Body with Soul
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Fit For Pregnancy And Motherhood

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Historically, it has long been suggested that women who were physically fit tended to have easier labours than those with a more sedentary lifestyle (Vaughan, 1951). Until the twentieth century, however, most women were simply grateful to survive the many dangers of pregnancy, labour and the early postnatal period. Having a healthy baby was an additional bonus! Times have changed and, fortunately, medical and environmental advances have led to safer childbirth and reduced maternal mortality rates. Many women now face pregnancy and labour as they would a job or an examination: they study, prepare and train for it.

Training during and after pregnancy has numerous positive health benefits such as increased aerobic fitness, muscle strengthening and toning, flexibility, social interaction and psychological wellbeing. Exercising during pregnancy has also been shown to be helpful in reducing blood sugar levels in women with gestational diabetes, and evidence suggests that it can prevent the onset of osteoporosis and hypertension.

The physiological changes to a woman’s body due to pregnancy and delivery are significant. Because of the secretion of a hormone called relaxin, there is an increased laxity in all the connective tissues, thus causing the joints and muscles to have an increased range of motion and reduced stability. As the centre of gravity changes due to the enlarging ‘bump’, a woman’s posture has to adapt and with this there is an increased risk for developing pelvic girdle and back pain.

From a muscular point of view, the most obvious groups that get affected are the abdominal and pelvic floor muscles due to the stretch and strain placed on them. Towards the end of the third trimester, the vast majority of women will experience a natural separation of the rectus abdominal muscle (commonly referred to as the ‘six pack’ muscle). This long vertical line separating the abdominal muscles can over stretch and is most visible as a ‘doming’ when a woman tries to sit up from a lying down position, or when she coughs, sneezes, laughs or lifts. In most women, this gap resolves naturally within the first 4-6 weeks after they deliver. However, it is very important to check with a doctor, midwife or physiotherapist if she is not sure as simple repetitive motions of daily activity can worsen this gap between the muscles. Current evidence and expert opinion suggest that women with an abdominal muscle separation should attempt a progressive strengthening programme (with correct technique!) for at least one year postnatally before considering surgical options.

Pelvic floor problems, such as urinary incontinence and prolapse, are fairly common with the former affecting 1 in 3 women who have had a baby. A study by Mason et al (2001) showed that women who had learnt and practiced pelvic floor muscle contractions (also commonly referred to as ‘Kegels’) during pregnancy experienced less urinary incontinence postnatally than those who had not learnt the skill antenatally. All pregnant women should be taught how to exercise their pelvic floor muscles correctly and they should be referred to an appropriately trained professional if they are experiencing any symptoms of pelvic floor dysfunction. Prevention is the key to success!

Swimming is possibly the perfect exercise to practice during pregnancy. The buoyancy of the water supports the woman’s increasing body weight, allowing her to continue with muscle toning and strengthening, and improving her physical fitness and endurance, as well as promoting a sense of well-being. Even non-swimmers can benefit from a programme of exercises and relaxation in a pool, such as walking and marching inside the water. Women with pelvic girdle pain (which often presents as pain in the pubic joint), however, should be careful to avoid the breast stroke as it places a high degree of strain through the joints in the pelvis.

Pilates and Yoga are also very popular choices of exercise during and after pregnancy. When taught by properly trained and accredited teachers, these two modalities allow women to develop better body awareness, relaxation and general fitness, offering specific benefits to posture, coordination, abdominal and pelvic floor muscle strength. Women who return too quickly to doing vigorous sit ups, curl ups or crunches without properly checking their abdominal muscles are at risk of worsening the separation of those muscles.

Bed rest is not uncommon in women with ‘at risk’ or ‘high risk’ pregnancies. This period of reduced activity has many obvious implications and consequences to a woman’s aerobic capacity and muscular conditioning. Pregnant women who require bed rest must have an in-depth discussion with their medical team (which will hopefully include a physiotherapist!) on how to manage this situation and reduce the negative impact on their fitness levels. There is generally no reason why routine exercises for leg circulation, pelvic floor muscles and gentle movements to encourage good posture and back comfort should not be taught and practiced regularly.

It is impossible to set strict guidelines for women wanting to exercise during pregnancy as there are too many variables, such as individual fitness levels, the intensity and type of exercise and the individual factors affecting each pregnancy. Women must consult with their obstetric team and get guidance on what is safe to practice. The current medical expert recommendations are that all women without contraindications should be encouraged to participate in aerobic and strength conditioning exercises as part of a healthy lifestyle during their pregnancy (SOGC, 2003). Once those have been cleared, find the appropriate professionals and get moving towards feeling healthier and stronger during and after pregnancy!

Here are the links for guidelines and contraindications for exercise during and after pregnancy:

Monica Donaldson, Physiotherapist.