PRE NATAL FITNESS
Exercise during pregnancy can be a very beneficial experience if you are conscious of the precautions to take and knowledgeable about the effects that exercise can have on you and your developing baby. During a normal low risk healthy pregnancy, providing you have been exercising prior to your pregnancy, moderate exercise is safe for the foetus. Exercise is also said to prevent varicose veins, haemorrhoids and low back pain – not to mention boosting self-esteem. The guidelines and limitations for exercise should start as soon as you know you are pregnant, or begin trying to become pregnant. If you have any concerns at all ask your doctor. The limitations put on the type of exercise, frequency, intensity and time are for the benefit of the developing baby, not for the mother. Normally, the mother can handle exercise much better than the baby. Don’t forget no two women are the same particularly during pregnancy so whilst some exercise is perfectly safe for some it is not for others. Be aware of how you and your body are responding and. if you have ANY doubts or worries, consult your doctor.
Do not become overheated or exercise until you can’t catch your breath to speak. Always drink plenty of water before and during exercise even if you don’t feel thirsty. Some women experience low blood sugar levels resulting in light headedness or faintness, a light snack approximately two hours before exercise should prevent this. Carry a small carton of fruit juice to your class in case. Be aware of any feelings of dizziness or faintness. If you do start to feel light headed whilst lying on your back roll onto your left side until the feelings subside.
Avoid exercise in a supine position (lying on back) after the first trimester (three months). Supine positions may interfere with the cardiac output (blood from the heart) to the foetus. Upper body exercise is encouraged as it does less to divert blood flow away from the foetus than lower body exercise.
Avoid extreme rotational movements of the spine as there is a small chance of causing the placenta to tear away from the uterus.
The transverse abdominal muscles (the muscles that pull your stomach in towards your spine) should be exercised throughout pregnancy as they are partly responsible for helping to push the baby out. Do static abdominal contractions either seated, standing, lying on one side or on all fours if comfortable, NOT lying on your back after the first three months.
As the baby grows the centre of gravity changes so avoid positions and movements that present a challenge to balance in order to prevent falls. The overall intensity should be mild to moderate as pregnancy hormones relax ligaments and joints, making you more susceptible to strains, sprains and dislocation. Do not do any exercise where the legs are abducted i.e. taken away from the centre of the body. Avoid sitting in a cross legged position. Care should be taken also not to over-stretch. It is important however to continue to stretch otherwise the muscles can become too tight and cause imbalance.
During the second trimester about 30% of pregnant women will experience diastasis recti which is the separation of the muscles that allow you to bend forward and back. These are the muscles which run from your breastbone to your pubic bone. If this does occur then all abdominal/sit up type exercise should cease. This will reduce support for the back, so care should be taken to avoid any risk of back injury. Do not do full sit-ups at any time. In addition, all exercises performed on the back should be avoided.
IN SUMMARY – AVOID
Overheating and getting thirsty
Any challenge to your balance once your centre of gravity has changed
Lying on your back after first trimester
Lying on your tummy once bump has developed
Abduction of the legs i.e. taking the legs away from the centre of the body.
Sitting cross legged.
Extreme rotational movements of the spine
Lifting anything heavy
If separation of the muscle that runs from the breastbone to the pubic bone has occurred it is recommended that all abdominal/sit up type of exercise should cease. Exercise that works the upper body in a seated, standing or on all fours position is more appropriate.
If at any time during your exercise session you feel very hot, faint, dizzy, short of breath, experience vaginal bleeding, have palpitations, blurred vision, disorientation or severe or continuous headaches, STOP IMMEDIATELY. It is also important to stop if you experience lower abdominal pain, tightness or cramping, back pain or pubic pain. If you experience any of these symptoms, consult your doctor or call an ambulance.
Enjoy your pregnancy this is a special time. Relax, put your feet up if you are tired and ask your family to understand when your mood swings are at their worst!
Aids the repair of body generally and promotes circulation.
Aids the physical and psychological recovery.
Aids any symptoms of mild postnatal depression
Aids the recovery of the abdominal area
Aids weight reduction
Maintain or improve energy levels.
Repairs the pelvic floor preventing prolapse and stress incontinence
Prevents or improves back or sacroiliac pain.
Reduces recovery time.
Improves confidence to deal with new baby.
Social interaction will improve confidence generally.
As soon as possible after the birth it is essential to start to exercise the muscles of the pelvic floor.
Pelvic Floor Exercises
The pelvis floor muscles form a sheet of muscle between the pubic bone, the tail bone and the bottom of the pelvis. This sheet of muscle supports the contents of the pelvis and abdomen and one of its’ roles is to maintain continence. Pulling up this muscle also aids in the pulling in of the abdominals – the Core. The pelvic floor will not remain contracted all the time. However, it is important that these muscles are regularly exercised after childbirth and as one gets older to maintain continence.
In this order either seated, standing, on all fours if comfortable to do so and bleeding has stopped, or lying down:
Slow twitch muscles Close and draw up the muscles of the back passage as if you are trying to stop passing wind. Make sure you do not tighten the muscles in your buttocks while you do this. Now close and draw up the muscles around your vagina and urethra as though you are trying to stop a wee. Hold this for five seconds without holding your breath and then slowly relax and release the muscles. Repeat five times then:
Fast twitch muscles Pull up the pelvic floor muscles as before hold for one second and then release the muscles. Repeat five to ten times or until the muscles feel tired.
This should be done 5 times a day.
Tips and Reminders
Alcohol will affect the next two feeds.
Wear a good supportive bra.
Exercise does not turn the milk sour!
Delivery – Caesarion and Normal
Massage the scar area if you have had a Caesarion.
The abdominals are already in two halves so it is only the linea alba (white line) that is cut to bring baby out. Do not exercise the abdominals with any forward flexion e.g. sit ups until you have been give clearance and the gap between the abdominals has narrowed to a two finger gap. Your midwife should check this.
Start gently and gradually build up your strength. Do not be impatient.
If you have stopped bleeding and been given clearance to exercise then, in addition to the pelvic floor exercises you can do the following exercises:
Core Stability Exercises
Abdominal Hollowing Standing – this exercise can be done at any time of your pregnancy.
Start Position – Stand with your feet in line with your hip joints, knees soft, spine long and sacrum dropped towards the floor. Keep the back of the neck long and shoulders down and relaxed.
Action – Place the fingers of your right hand on your belly button and your left hand on your lower back. Breathe in and relax your abdominals against your fingers, just let them go. Breathe out and feel as if you are drawing your hipbones closer together as you bring in the abdominals away from the fingers of your right hand. Hold this abdominal contraction for 3 – 6 seconds breathing normally. Relax the position and move your feet. Bring your feet back to the start position and repeat the exercise two to three times.
Watchpoints – The lower back should not change position when you draw the abdominals in. There should be no movement in the pelvis. The ribs should stay soft and down.
All Fours Abdominal Hollowing level 1 – purpose – trunk stability against the loading of the limbs helps to develop endurance in the core. This exercise will also help to stabilize around the sacroilliac joint, pelvis and shoulder girdle.
Start Position –On all fours, wrists below the shoulders, knees below the hips, front of foot flat on floor if comfortable, pelvis in neutral, head in line with the spine, neck long.
Action – Inhale deep into the ribs without moving any other part of your body, exhale and engage your pelvic floor and abdominals bringing the hip bones closer in together without moving any other part of your body. Hold the contraction breathing normally for up to 10 seconds. Relax back to take the weight off your wrists and then move back into your start position and repeat the exercise 2 – 3 times.
All Fours Abdominal Hollowing – Level 2 Cat Pedals
Start Position – as level 1 above.
Action – Bring your shoulders back and down away from your ears bringing your elbows nearer to your ribs. Keep your head in line with your spine and the pelvis in neutral. Engage the pelvic floor and abdominals (bringing the hip bones closer together) and lift one hand off the floor with the elbow bent keeping the rest of the body absolutely still. Hold this position for a few seconds breathing normally. Lower the hand to the floor and repeat the exercise with the other hand. Keep the abdominals contracted right the movement. Repeat 3 – to five times moving fron hand to hand. Sit back and rest the wrists.
All Fours Abdominal Hollowing – level 3 Knee Lifts
Start Position – as levels 1 and 2 above.
As above but, instead of the hand, lifting the knee no more than an inch away from the ground keeping in line with the hip and the foot on the floor. Avoid twisting the upper body or dropping the supporting hip down to one side.
Start with three times per week and increase to five and then every day.