1) Exercise
My top tip is get moving! In pregnancy, exercise has been shown to have minimal risks and promote health and emotional benefits, although modifications will need to be made to adapt to your changing body.
What is the best exercise to do? The American College of Obstetrics and Gynaecology recommends walking, swimming, stationary bike, low impact aerobics, pre-natal yoga, pre-natal pilates and strength training.
Pre-natal pilates is excellent as it incorporates the core and pelvic floor. An exercise program in pregnancy should contain functional movement patterns in preparation for when baby is born. Exercises that a mum performs every day such as squats, lunges, pushing and pulling movements.
Obviously the best option is to go into your pregnancy with a sound level of strength, stability and fitness, but it's not too late to start a gentle routine during also. Start gradually and build up slowly. The aim is 30 minutes per day for most if not all days of the week. You should be able to talk comfortably when exercising to avoid over exertion.
* Disclaimer: Always get clearance from your doctor prior to exercising and for an individually prescribed exercise program seek the advice of your women’s health physiotherapist.
2) Pelvic Floor
What are pelvic floor muscles and why are they important? They are a large sling of muscles extending from your tailbone to pubic bone and from both sit bones. They support our pelvic organs (bladder, bowel and uterus with baby), help us control our bladder and bowel movements and support our pelvis and back.
How do we strengthen them?
• Lie on you back with knees bent (if early pregnancy) or on your side with knees bent (if late pregnancy).
• Gently squeeze and lift these muscles by visualising stopping passing wind and urination, imagining a lift going up floors inside you.
• Hold for 5 seconds and relax for one breath.
• Repeat 10 times.
• Aim for 3 times per day.
• The key is no breath holding and relax all other muscles.
• ENSURE you are fully RELAXING ALSO! It is your baby's door after all!
I would encourage pregnant women to seek help from a women’s health physiotherapist to ensure correct contraction of these muscles.
3) Posture
Your posture changes considerably in pregnancy. Your centre of gravity shifts forward as your bump and baby grows in size. To adapt to these changes, your lower curve in your spine tends to get bigger, pelvis tips forward, shoulders round forward, chin pokes and foot arches flatten.
It is important to be aware of your posture to help limit these changes which can cause aches and pains in different parts of the body.
• Stand up tall, visualise a string pulling you up towards the ceiling from the top of your head.
• Rock your body forward and back (towards toes and heels) until you can feel your body weight passing through the front part of your ankle bone. Weight should be even on both feet.
• Relax your knees
• Gently tuck your pelvis
• Relax your shoulders and gently roll them back
• Walk tall, visualise that string pulling you up tall as you move
4) Take care of your back
Pelvic girdle pain (pain around back, pelvis and buttocks) is common with approximatly 65% of women experiencing it during their pregnancy. The good news is the majority of people get better (only 5-10% experience ongoing pain after delivery) and most respond really well to conservative treatment (physiotherapy, massage and modified exercise).
Top tips when experiencing pelvic girdle:
• Seek help from a women’s health physiotherapist
• Keep weight evenly on both feet when standing and sitting
• Do not cross legs at feet or ankles
• Pillow between knees when sleeping
• Keep knees together when turning in bed
• Contract pelvic floor muscles with changes of position, lifting, and pushing
• Limit heavy lifting especially shopping and toddlers
• Sit down to put on clothes
• Good supportive shoes (gym trainers)
• Shorten your steps when walking
• Belts/supportive wear (e.g. SRC Pregnancy shorts/leggings can be helpful - check with your physiotherapist if you are unsure
5) Self-Myofascial release
Myofascial release is manual therapy for the release of tension in muscles and their surrounding connective tissue (fascia). Good news is all you need is a tennis ball. The main areas that get tight and achy are the back muscles and hip muscles. They are working hard all day to maintain your posture and support your bump. Standing sideways against the wall place the tennis ball between your hip muscles (gluteals and piriformis are the main targets) and the wall, gently move the ball around until you feel a tender area. Once you find this tender area apply sustained pressure with your body against the tennis ball. Wait for the pain to subside and then move to the next spot. This helps to release the tension in the tight bands within these muscles. Same can be done with your back muscles.
6) Stretching
It’s nice to stretch out these muscles after you have released them.
• Seated gluteal stretch
• Sitting with your right leg crossed over left with outside of ankle resting on knee. Keeping your back straight, lean forward from your hips until you feel a stretch in your buttock area. Hold this for 30 secs x 5 reps
• Childs pose
• On your hands and knees, widen your knees slightly to make room for the bump. Move your hips backwards as far as you can.
7) Tips with toddlers
Now for those of you who have a toddler at home while pregnant. While it’s impossible to stop lifting our toddlers here are some tips to help especially when heavily pregnant.
• Buy a step and leave in the car to encourage your little one to climb into the car themselves.
• Encourage hug time while sitting on the couch, lying in bed rather than standing or walking.
• Lift safely. Bend at the knees, lift gently, no sudden jerking or twisting movements, carry little one close to your body.
• As you lift engage your pelvic floor to support your back and baby.
• Listen to your body. If it feels like it’s a strain, it probably is!
8) Relaxation
Taking time out to relax has many benefits during pregnancy such as reduction in C-section rate, better psychological wellbeing of mum and higher birth weight of baby. Different forms of relaxation include guided meditation, mindfulness, breathing techniques, massage therapy, exercise and yoga.
9) Taking care of tummy muscles
In pregnancy, as your baby grows your abdominal muscles become stretched and your six pack muscle separates along the midline. This is called a diastasis rectus abdominus or tummy muscle gap. It is painless and a natural occurrence for most women.
It is important to take care of your tummy muscles to ensure they provide support for your back and baby and prevent progression of the gap.
• Avoid sit ups, crunches and full planks as they can put too much strain through the abdomen.
• Get in and out of bed by rolling on your side and pushing up with arms rather than a sit up type movement.
• Be aware of your posture.
• Engage your pelvic floor with changes in position and lifting.
10) Good toilet habits
In pregnancy most women need to go to toilet >7/days and in the final trimester more than half of pregnant women need to get up >3 times per night. This is due to increased urine production in pregnancy and weight of the baby on your bladder later in pregnancy. If you are experiencing pain, leaking or you are limited in daily activities seek help and advice from a women’s health physiotherapist.
For more information to help reduce the effects of urinary incontinence, prolapse and injury during your pregnancy, please book in with me for a consultation or one of my '4th Trimester Care Workshops'.
havenforwellness@gmail.com