Birth has been compared to climbing a mountain or completing a marathon. Being physically fit is an advantage. Exercise generally improves pregnancy, birth and newborn outcomes for people with normal pregnancies. There may be a protective factor for gestational diabetes, congenital anomalies, miscarriage, placental problems, intrauterine growth restriction, high blood pressure or fetal death. Evidence suggests that abnormal heart rates, cord entanglement, and the presence of meconium are significantly reduced. While there is no increase in premies, there may be fewer postdate gestations.
Those who engage in regular, vigorous exercise require less intervention in labour, including a substantial decrease of cesarean birth rates. They may have faster labours, both in stage-1 and stage-2, compared to those who are sedentary. However, keep in mind that during pregnancy, ligaments and tendons soften, center of mass shifts, blood volume and oxygen levels change. During pregnancy one is more prone to falls, muscle / joint injuries, and running out of steam.
There are many benefits to exercising during your pregnancy:
- Feel comfortable in and enjoy your body
- Increases circulation
- Promotes tone in muscles and increases stamina
- Promotes well-being; prevents depression
- Oxygenates blood to reduce fatigue
- Improves placental function
- Reduces pelvic congestion and cramping, low backache, ligament pain and constipation
- Prevents blood congestion in lower body, reduces leg cramps, tension, and varicosities
- Recovery of organ tone and placement; prevents prolapsed pelvic organs post-partum
- Gestational diabetes and blood sugar issues improve after exercise
- Moderately high blood pressure may be lowered
- Improves pregnancy, birth and newborn outcomes
- Contributes to shorter labours and fewer medical interventions
Relaxation for Birth Prep
- It’s important to do exercise and also practice relaxation.
- Relaxation must be practiced daily to be effective, especially as a labour tool.
- Yoga, meditation, tai-chi, or just listen to a relaxation CD.
- Conscious awareness of relaxing muscles balance building and toning; especially important if you are muscle-bound or super-muscular.
- LISTEN TO YOUR BODY; DO ONLY WHAT FEELS GOOD!
- Continue your regular exercise program, but listen to your body; modify/stop as needed.
- Exercise on a firm surface.
- Balance exertion with relaxation periods.
- Remember your center of balance / weight distribution is quickly changing.
- Warm up and cool down well to prevent injury and pooling of blood in the extremities.
- Feel your baby move inside you – pay attention.
- Stay hydrated to ensure proper cooling and adequate blood expansion. Drink 4-8oz water before exercising and 2-4oz every 20-30 minutes during; double this amount at high elevations. This is in addition to your regular pregnancy water requirements.
- Exercise in a cooled or air-conditioned room, especially in hot, humid weather.
- Consume additional calories to sustain exercise. Moderate exercise in an average sized woman requires 600-700 additional calories daily.
- Taper off gradually if you’re used to vigorous exercise and have to exercise less. An abrupt drop in activity can cause constipation, circulatory problems, or nervous irritability.
- Begin slowly if you have not routinely exercised.
- If motivation is an issue, think of it as movement rather than exercise.
- Start twice weekly and increase to 5 times. A 10-20minute walks is a great start!
- Videos can help you learn to exercise but ensure they’re safe for pregnancy.
- Discuss beginning an exercise program with your medical care provider.
- Inversions and twists, especially during yoga.
- Sit-ups or crunches as they stress abdominal muscles, weakening and lengthening them in the long run. Post-partum recovery of a tight core in this case is difficult or impossible. In fact, every time you go from laying to sitting/standing, roll over on your side first.
- Exercising to the point where you cannot carry on a conversation.
- Weights or exercises that require holding your arms over your head for an extended period of time or for many repetitions.
- Impact exercises (once they no longer feel 100% great, if you’re used to them).
- Laying on your back for extended periods of time.
- Any exercise that can cause trauma to the abdomen or pelvis.
- Valsalva manoeuvres / inner pressure on pelvic floor (e.g. some breathing patterns that resemble bearing down).
- Scuba diving due to increased pressures of submersion.
- Sudden changes of position or level.
- Exercises that require standing on one leg as that can cause pulling in the pubic symphysis, not to mention balance issues.
- Starting a vigorous exercise program after 26 weeks if you’re new to exercise.
- Strenuous exercise during last trimester, no matter how fit or used to high intensity you are (correlated with lower birth-weight babies).
Contraindications for Exercise
- Placenta previa
- Tearing or separation of placenta (abruptio)
- Premature rupture of membranes (PROM)
- Incompetent cervix
- Chronic heart disease
- Premature labour
- PIH (pregnancy induced high blood pressure)
- Pre-eclampsia (a.k.a. toxaemia)
- Fever (or presence of infection)
- Acute and/or chronic life-threatening condition
Warning Signs or Symptoms – Stop IMMEDIATELY and seek medical attention in case of:
- Pain or discomfort
- Bleeding or fluid discharge
- Feeling ill, dizzy, faint, disoriented, nauseated
- Heart palpitations or chest pain
- Severe headache
- Difficulty walking or moving
- Regular strong contractions
- Hyperventilation – take slow deep breaths until it passes
Conditions for Assessment
If any of these issues are a concern, then consult with a perinatal fitness specialist. There are often things you can do to exercise safely with special circumstances.
- Extremely sedentary lifestyle
- Gestational diabetes or blood sugar issues
- Marginal or low-lying placenta
- History of IUGR (decreased or slow fetal growth)
- High blood pressure
- Irregular heartbeat or mitral valve prolapse
- Oedema / swelling of face and hands
- Multiple gestations / foetuses (twins, triplets etc)
- Thyroid disease
- Three or more miscarriages
- Excessive over- or underweight
- Nerve compression injuries – don’t stretch to extremes or do weight bearing on the affected part
- Pelvic-floor exercises – see below
- Prenatal yoga
- Dance (belly dancing is especially good for birth)
- Daily squatting – start with supported squat for as long as feels comfortable (holding a pole or counter, or sliding down a wall) – maybe only seconds at first. Build flexibility and endurance in this position. Feet should be parallel to each other.
- Pelvic rocking – all fours and do cats & dogs. Start with 5 of each and build to 20 daily.
- Any stretching that increases flexibility and flow to pelvis, such as cobbler-sit, pigeon pose, or straddles. A good prenatal yoga DVD or class can teach you these.
- See special note below for those who participate in extreme sports or live in the mountains.
Pelvic floor exercises are particularly important when preparing for birth:
- Assists with relaxation of pelvis floor – prevents tearing
- Tones pelvic floor to prevent prolapse, incontinence, haemorrhoids
- “Elevator Kegels” – Kegels are often mentioned as a good pregnancy and post-partum exercise but need to be done properly, like an elevator, not just a urination squeeze. Relax all muscles except pelvic floor and vagina. Tighten those muscles progressively, layer by layer, then release slowly. Build up to cycles of 15, for a total of 50 contractions daily. Do not hold longer than 5 seconds at a time, nor perform regularly during urination, as this may contribute to urinary tract infection.
- Squats are excellent for pelvic floor health
Posture – While Exercising or Resting
- Maintain good posture to prevent low back pain, shortness of breath, and indigestion.
- Hold head high (crown to sky), shoulders back, abs and lower back strong, tailbone tucked in and feet slightly apart.
- Spend time on the floor! Carpet or a firm pillow can keep your bones comfortable. Crawl on all-fours during the last trimester to ensure optimal fetal positioning. Sit on the floor to open your hips.
- Be diligent with posture, especially sitting postures, to ensure the best possible fetal position for labour and birth.
- Sit tailor-style often – this strengthens the back
- Sit straight up and on sitz-bones
- Consider sitting on a ball, saddle seat, knee-chair, or sit-stand chair to ensure your knees stay below hips, and your back maintains healthy alignment following natural curves
- Avoid slouching, reclining and upholstered furniture as much as possible
The rest of this article is a SPECIAL NOTE to those who are…
Extremely Fit / High Performance Athletes / and/or Living in Mountains
People in this category have a different reality. The following are guidelines for those folks who have lived at high altitude longer than 6 months pre-pregnancy (and are therefore adapted to high altitude), are active in the mountains, accomplished in mountain or other extreme sports, addicted to Ashtanga yoga and/or super-fit compared to the general population.
Intense exercise is contraindicated in the last trimester and is correlated with lower birth weight babies. It’s only 1 season in the grand scheme of life and could be an opportunity to try something new or softer.
The most important thing is to LISTEN TO YOUR BODY!!! If it feels good, keep going. However there WILL come a point where you feel tired. You may also feel a bit clumsy as your body changes. There is no benefit to pushing through at that point. You’re growing a whole person inside and your baby deserves your energy and nutrients. Play in the mountains if it feels good but be willing to stop, modify or slow down.
Anyone who exercises compulsively is particularly at risk for ignoring their body’s subtle calls of distress. Balance exercise with rest and relaxation. If you’re super-muscular or muscle-bound then consider decreasing exercise and increasing relaxation time. Take a class specific for un-exercising muscles. You might feel stir crazy, but learning to loosen and relax your body will pay off greatly during the birth process and for post-partum recovery.
Do your sports partners know you’re pregnant? Is it fair to either of you to keep this a secret? During early pregnancy, before you “show”, you’re likely to be tired and possibly nauseated. Your play partners may assume you’ll push through. Do not push through. Even if they know you’re pregnant they may not understand it actually does affect your performance. A good conversation might be in order before setting out. I strongly encourage you to tell them, or at least think about why you’re not telling them. Then look at those reasons and decide if you should be relying on each other for life and safety out there.
For any endurance activities lasting longer than a yoga class, be prepared to nourish yourself. Eat and drink constantly. Use a health electrolyte drink. Take breaks – yes, breaks – as in rest.
Tips for Mountain Activities in addition to the ones above (see “Exercise do’s”). Remember that high intensity exercise is contraindicated in the last trimester, and LISTEN TO YOUR BODY!! You absolutely must take rests and eat/drink LOTS to safely participate in these activities.
- Cycling – tone it down before when your clipless pedals start releasing due to knees-out position. Be careful of weight distribution changes, and consider switching to fire-roads or road-biking rather than single-track.
- Climbing – when your harness no longer fits, stop. (OK – maybe stop before that.) Do not borrow a bigger harness! Top-roping is safest. If you must lead use lots of pro and be extra diligent about falls. Seriously consider leading about 3 points back from your pre-pregnancy ability. Make your climbing partner carry the ropes and half the pro.
- Ice climbing presents cold weather challenges in addition to the extra risks over rock-climbing. Even more moisture is lost through respiration and staying warm in the cold, so drink even MORE WATER than recommended above. Also pay extra attention to fingers & toes and frost-bite; your blood volume and distribution are changing.
- Altitude – almost all prenatal books warn about high altitude. If you’ve lived at altitude for longer than 6 months, then your physiology will have adapted. Continue going to places you went pre-pregnancy but allow more time to get there.
- Hiking – be diligent about pack weight distribution, and take rests. Yes – rests!! Don’t wait until you feel light headed. Take lots of snack & water breaks. Carry that bear spray because you’re now likely the slowest runner in the group J. Make your hiking-mates carry the heavy stuff!
- Skiing – if it feels 100% good, do it. Seriously watch for back-country avalanche bulletins. Make your ski-buddies break trail and carry extra gear. Consider spending more time on track-set or groomers. If using lifts take a big drink on every ride.
- Yoga – if and only if you’ve been a dedicated yogi for years and are very body-aware, then it’s possible to continue your regular practise, modifying as your body tells you.
Effects of Stress and Adrenaline on Unborn Babies
The emerging field of perinatal psychology has fascinating info. Pregnant adrenaline junkies make adrenaline junkie babies – great for fun but also a special challenge on adrenal health later in life and appropriate stress-coping mechanisms. One big way to help baby cope is to explain what you’re about to do, that it may feel scary, but that baby is safe. When the stressful event or adrenaline rush is over tell baby all is will now, baby is safe, and scary event is over.
Imagine you’re blindfolded, wearing ear-plugs, and can’t talk. Then someone drops you into the craziest roller-coaster ever but doesn’t tell you anything about it. That’s what it’s like for baby to accompany you for any event that raises your adrenaline – sports, argument with partner, work-related stress, and near-miss car crash.
A word about “they say”:
People will have strong opinions about what you’re doing and will be more than willing to share those opinions. It’s frustrating to hear that you’re irresponsible to be climbing, especially from a non-climbing, flat-lander, possibly couch potato, who doesn’t know how much you’ve already changed your practise! It’s even more frustrating to hear it from a well-meaning local athlete. Some people will refuse to play in the mountains with you, feeling they’re contributing to your “irrational” behaviour. Others may take your partner aside to try to convince you both how risky your actions are. Fortunately many others totally “get it”! Play with people who understand and are willing to accommodate and be safe.