Exercise is an integral part of a healthy lifestyle. It helps prevent disease, is important for healthy bones and can help reduce stress, manage fatigue and leads to a better overall quality of life. This is even more important when you are pregnant and when there is a newborn to care for.

Pregnancy and childbirth have a major impact on a woman’s body, both internally and externally. A guided exercise program can help cope with these changes as well as aid recovery and prevent issues further down the track.

During pregnancy, every system is affected, including respiratory, cardiac/circulatory, hormonal, biomechanical and musculoskeletal. This can lead to feelings of shortness of breath, tiredness, swelling, varicose veins, postural changes and issues such as lower back pain, pelvic joint pain, carpal tunnel symptoms, rectus diastasis (separation of the abdominal muscles) and urinary incontinence.

During childbirth, there is further stress on the body, particularly to the core stability system. The pelvic floor and muscles of the abdominal wall are all stretched during the pregnancy. Pelvic floor muscles are further stretched and can also be torn during vaginal childbirth. During a caesarian-section, the abdominal muscles are cut and need to heal and be re-trained. Tearing of the pelvic floor muscles are graded and can have different implications for the treatment depending on the extent and what is involved.

Following the birth, the body needs time to heal, to be in the best shape to care for the newborn baby and everything that comes with it. The core stability muscles need time to heal and recover and be re-trained. Some recommendations to help reduce stress on the body and manage/prevent issues such as back pain for everyday activities include:

1. Re-training transversus abdominus (deepest abdominal layer).
   This is important for stability and control. It is especially important to protect our back and keep our body stable to be able to move efficiently. It works with the pelvic floor and to prevent issues like back pain down the track. It is important to protect any separation of the abdominal muscles from separating further and allow it to heal. For this reason, heavy abdominal exercises should not be commenced until the transversus abdominus is strong enough to control them.

2. Re-training the pelvic floor.
   These muscles also assist in back support. They also have a major role in maintaining continence. They are weakened during pregnancy and without specific strengthening, they stay weak and can cause issues e.g. incontinence or prolapse now or in the future.

3. Moving properly
   1. Lifting well, bending through the knees, bring the load close to your body and use leg muscles to stand. Maintain a neutral spine.
   2. Feeding in a good position sitting on a kitchen chair as opposed to a lounge, placing a small pillow in the curve of your lower back for support, Build some pillows up on armrest/your lap to bring your baby to you rather than you coming down to the baby.
   3. Maintaining neutral spine
   4. Avoiding positions/movements that put too much pressure through the pelvis

4. Asymmetrical movements e.g. lunge positions, standing on one leg.

5. Rolling in bed as a log.

6. Place pillow between knees for sleeping/moving in bed.
   
7. Getting in/out of bed through the side.

8. Take help when it is offered.
   Just realising that your body has been through a lot and needs time to recover. This time is not always easy to come by with a newborn baby.

For most people, exercise is encouraged during pregnancy with some guidelines. However, there are some risks that can affect mother and baby and these are higher in some women. Therefore it is important to have Dr’s approval before embarking on an exercise program.

Recommendations for exercising during pregnancy include:

• Moderate Intensity due to the cardiac changes the body is already in an exercised state, therefore you don’t want to increase heart rate too much.
• Keep cool avoid hot, humid conditions, wear loose clothing, stand near fan or air-conditioner if in the gym. As baby is not able to regulate temperature.
• Stay hydrated drink lots of water even if swimming.
• Warm-up and cool-down well Due to circulatory changes need to warm-up and cool-down to avoid blood pooling and leg cramps.
• Avoid breastroke, single leg exercises, wide lunge/stance positions as this can put extra stress on pelvis.
• Avoid exercising on back after approximately 12-16 weeks as the baby in the uterus can put pressure on one of the major veins of the body and reduce blood flow.
• Activate pelvic floor muscles during all exercises to keep as strong as possible, during the later stages may be harder to feel.
• Stop if feeling dizzy, nausea, if vaginal bleeding or leakage amniotic fluid.

Pilates is a great way to exercise during and after pregnancy, as it is targeted toward retraining the internal support muscle system and improving posture. The exercises can be modified and the intensity is ideal. By getting the muscles working, it can also help pump fluid around the system and give circulation a boost to help with swelling.

If you are encountering any issues during your pregnancy or are not sure whether activating right muscles while training pelvic floor or transversus abdominus, please don’t hesitate to contact your doctor or physiotherapist.

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