You’re pregnant, congratulations! The next few months are going to be filled with excitement while you await the safe arrival of your little one. During the antenatal period many women wish to continue to pursue an active lifestyle while others may take this as an opportunity to improve their health and fitness in preparation for motherhood. A question that is often asked to health professionals ‘is exercise safe and what should I avoid?’
For many years pregnant women were treated as if they had an illness and advised to relax, avoid any kind of strenuous exertion and to minimise bending and stretching for fear of ‘squashing the baby’ but like all aspects of medicine, new evidence comes to light and exercise in pregnancy is now strongly encouraged.
The NHS, NICE, Pelvic Obstetric & Gynaecological Physiotherapy (POGP), the Royal College of Obstetricians and Gynaecologists (RCOG) and the U.K. Chief Medical Officer amongst others all recommend moderate intensity exercise during pregnancy, to alleviate or reduce the risk of women developing gestational diabetes, pregnancy-induced hypertension (high blood pressure), while exercise can assist in lower gestational weight gain and improved cardiorespiratory fitness. It’s also a key factor in maintaining muscular strength (as many women experience lower back and pelvic pain due to the lengthening of the abdominal and pelvic floor muscles during pregnancy), eases constipation as well as maintaining mental wellbeing during the antenatal period.
Research from the University of Southampton highlights that moderate intensity exercise is associated with lower rates of antenatal depression (a condition which affects around one in 10 women at some point during pregnancy).
But how much physical exercise should pregnant women be aiming for and what type of exercise is best? Physical Activity in Pregnancy (2017) recommends aiming for at least 150 minutes of moderate intensity every week.
If you regularly exercised before falling pregnant, you should be fine to carry on with most activities but you might want to lower the intensity as you progress through the trimesters.
If you haven’t been active for a while or are starting from scratch, start gently and build up gradually. But always remember to listen to your body and stop exercising should you feel any pain or discomfort.
Mix aerobic, strengthening & pelvic floor exercises:
• Aerobic exercise such as brisk walking, cycling, low impact exercise classes (look for classes hosted by those who hold ante natal qualifications) or swimming/aqua classes raises the heart rate and makes you slightly breathless. These types of exercise will increase cardiovascular fitness and increase stamina for labor and delivery.
• Strength training involves strengthening the muscles, often utilising weights, resistance bands or your own body weight. Strengthening exercises will strengthen the body in preparation for delivery whilst also preparing a new mumma for all the carrying and lifting once baby is born. If strength training isn’t something that you have attempted before, it’s important that you seek advice from a physiotherapist or a FitPro on how to lift weights safely. As you progress through your pregnancy the hormone Relaxin helps to soften the ligaments in the pelvis. Knowing the correct techniques to use before attempting to lift and avoid injury is vital.
• The Pelvic Floor is under a great deal of stress during pregnancy and stretches to nearly 4 times its normal length during delivery. It’s important to work these muscles to maintain strength, function and support during pregnancy and beyond, but like any muscle in the body it’s also vital that we know how to relax them too. Many women find Pilates and Yoga beneficial during the antenatal period, where strength and flexibility as well as pelvic floor engagement and relaxation is taught and encouraged.
Trimester by trimester
Pregnancy affects each women differently and no two pregnancies are alike so when it comes to physical activity it needs to be individual to each woman.
There are no hard and fast rules but adaptations may need to be considered as you progress through the trimesters. Any worries, concerns or you are unsure what you can do check with your your midwife, physiotherapist or GP for advice.
Physical activity can be challenging in early pregnancy as this is the period when you’re most likely to experience morning sickness and fatigue. This exhaustion can reduce motivation to perform any exercise, as commuting to work or caring for a toddler can zap all your energy early on. Blood pressure may be lower than usual during this time, leading to an increased risk of fainting. Regular short walks or attending Pilates can feel achievable early on.
During the first trimester for those who are feeling more energetic, continuing with your sporting activities is safe unless told otherwise.
As the second trimester approaches most women begin to feel themselves again, as fatigue and morning sickness tend to ease. Although some types of exercise aren’t sensible to do (i.e contact sports, skiing, horse riding), in general, you can continue with what you enjoy as long as you feel safe and pain-free.
It’s recommended that women avoid lying on their backs in the 2nd and 3rd trimester. As your baby grows and increases in weight, lying on your back could add pressure on the blood vessels reducing the flow of blood returning to the heart. So if you’re keen to continue or commence yoga or Pilates consider purchasing a wedge which can easily be ordered online.
By the third trimester, carrying considerably more weight can make many mothers-to-be, feel tired and struggle with exercise they found easier early on. Aerobic exercise isn’t harmful but can be a struggle for some.
Stretching, relaxation and flexibility classes can improve sleep, reduce anxiety, increase strength & endurance, ease back pain and improve shortness of breath. Working on pelvic floor relaxation and considering perineal massage (from 35 weeks) can all be considered.
When should I stop exercising or avoid it?
There are certain warning signs that you shouldn’t ignore.
If you develop any of the following while exercising, stop and get in touch with your midwife or GP as soon as possible:
• feeling dizzy or faint
• a headache
• difficulty breathing/chest pain
• pain and swelling in your calf
• bleeding, or fluid coming from your vagina
• painful contractions
• your baby not moving as much as usual
If you have been told you have a shortened cervix, placenta previa (after gestation week 26), persistent bleeding or restrictive lung disease, exercise is contraindicated.
Things to remember:
Dehydration – When pregnant, your body temperature may increase more than usual when you exercise. Try to avoid exercising in hot or humid environments. Be sure to keep hydrated so that you don’t feel thirsty. Don’t do more than you feel comfortable doing – listen to your body!!
Injuries – During pregnancy, your body produces Relaxin, a hormone that causes your ligaments and tendons to soften and become more elastic in preparation for childbirth, this can lead to an increase risk of injury because of the extra flexibility at the joints. Some women may also find it more difficult to balance, especially as you progress through your pregnancy as your centre of gravity shifts due to the weight carried at the front.
You can reduce your risk of injury by warming up and cooling down correctly, and avoiding making sudden changes of direction when exercising.
How soon can I exercise after giving birth?
Many new mothers wait for their 6 week check with their GP before considering returning to exercise.
If you had a caesarean delivery you may need to wait a tad longer before returning to exercise. An assessment by a Women’s Health Physiotherapist can be really beneficial to assess posture, breathing control, stomach muscle separation, pelvic floor strength and function and to discuss what exercises could be beneficial to start postpartum.
Listen to your body and don’t do more than you feel able to. Enjoy the first few weeks with your new addition. You’ve done the most amazing job… now is the time to rest, recover and recuperate!
• Aishling Burke is a Men & Women’s Health Physiotherapist (Restore Physiotherapy), with clinics in Tonbridge and Brentwood, Essex. She treats individuals who experience pelvic floor dysfunction ( bladder, bowel, pelvic pain pelvic organ prolapse, menopause issues), carries out Mummy Top to Toe Reviews and treats breastfeeding issues from mastitis to engorgement.
Aishling is also a ScarWork Therapist and works with those who have undergone breast, gynae or prostate surgery and adjunct therapy. Ever studying, she is passionate about empowering her patients and improving their quality of life. You can contact her on social media via www.instagram.com/restore_physo and www.facebook.com/PTRestore or via her website at www.restore-physio.co.uk.