Welcome to Chinese Medicine Bristol's official blog! Here, Acupuncture and TCM pracitioner Sandra Arbelaez will share information about Acupuncture and Chinese Herbal Medicine, how they work, and the latest research and developments related to TCM. You will also find knowledge and ideas on how to enjoy a full, healthy life that she has picked up over the course of 15 years of exploring the world of natural health

Thursday 5 July 2012

How to have a healthy pregnancy- Third trimester

This post focuses on the third trimester of pregnancy and is the last one in the series dedicated to pregnancy health. The first and second trimesters are discussed in separate posts.

In the third trimester of pregnancy (weeks 28 to 40 in the UK), most women experience incredible growth in their wombs. During this period, the baby will go from about 40cm to 60cm in length; and from about 1kg to between 2 and 4 Kg in weight. The fully formed body of your baby will spend the last few weeks of pregnancy growing in size and strength, and refining its functioning.  The highlights of baby developments at this time include the baby’s bone marrow starting to produce its own blood supply, the liver starting to store iron sourced from the mother, the production of a special fatty tissue that will provide the baby with warmth after birth, the strengthening of the immune system by drawing antibodies from the mother, and the mastering of the sucking and swallowing reflexes ready for breast-feeding.

Third trimester growth
The mother in the meantime may not be having such a good time. The huge amount of baby growth not only may result in an uncomfortably big belly that can give you an aching back and legs, but may also leave little room for your own digestive system and bladder causing frequent urination, indigestion, and heartburn, amongst other things. Uncomfortable sensations may also be felt in the lower abdomen and groin areas as the baby gets into position, and this may become more acute once the baby’s head engages at some point between weeks 36 and 40.

TCM views of third trimester symptoms

Some of the symptoms commonly experienced during the third trimester are purely consequences of the physical pressure exerted by the baby on the mother’s organs. However, an increased severity in these symptoms can reflect imbalances in the mother’s energy. Common third trimester symptoms may fall into the following TCM categories:

  • Qi/Yang deficiency (of Spleen/Kidneys): Indigestion, loss of appetite, constipation, haemorrhoids, varicose veins, oedema (water retention), frequent and copious urination, lower back ache, vaginal discharge.
  • Blood deficiency: Insomnia, anxiety, cramps, carpal tunnel syndrome, anaemia, constipation.
  • Yin deficiency: Feeling hot, night sweating, excessive “Braxton hicks” (false contractions), insomnia, anxiety, high blood pressure, gestational diabetes.

Acupuncture combined with gentle massage can help relieve some of the uncomfortable aches, carpal tunnel syndrome, and water retention. Other symptoms such as digestive problems, insomnia and anxiety, cramps, and sensations of heat can also be relieved by Acupuncture and personalised advice from your TCM practitioner. Your Acupuncturist can also help you manage high blood pressure and gestational diabetes.

 Although most of the above symptoms can be classified as normal, bear in mind that when they become severe they may present risks to the pregnancy. Close contact with your health practitioner or midwife at this time is essential and any severe or unusual symptoms should be notified to them immediately.

Third trimester essentials 


This is the time when all your efforts to be healthy during the pregnancy will pay! If you have managed to maintain yourself well-nourished, rested, strong, and flexible, you will be more able to enjoy this time. 

In the first trimester of pregnancy the focus was on maintaining a strong Yang energy and a healthy supply of Blood, while in the second trimester Yin and Blood became the main substances to be nourished. In the third trimester, the mother’s Qi needs to be tonified and supported, while continuing to nourish the Blood. Where signs of Yang or Yin deficiency have been present in the previous trimesters, these substances need attention too. For this you can follow the same advice given for the first and second trimesters, respectively.

To nourish Qi and Blood we need to focus on the following:

Diet: Following the basic rules for a healthy diet accordingto TCM is recommended during this stage of pregnancy. As in previous trimesters, stay clear of stimulants and toxins as much as possible: alcohol, drugs, tobacco, black tea and coffee, refined sugar and chemical additives and preservatives. In addition there is some specific advice that can be followed at this time:
  • Unless you are feeling very hot and suffering from constant heartburn, herbs and spices with gentle warming properties such as ginger, basil, thyme, cumin, and garlic can be used in small amounts . Heavier spices need to be avoided as there pungent flavour strongle moves the Qi and Blood which can result in premature labour. They can also create internal heat that can make you and the baby restless and uncomfortable.

  • If you suffer from constant heartburn and feel very warm all the time, you will need to avoid all herbs and spices and consume cooler foods such as melons, cucumber, salad vegetables, steamed vegetables, plenty of water (at room temperature), and drink mint tea after every meal.

  • If you feel full easily due to lack of space in your belly, try to eat little and often, making sure you have nutritious snacks rather than sugar-filled foods or an excess of refined carbohydrates which will make you feel full quickly but provide little in terms on nutrition. Favour fruit, vegetables and small amounts of wholemeal grains and protein-rich foods (good quality meat/fish, nuts, seeds, sprouted beans, beans and pulses, etc.).

In addition, as Calcium and Iron requirements increase at this time, foods rich in these minerals need to be increased in your diet. 

  • Iron: Blackstrap molasses, unsulfured dry fruit such as dates, apricots, and figs, beetroot, dark leafy vegetables, and red meat. Making sure there is an adequate amount of protein in the diet is also regarded as essential to nourish the Blood in TCM, as is to avoid pushing yourself when you feel tired.

  • Calcium: Bony fish, small amounts of seaweed, soya beans and soya products such as soya milk and yogurt, tempeh and tofu (make sure they are non-GM products), kale, collard greens, almonds, sesame seeds, and blackstrap molasses. Dairy products such as cottage cheese and low-fat yogurt can also be included. However, and excess of dairy products needs to be avoided particularly if your digestion is sluggish as they trigger the production of mucus in the digestive system and, according to TCM, this can block the channels and delay labour.

Acupuncture can be effectively used for symptoms such as indigestion, sluggish digestion, constipation, and heartburn. Often, some individual adjustments to the diet can make an immediate difference to these symptoms.

Pregnancy yoga classes help flexibility and relaxation
Exercise:  You will need a certain amount of “fitness” for labour not to be too hard on your body. This is a very different type of fitness from the one you can get in the gym. First you will need to be well-rested so that you feel you have energy. This can only be achieved by resting enough and eating the right foods for you.  You then will be able to build up some strength and stamina which can be achieved by gentle walking and swimming (breast stroke is best!). This is not competitive exercise or calorie-burning stuff, so you do not need to push yourself hard.

Pregnancy yoga can also give you tools to achieve relaxation through breathing, and help you maintain flexibility in the right places.

If fatigue prevents you from exercising, it is possible that you will benefit more from resting than from making yourself exercise. Acupuncture can help increase energy levels and improve sleep. A TCM practitioner can help you adjust your diet so that you can obtain more energy from food and sleep.

Relaxation and sleep: Learning to relax becomes more important as the end of the pregnancy approaches. Regular meditation and gentle breathing will help you maintain fears and every-day stresses at bay so that they don’t build up making your mind spin out of control.

Sleep may be uncomfortable at this stage because of your body shape.  You will need to experiment using cushions and different layers of covers depending on what your specific problem is. If the problem is not being able to switch off, you can follow the same advice given for the second trimester in my last post.

If insomnia and disturbed sleep are not improved by self-help techniques, Acupuncture and Reiki can promote the relaxed state necessary to induce sleep. Often only a few sessions are required to improve sleep patterns.

Antenatal classes inform you and give you choices
Get “mentally” ready: Have you ever gone into something without knowing what to expect, and come out thinking that if you had known more about it you could have made the most of it? It could be safely said that labour has the potential of making you feel like this. We all have a deep fear of pain, but some of us are truly terrified of it. Burying your head in the sand will not however help you overcome the fear of labour. 

The first thing you need to do is find out what it’s all about. This is the function of antenatal classes, they will arm you and your partner with the knowledge of the processes involved in late pregnancy, labour and the early days of your baby.  Not only will you learn what to expect but you will be informed of a range of options available to you when the moment comes. In my opinion, the earlier into your third trimester you go to the classes, the better. The reason for this is that you will have enough time to process the information and prepare yourself by exploring ways in which you can work on your fears.  

Relaxation and breathing techniques come to life here as they are often good enough tools to prepare you and help you throughout labour, you can learn specific techniques and yoga postures to help you prepare physically in “active birth” classes. When this is not enough to curb your fear, hypno-birthing classes or individual hypnotherapy sessions may be able to help you override it.

In addition, planning ahead so that you can have enough rest and proper nutrition during at least one month after giving birth should be part of your priorities right now. Click here for some useful reading on the subject. 

Last weeks’ issues

Weekly Acupuncture sessions can be especially helpful from the 34th or 36th week. Acupuncture during the last month of pregnancy can help promote relaxation, increase energy levels and stamina, and is considered to enhance the softening of the cervix in preparation for labour and childbirth. These effects build up over the few weeks prior to labour giving the expecting mother increased strength and, in my experience, an easier labour.

Moxa can help turn breech babys
Breech baby:  Acupuncture and Moxibustion in specific points, are considered  safe and effective treatments for breech presentation (1). Greater effectiveness of these treatments is seen between the 34th and 36th weeks. One or two weekly treatments are given for one or two weeks, and moxa will be supplied for the mother to burn on specific points at home between treatments.

Overdue labour:  If you have gone over your due date, do not panic! The normal pregnancy term is different from one woman to the next and it is perfectly normal to give birth after your due date even until the 42nd week. Unless your midwife or medical practitioner has identified possible complications, you do not need to feel pressurised to go into labour before your time.

Fear, anxiety, low energy, and a not-so-perfect diet can all contribute to delay labour so all the work that you have done to maintain yourself healthy and strong before this point should render its benefits here. Acupuncture can be used to induce labour (2) by using the Acupuncture points that are contraindicated during the rest of the pregnancy. Personalised advice as to diet, relaxation and specific points that the expecting mother can massage at home should supplement the treatment to enhance its effects.

Overall, the last trimester of pregnancy can be a challenge not just physical but also emotional particularly for first-time mothers. Making sure that you maintain your physical and mental health at this time is not only important to prepare you for labour but it will give the basis for your health in the post-partum period. As I mentioned on my first post about pregnancy, I have seen the health of women being completely transformed by pregnancy. This is an opportunity to become aware of your body and to introduce health-inducing habits into your and your baby’s life. Recruiting your partner can make the experience all the more fulfilling as you can both learn and grow together and create an environment of health and awareness that will benefit both of you and your child for years to come.


1. Study shows acupuncture and moxa to be safe and effective treatmentsfor breech presentation http://www.ncbi.nlm.nih.gov/pubmed/15280133

2. Inducing labour is listed as a condition effectively treated by Acupuncture by the World Health Organisation: http://www.acupuncturetoday.com/mpacms/at/article.php?id=29001

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