WHAT TO EAT IN THE THIRD TRIMESTER {S2E5}

{1:04} Hello, and welcome to episode 5 in the second series. Today I'm talking about what to eat in the third trimester. The reason I want to talk about this is so often pregnant moms know exactly what not to eat during pregnancy. But I think it's more fun to know what you can eat. Or even better, what's the very best thing you can do for yourself and your growing baby when it comes to nutrition. This is part of my series covering the very best nutrition for the first 1000 days of motherhood - so that's from conception to two years postpartum. And the reason why I always talk about this period is because that's when the greatest development and growth in your child happens. But it's also the most critical time for you as a mother to really look after yourself and be the healthiest you can be for yourself and your baby. So last month, I covered the second trimester. So if you haven't listened to it, do go back and listen to it the first episode in this series.

This month, I'm covering the third trimester. And what I'm going to share is I'm going to talk a little bit about the growth and development your baby is going through, I'm going to talk about the key nutrients to help support that growth and development. And I'm also going to cover the common symptoms you might be experiencing during this third trimester, and how to manage them naturally as best as possible. I'm going to also talk about the top five foods, I think are key to eat to keep you nourished. And I'm also going to do a really little sneak peek into what you might need to think about after giving birth. Because although I'm going to do some episodes covering nutrition during labor and nutrition after giving birth, if you're in your third trimester, you actually need to start thinking about that now. So I'll give you a little sneak peek into that.

So during the third trimester, I think the two areas that are really, really important to think about the growth and development of your baby. And it is particularly key to think about his brain development. But the other area that I think is really key that's often overlooked is about building your strength as a mother and your nutrient reserves ready for labour and breastfeeding. Because it is going to take a little bit of time and a little bit of thought to prepare for labour and breastfeeding.

{3:27} Now the other thing that I think is really fascinating that I'm not actually going to cover in this episode is around your microbiome and the bacteria in your body. It's a huge topic, and I'm going to do a whole episode on it at some point in the near future. But I will mention here that the microbiome changes as you go through pregnancy. In the first and second trimester, your gut microbiome looks pretty much like any healthy woman. But in the third trimester, your gut starts getting less diverse. And this is fascinating, because I think that's counterintuitive. But what happens is that the focus that's being on microbes that produce energy, and of course pregnancy and childbirth are energy-hungry processes, so as much energy as you can get from your food, whether it's directly through digestion, or with help from your bacteria the better. But I think it's important to know this because this reduced diversity could be problematic if you go into pregnancy with gut issues or a less diverse microbiome than would be ideal. And let's face it, that's probably most people because of the diet and lifestyle many of us lead. So as I said, I'm not going to go into that into much detail at all because there just isn't time - it's a huge topic - but I will do a whole episode on that in the future.

{4:50} So in terms of the baby's development, your baby is going to grow from the size of an aubergine roughly to a large melon before he is born at term. That's three months of enormous growth, it's quite incredible. The really important systems that are growing are the nervous system and the brain continuing to develop. Just as in the first trimester, the baby's brain is growing very, very fast in this trimester, in the final one. And it's really important to replenish the nutrients that the baby's taking from you to facilitate that growth. So the nutrients that are particularly important here are omega-3 and B-vitamins. Because the baby is pulling these from your reserves, and if they're not replenished, you might start feeling symptoms like feeling particularly tired or fatigued, or even maybe difficulty remembering things. So if you have those kind of symptoms, it could be a sign that you're just not replenishing what your baby's taking from you.

Now, the other really exciting thing, linked to the nervous system development is that your baby is starting to be able to perceive using all five senses. So in the previous trimester, he started being able to see dark and light and to be able to hear, but now, in the third trimester, he starts being able to become sensitive to hot and cold and pressure. That's pretty exciting to just know that your baby's starting to sense what's going on in the world outside. He's also building muscle and storing fat. And this is really key to make sure that he is able to stay warm when he's born. And that also means that he's sort of starting to smooth out those wrinkles, and starting to look like a little baby that you expect to see when he's born.

His immune system is maturing, getting him ready for the outside world, which is obviously full of germs that he's never come across. And the really key thing to know about when it comes to the immunity is that he is receiving maternal antibodies from you. So you are starting to help protect him against viruses and bacteria outside of the womb. And this protection lasts for a few weeks. But breastfeeding can help extend that immunity, so especially the colostrum, that first milk that he'll receive in the first few days of life. So if you are planning to breastfeed, getting that colostrum in particularly is super, super important.

Now, you might start feeling increased movements, you might feel very definite periods of activity in periods of rest, you might be identify, perhaps, patterns of sleep and wakefulness. And this is usually around the time when the midwife will start suggesting that you keep track of baby's movements, and if there's any changes to talk to them about it, because every baby sort of moves completely differently. Because you'll be feeling him moving all the time, you'll know what feels normal and not.

Now the final thing that I think is really cool to know about at this point is that the coating of vernix, which is that sort of waxy substance that is keeping baby warm, in there is becoming thicker. And many babies are actually born with the vernix still on their skin. And this is an incredible thing. It's got antimicrobial properties, which again, is a sort of protection against infection in the outside world in his first few hours, it's a natural moisturiser, which is why they're born with it. And it helps to regulate their temperature. So it's actually a really great thing to be born with. If you can delay that first bath after they're born for at least the first 24 hours, that means they're going to get all of those sort of properties and awesome things related to having the vernix.

{8:29} But in terms of key nutrients to to think about in the third trimester. So remember, the focus is on what the baby needs for his growth and development, but also on building your reserves ready for delivery and breastfeeding. So when it comes to the brain and nervous system, you're looking at B-vitamins and manganese, magnesium, omega-3, potassium and vitamin A as being really, really key for these systems. To support blood volume and blood production, you're looking at copper and iron. And also vitamin C which helps with iron absorption, especially if you are vegetarian and the source of iron that you're getting is plant-based which is not as easily absorbed by the body. To help with blood glucose regulation, you're looking at magnesium and manganese as being really key for this. Bone and teeth, healthy bone and test development - calcium, vitamin D and vitamin K are really key but also vitamin A, vitamin C, manganese and phosphorus are super important for bone and teeth development. When it comes to cell, tissue and muscle structure and growth, you're looking at protein as the number one most important thing to think about here. But also vitamin A, vitamin E, selenium and zinc. The immune system - so making sure that your immune system and the baby's immune system is building and developing well, you're looking at vitamin C, Vitamin E and zinc.

{9:54} When it comes to building your reserves and your nutrient stores, you're looking at making sure that you're getting enough protein and fat in because these are really important for your energy levels, and also micronutrients that support immunity, healing and repair. So I've already mentioned them vitamin C, zinc, vitamin E, also magnesium and selenium.

Now during the third trimester, you might find that you have an increased appetite, and you do you actually have an extra 400 to 500 calories, extra calories needed. So that kind of looks like an extra couple of snacks basically across the day. But listen to your body and eat when you're hungry. I usually start suggesting that clients include two snacks a day in between meals, or if they are suffering heartburn or acid reflux, I think about maybe having five smaller meals spaced out across the day.

{10:46} Common symptoms in third trimester tend to revolve around the fact that your belly is getting quite large. And these uncomfortable symptoms are linked to the fact that your organs are getting squashed. So, for example, quite often, you start feeling a bit breathless or short of breath. And you also have an increased pulse as well towards the end of the pregnancy. And this is because your lungs are being squashed by your growing babies, you just just have much smaller capacity to take deep breaths. Once the baby drops down into the pelvis later in pregnancy, you start getting more space again, and you can start taking those breaths. But this usually doesn't happen until sort of towards the end of the third trimester. It's relatively common. But if you are worried if you're finding it very difficult, or if you're concerned about being a bit breathless, then do talk to your GP or midwife about it because it could be a sign that something else is going on.

Now the other really, really common is an increased need to urinate to go to the toilet to pee. And again, this is because your baby is sitting right on top of the bladder. So there's just a lot less space to store urine, essentially. Don't cut down on drinking fluids, because it is so important to stay hydrated. Dehydration can be can cause low amniotic fluid, and this increases your risk of having an induction. So definitely important to stay hydrated to keep going on the sort of one and a half to two liter fluid intake depending on your activity level, and what you eat as well. But you know, perhaps consider drinking more earlier in the day and tapering down towards the evening, so that reduces your need to go at night. But do make sure that you are drinking enough during the day. One thing to be aware of that if you do have an increase urge to go but not much just coming out to just make sure you get checked for a UTI, because that is one of the common symptoms of potentially having a UTI.

Another really, really common one, and this is something I really suffered with is heartburn and reflux. This is again because your stomach and your oesophagus is just a little bit more squashed because of you're growing belly. So the obvious things to think about is to have small meals more frequently, like I mentioned already, so five small meals across the day rather than three larger ones. And this is especially true towards the evening, so to try and just not eat big meals at night. Try to identify the triggers; the common ones are fatty food or spicy food or certain fruits, especially citrus fruit. But sometimes it's just not possible to identify what is triggering it - I never really identified what my triggers were to be honest. So when you are eating food, try not to drink too much liquid with it. And certainly don't try and down a big glass of water in one go. Because that can sort of dilute the stomach acid a little bit and that can cause problems and obviously fill you up with liquid rather than the food. But again, don't use that as a reason not to drink fluids just avoid it around meal times. After you have eaten obviously sit upright - let gravity help with the digestive digestion and at nighttime if you can just sort of prop yourself up a little bit more than you might normally, that could help as well with making sure that that reflux hasn't come back up. In terms of food - green leafy vegetables, which is rich in magnesium can help with healthy muscle contractions, which is obviously a key for getting the food moving in the right way. Now one thing to mention is that quite commonly heartburn and acid reflux is assumed to be linked with high stomach acid. And so most medications that you might get from the doctor or over the counter address this by reducing stomach acid. But quite often what we find is that the reverse is the truth. So it's actually often can be due to too little stomach acids and in the long term antacids that try to neutralise stomach acid can make the problem worse due to long-term inhibiting stomach acid release. Now stomach acid is really important obviously for the proper digestion of food but also for the absorption of a lot of nutrients, particularly minerals like calcium and zinc, and in the long term if you taking antacids for long periods of time, it can also affect the absorption of B12, which is really vital for brain and nerve health. Now, healthy stomach acid is really important in pregnancy. So don't just assume that acid reflux and heartburn are due to high stomach acid. If you do need short-term relief, what you could do is add lemon juice or apple cider vinegar to food - counterintuitively, although they're acidic on the tongue, they actually become alkaline on ingestion. And this can moderate that excessive acidity if that is a problem. Another thing that I used to find very useful was to dissolve a small amount of bicarbonate of soda in water, so something like just a small quarter teaspoon or so and drink that in a small glass of water a couple of times a day, particularly just before going to bed - I used to find that quite helpful just to sort of neutralise that acid a little bit.

Now another really common symptom, again due to squashing of organs is constipation. Now, early in pregnancy, this is more due to muscles relaxing because of the increase in progesterone hormone. And this can affect muscle contraction and release in the gut, which means that food doesn't pass as effectively to be eliminated as it should. Later in the third trimester, the weight of the baby on the bowel makes that even worse. And then another thing that often happens is if you end up being prescribed iron tablets because of kind of iron-deficient anaemia, which is again relatively common in pregnancy, this can cause constipation, because of the particular form of iron that is used in the prescribed tablets. So if that is causing a problem, or if you can really see a link there, then you might consider changing to an iron supplement that is a little gentler on the stomach. And constipation is also often linked to anxiety and fear - your emotional health is so linked to your gut. If you think about the fact we use phrases like 'gut instinct' or 'butterflies in my stomach', so we know just by language that there is a link there. So if there is any concern or fear or anxiety, particularly around birth, that could be affecting how well your gut is working. So in terms of how to ease symptoms naturally, a tablespoon of flaxseed or chia seeds soaked in water for around about half an hour until they go quite gloopy, and then sort of drunk all in one go. That can really help, it can be quite useful to maybe drink it at night when you're feeling a little bit more relaxed. And then usually first thing in the morning, you'll need to go to the loo. If you are doing this, make sure you drink enough water because they can sometimes cause the opposite effect and worsen the constipation, so you have to be really well hydrated for this. Obviously eating plenty of vegetables, again, for the fiber to help sort of bulk up the storage and move in the right way. And then making sure you're drinking enough water to get the bowels moving properly. If you are suffering from constipation, definitely have a look at how much sugar you're eating and look at really reducing your sugar intake because if you have got waste matter sitting in the bowels for quite a long time, excessive sugar can lead to fermentation which can cause lots of problems later on as well. And then if there is a link there with emotional health and think about reducing stress, managing fear and anxiety. If you're worried about birth and concerned about how well that's going to go have a look at things like hypnobirthing which can really help with understanding how labour works and how childbirth happens and really great strategies to reduce stress and anxiety around childbirth.

One last thing, linked to the constipation is haemorrhoids. And another, also linked is varicose veins because it's a similar sort of mechanism that causes them. So as you know by now that in pregnancy, you have an increase in blood volume. So this means that the blood vessels expand and then the blood can often collect in veins and that can cause swelling and protrusion. So if it's in the rectum, that's when you get haemorrhoids or in the legs that that's when you get varicose veins. And these can be really painful or itchy and just not very nice really to have. So to prevent it from a sort of natural point of view, eat vitamin C-rich foods and things like fruit and vegetables - berries particularly which are rich in something called anthocyanidins which are very useful for helping with haemorrhoids and varicose veins. On a more practical level, don't stand or sit too long, so just getting up and going for little walks, especially if you are working from home, or sitting down at the computer for long periods of time. Generally just some gentle exercise or going for a really nice early morning walk can really help to get things moving. And then having a really lovely calming bath in Epsom salts can also help with with these symptoms.

And then finally, really common towards the end of pregnancy, mums can suffer difficulty sleeping or sometimes it's called pregnancy insomnia. And there could be so many reasons for this. So it could be anxiety, it could be because of the increased pressure on your bladder, so you're getting up to pee a lot more. It could be the heartburn is really, really uncomfortable. Other symptoms that I haven't really talked about things like leg cramps, and restless leg syndrome, carpal tunnel pain, these are all things that could keep you awake at night. So if you can try and address these things using the natural suggestions that I've suggested earlier, that could help minimise sleep disruption. But I do also wonder whether maybe there is some link between kind of making sleep becoming lighter towards the end of pregnancy as a preparation for birth and the sort of broken sleep that happens later on with night feeds. I do find it really amazing how little sleep mums can survive on, given how much we know the effects of poor sleep can have on our health when it comes to immunity and long term effects as well. It does seem like a bit of a mistake in evolution that mums end up with so little sleep just when at a time in their life when they need it. So it is incredible, we are really resilient, amazing people when it comes to sleep as mums. But I do want to point out that the quality of your sleep is really important. You might not be able to do much about how much sleep you get either, even now during the third trimester, if you're suffering from pregnancy insomnia, or later on when your baby's born. I did a whole episode about sleep a couple of episodes ago. So if you want to catch up on that, listen to episode 3 of this season 2, because I talk about how to improve your sleep quality even when you're getting very little sleep. And I think this is important because this is going to affect whether you are literally just surviving on the broken sleep or whether you can find a way to thrive despite the broken sleep.

There are quite a few other symptoms that I didn't actually mentioned. So things like restless leg syndrome, carpal tunnel, more serious ones like gestational diabetes, preeclampsia, there's a lot going on. So perhaps maybe in the future, I'll do an episode on these other symptoms.

{22:53} But before I get on to the five key foods to eat, I just want to kind of hammer this point home that I think the third trimester should be considered your turning point when it comes to the motherhood journey. Because how well you eat now and how are you prepare for labour and the fourth trimester and the postnatal phase is going to determine how you're going to experience the following few years of early motherhood. So nutrition during the third trimester is not just about what your baby needs to grow, it's about what you need to recover, after giving birth and how to build resilience for the stress of giving birth and looking after baby and learning how to breastfeed and dealing with those wakeful nights. I think this is an area massively overlooked in maternal health - not enough thought is given to how to build stores for birth and healing. And I think not making this a key area around maternal health is potentially a major contributor for postnatal issues such as depression, difficulty bonding, problems breastfeeding, slow recovery, low energy, fatigue, long term issues around maternal health, all those things that just kind of know are just a given for mums.

But what if they're not? What if focusing on nutrition, really putting basic principles in place right now in the third trimester especially is going to be the difference between just surviving as a mum or truly thriving as a mum? So I really do think it's worth putting in the effort now to focus on quality, nutritious food.

{24:32} On to the five key foods to eat in the third trimester. Again, a reminder, the focus is on building your strength and building your stores to feed the baby in the final trimester, but also storing nutrients for labor and breastfeeding. So in particular, the ones that I think are really important a fats for that energy for labour and breastfeeding and protein to build muscle to make sure that you have what you need to build back up after giving birth. And also the micronutrients to support immunity, healing and repair.

So my number one food for the third trimester is chia seeds. Now these are really great source of protein. They also are a source of omega-3, which is a plant-based form of omega-3. Because it's plant-based, it means that your body has to go through several other steps to convert it into something that is useful for the brain, but it's still a great source. And it's also really good for source of fibre, which as I mentioned earlier, is really helpful if you do have constipation.

My second key food in the third trimester is pulses and beans - plant-based forms of protein. Again, these are really great sources of fibre, and they really help to feed the gut bacteria, which I haven't really talked a lot about and I will do a whole episode on it in the future. But the gut bacteria love the fibre that you that you can't digest from things like pulses.

My third key food is grass-fed lamb. So lamb in the UK is almost exclusively fed on grass year round, and it is a better choice than red meat like beef if you can't afford to source grass-fed beef because it is pretty expensive to buy fully grass-fed beef. But grass-fed meat in itself is an awesome source of omega-3 fat because and it's higher in grass-fed meat because they eat solely grass, they're not fed on any grains. Meat genuinely is a really awesome source of iron and protein, which are both really important for recovery after giving birth, particularly the iron because of blood loss from labour, which I'll cover in a lot more detail when I do the episode on nutrition during labor.

My fourth key food is avocados, because it's a great source of fat. And it's also a good source of vitamin E, which is awesome for your skin, particularly if you might be getting stretch marks to nourish from the inside out. But vitamin E is also really important for your immune health. You can add avocados to smoothies, you can have it for breakfast, I made a really awesome avocado chocolate honey pudding the other day, which is such a nice little treat and it's pretty healthy.

And then my final key food is ginger. And this is something that I think is great generally for everyone, but particularly during pregnancy and postnatally as well. It's really warming, it helps with nausea or vomiting, which some people sometimes experience later in pregnancy because of that squashed stomach. It's a great anti-inflammatory, especially if you have joint pain. And it's a good antioxidant as well. You actually don't need much to get benefit from it. So a couple of slices in warm water, either drank maybe first in the morning or in the afternoon cooked with chicken or in a soup or sometimes I grate it into rice when I'm cooking it. Now one top tip that I think is really useful to pass on to you is that you can peel the skin from ginger with a teaspoon. And if you do it with a teaspoon rather than a knife, you kind of just take a really thin scraping off rather than big chunks. And as with many fruit and vegetable, the greatest concentration of nutrients is actually just under the skin. So you want to take off as little as possible.

Now I have talked a little bit about hydration, but I just want to remind you again hydration is really, really key. Low hydration can potentially lead to low amniotic fluid which increases your chance of being induced.

{28:43} So in a nutshell, the focus during the third trimester is on your baby's growth, particularly the brain, but also on building your strength and nutrient reserves in preparation for labor and breastfeeding.

The key developments that your baby goes through is around the nervous system, the brain development, muscle and fat and the immune system maturing, getting ready for the world outside.

The symptoms that are commonly experienced in the third trimester are generally around the organs becoming more squashed and increased pressure on veins. So that's where your bladder is being squashed, your lungs, your stomach, your bowels and your veins start swelling up because of extra blood.

As a recap, you do have an increased calorie need in the third trimester. So if you do have increased appetite, go ahead have an extra couple of healthy snacks in there every day. Just make sure that you're focusing on fat and protein in every single meal to build your stores for labour and breastfeeding. And it's really key at this point to support your immune system in preparation for healing and repair for labour and after giving birth.

And staying hydrated is really important to ensure the balance of electrolytes and to support the amniotic fluid.

{30:04} I'm going to cover eating during labour and the postnatal phase in future episodes. But I did want to take this opportunity to mention it now. Because if you're listening and you're sort of late into your third trimester, and you're about to pop, it's important to know this now, because you need to think about it during a third trimester rather than wait until you've given birth. So this is a really key time to start thinking about batch cooking for the postnatal period. It's not just about having some food available to eat in the freezer, although any food is great, but having really nutritious food in your freezer, designed to nourish and nurture you, designed to build strength for healing and repair is even better - it's the best thing you can do for yourself. So think about things like bone broths, and stews, soups - stuff that's really easy to digest and is warming, and also easy to heat up. Think about 'what can I eat one-handed', and lots and lots and lots more snacks than you think you need, because breastfeeding, multiple nighttime wakeups is going to really take out a lot of energy from you.

And this is also a time to ask, have you written a postnatal plan? Many mums write a birth plan, but what about the postnatal period? So who have you got there to support you? Who do you want around you? Who do you really not want around you? How do you want to be supported, who is going to be there to cook your food or to reheat your food or to drop food off?

To help you get started with thinking about these sorts of things, particularly on writing a postnatal plan and batch cooking. I've written a guide for each, which you can download from my website, and I'll put the links in the shownotes for you to download. I really think this is something that is important to think about now during the third trimester. Because if you wait until you've already given birth, it's just so much harder to catch up on it.

I hope that was useful. I'd love to know which part was new information to you. That was a bit of a lightbulb moment to you that you think is going to be particularly helpful. Do let me know. I love hearing from you. And I'll see you in the next episode. Bye.