Exercise and Your Body During Pregnancy

Congratulations on your pregnancy! Pregnancy is an incredible journey that brings about many miraculous changes in your body. Scientific evidence and Australian guidelines tell us that staying active during this time is beneficial for both mum and baby, but it’s important to understand how to adapt our routines to accommodate these changes safely. In this blog post we’ll explore the various systems and areas of the body that undergo changes during pregnancy and provide tips on how to move and exercise safely and effectively.

Pelvic Floor

The pelvic floor muscles, which support the bladder, bowel, and uterus, undergo significant strain due to the increasing weight of the baby. Hormonal changes also cause these muscles and their supporting fascia (strong connective tissue) to soften, preparing for childbirth.

How to Adapt:

Pelvic Floor Muscle Exercises: Strengthening the pelvic floor muscles now can help prevent incontinence and prolapse later on, as well as supporting the growing baby. Practice pelvic floor muscle exercises daily by contracting and relaxing these muscles. The relaxation part is just as important as the contraction! If you’re unsure how to do this, it’s worth checking with your women’s health physio (trust me, we love talking about it).
Proper Breathing: Use diaphragmatic breathing to engage the pelvic floor naturally.
Limit Heavy Lifting: For most women, limiting heavy lifting and high impact exercise is recommended to reduce the risk of straining the pelvic floor. If you’re very accustomed to these activities you may be able to continue through pregnancy, but it’s a good idea to consult with your health care provider along the way.
*If you have to lift an older child, squeeze and lift your pelvic floor muscles first, maintaining this contraction throughout the lift. This is called “The Knack”.

Abdominals

The abdominal muscles, especially the rectus abdominis (the "six-pack" muscles), stretch to accommodate the growing uterus. This can lead to a widening of the connective tissue between the muscles and is known as diastasis recti. It’s a completely normal and necessary part of growing a baby human, but measures can be taken to help prevent excessive or persistent separation.

Physiotherapist checking Rectus Diastasis

How to Adapt:

Core Strengthening: Focus on gentle core strengthening exercises, such as pelvic tilts and modified planks, to maintain muscle tone.
Avoid Crunches: Avoid traditional crunches and sit-ups, as these can exacerbate diastasis recti.

No doming: Ensure your abdominal muscles aren’t loaded or strained to the point where they bulge outward at the middle of the tummy.
Avoid Sitting Up from Lying: Instead it’s best to roll onto your side first and use your arms to push you up to sitting.

Breasts

Breasts get bigger and heavier due to hormonal changes and milk production, which can lead to discomfort and changes in posture.

How to Adapt:

Supportive Bras: Wear well-fitted, supportive bras without underwires during exercise to minimise discomfort.
Stretches: Incorporate gentle neck, shoulder, upper back and chest stretches to alleviate tightness and maintain good posture.
Low-Impact Exercises: Opt for low-impact exercises, such as swimming, walking, Pilates or yoga to reduce breast discomfort.

Spine, Hips & Pelvis

The spine, hips, and pelvis adjust to support the growing baby, leading to changes in posture and potential discomfort or pain. Pregnancy hormones cause ligaments to soften and become more flexible, which is extremely helpful when you think of how your baby might need to fit through your pelvis in a few months, but also can contribute to discomfort.

How to Adapt:

Postural Awareness: Avoid spending too long in any one position throughout your waking hours. Your joints will stretch (a microscopic amount) more when you stay in a position for longer, which can lead to pain when you start moving again. Maintain good supported posture using pillows, wedges and backrests, and move around every 20-30 minutes.
Hip and Pelvic Mobility: Practice gentle hip and pelvic mobility exercises, such as prenatal Pilates, yoga or hip stretches, to reduce stiffness and discomfort.
Avoid Overstretching: It can be easier to accidentally stretch too far when you’re pregnant, especially around your hips. To avoid causing pain or injury to your newly bendy joints, stick to just creating a gentle feeling of pulling in the muscles.
Strength Training: Strengthen the back and hip muscles with exercises such as squats to support the spine. Resistance exercise is recommended 2-3 times per week.

*For some pregnant women with increased hip, pelvic and lower back pain, asymmetrical exercises which load one leg can exacerbate their symptoms. If you think this might be you, avoid lunges, step-ups and single-leg exercises, and make sure you get checked out by your physio.

*Some women also get sharp abdominal or pelvic pain on one or both sides when changing position or moving suddenly. It’s always worth checking this with your obstetrician or midwife, but it’s often just the ligaments that support your growing uterus. Use your deep abdominal and pelvic floor muscles to support your bump when changing positions, eg turning in bed or getting up from a chair.

Cardiovascular System

The cardiovascular system works harder during pregnancy, with increased blood volume and heart rate to support the growing baby. This can lead to increased muscle fatigue, shortness of breath blood pressure fluctuations, and the dreaded cramps.

How to Adapt:

Moderate-Intensity Exercise: Engage in moderate-intensity exercise, such as brisk walking, swimming, and Pilates to improve cardiovascular health.
Avoid Supine: Physios and medical bodies around the world recommend not lying on your back to exercise beyond the first trimester. The increased weight of bub, uterus, etc can compress the vein bringing blood to your heart, resulting in reduced blood flow and dizziness. Your trainer can provide you with exercises in other positions such as side-lying, sitting, standing or all-fours.
Avoid Prone: while we’re at it, off the topic of the cardiovascular system, but best to avoid lying on your tummy once your bump starts to pop out. Mainly because it’s just really uncomfortable!
Hydration: Stay well-hydrated before, during, and after exercise to support cardiovascular function.
Stay Cool: Wear layers you can remove when working out, and ensure good ventilation and air-conditioning to avoid overheating.
Listen to Your Body: Pay attention to signs of fatigue or dizziness and adjust the intensity of your workouts accordingly.

Digestive System

Hormonal changes which cause some of the muscles in our organs to relax, and the growing uterus can affect the digestive system. A more sluggish gastro-intestinal tract, combined with pressure from the bump, commonly leads to issues such as constipation and heartburn/reflux.

How to Adapt:

Gentle Movement: Gentle exercise, like walking, can help stimulate digestion and alleviate constipation.
Post-Meal Activity: Avoid vigorous exercise, or lying flat immediately after eating to reduce the risk of heartburn.
Stay Hydrated: Sip (don’t guzzle) plenty of water throughout the day to support digestion and overall health.
Avoid Straining: Ensure adequate fibre intake through diet or supplementation to avoid becoming constipated. A full rectum and/or needing to strain puts a lot of unwelcome pressure on your pelvic floor and bladder. Physios recommend sitting with your knees bent up and feet elevated on a stool, to almost mimic a squatting position, when opening your bowels.

To Summarise

Feeling overwhelmed? The following dot points summarise what to avoid, and what to do when exercising:

Don’t exercise in supine, aka lying on your back, beyond the first trimester (and avoid lying on tummy from around this time too)
Don’t do traditional ab crunches and sit-ups
Avoid overstretching, especially around the hips
Do consult with a healthcare provider before beginning any new exercise routine during pregnancy
Do participate in moderate intensity, low impact cardiovascular and resistance exercise, plus gentle stretching for 2.5-5 hours per week
Do daily pelvic floor muscle exercises
Stay adequately cool and hydrated when exercising

Feel free to reach out if you have any questions or concerns, or would like assistance with exercising during pregnancy.