Exercise
both before and during pregnancy is essential. Before pregnancy, it
helps to keep you fit so you can carry a healthy child to term. During
pregnancy it helps to strengthen the muscles that protect your joints
and spine. Also, when you combine specific exercises with breathing
and relaxation techniques, it helps to prepare you for labour and positions
of delivery.
CHANGES IN YOUR BODY
The body changes in various ways during a pregnancy. Besides the obvious
physical changes ( cessation of menstruation, enlargement of breasts
and uterus, weight gain), there is loosening and stretching of ligaments
around joints especially in the pelvis.
As the pregnancy progresses, you become larger in size and ungainly
in shape. You lose agility and mobility and become breathless more easily.
You may also feel a bit unstable on your feet due to you centre of mass
being more forward than normal. To try and prevent this you should try
to walk with your shoulders back, feet wider apart and waddle. These
compensatory actions result in you using your muscles in a different
way. This may result in some aches and pains. Maintaining your posture
helps your balance and avoids most of these aches. However, if you keep
your body fit during the pregnancy, your muscles, joints, ligaments
will handle the stresses more easily. Look at it as your body being
in a special state and not an abnormal state.
BENDING
AND LIFTING
The hormones of pregnancy soften the ligaments of the lower back and
pelvis therefore, heavy lifting during pregnancy should be avoided.
Plan your lift. Use your thigh muscles by bending the knees and keep
your back upright. Keep your feet apart to give you a stable base. Hold
your abdominal muscles and pelvic floor in and breathe out as you lift.
Keep the load close to your body. When standing or walking with a load
do not twist, but turn by moving your feet.
When carrying shopping
bags try to distribute the weight evenly by carrying an equal number
of bags on each side. While carrying a toddler, shift him from side
to side while your body is up straight. If you need to do anything low
down, squatt first or get on your hands and knees as this will take
the pressure of your uterus off your spine. Be aware of lifting objects
from a height - your back will arch and if the object is heavier than
you anticipated you may lose balance and then topple over.
In later pregnancy you
will need to adapt all your movements, even the most simple of ones.
When getting up from a chair, shift your body weight forward in front
of your hips and use your thighs to push yourself up. When getting up
from lying, go through side-lying and use your arms to push yourself
up into sitting. If you need to pick up your baby or an older child,
remember to bend your knees and keep your back straight while holding
your stomach in.
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KEEPING FIT
Pregnancy, labour and the delivery of your child places huge demand
on your body. Therefore, the fitter you are before and during the pregnancy,
the easier time you will have during the pregnancy and the less you
will stiffen up. Concentrating on good posture during standing, sitting
and walking will decrease the likelihood of aches and pains.
Always check with your
doctor prior to starting with an exercise programme. Some women who
have had miscarriages are advised not to exercise for the 1st 3 months.
Once you are given the
"OK" to exercise, here are a few tips:
- Join a class that
specifically exercises pregnant women. You will be a lot more motivated
in a class environment than trying to do it on your own
- Go slowly! If you
were not very fit before you fell pregnant, do not try and overdo
it too soon. Start slowly and gradually increase the load.
- Try to exercise regularly.
10-15 minutes daily is far better than only 2 days a week
- Do a warm-up routine
before you do any exercises to get the blood flowing.
- Do not exercise to
the point of fatigue
- Never do an exercise
that causes pain. Pain is there for a reason and means that something
is wrong. Try a variation of the exercise.
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PELVIC
FLOOR MUSCLES
Many people do not know
much about these "pelvic floor muscles". They support the
uterus, bowel and bladder in a sling-like fashion. The muscles run from
the back to the front , attaching to the sacral bone and pubic bone
respectively, in a figure of eight form. They overlap in the middle
and are therefore thicker at the perineum.
During pregnancy there
is a surge in the amount of progesterone. This hormone helps a women
prepare her body for the birth of her child by softening her ligaments
and joints as well as the pelvic floor muscles. As the uterus enlarges,
more and more pressure is exerted on the pelvic floor causing it to
stretch and weaken. This may result in unusual aches and pains, incontinence
or leakages, and sometimes vaginal prolapse post-partum. Sometimes this
weakening of the pelvic floor post-partum results in some discomfort
or "stress incontinence" - leakage of urine with coughing,
laughing, sneezing or lifting. This is not something to get overly concerned
about but, is a problem that must be addressed.
Pelvic floor exercises
have been developed to help a women strengthen these muscles to help
her current condition and to prevent complications later on. The exercises
must be started slowly as these muscles will fatigue easily. It is good
to start these exercises early on in life, even before your pregnancy,
so as to prevent problems but, they will also help with the delivery
of your child. One needs to make the exercises part of your everyday
routine so as not to take a huge amount of time out of your day. When
starting with the exercises, try to isolate the muscles while lying
on your back with a 5 second contraction, 5 times. Once you have mastered
this, try to do the same in more functional positions - sitting in the
car, standing in a queue, pushing a shopping trolley etc. Do try and
do the exercises as often as you can - do less more frequently.
How do I find and contract
the pelvic floor?
- Lie on your back with
your legs crossed over.
- Squeeze your legs
together and tighten as if you feel the need to urinate but must wait.
These are your pelvic floor muscles which you will feel tightening
inside your vagina.
- If you do not feel
very much while doing this, place one of your fingertips on the opening
of your vagina while doing the same exercise and you may feel more
of a contraction.
What exercises can
be done?
1. Lie on your back with your knees bent and feet flat on the floor.
Concentrate fully on trying to pull the "hammock-like" pelvic
floor up into the vagina, instead of letting it hang down. When you
have this mastered, progress this exercise to the sitting position and
then to the standing position. These are more functional than only lying
on your back. If lying on your back is still too difficult, try placing
a pillow under your pelvis while lying down so as to tilt your pelvic
floor upwards. Then try doing the same exercise. All this does is to
position the muscles in a way that gravity can assist you until you
are strong enough to oppose gravity.
2. While having intercourse with your partner, use your muscles to squeeze
his penis once he has penetrated you. You can also use this as a gauge
to see your improvement - your partner will be able to feel if your
contraction is getting stronger and will like to feel like he is playing
a part in your improvement!
3. As in exercise no. 1, but, think of the pelvic floor as a lift in
a block of flats. Contract your pelvic floor so that you stop at each
level of the flats for a few seconds. Imagine that there are 5 levels.
Hold the contraction at each level and do not relax the muscles. When
on the 5th floor, go back down through each floor of the block of flats
until you are on ground floor again. When on ground floor, relax the
pelvic floor totally so that it bulges out a little bit. If you push,
as if the lift must go to the basement, you will feel the lips of the
vagina opening. This movement will aid the baby's head being born.
Preparing to deliver the baby's head
By now you should have a better idea of where the pelvic floor is, how
to relax and how to contract it. You can now start to prepare yourself
for the birth of the baby's head.
a) Lie on your back with
your knees bent, feet on the floor, squeezing your feet and knees together.
Feel how the muscles in your inner thigh tense up. At the same time,
your pelvic floor muscles are tightened. Women tend to tense up when
their baby's head is coming through the birth canal. You need to try
and relax you knees and inner thighs completely in order to relax your
pelvic floor and this will help make passage of the head easier.
b) Lie flat again with
your knees bent and feet and knees apart. Let your knees open and drop
to either side. Your feet must roll over their ankles. Try and relax
your legs and pelvic floor more and more so that your thighs drop further
and further. Practice huffing in this position as you will be asked
to do it when the baby's head is ready to pass through.
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WHAT
EXCERCISES CAN I DO?
There are various exercise
classes available for pregnant women to attend. One needs to look into
what classes are being offered, what you feel you would be happiest
doing or ask advice about what exercise would be beneficial to you.
Some classes are purely for a workout to improve strength, flexibility
and stamina. Others are more focused on the birth itself. Either way,
it is a time where you come into contact with other women going through
the same as you.
YOGA
Yoga has been around for many years. It looks at working on flexibility,
muscle control, breathing, relaxation and becoming one with your body.
The breathing techniques are not the same as those taught in ante-natal
classes but, are said to help raise your pain threshold.
SPORTS
Walking: This is a great form of exercise and is safe. Just remember
to walk in a safe area and watch your step so as not to trip and fall.
DO NOT get too breathless because when you are out of breath it means
your baby is also getting less oxygen.
Swimming: Swimming is fantastic exercise to do and can be done up until
your due date. Be careful that the water is not too cold as this may
result in you cramping. Water is bouyant and helps support your body
resulting in less stress on your body and joints.
Cycling: Cycling is fine to do until your abdomen is too large and heavy.
This may result in lower back pain and put you off balance.
OUR
PRACTICE IS OFFERING A FULL ANTE-NATAL PROGRAMME WHICH INCLUDES EXERCISE
CLASSES. THERE ARE A VARIETY OF CLASSES RUN BY EXPERTLY TRAINED PROFESSINALS.
THESE CLASSES INCLUDE YOGA, A BOIKINETICS CLASS, PILATES, AS WELL
AS A CLASS RUN BY A PHYSIOTHERAPIST WHO CONCENTRATES ON DEEP STABILISERS
AND THE PELVIC FLOOR.
GENERAL EXERCISES
STRETCHES
One should always start
an exercise routine with a warm-up session and stretching. This helps
to warm and loosen the muscles and joints to make movement easier and
prevent injuries. Remember to concentrate on your breathing while warming
up. Make sure you are comfortable even if you need to lean against a
wall or on cushions and keep your posture correct. Repeat the exercises
8-10 times. Below are a couple of stretches described to help you maintain
your flexibility during your pregnancy.
1. Sit on the floor with
your back up straight, knees bent and soles of the feet facing each
other. Take a very deep breath in and fill your lungs as full as possible.
Breath out through pursed lips. As your inner thighs stretch more, pull
your feet closer to your body and repeat the breathing.
2. While sitting on the floor with your legs crossed over, take a deep
breath in and out. Place your left hand on your right knee and you right
hand as far behind your back as possible while trying to look over your
right shoulder. Hold this for 5 seconds and turn to the left.
3. Position yourself on your hands and knees. Round your back upwards
while also pushing your pelvis back and curling your chin onto your
chest. Now relax your back and let it hollow while you are tilting your
pelvis forwards. This exercise looks similar to the way a cat stretches
its back, rounding it and hollowing it. We call this the hump and hollow
exercise.
4. Lie on your back with your knees bent, feet on the floor and arms
outstretched to either side. Roll your knees to the left and aim to
put them on the floor while keeping your back flat against the floor.
Hold this for 5 seconds and then roll the knees to the right.
5. Sit on a chair with your feet supported on the floor and arms relaxed
at your side. Slowly curl through your spine by putting your chin on
your chest and rolling down towards the floor. This may become more
difficult to do as your pregnancy advances and your tummy enlarges.
EXERCISES
1. Lie on your back with
your legs stretched out and arms at your sides. Lift one leg slightly
off the floor and roll your ankle around in a circle 5 times. Lower
your leg and repeat it with the opposite leg.
2. Lie on your back with your knees bent and feet on the floor. Pull
in your "lower" tummy first and then lift your bottom off
the floor an inch or 2. Hold it for 3 counts and repeat it 15 times.
3. Sit on a chair with your feet supported on the floor. Hang your arms
at your side and slowly slide your left arm down the side of the chair
so that you stretch your right side. Lift your trunk up to the centre
again and slide down to the right. Repeat this 10 times to each side.
This exercise works on that dreaded waistline.
4. While sitting on the chair, cross your arms over your chest and twist
your trunk to the left. Hold for 5 counts and then twist to the right.
Repeat 5 times to each side.
5. Sit on the floor with your knees bent in front of you and feet on
the floor. Place both your hands on the floor behind you with your fingers
pointing towards your bottom. Slowly bend your elbows in 3 counts and
then straighten them in 3 counts. Repeat 15 times. This exercise will
help prevent those sagging triceps.
Wanting to tone your
legs and buttocks?
Repeat exercise 2 above.
If you are in a place where
you can use the stairs rather than the lift, take advantage.
