Exercise in pregnancy. Do we do it? Do we not? What exercise can we do? What can’t we do? These seem to be the questions frequently asked amongst mums to be, who want to keep an active lifestyle. We know exercise is recommended in non-pregnant life and we are constantly told different things on what we should be doing and how many steps we should be walking each day to improve our health. The NHS ‘Live Well’ campaign recommends that 30 minutes of moderate aerobic exercise a day can significantly improve our health and wellbeing. This should not stop in pregnancy. The recommendations have in fact altered slightly with current guidance now stating vigorous exercise and light strength training should be incorporated into to the exercise routine of a healthy pregnant women. Exercise is safe in a low risk pregnancy and if you have not been told otherwise. The general advice given from the Royal College of Obstetricians and Gynaecologists is to continue with your normal exercise routine if you feel you can do it, but to also consider becoming more active if you have not been pre pregnancy. The long term benefits of exercise and a positive change of lifestyle is only going to be beneficial to you and baby.
Obesity in pregnancy is a big problem with 15-20% of women in the UK having a BMI of over 30 at their antenatal booking appointment. Obesity increases the risks of complications during pregnancy and birth, with a BMI of over 40 being a much more high risk pregnancy with increasing risks. You may remain in midwifery led care with a BMI of under 35, which includes being able to birth in a birth centre. Whilst BMI is definitely in the ‘dark ages’ of measurements it is far too difficult to measure body fat percentage in the pregnant woman and is unfortunately what we have to go by in line with the NHS recommendations, so please do not be disheartened if you live a healthy lifestyle, carry some muscle but still have a BMI of over 30. It is encouraged that anybody no matter what your size or shape makes positive changes, leads an active, fit and healthy lifestyle and includes good nutritious food in their diet.
Midwives and health professionals want to help women who are thinking about having children change their lifestyle before conception, but equally help women make the healthy changes during pregnancy to instil these changes for life. Not only will this help significantly during labour but it will encourage positivity and relaxation, promote bonding and reduce depression in the postpartum period.
Exercise in pregnancy is associated with higher aerobic fitness levels, which when you think about it is only going to help you succeed in the tiring physical activity of labour and childbirth. Furthermore, during pregnancy there is a prevention of lower back pain, urinary incontinence, a control of weight gain and a reduction in symptoms of depression and low mood. For women who have been diagnosed with gestational diabetes exercise can prevent the need for insulin by controlling blood glucose levels if a healthy diet is also followed. A reduction in high blood pressure or pre eclampsia is associated and significant blood loss after birth decreased. Benefits to the baby include decreased fat mass, improved stress tolerance, advanced neurobehavioural maturation and decreased childhood obesity. The benefits are endless, physically and psychologically.
As always there are risks associated with exerting yourself during pregnancy and I would advise anybody to discuss it with their midwife and a perinatal qualified personal trainer. If you have low or indeed high blood pressure, a low lying placenta or any other risk factors that may make your pregnancy ‘high risk’ I would not recommend you do any high intensity exercise, however there is always something that everyone can do, you just need the correct guidance.
The benefits of exercise to pregnancy and labour are vast. If you think physiologically, our core, which is all of the muscles around our stomach and back are responsible for all the rotation and flexion of our spine. These muscles originate on either the pelvis or the spinal column and are intimately connected to the muscles of the hip and back and are critical to the proper functioning of both. Add a good few extra kilograms i.e a growing pregnancy bump, a weight that is predominantly carried on the front of your stomach and it will ultimately add strain on your back. The extra flexibility of the hip and surrounding ligaments in joints from an increase in oestrogen during pregnancy all puts extra pressure on the abdominal muscles and pelvic floor. Then, well you get the idea, we now instantly can see why many women have SPD (symphasis pubic dysfunction) and back pain, let alone a hard time just getting out of bed in the morning during those last few weeks!
Pilates, pregnancy yoga, strength training, jogging or fast paced walks all contribute to building that core strength as well as working on fitness levels. We essential do a sit up every time we get out of bed! The importance of core stability and strength is often overlooked, however with the correct input from a personal trainer, a women who has been partaking in regular exercise may find it easier to cope with the pregnancy weight gain aches and pains, dramatically improve their pelvic floor strength and will ultimately be fitter, stronger, healthier and more prepared for labour, birth and postpartum recovery of the abdominal muscles, pelvic floor and core post baby.
There are plenty of pregnancy and postpartum trained personal trainers, pregnancy yoga and baby friendly classes after a quick Google search and I’m really pleased to see it becoming more popular and widely available. People are beginning to understand the importance of health and wellbeing, particularly during pregnancy and the postpartum period. Catherine Jasat, one of Cheltenham’s antenatal and postpartum personal trainers (PT), has trained many pregnant women, many right up to their due date. She says they all maintained, or increased, their core strength, pelvic stability, strength and cardiovascular fitness. The exercise programmes that she plans as a qualified PT enables women to avoid or reduce common problems and gives them the strength and fitness to endure labour for as long as they need to, without becoming as exhausted as an unfit woman may. She understands how hard it is to labour actively if you can’t even go up the stairs without getting out of breath! Catherine tells me so far, 100% of the women she has trained have had straightforward pregnancies and uncomplicated vaginal deliveries. She really believes that pregnant women should be encouraged to exercise, even if they didn’t before they became pregnant and states that she sees the overwhelmingly positive advantages and changes in these women’s physical and mental health. Surely these positive, motivational stories are the ones we want to hear as new mums to be?!
So what exercise can’t you do in pregnancy? Choose activities that minimise the risk of loss of balance. No contact sports, no exercises where you must lie flat for long periods of time or exercises that put pressure on your stomach i.e the dreaded burpees. No exercise that is deemed unsafe or at high altitude i.e climbing, or anything where you are pushing your heart rate to its maximum level for extended periods of time, although studies do state you can safely exert yourself up to 95% maximum heart rate for short periods of time. Reasonable goals of aerobic conditioning should be to maintain a good fitness level throughout pregnancy without trying to reach your peak.
There is, perhaps most importantly, a significant decrease in postnatal depression and anxiety that has been found with active lifestyles. As we know exercise is very good for our mental health as we stimulate the brain and produce lots of happy hormones, which act as an antidepressant. However, it can also be a great way for mothers who have recently had a baby to step forward into a routine of getting out of the house, socialising and not ‘just being mum’. Many studies have found women can feel quite lonely and sometimes isolated whilst on maternity leave which can increase the risk of postnatal depression and low self esteem after having a baby. It is also great to know, exercise during lactation does not affect the quantity or composition of breast milk or impact the growth of the baby. Furthermore, statistics have shown an increase in continuation of breastfeeding by women with active lifestyles. Mental health is becoming a bigger issue within maternity and it is essential that women are supported by family, friends and healthcare providers, to maintain a level of physical exercise throughout this period.
So to summarise, exercise is beneficial for women during pregnancy and also in the postpartum period. It is not associated with risks for the newborn and can lead to changes in lifestyle that imply long-term benefits to the whole family. Tackling the UK’s problem with obesity and setting a good role model to our children begins with pregnancy! So get out there mums to be. Exercise in pregnancy. Do we do it? YES we do!
A Guest Blog from Oli Jeacock
Oli is a busy Mum and NHS and private midwife. She is also charity trustee of ‘The African Maternity Link’. Improving birth outcomes through education and training in Sierra Leone. www.theafricanmaternitylink.co.uk. On Instagram and Facebook.