This post is adapted from the 3/17/11 DTP Blog on Pregnancy Exercise Safety. For more evidence-based information on Pre/postnatal Health & Fitness, check out the DTP Blog. The Blog includes information starting prior to conception and continuing through postpartum and mom-baby fitness.
There are three sections to this post: 1) moms-to-be, 2) pregnancy fitness teachers and personal trainers and 3) some specific contraindicated and adapted exercises. All information presented is based on peer-review research and evidence collected over a 30 year period of working with this population. More information on safety can be found on this site on the page Benefits, Safety & Guidelines.
1) Safety & Exercise Guidelines for Moms-To-Be
First and foremost, be safe. Trust your body. Make sure your teacher or trainer is certified by an established organization that specializes in pre/postnatal exercise, has worked under master teachers during her preparation, and can answer or get answers to your questions.
These are the safety principles that we suggest to our participants:
- get proper screening from your health care provider
- protect yourself
- do not overreach your abilities
- you are responsible for your body (and its contents)
Squatting is an example of a standard pregnancy exercise used for childbirth preparation that must be adapted by each individual based on body proportions, flexibility, strength and comfort.
Don’t assume that because your teacher and some participants can do a certain movement or position that you should be able to do it just like they do. If your teacher is well trained, she will be able to help you select variations that are appropriate for your body.
When you are exercising, make sure you are getting the most from your activity. Keep these findings in mind when choosing your workout routine:
- Aerobics and strength training provide the greatest health benefits, reduce the risk for some interventions in labor, help shorten labor, and reduce recovery time
- Centering helps to prevent injury; relaxation and deep breathing reduce stress; and mild stretching can relieve some discomforts
- Avoid fatigue and over-training; do regular exercise 3 — 5 times a week
- Eat small meals many times a day (200–300 calories every 2–3 hours
- Drink at least 8 cups of water every day
- Avoid hot, humid places
- Wear good shoes during aerobic activities
- BE CAREFUL! LISTEN TO YOUR BODY!
If you experience any of the following symptoms, stop exercising and call your health care provider:
- Sudden pelvic or vaginal pain
- Excessive fatigue
- Dizziness or shortness of breath
- Leaking fluid or bleeding from the vagina
- Regular contractions, 4 or more per hour
- Increased heartbeat while resting
- Sudden abnormal decrease in fetal movement (note: it is completely normal for baby’s movements to decrease slightly during exercise)
2) Safety & Exercise Guidelines for Teachers & Trainers
A principle of practice that increases in importance for fitness professionals working with pregnant women is having the knowledge and skills to articulate the rationale and safety guidelines for every movement she asks clients to perform.
This goal requires adherence to safety as the number one priority. Here is how we delineate safety and the procedures we require of our instructors for achieving safety in practice:
First priority: safety [First, do no harm]
- sometimes medical conditions preclude exercise
- find an appropriate starting point for each individual
- individual tolerances affect modification
- general safety guidelines are physical
- pregnant women also need psychological safety
Mind-Body Safety Procedures
- Centering enhances movement efficiency and safety.
- Always begin with centering.
Strength Training Cautions
- avoid Valsalva maneuver
- avoid free weights after mid pregnancy (open chain; control issue)
- avoid supine after 1st trimester
- avoid semi-recumbent 3rd trimester
- keep in mind the common joint displacements, and nerve and blood vessel entrapment when designing specific exercises
Aerobics or Cardiovascular Conditioning Procedures
- Monitor for safety
- Instructional style needs to be appropriate.
- Walking steps with natural gestures can be done throughout pregnancy
- Vigorous steps with large gestures are more intense, appropriate as fitness increases
- The ability to create movement that will be safe and work for various levels of fitness and at different points in pregnancy is one of the most critical skills for pregnancy fitness instructors.
- Setting should provide physical and emotional safety
Equipment must be well-maintained
3) Contraindicated and adapted exercises
Exercises for which case studies and research have shown that there are serious medical issues include the “down dog” position, resting on the back after the 4th month, and abdominal crunches and oblique exercises. Here is more information and adaptation suggestions:
Contraindicated: “Down Dog” requires that the pelvic floor and vaginal area are quite stretched, bringing porous blood vessels at the surface of the vagina close to air. There are records of air entering the vaginal blood vessels in this position and moving to the heart as a fatal air embolism.
Adaptation: Use the child’s pose, with the seat down resting on the heels and the elbows on the ground, hands one on top of the other, and forehead resting on the hands. Keep the heart above the pelvis.
Contraindicated: Resting on the back during relaxation.
Adaptation: Rest in the side-lying position. About 75% prefer the left side, 25% prefer the right side.
Contraindicated: Abdominal crunches and oblique exercises can contribute to diastasis recti in some women. The transverse abdominal muscle is not always able to maintain vertical integrity at the linea alba, and thus there is tearing and/or plasticity of that central connective tissue.
Adaptation: Splinting with curl-downs, see positions below. By pressing the sides of the abdomen toward the center, women can continue to strengthen the transverse abdominals without the shearing forces that place lateral pressure on the linea alba.
Curl-downs are generally the safest and most effective abdominal strenthening exercise.
Splint by crossing arms and pulling toward center (L)
Or, splint by placing hands at sides and pressing toward center (R)