Exercise in pregnancy

Those of you who know me are probably laughing as you read this, as I’m not a great lover of exercise.  I also know that in pregnancy it can be really hard to get motivated enough to do exercise: the nausea, the fatigue, the aches and pains… I’ve been there.  I know how easy it is just to curl up on the sofa rather than get active.

pregnant woman with feet up

However… there are lots of benefits to exercising in pregnancy.  Regular exercise in pregnancy can help maintain a healthy weight gain in pregnancy, reduce your risk of developing gestational diabetes (or help control blood sugars if you do develop gestational diabetes), reduce your risk of pregnancy related high blood pressure and even increases your chances of having a normal birth rather than a caesarean section.  Babies are more likely to be an “average” weight and may tolerate labour better than if you don’t exercise.  Additionally, exercise will help relax you and can even help with feelings of depression and anxiety in pregnancy.1,2,3

Exercise (even moderate exercise) can be completely safe in pregnancy.  If you are used to a certain level of activity (for example, going to the gym regularly) it is almost certainly ok to maintain this level, provided YOU feel ok with it, listen to your body and reduce the intensity as you feel you need to (which will probably happen as your pregnancy progresses).  There ARE a few caveats with exercise in pregnancy.  Gentle exercise can be initiated in pregnancy if you are usually sedentary, but if your idea of exercise is reaching for biscuits while watching tv, a brand new, strenuous exercise regime is NOT a good idea. What you’re aiming for is a level of exercise which gets your heartbeat going a bit faster and you can still hold a conversation. Avoid contact sports where you could experience trauma to your bump or sports where you may be likely to fall; so activities like hockey, horse back riding, even cycling, should probably be avoided.  Additionally, pregnancy tends to soften the ligaments, which may make you more prone to soft tissue injuries, so weight training may need to be modified.  Avoid becoming overheated during exercise and avoid exercises where you lie flat on your back once you’re into your second trimester (it can make you very lightheaded).2,3

pregnant woman walking

Walking is a great form of exercise in pregnancy.  It’s free and not only is it good for cardiovascular fitness, it can help tone your core muscles (see below).  Swimming or specific aquanatal classes can also be beneficial, provided the pool temperature isn’t above 32 C; in particular, pelvic pain can be eased by the buoyancy of water.

As well as cardiovascular exercise (which increases your heartrate) it is probably worth considering other forms of exercise which stretch and tone the muscles of your your abdomen and pelvis.  I had a “eureka” moment when I did a Spinning Babies workshop a few months ago and I realised the importance of exercising the muscles attached to the pelvis and how this can impact on the position of the baby within the uterus and pelvis.  Pregnancy yoga is great for this, I did a course during my pregnancy and bought a DVD to do at home.  Both the course and the DVD were very similar, and definitely helped ease some of the aches and pains.  I always slept a lot better if I had done yoga during the day, and the breathing and visualisation exercises were helpful for coping with pain in labour.  Pilates based pregnancy classes are also available and it’s worth noting that physiotherapists often will give you pilates based exercises if you have pelvic pain during pregnancy.  Spinning Babies have a daily exercise programme on their website, some basic exercises can also be found here, and if you like to read, the book Active Birth by Janet Balaskas has a comprehensive selection of specific exercises you can do in pregnancy, with accompanying photos.

pregnancy yoga

Strengthening your abdominal muscles will help support your uterus and help take some of the strain off the ligaments which support the uterus within your abdomen.  Lax stomach muscles mean that these ligaments have to do all the work, which can contribute to back pain and pelvic pain.  These ligaments are attached to either your back or pelvis at one end and your uterus at the other end – imagine them being stretched like a tight rubber band, trying to support a growing uterus without the support of strong abdominal muscles.  No wonder you get back and pelvic pain, right?  You can do exercises which are specifically designed to give these ligaments a bit of a break and a chance to relax and balance out, as occasionally one side can hold more tension than the other, causing the uterus to get “twisted”, these exercises are called the “Three Sisters of Balance” and they can be found on the Spinning Babies website.  There are some doulas in Northern Ireland who can help you do these during your pregnancy as part of the care they offer.  I don’t do hands on teaching of these techniques in my classes, although I will talk about them in more detail. I can also do them with you as part of a private antenatal session (I’m insured to provide antenatal education and care as a doula). 

Along with strengthening your core muscles, good posture in pregnancy is essential for helping baby position properly in the pelvis and for relieving aches and pains.  Try to avoid lounging – sit upright so you are sitting on your “sit” bones, rather than on your tail bone and your knees should be lower than your hips.  Not quite sure where your sit bones are?  Sit upright and slide your hands under your bum, you should be able to feel the bony parts of the pelvis called the ischial tuberosities, which are your “sit” bones, they should be taking your weight, NOT your tailbone. If you want to watch tv, instead of sitting with your feet up all the time consider sitting on a narrow chair, but facing the back of the chair, so you’re leaning forward slightly.  Alternatively, you can purchase an exercise ball and use this to sit on while watching tv. A 75 cm or 85 cm ball is probably the size you’ll need to ensure you’re sitting with your knees below your hips. Add in some gentle circle motions with your hips while you’re sitting on the ball and you’ll help mobilise the joints and ligaments in your pelvis; all good preparation for labour.

What about pelvic floor exercises?  Some antenatal exercise classes will include pelvic floor exercises as part of the routine. Pelvic floor exercises are very important, as the pelvic floor acts as a “hammock” in pregnancy and supports the growing uterus and other internal organs.  Your midwife will remind you to do your pelvic floor exercises following birth as a way to reduce incontinence issues.  HOWEVER I think we need to add in something else.  Let me explain… Pelvic floor exercises act to tighten these muscles, in essence narrowing the space between the pubic bone and tailbone.  It’s essential that the tailbone can move back in labour as this widens the space available for the baby to come out.  One way to increase the movement in your tailbone is to learn to squat.  We aren’t particularly good at this position (in the West, at least) because it’s not something we do daily, but practising can help stretch all the muscles and ligaments around your back and pelvis and increase the movement in the bones of the pelvis.  Squatting is also a great position in labour (especially as the baby is being born) so practicing in pregnancy can make it easier to squat in labour.  Take it easy when starting to squat and bear in mind that as your pregnancy progresses your knees will automatically fall out to the sides because of the bump in the way.  Also best to avoid squatting if you have haemorrhoids (piles), vulval varicosities, vaginal bleeding or a cervical stitch in place.  However, once you’ve practiced squatting a few times the stretch feels great, especially if you HAVE been slouching on the sofa a little bit too much.4,5

Finally, don’t feel guilty if you really don’t feel like exercising when pregnant.  I know that sometimes you can feel totally miserable and all you can do is lie on the sofa.  However, you might find that a gentle walk or a soothing yoga sessions makes you feel so much better. 

Oh, and massive disclaimer:  while most of the exercises I’ve mentioned should be fine, always double check with your doctor or midwife that any exercises you do are ok for your personal circumstances in pregnancy.

References:

1.       https://www.rcm.org.uk/learning-and-career/learning-and-research/ebm-articles/the-physical-effect-of-exercise-in-pregnancy downloaded 11/07/16

2.       https://www.rcog.org.uk/globalassets/documents/guidelines/statements/statement-no-4.pdf downloaded 11/07/16

3.       http://www.nhs.uk/Conditions/pregnancy-and-baby/pages/pregnancy-exercise.aspx downloaded 11/07/16

4.       Balaskas, J, ( 1989) Active Birth, Thorsons, London

5.       Calais-Germain, B, Vives Pares, N, (2009) Preparing for a Gentle Birth:  The Pelvis in Pregnancy, Healing Arts Press, Rochester

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Rebecca

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