, postures, getting adjusted, and integrating other therapies). For me it reduced tons of the stress and gave me some reassurance to pay attention to things like where I was feeling the baby’s movements (kicks, hiccups), where the heart beat was when I visited the midwife. I also tried to keep in mind that babies move at different times, some get into an ideal position right when labor starts and some hang out head down for the last few months of pregnancy. So my advice to mamas would be do what you can, feel ok with that and let go of the rest. When it comes to baby position, labor, and other concerns that come up while pregnant. We really don’t have a lot of control over the whole thing. So just trust yourself, your body and your baby.

For some more fun tips and tricks you can check out

I’ll be sure to update with any changes for me in the next little while 🙂

With much love,

Dr. Gillian


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