Over the last several years, we’ve seen the pendulum swing widely with respect to exercise during pregnancy. First pregnant people were told to take it easy- to keep their heart rate under 140 bpm, to not lift anything heavier than 10 lbs, and certainly not to run or engage in anything more strenuous than walking or yoga. One popular childbirth preparation book on my shelf suggests “Brisk walking is good from the beginning to the middle of your pregnancy. After that you may want to slow down a bit so that your baby is not jostled too much.” I’m guessing the authors never tried to wrangle a toddler while pregnant!
On the flip side, now we’re told that pregnant people can “keep doing what they were doing before they got pregnant” and to “listen to their bodies” without much guidance as to what that really means. We’re now flooded with images of pregnant Crossfit athletes and professional athletes competing at high levels. Where does the truth lie?
To begin, exercise during pregnancy benefits the pregnant person and the baby in so many ways (1,2). A non-exhaustive list of benefits conferred by prenatal exercise includes:
- Prevention of excessive weight gain during pregnancy
- Reduction of the risk of pregnancy complications including gestational diabetes and preeclampsia
- A decrease in maternal discomfort and injury, including the occurrence and severity of low-back pain
- Prevention and improvement in the symptoms of depression
- Possible reduction of the risk of medical interventions, including cesarean or instrument-assisted delivery
- Improvement in the growth and functional capacity of the placenta which may provide protective reserves for baby if complications arise in labor
There is no evidence that recreational exercise as a part of an uncomplicated pregnancy causes any harm to the developing baby (1,2). There is some data from a study of pregnant Olympic athletes suggesting that exercise over 90% maximal heart rate may compromise fetal blood flow (3), but most of us aren’t pushing that type of intensity. And so most if any concern over prenatal fitness should revolve around keeping mom’s body (and specifically, her core and pelvic floor) happy and healthy.
So, what do you need to know to continue your exercise routine into pregnancy?
First, know that American College of Obstetricians and Gynecologists (ACOG) recommends that people experiencing uncomplicated pregnancies engage in aerobic and strength training programs (1). They recommend women engage in at least 150 minutes of moderate-intensity work every week (spread over multiple days). Moderate-intensity equates to a 4 to 6 out of 10 on a scale of perceived exertion. Another way to measure exertion is using the “talk test”. Pregnant individuals should be able to talk (but not sing) while carrying on their activity. For a variety of reasons, heart rate is not an accurate measure of workload during pregnancy and should be avoided. Other common sense recommendations include maintaining adequate hydration, avoid overheating and watch out for warning signs to discontinue exercise. These warning signs include vaginal bleeding, regular painful contractions, amniotic fluid leakage, breathlessness before exertion, dizziness, headache, chest pain, muscle weakness affecting balance or calf pain or swelling.
Basic Strategies: Alignment, Breathing, Movement modifications
Next, there are three basic strategies you can implement into your exercise program to keep your core and pelvic floor healthy and happy throughout your pregnancy. These strategies involve manipulating your body alignment, breathing technique and exercise variables. If it’s an option, consider working with a prenatal fitness specialist or pregnancy and postpartum athleticism coach to dial in your specific program since every body and every pregnancy is unique.
While there is no such thing as a “perfect” alignment, there is an alignment strategy that may be more optimal for the coordination and function of your core and pelvic floor and may be particularly interesting to explore during pregnancy and postpartum.
This basic strategy is a “stacked” or “ribs over hips” alignment. You want to make sure that your pelvis isn’t thrust way out in front of your ribs, such that it begins to tuck under. Nor do you want to have your ribs thrust way out in front of your pelvis.
During pregnancy, practicing a stacked alignment may help decrease the severity of diastasis recti (the temporary separation of abdominal muscles that occurs during pregnancy) and the incidence of incontinence. It can also improve fetal alignment in the uterus and enable easier breathing.
How do you know if you’ve dialed in your alignment? Consider that your optimal alignment is the one in which you can best access your diaphragm and pelvic floor. Pay attention to how you feel when you breath and perform your exercise movements or activities of daily living (like picking up your kid) from the starting point of a certain alignment. Can you take a better breath (also refer to the next section of this post)? Do you feel stronger and more supported when you perform a movement? Do you have any pelvic floor symptoms that crop up or go away when you hold your body in a different manner? Find an alignment that allows you to breath more effectively, feel strong and minimizes any pelvic floor or core discomfort.
Your breath is your most powerful tool to stabilize and support your body during movement, manage intra-abdominal pressure and keep your body strong and healthy during your pregnancy. Take a look at what happens every time you take a breath:
There are several breathing strategies you can use to complement your fitness and daily movements; they are all based on the fundamental “connection breath” (also called the “piston breath”).
The connection breath trains the coordination and optimal function of the core and pelvic floor. You may practice this breath lying on your back with your knees bent or sitting with stacked alignment on a stability ball. As you practice, you may place one hand on the side of your rib cage and one hand on your belly to help yourself feel the movement of your ribs and belly.
To perform this breath, first focus on the inhale. Expand your rib cage, bringing awareness to its expansion from front to back and side to side. At the same time, relax and release your pelvic floor. On the exhale, blow out all your air through pursed lips and focus on contracting the pelvic floor (just like performing a kegel, at 30 percent max effort or so). Over time this pelvic floor contraction will become reflexive with your breath cycle.
Once you have mastered this breath, apply it during exercise and practice “exhale on exertion”. Inhale during the easy portion of the movement (e.g. descending into a squat) and exhale during the effortful portion of the movement (e.g. rising from the squat). As you work on becoming familiar with “exhale on exertion”, remind yourself to gently contract your pelvic floor during your exhale. The strength of your exhale and pelvic floor contraction will vary depending on the demand of the exercise you are performing. Experiment!
During movements that require a lot of effort, exhale through pursed lips, like you are blowing out birthday candles. This will increase the response of the pelvic floor.
Finally, avoid holding your breath during exercise or daily activities like lifting a child. Breath-holding is a strategy that puts a lot of pressure on a pelvic floor already strained from the demands of a growing uterus.
There are a lot of nuances and variations to breath work during exercise (too many to delve into here!) so if this doesn’t feel intuitive, or if it doesn’t feel like enough to support your movement, consider downloading my free resource, The No B.S. Guide to Breathing for a Strong Pregnancy and Postpartum; this guide dives deep into how to perform the Connection Breath and apply it to movement. You are also welcome to reach out for individual advice.
As your pregnancy progresses, you may need to modify your activities. That may mean switching from running to walking. Or eliminating other high impact activities like jump roping. It may mean adjusting your strength training regime.
With respect to strength training, you will find that as your pregnancy progresses you will naturally want to decrease the weight you lift. When lifting lighter weights, you may consider increasing the challenge by increasing the number of reps you perform or your time under tension (i.e. performing your lifts more slowly). There are a whole host of modifications that may make sense later in pregnancy, from eliminating overhead lifts, avoiding front-loaded abdominal exercises (like planks or crunches) to avoiding strict supine exercises if they cause nausea, dizziness or discomfort. Remember to increase the amount of rest you take between sets or sessions, depending on how your body is responding to and recovering from your exercise selections.
“Listen to your body”
In addition to the warning signs provided by ACOG (listed above), be aware of signs and symptoms that you might be overdoing it with respect to your core and pelvic floor. Keep in mind the ‘4 Ps’: pee, pain, pressure and peaking. If you experience any leaking during exercise, pain in your pelvic floor or elsewhere, or pressure through your pelvic floor or abdominal midline, it’s time to take a step back. If you see peaking, coning or bulging of your abdomen along your midline, that is a red flag that you need to pause that particular lift or exercise, and consult with a qualified coach or pelvic floor physical therapist to evaluate your breathing and movement strategies.
Focus on the long game. Be flexible day to day, trimester to trimester. Be mindful that there will be days where you are fatigued, slept poorly, experience morning sickness, or otherwise don’t feel like exercising. Listen to those signals. Approach your body and workouts with compassion.
Pregnancy is a temporary chapter in your life. Everything you do now should set you up for a strong postpartum recovery. Even though you need to modify your work right now, you will have an opportunity to return to your sport or activity of choice after your recover from your baby’s birth.
(1) American College of Obstetricians Gynecologists. 2020. Physical activity and exercise during pregnancy and the postpartum period. Committee Opinion No. 804. Obstet Gynecol 135: e178-188
(2) Clapp III JF, Cram C. 2012. Exercising through your pregnancy: Addicus Books
(3) Salvesen KÅ, Hem E, Sundgot-Borgen J. 2012. Fetal wellbeing may be
compromised during strenuous exercise among pregnant elite athletes. Br J Sports Med 46: 279-83
My mission is to make sure that having a baby is not a reason why you can’t do all the things.
Contact me if you have questions about exercise or pelvic health pertaining to pregnancy or postpartum. I work with people locally (Seattle’s Eastside: Redmond, Bellevue, Kirkland and surrounding areas) and online to develop personalized pregnancy and postpartum personal training plans. I also offer labor support (birth doula services) within the greater Seattle-Metro Area.