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Ripe & Ready Part II – Third Trimester

With so many social expectations around the “due-date”, it is hard to be pregnant and not feel like there is a clock that starts ringing ferociously on that magic day. We know that our due-dates are the best guess for a birthday that can take place weeks before or after. There seems to be a fine line between letting nature take its course, and being proactive so that our bodies are as prepared for the birth as possible. Numerous strategies can support your body’s innate ability to give birth naturally and possibly decrease your chances of going far past your due date. We have tried to outline the strategies we have found to be the most effective in nurturing and ripening your mind and body for labour.  Awaiting baby after your due date has passed may be stressful, especially if you are considering electing a medical induction at some point which may not look like the birth you had envisioned for yourself. 

Fun fact: when your labour will start is mostly determined by a complex interplay of maternal and fetal hormones that starts in early pregnancy. This is why pregnant people rarely start labour if they are sick, and the same can be true if they have overwhelming fear or anxiety – both of these can slow down the production of necessary hormones.

Another factor is the fetal position in late pregnancy which in turn can be influenced by various other factors including fetal size, maternal energy, pelvic alignment, pelvic floor tension, and lifestyle habits.

The third trimester, is the time when the cervix especially starts to ripen. Continue with everything from the Second Trimester that you have started. If you haven’t signed up for Prenatal Classes or hired a Doula, it’s not too late.

Early Third Trimester

Acupuncture

Acupuncture, along with its many other benefits, can be used to promote optimal fetal positioning and hormonal balance, as well as induce labour when needed. 

Herbs

Below is an example of a tasty, nurturing tea blend that you can make yourself, or have a herbalist mix for you:

Essential Oils

Add 3 drops of Lavender essential oil, and 3-5 cups Epsom Salts to a bath 2-3 times per week. While you are in the bath, focus on relaxation of your abdominal muscles and pelvic floor.

Additionally, you can have a Labour Blend made for you by an aromatherapist. Massage this into your belly or lower back daily from 36 weeks while practicing relaxation or just before bed.

Once you are in labour, applying the oils to your belly – or in the labor tub –  will trigger your sense of smell to bring you right to that relaxed place.

Optimal Fetal Positioning strategies

Once babies are head down, if they are anteriorly positioned, i.e. their face is towards the mother’s back (which presents a smaller diameter into the pelvis), they will be able to sink deeply into the pelvis and onto the cervix. This promotes cervical ripening, as well as minimizes back pain in late pregnancy and during labour.

In order to promote anterior positions:

• Float or swim with the belly down
• Garden. Clean your floors by hand. Crawl around on hands and knees.
• Practice yoga, including Child’s Pose and alternating Cat-Cow Poses
• Walk up stairs sideways two at a time
• Use forward leaning positions when relaxing or at work: sit on a birth ball, kneeler-rocker or chair facing the back
• Sleep sidelying (preferably left side), not on the back – but only if this is comfortable and doesn’t result in less sleep!
• Spend 15+ minutes a day in a “polar bear position”, i.e. with your knees and chest on the floor. Use pillows to make yourself more comfortable while you meditate, read, watch TV, etc. Also effective for reducing back pain in late pregnancy.
• Belly Lifting: use this technique during Braxton-Hicks contractions in the last weeks of pregnancy. It can also be used in labor. The theory is to change the pressure vector on the baby’s body and head, thus helping baby to better flex and/or rotate its head.
  • Stand with knees bent. Put your hands around and under your belly, lifting up gently. It works best when having contractions but can really be done anytime.
  • Two-person technique: have your birth partner stand behind you holding the ends of a towel or scarf that is wrapped under your belly. They will gently use this to lift your belly.

In order to avoid promoting posterior fetal positions:

• Avoid reclining in armchairs, sitting in bucket car seats, or anything where the knees are higher than the pelvis
• Avoid crossing the legs, which reduces the space at the front of the pelvis and opens it up at the back
• Avoid sitting with feet elevated
• Avoid deep squatting, which open up the pelvis and encourages the baby to move down, if the baby is known to be posterior
• Even if you try these techniques – your baby may still enter the pelvis in a particular way because of the shape of your pelvis. 

Homeopathics

30c Pulsatilla daily from 33-36 wks, for optimal positioning UNLESS your baby is known to already be in an optimal position.
Homeopathics are sugar pellets which are impregnated with highly diluted substances or the “energy” of plants.  There are no associated side effects with taking homeopathics.  For maximum effectiveness, the pellets should be dissolved under the tongue, and should be taken at least 15 minutes before or after eating or drinking.

Sex

Orgasm strengthens the uterine muscles and ripens the cervix. For those with male partners: semen contains prostaglandins, which are hormones that act to ripen the cervix.

Birth plan

Having a birth plan, whether formalized in writing or verbalized with your birth team, will increase your sense of trust and control, allowing you to let go into labour. Reading the Pomegranate Midwives’ Birth Plan will give you an idea of what to expect from our end.

After 36+ weeks

Evening Primrose Oil (EPO)

EPO contains prostaglandin precursors – as well as essential fatty acids – which help ripen and soften the cervix. It is also used to help prevent postpartum depression, so keep taking any leftovers orally after your baby is born.

• Take 1000 mg orally in the morning
• Insert 1000 mg intravaginally at bedtime, as close to your cervix as you can reach. If this is too hard, then just take it orally.

Herbal Tincture

The term Mother’s Cordial refers to any blend of herbal tinctures that is used to support cervical ripening and uterine toning. Because herbs used for this goal tend to not taste good, they aren’t usually drunk as a tea. Have a herbalist or naturopath make you a blend, or ask your midwife for a recipe. The following is the typical blend that Pomegranate midwives prescribe:

Homeopathics (see above re: how to take homeopathics)

Keep repeating the Arnica-Cimicifuga-Caullophyllum cycle until birth.

Don’t forget self care!

Eat, drink, take naps. Don’t exhaust yourself by the end of the day in case labour starts in the middle of the night.

After 40+ weeks

Stretch & Sweep

Sounds like spring cleaning, but actually refers to a procedure whereby your midwife inserts 2 fingers into your vagina with the intention of reaching your cervix. If the cervix is open, your midwife will stretch your cervix; this action will help release prostaglandins, an essential hormone for labour. While this procedure is not related to a higher risk of infection or your water breaking prematurely, it has been shown to be associated with an earlier labour, especially if repeated over a number of days. Let your midwife know if you are interested.

Time/Patience

Ultimately, your baby will come at the most appropriate time. Even the most aggressive ripening techniques will not bring on labour if your baby isn’t ready!