IN the recent past there were concerns about the safety of exercising while pregnant.  In fact, it wasn’t that long ago that the advice to expecting mothers was to sit back and rest for fear of losing their babies.

This seems a bit odd to me, when you consider that our predecessors lived much more physically active lives than we, and yet managed to reproduce just fine, or we wouldn’t be here to talk about it! 

Unfortunately, I find that there are still some care providers today that are advising healthy pregnant women to sit still and take it easy.  In fact, I often am contacted by women, who are seven months or more along; time and again, they ask,

 “Is it okay to walk during my last trimester?”

My reply (after confirming that she hasn’t had any problems during her pregnancy) is always,

“ABSOLUTELY!  In fact you better start walking if you want to have a natural birth.  You’re going to need the stamina, not to mention the benefit of limbering your joints and opening the inlet of the pelvis so that the baby can easily engage!”

 Fortunately, care providers who heed the scientific evidence advise activity during pregnancy.  Sadly they are frequently met with resistance from women who have been influenced by their mother’s generation (the ones who were told to sit still). 

This often results in sedentary women who are much more prone to muscle deterioration, build up of unhealthy fat, gestational diabetes, and pregnancy induced hypertension and toxemia.  These are women who often times truly need to be “delivered” of their babies by medical interventions, rather than enjoying a fully natural birth experience of their own will and strength.

What does the evidence say? 

In Varney’s Midwifery (4^th Edition, pages 200-201) there is much research evaluated with regards to exercise during pregnancy.  Based on review of the scientific evidence they state:

“There is no evidence that exercise contributes to congenital anomalies, spontaneous abortion, abruption placentae, intrauterine growth restriction (IUGR), pregnancy-induced hypertension (PIH), or fetal demise.  Rather, there may be a slight protective factor for some of these conditions.”

“Evidence also suggests that heart rate abnormalities, cord entanglement, and the presence of meconium [fetal bowel movement in the womb, which may be considered a sign of stress on the baby] are significantly reduced for babies of exercising women.”

“Those who engage in vigorous exercise require less intervention in labor – including a substantially decreased rate of cesarean birth – and may have shorter…labor than nonexcercisers.”

“…sedentary women were 4.5 times as likely as exercising mothers to deliver by cesarean.”

What are current recommendations? 

Holistic Midwifery:  Care During Pregnancy (Volume 1, pages 262-265) presents the current exercise recommendations by the American College of Obstetricians and Gynecologists.  In summary it says:

1. After the first trimester, avoid lying on the back.

2. Avoid long periods of sitting still.

3. Be aware of changing center of balance.

4. Avoid any activity that may cause abdominal trauma.

5. Avoid the Valsalva maneuver (holding the breath and bearing down).

6. Caloric intake must meet demands of the activity as well as the pregnancy.

7. Drink plenty of water while exercising and don’t become overheated and be aware of increasing need for salt intake to compensate for sodium loss via sweating.

The Royal College of Obstetricians and Gynaecologists recommends: http://www.rcog.org.uk/womens-health/clinical-guidance/exercise-pregnancy

• All women should be encouraged to participate in aerobic and strength-conditioning exercise as part of a healthy lifestyle during their pregnancy.

• Reasonable goals of aerobic conditioning in pregnancy should be to maintain a good fitness level throughout pregnancy without trying to reach peak fitness level or train for athletic competition.

• Women should choose activities that will minimise the risk of loss of balance and fetal trauma.

• Women should be advised that adverse pregnancy or neonatal outcomes are not increased for exercising women.

• Initiation of pelvic floor exercises in the immediate postpartum period may reduce the risk of future urinary incontinence (See Lifelong Pregnancy Exercise).

• Women should be advised that moderate exercise during lactation does not affect the quantity or composition of breast milk or impact on fetal growth.

Benefits of Exercise to the Placenta*

I find it particularly interesting that women who exercise prior to conception and continue throughout their pregnancy, (as well as those who initiate an exercise regimen within the first 6 to 8 weeks of pregnancy when the placenta is forming), have healthier, better functioning placentas. 

In fact, in Varney’s Midwifery (4^th Edition, pages 193-201) the scientific evidence is summarized and it states:

“…favorable changes in…placental function [along with maternal adaptations to exercise], augment [enhance] oxygen and nutrition delivery in a healthy pregnant woman who continues exercising throughout her pregnancy.”

It would stand to reason that the better functioning of the placenta would increase the baby’s ability to withstand labor and would therefore result in less incidence of fetal distress (a common reason cited for emergency cesarean delivery).

Safety First

Pregnant women should always consult with their care providers before starting an exercise program.  Safety is obviously the first priority.  Things to consider (adapted from Varney’s Midwifery):

1) In the first trimester, fatigue and nausea may slow women down.  Women should be warned about the effects of deconditioning (the muscles quickly deteriorate with inactivity) and resume exercise slowly and cautiously.

2) Although not required, an exercise instructor who is trained in prenatal fitness will be able to provide advice about appropriate activity during pregnancy. Joining an instructor-led prenatal exercise group provides guidance regarding the exercise routine, motivation to keep going, and important social interaction for expectant mothers.

3) Mothers should be aware of warning signs, such as swelling of the face and hands, over exertion, over heating, fatigue, or anything else that just doesn’t seem “right.” Exercise in pregnancy should never be painful or hurt.

4) An inactive woman should be discouraged from starting a vigorous exercise routine after 26 weeks, as the lack of exercise in the first two trimesters results in the lack of fetal enhancements (noted above in “Benefits of Exercise to the Placenta”) that protects the fetus in the third trimester.

5) Walking, swimming, Kegels (See Lifelong Pregnancy Exercise), and pelvic rocks are always suitable unless there are specific contraindications.

6) Women should avoid sports that are dangerous due to impact (soccer, football, squash, etc.).  She can still practice on her own so she doesn’t lose range of motion or coordination, or with a partner willing to be noncompetitive and only practice for the sake of the workout.

Conclusion

Pregnancy is not a condition of illness, but rather a very healthy and normal period in a woman’s lifecycle.  To treat an otherwise healthy woman as fragile or incapable of moving during this time is really a disservice to her and her baby.  In closing I’d like to address all my mama readers, “Get off your computer and get moving!”

 *The placenta is an organ that connects the developing baby to the wall of the mother’s womb via the umbilical cord.  It allows nutrient uptake, waste elimination, and gas exchange via the mothers blood.  For more about this amazing organ, see the “Blood Doesn’t Mix” section of Blood Pregnancy and Nutrition.

 ©2012 aisha_alhajjar@yahoo.com, All Rights Reserved  (All writings are the original work of Aisha Al Hajjar and are based on her personal research, experiences, and opinions; they do not necessarily reflect the views of any organization or this publication.)