This post is adapted from the 3/17/11 DTP Blog on Preg­nancy Exer­cise Safety. For more evidence-based infor­ma­tion on Pre/postnatal Health & Fit­ness, check out the DTP Blog. The Blog includes infor­ma­tion start­ing prior to con­cep­tion and con­tin­u­ing through post­par­tum and mom-baby fitness.

There are three sec­tions to this post: 1) moms-to-be, 2) preg­nancy fit­ness teach­ers and per­sonal train­ers and 3) some spe­cific con­traindi­cated and adapted exer­cises. All infor­ma­tion pre­sented is based on peer-review research and evi­dence col­lected over a 30 year period of work­ing with this pop­u­la­tion. More infor­ma­tion on safety can be found on this site on the page Ben­e­fits, Safety & Guide­lines.

1) Safety & Exer­cise Guide­lines for Moms-To-Be

First and fore­most, be safe. Trust your body. Make sure your teacher or trainer is cer­ti­fied by an estab­lished orga­ni­za­tion that spe­cial­izes in pre/postnatal exer­cise, has worked under mas­ter teach­ers dur­ing her prepa­ra­tion, and can answer or get answers to your questions.

These are the safety prin­ci­ples that we sug­gest to our participants:

• get proper screen­ing from your health care provider
• pro­tect yourself
• do not over­reach your abilities
• you are respon­si­ble for your body (and its contents)

Squat­ting is an exam­ple of a stan­dard preg­nancy exer­cise used for child­birth prepa­ra­tion that must be adapted by each indi­vid­ual based on body pro­por­tions, flex­i­bil­ity, strength and comfort.

Don’t assume that because your teacher and some par­tic­i­pants can do a cer­tain move­ment or posi­tion that you should be able to do it just like they do. If your teacher is well trained, she will be able to help you select vari­a­tions that are appro­pri­ate for your body.

When you are exer­cis­ing, make sure you are get­ting the most from your activ­ity. Keep these find­ings in mind when choos­ing your work­out routine:

• Aer­o­bics and strength train­ing pro­vide the great­est health ben­e­fits, reduce the risk for some inter­ven­tions in labor, help shorten labor, and reduce recov­ery time
• Cen­ter­ing helps to pre­vent injury; relax­ation and deep breath­ing reduce stress; and mild stretch­ing can relieve some discomforts
• Avoid fatigue and over-training; do reg­u­lar exer­cise 3 — 5 times a week
• Eat small meals many times a day (200–300 calo­ries every 2–3 hours
• Drink at least 8 cups of water every day
• Avoid hot, humid places
• Wear good shoes dur­ing aer­o­bic activities
• BE CAREFUL! LISTEN TO YOUR BODY!

If you expe­ri­ence any of the fol­low­ing symp­toms, stop exer­cis­ing and call your health care provider:

• Sud­den pelvic or vagi­nal pain
• Exces­sive fatigue
• Dizzi­ness or short­ness of breath
• Leak­ing fluid or bleed­ing from the vagina
• Reg­u­lar con­trac­tions, 4 or more per hour
• Increased heart­beat while resting
• Sud­den abnor­mal decrease in fetal move­ment (note: it is com­pletely nor­mal for baby’s move­ments to decrease slightly dur­ing exercise)

2) Safety & Exer­cise Guide­lines for Teach­ers & Trainers

A prin­ci­ple of prac­tice that increases in impor­tance for fit­ness pro­fes­sion­als work­ing with preg­nant women is hav­ing the knowl­edge and skills to artic­u­late the ratio­nale and safety guide­lines for every move­ment she asks clients to perform.

This goal requires adher­ence to safety as the num­ber one pri­or­ity. Here is how we delin­eate safety and the pro­ce­dures we require of our instruc­tors for achiev­ing safety in practice:

First pri­or­ity: safety [First, do no harm]

• some­times med­ical con­di­tions pre­clude exercise
• find an appro­pri­ate start­ing point for each individual
• indi­vid­ual tol­er­ances affect modification
• gen­eral safety guide­lines are physical
• preg­nant women also need psy­cho­log­i­cal safety

Mind-Body Safety Procedures

• Cen­ter­ing enhances move­ment effi­ciency and safety.
• Always begin with centering.

Strength Train­ing Cautions

• avoid Val­salva maneuver
• avoid free weights after mid preg­nancy (open chain; con­trol issue)
• avoid supine after 1st trimester
• avoid semi-recumbent 3rd trimester
• keep in mind the com­mon joint dis­place­ments, and nerve and blood ves­sel entrap­ment when design­ing spe­cific exercises

Aer­o­bics or Car­dio­vas­cu­lar Con­di­tion­ing Procedures

• Mon­i­tor for safety
• Instruc­tional style needs to be appropriate.
• Walk­ing steps with nat­ural ges­tures can be done through­out pregnancy
• Vig­or­ous steps with large ges­tures are more intense, appro­pri­ate as fit­ness increases
• The abil­ity to cre­ate move­ment that will be safe and work for var­i­ous lev­els of fit­ness and at dif­fer­ent points in preg­nancy is one of the most crit­i­cal skills for preg­nancy fit­ness instructors.

Venue Safety

• Set­ting should pro­vide phys­i­cal and emo­tional safety
  Equip­ment must be well-maintained

3) Con­traindi­cated and adapted exercises

Exer­cises for which case stud­ies and research have shown that there are seri­ous med­ical issues include the “down dog” posi­tion, rest­ing on the back after the 4th month, and abdom­i­nal crunches and oblique exer­cises. Here is more infor­ma­tion and adap­ta­tion suggestions:

Con­traindi­cated: “Down Dog” requires that the pelvic floor and vagi­nal area are quite stretched, bring­ing porous blood ves­sels at the sur­face of the vagina close to air. There are records of air enter­ing the vagi­nal blood ves­sels in this posi­tion and mov­ing to the heart as a fatal air embolism.

Adap­ta­tion: Use the child’s pose, with the seat down rest­ing on the heels and the elbows on the ground, hands one on top of the other, and fore­head rest­ing on the hands. Keep the heart above the pelvis.

_________

Con­traindi­cated: Rest­ing on the back dur­ing relaxation.

Adap­ta­tion: Rest in the side-lying posi­tion. About 75% pre­fer the left side, 25% pre­fer the right side.

_________

Con­traindi­cated: Abdom­i­nal crunches and oblique exer­cises can con­tribute to dias­ta­sis recti in some women. The trans­verse abdom­i­nal mus­cle is not always able to main­tain ver­ti­cal integrity at the linea alba, and thus there is tear­ing and/or plas­tic­ity of that cen­tral con­nec­tive tissue.

Adap­ta­tion: Splint­ing with curl-downs, see posi­tions below. By press­ing the sides of the abdomen toward the cen­ter, women can con­tinue to strengthen the trans­verse abdom­i­nals with­out the shear­ing forces that place lat­eral pres­sure on the linea alba.

Curl-downs are gen­er­ally the safest and most effec­tive abdom­i­nal stren­then­ing exercise.

Splint by cross­ing arms and pulling toward cen­ter (L)

Or, splint by plac­ing hands at sides and press­ing toward center ®