Exercise and Fitness in Pregnancy

• Regular exercise (at least three times per week) is better than spurts of heavy exercise followed by long periods of no activity.

• Brisk exercise should not be performed in hot, humid weather or when you have an illness with a fever, such as a cold or flu.

• Avoid jerky, bouncy or high impact motions. Activities that require jumping, jarring motions or rapid changes in direction may cause pain. Exercise on a wooden floor or a tightly carpeted surface to reduce shock and provide a sure footing. Wear a good-fitting, supportive bra to help protect your chest.

• Avoid deep knee bends, full sit-ups, double legs raises and straight leg toe touches. During pregnancy, these exercises may injure the tissue that connect your leg and back joints.

• Avoid Hot Yoga, Saunas or Hot Tubs.

• Always begin with a 5-minute period of slow walking or stationary cycling with low resistance to warm up your muscles.

• Heavy exercise should be followed by a 5-10 minute period of gradually slower activity that ends with gentle stretching in place. To reduce the risk of injuring the tissue connection your joints, do not stretch as far as you possibly can.

• The extra weight you are carrying will make you work harder as you exercise at a slower pace. Measure your heart rate at peak time of exercise. Do not exceed your target heart rate.

• Get up slowly and gradually from the floor to avoid dizziness or fainting. Once you are standing, walk in place for a brief period.

• Drink water often before and after exercise to prevent dehydration (lack of enough water for the body’s needs).

• People who do not exercise before becoming pregnant should begin with physical activity of very low intensity and move to higher levels very gradually.

• Stop your activity and consult your care provider if you experience pain, tachycardia (rapid heartbeat), bleeding, back pain, shortness of breath, pubic pain, palpitations (irregular heart beat), faintness, and difficulty walking or any other unusual symptoms.

• Almost any form of exercise is safe if it is done in moderation. Some exercises offer aerobic conditioning of the heart and lungs; others relieve stress and tone muscles. Pregnancy causes many changes in your body, some of which have an effect on your ability to exercise. These changes can interfere with activities that require good balance, so you may wish to modify your form of exercise during pregnancy.

• Walking is always good exercise. If you were not active before you become pregnant, walking is a good way to begin an exercise program.

• Swimming can be continued if you were used to swimming before pregnancy. Swimming is excellent for your body because it uses many different muscles while the water supports your weight. However, it is best not to dive in the later months of pregnancy. Scuba diving is not recommended during pregnancy.

• Jogging can be done in moderation if you were used to jogging before you became pregnant. Avoid becoming overheated, stop if you are feeling uncomfortable or unusually tired, and drink water to replace what you lose through sweating.

• Tennis is generally safe if you were used to playing tennis before pregnancy, but be aware of your change in balance and how it affects rapid movements.

• Golf and bowling are fine for recreation but don’t really strengthen the heart and lungs. With either of these sports, you may have to adjust to your change of balance.

• Snow skiing, water skiing and surfing pose some risk. You can hit the ground or water with great force and taking a fall at such fast speeds could harm your fetus. Before you decide to participate, you should talk with your midwife.

The pubococcygus (PC) of pelvic floor muscles stretches from the pubic symphysis in front to the “tailbone” in back and forms a “sling” of support for the bladder, the uterus, the vagina and part of the rectum. The muscle fibers are interlocking and surround the opening of the bladder (urethra), the vagina (vaginal introitus) and the rectum (anus). This muscle has an important role in pregnancy and childbirth. The benefits of achieving and maintaining good tone in this muscle are many and include:

• Prevention of urinary incontinence or loss of bladder control, especially when laughing, coughing or sneezing.

• Possible prevention of prolapsed or “sagging” uterus or other pelvic organs.

• Promotes healing and decreases discomfort from stitches, episiotomy and/or hemorrhoids.

• Decreases discomfort from pelvic exams.

• Sexual advantages including increased tone and sensitivity.

• In men, a possible decrease in likelihood of developing prostate problems by enhancing circulation and support. To perform Kegels, you want to control and relax certain sets of pelvic muscles, one at a time. First, contract your muscles like you are holding back urination. Then, tighten your muscles like you are holding back a bowel movement. Finally, contract the vaginal muscles. It may take some practice to isolate each of these sets of muscles but keep practicing. Relax and contract each set of muscles separately, contracting them harder and longer each time.

If we could sum up how to cope best with labor in one word, it would be “RELAX.” Sounds simple, but it is actually difficult to do. Tensing, tightening, and squeezing in response to pain are common reactions, but they actually increase the amount of pain perceived and decrease oxygen to the muscles making them work insufficiently.

Loosening, relaxing and opening actually helps the muscles to work more efficiently and decreases pain. Trust your body – it knows very well what to do. It is our minds that usually get in the way! Some tips for doing relaxation exercises with a partner:

• Make practice time a team effort, both of you can learn to relax – it is helpful in everyday life.

• Talk about what increases relaxation and what provokes tension in each of you. You may learn some interesting things about one another.

• The tone of your voice and the firmness of you touch can affect relaxation in your partner. The partner should look for tension, feel for tension and coax tension away with both verbal cues and touch.

• Practice! It really will help you when you need it.

Reducing Your Need for an Episiotomy

Most nurse-midwives do not routinely perform an episiotomy, the incision in the perineum to make the opening larger, when they help deliver a baby. Most of our clients prefer not to have an episiotomy if it is not necessary. The nurse-midwife may do an episiotomy if it looks like the tissues may tear extensively or if the baby needs to be born immediately due to distress.

Many clients have asked if there is a way to prepare for birth and avoid an episiotomy. Perineal massage helps you prepare for the sensation of pressure, stretching and burning that comes as your baby’s head is born. Knowing what those sensations will be like can help you to relax and give birth as opposed to tensing up and working against your body’s rhythms. The position in which you give birth may affect the likelihood of perineal tearing. Side-lying and hands and knees positions reduce the strain on the perineum.

Either you or your partner may do the massage, however, it may be easier for your partner to perform it.

Some suggestions:

• The first few times you do this, use a mirror to locate your perineum - the area between the vaginal opening and the anus.

• You may want to do this in the bathtub or use warm compresses before beginning.

• Use wheat germ oil, Vitamin E oil or some type of vegetable oil as a lubricant. Do not use mineral oils.

• Begin doing the massage around 34 weeks – aim for doing the massage daily for approximately five minutes each day.

• Make yourself comfortable in a semi-seated position lying back on some pillows. Instructions

• Wash your hands

• Put one of the above lubricants on thumbs and index fingers.

• If doing massage yourself, use thumbs; if partner is doing the massage, have them use index and middle fingers of one hand.

• Place finger (or thumbs) approximately two inches into vagina and gently press down toward bed or buttocks. You will feel a burning, tingling or stinging sensation. Stop at point of burning and hold for approximately 1-2 minutes while you take a deep breath and consciously relaxes those muscles.

• If using fingers – keep fingers together and move side-to-side in U shape while maintaining downward pressure. Do not move more than three inches to either side of the midline. Continue U-shape movement for 2-3 minutes. If using thumbs – do same type of U-shape movement, but start at midline and move thumbs separately up each side.

• Concentrate on relaxing the muscles involved in response to the pressure and burning.

You will find over time that you will stretch further before the burning starts – this is progress! The massage will stretch the vaginal tissue, perineal skin and the muscles that surround the vagina. In the beginning the feeling of tightness and burning will be almost immediate, but with time and repetition, the tissue will relax and stretch. You will later recognize this stinging sensation as the baby’s head is crowning and your perineum stretches around it. If you have any questions, ask a midwife.