Exercise during Pregnancy and Post-Birth
Healthcare providers are encouraging women to exercise moderately during their pregnancy, unless they have any complications or have been advised not to. Exercise before and during pregnancy has been associated with reduced preeclampsia risk, prevention of gestational diabetes and has also been linked to a decrease in caesarean section rates and infants with higher Apgar scores. Generally, women who exercise regularly before pregnancy, should continue to be active and modify their routine as medically indicated. Women who have not been active before should consult a health professional for advice before commencing exercise. (Borg-Stein et al, 2005)
Physical changes during pregnancy have the potential to affect the musculoskeletal system at both rest and during activity, the main change being weight gain. The increase in weight will mean there are greater forces across the joints such as the hips and knees. This is one of the reasons why the frequency, duration and type of exercise may need to be modified during pregnancy. Ligament laxity is another well-known physiological change during pregnancy. This increase in ligament laxity happens in the first and second trimester of the pregnancy and remains for weeks to up to many months afterwards. Although there is a lack of clear evidence that musculoskeletal injuries are more prevalent in pregnancy due to this ligament laxity, it still needs be considered when prescribing exercise regimes. (Artal and Toole, 2012)
Many of the physiological changes of pregnancy remain for at least four to six weeks post-birth, this is why exercise regimes should be resumed gradually after pregnancy. Generally it is recommended that most women should wait six weeks after birth to start most types of exercise and eight to ten weeks after a c-section but exercise should only begin when physically and medically safe. This will vary from one woman to another, dependant on how the labour was, whether a C-section was carried out and how physically fit the mother was previously (Artal and Toole, 2012). Gentle exercise such as pelvic floor exercises can be started within a few days of an uncomplicated delivery however those with a c-section should wait until they have stopped bleeding and have medical approval to begin.
Fifty per cent of women suffer with a pelvic organ prolapse and 1 in 3 women will have urinary incontinence post-birth. If high impact exercise is introduced too early, urinary leakage may increase. A prolapse is often described as a “heaviness down below or something coming down.” The symptoms of a prolapse are often worse at the end of the day or after high impact exercise. Most women perform pelvic floor exercises, however approximately 30% of women are performing the exercise incorrectly and are actually bearing down rather than squeezing inwards and drawing upwards. Pelvic floor strength and endurance should be improved with regular pelvic floor exercises and then the intensity of the exercise programme can be gradually increased to match this. Pelvic floor exercises can be repeated four-six times a day in sets of ten. They can be done either sitting or standing and anywhere, anytime. The best way to find the muscles is to try stopping and starting (or slowing down) the flow of urine while you’re on the toilet. (Yates)
Low impact exercises such as swimming and cycling and gentle core exercises are recommended initially with a gradual return to higher impact exercise. Higher impact can be defined as taking both feet of the floor at the same time and it is a good idea to wait three to five months after delivery (depending on your level of fitness before and during pregnancy) before starting high impact exercise. It is important not to work through any form of pain. Pain is a warning signal that should never be ignored so it is important to make adaptations or stop altogether.
Exercise should not interfere with a mother’s ability to breast-feed. It has been shown that lactic acid is increased in the breast milk of mothers that are exercising at maximal intensity, but not in those that are exercising at moderate intensity. It is not clear whether this short-term increase in lactic acid makes the breast milk less palatable for the baby. For this reason mothers may consider breast-feeding their infant before they exercise, which will also help make the breasts more comfortable during exercise or to postpone the feed until one hour after a workout (Gregory et al, 2003). It’s also important to drink plenty of fluids, before, during and after exercise.
Exercise during and after pregnancy is important but it is also important that too much isn’t undertaken too soon. It’s essential to listen to your body and take it from there. If you have any questions about exercise, before, during or after pregnancy then speak to your GP, healthvisitor, midwife or give us a call at Avenue Clinic on 728 798. Avenue Clinic is a multidisciplinary clinic with a variety of therapists with a special interest in treating women before, during and after pregnancy including Osteopaths (Dimi Argyros, who also treats babies and children), an acupuncturist (Jo Vessey, with a special interest in acupuncture aimed at improving fertility) and massage therapist Joy who is trained in pregnancy massage and also does pregnancy yoga.
References
Artal, R. and Toole, M. (2012). Guidelines of the American College of Obstetricians and Gynaecologists for exercise during pregnancy and the postpartum period. British journal of Sports Medicine, 37, pp. 6-12.
Borg-Stein, J., Dugan, S. and Gruber. J. (2005). Musculoskeletal Aspects of pregnancy. American Journal of Physical and Medical Rehabilitation, 84 (30, pp. 180-192.
Gregory, A., Wolfe, L., Mottola, M. and MacKinnon, C. (2003). Exercise in pregnancy and the postpartum period. Journal of Obstetrics and Gynaecology Canada, 25 (6), pp. 516-22.
Yates, L. Web: http://www.cef.co.nz/articles/61?fwcc=1&fwcl=1&fwl
http://www.nhs.uk/conditions/pregnancy-and-baby/pages/your-body-after-childbirth.aspx#close
