PRE/POST NATAL INFO

 

Cycling and Pregnancy --Taking cycling classes during your pregnancy is safe, as long as you follow certain precautions.

Yoga and Pregnancy --Yoga physically, mentally and emotionally prepares one for the birth.

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General Exercise and Pregnancy

Below are guidelines and recommendations currently sanctioned by the American College of Obstetrics and Gynecologists (ACOG). 

• Regular, moderate intensity and duration exercise sessions are preferable.
• 20 min at a moderately hard to hard level of perceived exertion has been found safe for most healthy women.
• Recommended exercises include stretching, stationary cycling, swimming, and walking. Other types are either contraindicated or require modification. Evidence indicates that exercise of various types is tolerated well by women and their babies throughout pre and postnatal. Although there are specific dos and don’ts that apply there is no logical reason to change your approach to exercise because you are pregnant.
• Avoid jerky, bouncy, and wide range of motion movements and exercises that involve straining, jumping, or sudden changes in direction.
• Don’t exercise lying on the back after the fourth month.  Though extremely rare, lying stil longer than 5 min., under the weight of the womb can compress and block the large vein that returns blood to the heart. As long as the legs and torso are moving, there should not be a problem unless you get dizzy or the fetal heart rate is abnormal. Standing still causes the same problem more often than lying still. If one of these problems occurs, turn onto your left side until the symptoms subside.
• Five-minute periods of warm-up and cool-down stretching are recommended, but don’t stretch to the point of maximum resistance--due to release of the hormone Relaxin that causes joint instability until 6 weeks postpartum.
• Women with sedentary lifestyles should begin with short-duration, low-intensity activity and increase gradually.
• Stop exercise when fatigued. This is often the case in early pregnancy and immediately after giving birth. However, this response may be the result of other life stress and not the exercise. Practice rest-activity cycling. (Rest one hour for each hour of exercise).
• Stop and consult a physician if any unusual symptoms occur.
• Increase caloric intake to cover the demands of exercise.  Pay attention to eating habits to avoid low blood sugar. Have a healthy snack 15-20 min. before exercise and every 3 hours or so eat small quantities of foods such as; fruits, peas, beans, salads, pastas, nuts, whole grain breads. Avoid processed types of starches such as cereal, white bread, donuts, French fries, chips, popcorn, cakes, cookies and most other snack foods which can actually cause the blood sugar to fall rapidly about an hour after eating. This is not good for the baby and also makes most women hungrier so they end up eating more than they should.
• Drink fluids liberally before, during, and after exercise.
• Avoid environments with excessive heat and humidity. Most health care professionals recommend staying away from hot tubs, saunas and steam baths in early pregnancy. If it is less than 100.4 degrees Fahrenheit then it is probably OK to continue.

Use a Rating of Perceived Exertion Scale rather than heart rate to accurately monitor exercise intensity.  

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Benefits of Exercise

Current information indicates that fit women who continue to perform weight-bearing exercise throughout pregnancy and lactation at or above 50% of their pre pregnancy levels gain less weight; deposit and retain less fat; feel better; have less physical discomforts; lose postpartum weight quicker; less likely to incur varicose veins; do not increase the risk of exercise-related injuries; have shorter, less complicated labors; and recover more rapidly than women who either stop or don’t exercise. In addition, there have been no identifiable maternal ill effects from either early resumption of exercise after birth or exercise during pregnancy such as membrane rupture or pre term labor (it may actually decrease the chances of pre term labor) even if she exercises more during pregnancy than she did before she got pregnant. Furthermore, this appears to be true for many exercise modes, including running, many types of aerobics, cross country skiing, stair stepping, swimming, biking and circuit training.

Studies also indicate that regular exercise offsets the effects of pregnancy on lax ligaments, improves strength, maintains muscle tone, and reduces the incidence of low back pain and other musculoskeletal complaints. It also minimizes the inevitable upward and outward shift in a woman’s center of gravity as her uterus grows and protrudes, by maintaining back strength, good posture, and abdominal muscle tone.

The placenta of a woman who exercises grows much faster than the placenta of a woman who doesn’t. This produces a protective effect that reduces fetal risk if complications develop late in pregnancy. Studies show that babies born to women who exercise throughout their pregnancy have leaner babies without decreasing overall growth. Exercise during pregnancy may actually decrease the chances of giving birth to a very small baby. Also, newborns of women who exercise don’t have trouble with the transition to life outside the uterus and tend to be alert and easy to care for. They respond readily to things in their environment, self-quiet when they are disturbed and need much less consolation from others.

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Strengthen Your Pelvic Floor Muscles

The pubococcygeus muscles, which make up the pelvic floor have several important roles and can experience dysfunction during or following pregnancy (i.e. urinary incontinence, sexual performance, and spinal stabilization). Pelvic floor muscle exercise (PFME), often referred to as Kegels, have been advocated for decades to improve recovery of the pubococcygeus muscles following pregnancy. Interestingly, very few women actually practice them regularly if at all.

A recent study reported that 24% of pregnant women report urinary incontinence, yet only 17% utilize Kegel exercises regularly. So, why don’t more women using Kegels as a preventive strategy pre- and post-pregnancy?

Some researchers and doctors have questioned their effectiveness. However, a study published this month in the journal Clinics reported that women who performed regular Kegel exercises during pregnancy, regardless of dysfunction, did in fact improve the strength of their pelvic floor muscles 47.4% vs. 17.3% in controls.

The answer to the lack of PFME practice may not be physiological or mechanical, but educational. A recent study reported that only 64% of pregnant women surveyed were taught PFME. Of note, a high percent of those taught PFME continued to practice the exercises after delivery (68%) and 6 months later (63%).

This research presents a great opportunity for maternity fitness programs that include the education and practice of PMFE.

Your pelvic floor muscles comprise several layers of muscle attached to the front, back and sides of your pelvic bone. Along with other tissues, these muscles work like a hammock to support your pelvic organs, including your uterus, bladder, small intestine and rectum.

 

How to do Kegel exercises

It may take diligence to identify your pelvic floor muscles and learn how to contract and relax them. Here are some pointers:

Find the right muscles
To make sure you know how to contract your pelvic floor muscles, try to stop the flow of urine while you're going to the bathroom. If you succeed, you've got the basic move. Or try another technique: Insert a finger inside your vagina and try to squeeze the surrounding muscles. You should be able to feel your vagina tighten and your pelvic floor move upward. Then relax your muscles and feel your pelvic floor move down to the starting position. As your muscles become stronger — and you become more experienced with the exercises — this movement will be more pronounced.

A cautionary note: Don't make a habit of starting and stopping your urine stream. Doing Kegel exercises with a full bladder or while emptying your bladder can actually weaken the muscles. It can also lead to incomplete emptying of the bladder, which increases your risk of a urinary tract infection.

If you're having trouble finding the right muscles, don't be embarrassed to ask your doctor for help. He or she can provide important feedback so that you learn to isolate and exercise the correct muscles.

Perfect your technique
Once you've identified your pelvic floor muscles, empty your bladder and get into a sitting or standing position. Then firmly tense your pelvic floor muscles. Try it at frequent intervals for five seconds at a time, four or five times in a row. Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions.

Be careful not to flex the muscles in your abdomen, thighs or buttocks. To get the maximum benefit, focus on tightening only your pelvic floor muscles. Also, try not to hold your breath. Just relax, breathe freely and focus on tightening the muscles around your vagina and rectum.

Repeat three times a day
Perform a set of 10 Kegel exercises at least three times a day. The exercises will get easier the more often you do them. You might make a practice of fitting in a set every time you do a routine task, such as checking e-mail or commuting to work.

You can also vary your technique. Try doing sets of mini-Kegels. Count quickly to 10 or 20, contracting and relaxing your pelvic floor muscles each time you say a number. Or slow it down, gradually contracting and releasing your pelvic floor muscles one time. As you contract, visualize an elevator traveling up four floors. At each floor, contract your muscles a little more until you reach maximum contraction at the fourth floor. Hold the contraction and then slowly release the tension as you visualize the elevator traveling back down. Repeat 10 times.

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Contraindications for Prenatal Exercise

The contraindications to exercise for a healthy woman should be no different during pre or postpartum than they are during other times in her life. Pregnancy is a normal physiologic state, not a disease, and the benefits of exercise appear to be substantial for both the woman and the pregnancy. A healthy woman should be able to continue her exercise regimen throughout early pregnancy without specifically seeking medical advice unless she develops a significant physical injury, an acute bout of illness or chronic underlying disease, persistent or recurrent localized pain, and abnormal or heavy vaginal bleeding. Although this often turns out to be unrelated to the exercise, it is a warning sign that should not be ignored, as it often is the first sign of previously unrecognized disease.

Absolute Contraindications:

• Pregnancy-induced hypertension
• Ruptured membranes (Water breaks)
• Premature labor
• Persistent bleeding after 12 weeks
• A cervix that dilates ahead of schedule
• Poor fetal growth
• Multiple-birth pregnancy
• Placental disease
• A history of 3 or more miscarriages or a history of premature labor

Relative Contraindications:

• History of poor fetal growth
• History of rapid labors                                          
• Early pregnancy bleeding
• Extreme overweight/underweight
• Breech presentation after 28 weeks
• Palpitations or arrhythmia
• Anemia
• In mid and late pregnancy, a fall in the baby’s heart rate or no kicking for 30 minutes after exercise are two valuable warning signs. Exercise should not be resumed until your doctor advises.
• Avoid exercising to exhaustion.
• Diastsis Recti (slight separation of the linea alba in the rectus abdominus muscle) can sometimes occur. Consider options such as pelvic tilt and pelvic stability movements.

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Postpartum Contraindications

Absolute Contraindications during the first 6 weeks after birth:

• Bleeding (Bright red bleeding that persists for several hours.)
• Pain
• Infection (Lots of motion can spread infection whether in the breast, womb, incision or other site.)
• All of the above require a doctor’s care.

Relative Contraindications:

• Cesarean birth or traumatic vaginal birth: Some women start back as early as 2 weeks. The deciding factor is pain. If it hurts, stop, and if it feels good, it’s probably OK.
• Breast discomfort: If you’re engorged, don’t exercise. If not, more support will probably help with breast discomfort.
• Heavy urine leakage or pelvic pressure during exercise: Some leakage and pressure are normal at this time. However, if the leakage is heavy or lasts longer than a couple weeks, consult your doctor. The same is true for pelvic pressure.
• Some doctors advise against swimming for several weeks after birth, due to possible increased risk of infection until healing is complete.

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Beginning Exercisers:

Ideally, an exercise regimen should begin 6 weeks or more prior to getting pregnant so your body is used to the exercise before it has to deal with the pregnancy. If you’re already pregnant, begin at a level that involves no more than 3 20-min. sessions/ week at a moderate level of perceived exertion and keep it there until early pregnancy is over. Combine a weight-bearing exercise you enjoy and can continue for a minimum of 20 min. (running, uphill treadmill walking, aerobics, or stair climbing) with stretching exercises and light strength training to improve endurance, flexibility and strength. Avoid doing too much too soon.

Recreational Exercisers:

A combined exercise program is also recommended for the recreational athlete including endurance, strength, and flexibility components. Your current exercise regimen should be maintained with an emphasis on improving upper body strength. Weight loads, reps and sets should be maintained until later in pregnancy (10-12 weeks). Stretching should continue as well. There is no reason to exclude any stretching position including those performed on the back. While current guidelines recommend avoiding maximal extensions during pregnancy, there is no objective evidence that it is harmful or increases the incidence of dislocation. 

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Early Pregnancy:

Continuing regular, vigorous exercise throughout early pregnancy does not increase the incidence of ectopic or tubal pregnancy, miscarriage, birth defects, or abnormal development of the placenta. Women can continue their regular exercise program and maintain or improve their fitness level throughout early pregnancy. Beginning an exercise program at this time should be safe as long as the effort is moderate and the duration of each session is limited to 20-30 minutes 3-5 times/week.

Mid and Late Pregnancy:

Continue floor exercises, stretching, and weight training. Late in pregnancy appropriate support of the abdomen and breasts during exercise makes all the difference. For abdominal comfort, the key is upward lift and mild compression on the lower abdomen, which lifts the womb off the pelvic bones and stabilizes it. There are several commercial belts available at most stores specializing in maternity apparel. The key to stabilizing the breasts is compression, not lift. Wearing 2 athletic bras helps. In that’s not enough, try wrapping an Ace bandage around the chest, over the first but under the second.

Postpartum:

Many active women resume exercise within 2 weeks after the birth of their babies but the ACOG recommends not resuming full daily activities for a minimum of 6 weeks. The general consensus is that if is doesn’t hurt or cause heavy bleeding, it’s OK based on your doctor’s recommendation. The rule is start early and increase slowly. Ultimately, in the areas of weight loss and abdominal tone, it takes most active women between 6 months and one year to return to their pre pregnancy state.

In the first 6 weeks postpartum:

• Exercise 3 or more times/week (5 times/week is ideal)
• There should be no exercise-associated pain or heavy bleeding.
• Fluid intake should be high.
• Adequate rest is a must.
• Continue to support and stabilize the breasts and abdomen.
• Don’t overdo at first. 

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Breastfeeding:

Regular, vigorous, aerobic exercise at moderate to high intensity does not alter the quality or quantity of breast milk. However, extremely intense anaerobic exercise occasionally alters the taste. An option is to express milk before exercise. A woman can breast-feed, exercise, and diet, but she should limit caloric restriction and rate of weight loss. Women who reduce their caloric intake to less than 1500 calories/day may experience a decrease in milk production, and infant weight gain may decrease as well. Women who wish to combine exercise with breast-feeding to avoid volume depletion and poor performance, must drink adequate quantities of fluid at regular intervals throughout the day.

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Mommy's Coach

Expectant or new moms who need help learning how to get organized and stay motivated in the areas of food organization, family communications, baby planning, and time for yourself may benefit from a Mommy's Coach.

Carrie Vawter-Yousfi is a member of 24 Hour Fitness and a Mommy's Coach. She can help women become the best Mommy they can be by coaching them on how to manage the dynamics of a changing family that your baby brings or embrace motherhood for the very first time. Carrie offers parent workshops and one on one coaching services that teach you how to take the boredom out of routine by creating weekly habits to apply to your household.  Let her show you how to run your home like a business but with TLC.

Visit Carrie's website at www.coach4mommy.com for more information.

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