When should I stop my normal pre-pregnancy exercise routine?

We get a lot of emails from pregnant ladies who are worried about losing their fitness whilst pregnant. They have been working out and love their current exercise routine but obviously want to look after the baby too. Well the best way to look after baby and yourself is to keep exercising but modify as you progress through pregnancy.

Years ago, the advice was for pregnancy ladies to stop all exercise and to pretty much go on bed rest. Then this changed to a focus on only low impact exercise. However now we know from the recent research that exercise in pregnancy is a good thing, but that pregnant ladies tend to reduce their exercise. In the first trimester the advice is that you shouldn’t take up a NEW form of exercise, but this seems to sometime get misconstrued into “I must not exercise”. What this advice actually means is “Keep doing your normal exercise routine as much as you can/feel ok to do so”. Of course the nausea, tiredness and  pregnancy hormones may mean you find exercising harder than normal, but some ladies do find doing exercise can help them through this trimester. 

A study on over 1,000 pregnant ladies showed the rate pf physical activity was lower in pregnancy (20.1%) and that less than half received exercise advice in pregnancy (47.4%). Yes, when you are pregnant it is absolutely important to look after the baby, but part of that is looking after your own body so it is strong, fit and able to cope with not just the demands of pregnancy but of being a mum. Carrying, lifting, feeding, rocking and crawling after a small person is pretty tough on the body.

So can you continue your normal exercise routine? Yes to an extent. You will need to seek advice and modify some things. I was teaching spin until 7 months pregnant with my first baby and I taught Step Aerobics until 2 days before baby 1 and 1 week before baby 2. Through my 3rd pregnancy daily Pilates and functional work kept me strong and sane. Maybe surprisingly (or not) doing more Pilates and functional work lead to the pregnancy with the least aches and complications and a simple homebirth. So I’m not saying that you need to be running or cross-fitting your way through pregnancy, but that many forms of exercise can be adapted for you to continue whilst pregnant.

I have ladies who have run through pregnancy, who have continued to lift weights and to do modified cross fit. For all these ladies they have naturally tapered their levels of impact and exertion down as needed. Running may become a slow job with some walking, weights can be lighter and the range of movement smaller, cross fit moves can have some of the impact taken out.

All exercise needs to have a strong core as a foundation, this is even more important in pregnancy and postally. So for me, Pilates is essential as part of an exercise routine, but it doesn’t have to be the only thing you do. Having said that, it could be! Our pregnancy classes include whole body functional movements such as lunges, squats, wall press ups and wall planks that ensure our mums are working those global muscles as well as the core. It isn’t all breathing!

The 4 keys:

1. Listen to your body. When you feel hot, tired or just not right then stop.
2. Seek the advice of a trained exercise professional who knows their stuff. Someone who knows about pregnancy and if they don’t knows where to get help.
3. Expect to make modifications.
4. Keep your core strong. This is your foundation, with your abdominals being stretched and your pelvic floor taking a heavy load you need to have more focus on this. A specific Pilates class will do this for you or check out our DVD.

Posture, Breathing and Pelvic Floor Problems

Your posture plays a huge role in helping your body work effectively and functionally. Many of those aches and pains can all be related to poor posture, which can seem obvious. What can seem less obvious is the relationship between your posture and a weak pelvic floor. Posture can affect your bladder control, prolapse issues and weak pelvic floor problems. So it’s vital to work on getting it right.

Try this out…Sit in a slumped position, with your shoulders rounded and your chest compressed. A fairly typical posture for those who sit alot, and often how we relax on the sofa! Now try to breathe deeply, you should find it is difficult to fill your lungs. In this slumped posture your abdominal contents become compressed and your diaphragm can’t move downwards, so instead of using your diaphragm effectively you use your upper chest muscles to help you breathe.

Slumped forward position and breathing with the upper chest muscles increase pressure on the pelvic floor. Not good.  In this position your core muscles (including deep abdominal and pelvic floor) can’t effectively counter the increased pressure.

Guess what, sort out your posture and breathing and suddenly the core muscles start to work in the right way. Our bodies are built in an amazing way.

So start focusing on your posture, with a tall spine, shoulders down in the back, ribcage soft and not pushed out, tall neck and allow there to be space for your abdominals to work.

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Next focus on the breath. You want to breath using the diaphragm. That may sound obvious as it is how our bodies are built to work, but so many of us do not breath correctly. It is called Diaphragmatic breathing or thoracic breathing.  Some people breath with just their tummies, some people breath with just their ribcage. You want to use BOTH.

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Try out this exercise:

Place 1 hand on the bottom of your ribcage and 1 hand on the side of your ribcage. Breathe in slowly and deeply so that you feel your tummy rise and your ribcage expand out to the side. You want to focus on breathing into the tummy and ribcage whilst keeping the upper chest muscles relaxed. Think of your lungs like balloons expanding out to the side of the body.

Breathe out by letting the rib cage fall back to resting and the tummy fall back down.

It takes practise and you may find it quite forced at first. Try practicing when you are relaxing or use it as a way to relax throughout the day and it will become habit.

Exercise 2: breath with a band:

Tie a band or a scarf round your body just below the ribcage. Sit with good posture, your ribcage over your pelvis. As you breath in feel your ribcage expanding into the band. As you breath out the ribcage decreases in size. The band can be a nice way to practice your breathing.

Pilates in Pregnancy, it’s a must.

I’ve been lucky enough to teach antenatal pilates for 4 years now and in that time I must have worked with over 250 ladies. I’ve also used pilates myself through 3 pregnancies and it has helped keep me strong, shown me which parts of my body needed working on and enables me to keep working and being a hands on mum throughout. The comments we get from some of our ladies are:

“If I miss a class I really notice the difference”

“My hips and pelvis ache less and I can feel the difference Pilates is making”

“Classes help to keep me strong and relaxed during pregnancy”

“I always leave feeling better than when I arrived and with exercises to use in the week”

 

Pilates with Priya: Antenatal Pilates class

 

Antenatal Pilates offers multiple benefits including, developing your natural corset to support your back and baby, helping with the changes to your posture, pelvic floor education, breathing technique, toning the muscles and, thus, helping in weight management. Practising Pilates on a regular basis can improve posture, alleviate backaches, and, ultimately, help with labour and delivery. It can even help the baby rotate in the optimal position. I tend to have a format where I use a mixture of functional exercises that help in daily living, for example moves you will need to bend, lift, rotate, get to the floor, release stretches for the areas I know get tight as pregnancy progresses, core strengthening exercises and some move to help in labour and for baby positioning.

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Lets look at some of the changes that happen in pregnancy:

1. Breathlessness:

There is around 15-20% increase in oxygen consumption during pregnancy. The breathing rate will stay the same, but an expecting mum will breathe more deeply each time. The changes in the blood vessels caused by the hormonal changes together with the changed position of the ribcage and diaphragm may make a mum-to-be feel breathless at times.

The breathing we use in Pilates helps make an expecting mum’s breathing more efficient. Focusing on breathing in an antenatal class also has a relaxing and calming effect which can then be used in labour.

2. Muscle, ligament, joint and postural adaptations: 

Hormonal changes during pregnancy have an effect on muscles, ligaments and joints. There can be more movement, stretching and instability. A safe pregnancy pilates class will help you exercise within a safe range of movement and strengthen the supporting muscles. It can really help with conditions such as SPD/pelvic girdle pain.

3. Core Strength:

Pilates exercises focus on core stability, and pelvic stability. This obviously helps keep the abdominals strengthened  but it also can help keep your pelvis in good alignment and reduce pelvic girdle pain.

4.Posture:

Pregnancy affects posture as the centre of gravity shifts. Some women adopt a posterior pelvic tilt (tucked under) with a flat lower back, whilst others adopt an anterior tilt (bum stuck out) with an increased curve in the lower back. Either way it is not helpful for the body. Knowing about neutral posture will help you correct this in day to day life and pilates will provide you will a range of exercises to strengthen the right muscles.

So if you are pregnant, antenatal Pilates with a specialist teacher is a MUST. If you can’t get to a class or want something to use in between sessions check out my specialst Bump to Birth DVD.

Raspberry leaf tea – a natural labour aid?

Raspberry leaf tea is one of those buzzwords that sometimes gets floated around in the last trimester of pregnancy. Until pregnancy 3 I had never given it much thought but then it was suggested to me by a midwife. Being the kind of person I am I decided to look at the evidence for it.

Pilates with Priya: Raspberry Leaf Tea: a natural labour aid?

An observational study in 1999 (1) looked at over 100 women retrospectively. Those who had taken the tea did have a shorter labour. Sounds quite promising so far

Then moving to a review by Holst in 2009 (2) who found 6 studies to compare and contrast. One of these was 50 years old and all of these were relatively small in terms of numbers of people in the studies. Sadly there just isn’t much research on this topic. The findings were that the tea can help to facilitate more rhythmic contractions of the uterus but there were some conflicting results. Some studies did show a shorter first or second stage of labour but only by a few minutes.

A  better study in 2001 (3) (a randomised controlled trial) was conducted looking at the safety of the tea. It was found to be safe to take in pregnancy. When you look at the effects it had, these were it shortened the second stage of labour by a mean of 9.59 minutes and there was a lower likelihood of needing forceps.

So all in all there seem to be no safety concerns with taking sensible, moderate amounts of raspberry leaf tea (2-3 cups a day) or the capsules in pregnancy. It is advised you start this around 32 weeks of pregnancy. The benefits can be for some that it helps the uterus prepare for contractions and for some there may be a slightly shorter second stage of labour. The research shows us these benefits are by no means sizeable but hey, I quite like the taste of it and it can help pregnant mums feel like they are doing something to help labour be easier using a natural aid.

My top tip: don’t expect to find it in a local supermarket. You may need to order it online or go to a health food shop for it.

References:

(1) Aust Coll Midwives Inc J. 1999 Sep;12(3):20-5. Raspberry leaf and its effect on labour: safety and efficacy. Parsons M1, Simpson M, Ponton Thttp://www.ncbi.nlm.nih.gov/pubmed/10754818

(2) Holst, L., S. Haavik, et al. (2009). “Raspberry leaf – Should it be recommended to pregnant women?” Complementary Therapies in Clinical Practice 15(4): 204-208.   http://www.ncbi.nlm.nih.gov/pubmed/19880082

(3) J Midwifery Womens Health. 2001 Mar-Apr;46(2):51-9. Raspberry leaf in pregnancy: its safety and efficacy in labor. Simpson M1, Parsons M, Greenwood J, Wade Khttp://www.ncbi.nlm.nih.gov/pubmed/11370690

Carpal Tunnel: how to help.

This is one of those conditions that you certainly know you have when you get it. I’ve had it twice now: the first time was 4 months after giving birth to my boy. I would wake up in the night to feed him, pick him up, get pins and needles in both hands and then they would go numb. The end result being by the time we finished a feed I had to use my arms to put him back into his cot. It led to me having mutliple massages, which helped a little, and doing lots of research. I learnt a lot about my posture and how breastfeeding plus general stress was a huge contributing factor. A few changes to my feeding posture, extra pillows and a magic stretch really sorted me out.

Moving on to pregnancy 3 and the delight of carpal tunnel popped up again in the last few weeks. Certainly not as badly, this time general weakness in my grip strength, pain when in a hands and knees position (not ideal when teaching pilates) and pins and needles when sleeping or holding items for too long a time.

So as someone who has suffered from carpal tunnel I thought I would share my top tips on how to deal with it and how to help it.

Symptoms:

Pin and needles in your hands/fingers

Grip weakness

Numbness in the thumb, first and middle finger, that may extend to the whole hand

A dull ache in the hand/arm

How does it occur?

The median nerve runs all the way down the inside of your arm. It originates from the brachial plexus which is just above the shoulder (think halfway between the bottom of your neck and your shoulder, that bit that is often tense and you want a massage in!).

When this nerve is blocked, inflamed or has pressure on it, you can get the the above symptoms.

The carpal tunnel is a tunnel in your wrist designed to protect the median nerve. Pressure on this puts pressure on the nerve and hey ho, carpel tunnel syndrome.

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Image from: http://www.thebodyworksclinic.com/carpal-tunnel-syndrome/

Stats:

About 50% of pregnant women develop carpal tunnel, it will normally disappear all by itself.

More common in women then men.

Common in people with wrist injuries or those who do repetitive actions with the wrist.

For some people such as myself the issue can be to do with the tension and pressure on the nerve at it’s origin. So I know I carry my stress around my shoulders. Hence when teaching people pilates I so often focus on their shoulders! I can pinpoint the areas that are especially painful at these times. Those points are where the median nerve originates. So  it explains the carpal tunnel issues.

For others it is due to pressure or problems in the wrist areas. Perhaps you hold your wrists at an awkward angle for work or when bottle feeding a baby? Repetitive wrist actions or strenuous wrist activity can also be a cause especially if you have a weak wrist from an injury.

How to help:

Firstly, see the GP.  It is always good to get thee things looked at. They may offer you splints and depending on how bad things are you can even be offered surgery if it doesn’t clear up. I would suggest you try out some stretches and think about why you have the problem in the first place before jumping to surgery.

Exercises:

  1. Stretch your arm out to the side of your body and point your fingers down to the floor. Now take your ear towards your opposite shoulder. Bring the head back up and repeat.
  2. Wrist circles and making your hands into a fist, then extending the fingers into a star (think twinkle, twinkle little star).
  3. Place your arm out to the side, with fingertips on the wall. Glide your palm down so the whole palm in in contact with the wall. Work from fingers to palm a few times.
  4. Bring your right ear to your right shoulder, drop the left arm and shoulder away from you, this should stretch and release in your left side.