Tuesday, October 19, 2010

Exercising during pregnancy

pregnant woman weight lifting -- Workout With KarenI meant this to be part of my Sunday Surf, because I was reading and liking "Staying Active for a Healthy Pregnancy" from Becoming Mamas, which has some great info on the benefits of prenatal exercise, and wanted to comment on it. But I ended up writing so much that I thought I'd bump it out into its own post.

I've mentioned I'm running the Couch-to-5K plan in my first trimester here. I'm about 8 weeks pregnant and just finished my sixth week in the 9-week program. Which I guess means I started just about the time we got pregnant? Even during these first-trimester queasies, getting outside and getting moving always makes me feel better.

Last pregnancy I kept up ballet class and taking my usual long walks until somewhere in my second trimester, when those stretching ligaments made the hip and back pain way too much for pliés and eventually slowed my walking (with support belt) to a crawl. At that point, it was swimming or nothing, and I did love being weightless in the pool.

This time around, I'm committing to going into my second trimester as fit as possible. (Well, within reason; I'm still the only person among my friends who doesn't have a gym membership.) I'm hoping being active now might stave off pregnancy-related pains for as long as possible.

How to exercise during pregnancy

When we were trying for Mikko, I researched a lot about exercise and pregnancy and found some outdated advice that claimed exercise is always dangerous or put a lot of restrictions on what kind of exercise you can do, most of which is nonsense.

Here's some of the actual practical advice I've gleaned:

  • Exercising for most people during pregnancy is entirely safe. Always check with your midwife or obstetrician and how you yourself are feeling to make sure. If you have had previous pregnancy complications, you might be given advice to limit your activity, and that's fine. But for most, staying active is a good way to feel better, improve your sleep, and even make labor 6 and 1/2 month pregnant yoga Pincha Mayurasanaeasier because you'll be in shape for it.
  • If you were doing an exercise activity before pregnancy, it's generally fine to continue during the pregnancy. So if you were a dancer, you can keep dancing, and if you were a runner, you can keep running. The idea is that it might not be wise to take up a new activity during pregnancy — although I question that wisdom, personally. I took up running, as I said, and I think I'm doing it in a reasonable enough fashion that it's not an issue. I grant that it wouldn't be the best time to try to start training for a marathon that will take place in my third trimester, of course. But I know plenty of women who take up, say, yoga and swimming during pregnancy, and I can't see that that's a problem. If you weren't active before, just ease into whatever it is you want to do and stop if it hurts (or on medical advice).
  • There are various standards for heart rate and core temperature that are given to pregnant women. And then I've heard one or the other debated by opposing camps. For me, I just find it too complicated to track such things. Sometimes I get hot in ballet class, but I'll just move to the window or doorway to get some fresh air. The guidelines would have me leave the class to go take a vaginal temperature (no, seriously), which — well, it ain't gonna happen. So if you want to be ultra-safe, go ahead and look up the guidelines and try to follow them. For me, I ask myself a couple things: Can I talk comfortably at this pace? If yes, then my heart rate isn't too high. Am I feeling overheated? If yes, then I calm my movements and try to find some fresh air to cool down. This isn't a medical guide, note, but I think it works on a practical level. (And the American College of Obstetricians and Gynecologists says there are no studies that currently link exercise with fetal distress due to a rise in maternal heart rate or core temperature; in other words, although impaired blood flow itself can cause fetal distress or birth defects, there's been no link to suggest exercise alone can cause such effects.)
  • Whether you're a serious athlete or just the other side of sedentary, expect your activity level to decline during the pregnancy. Pregnancy is not the time to try to set world records in distance and speed. I'm not saying you couldn't, but — no, you couldn't. Your joints are going to change. Your breathing is going to change. Your blood volume, your center of gravity, your weight — it all affects how well you can perform athletically. And that's OK. You'll be able to pick up again at some point after the baby's born.
  • If you find yourself feeling more uncomfortable in your chosen activity as the pregnancy progresses, try a different type of exercise. One that's universally recommended for pregnancy is swimming, and I can testify that having the water take all your weight away is bliss. I did have to stop doing my favorite frog kick later in pregnancy because of pelvic and hip pain, but I loved doing some slow freestyle laps and then stretching along the side of the pool, underwater. I think I'll try water aerobics if I become pool-bound this time as well. Another treat is yoga, which will give you time to stop and meditate as you stretch. A gentle walk (and/or waddle) might be tolerable. Weight lifting or pilates can give you a more low-impact workout. You might be able to come up with something more original, too, if you think: maybe kayaking (assuming the boat and life jackets are big enough for two)? Spinning? Perhaps belly dancing?
Belly Dancer with child

  • This is up to you and the health care professionals helping you make wise decisions, but I would curtail any dangerous sports during pregnancy, or be really, really careful. While some activities may be fine early in pregnancy, or if done in a very controlled environment, increased risk of physical injury to your abdomen make them less appealing as your belly starts to protrude. Yes, the fetus is protected by the uterine wall and the amniotic fluid, but, come on — you want your baby to be safe. So I'm thinking about things like horseback riding, rock climbing, scuba diving (recommended at no time, due to compression issues), hang-gliding, downhill skiing, water skiing, hockey, boxing…I guess just consider the risks and injuries that you normally incur, and realize your baby will be experiencing that danger along with you.  Even with "safer" activities, be aware of obstacles like slippery or uneven surfaces. For instance, if you normally run or bike outside, during an ice storm, you might want to head for a treadmill or stationary bicycle. And be aware of how your changing body affects the safety of a sport. Tennis, for instance, might be a no-go if your stretching ligaments cause undue stress on your ankles and make you prone to fall.
  • Along the same lines, you'll probably want to step back on how vigorous your exercise is sometime in the second to third trimester. Some of this might depend on your own athletic level and how your pregnancy is progressing. For me, I plan to stop jumping in ballet as soon as I feel it's uncomfortable. I might need to keep tighter hold of the barre for balance and be careful in the center as my gravity shifts. I'll monitor how running makes my body feel and scale back if I feel too jostled. I also want to be careful not to over-stretch as my ligaments loosen, so I'll hold back when stretching during ballet class instead of pushing myself to do the splits. Your midwife or OB might have specific guidelines for you, depending on any risk factors associated with your pregnancy — and your body might surprise you by choosing its own path for when to scale back, as mine did with my pelvic pain last pregnancy.
  • Beware the dreaded back-lying. Ok, I'm being a little facetious with this one, because all over the internet, you'll find dire warnings about lying on your back at all later in pregnancy, since the enlarged uterus can compress the inferior vena cava and reduce blood flow to the baby. That said, you're likely to notice if this is happening and be made uncomfortable by it (such as your legs falling asleep) so that you change positions long before the baby's health would be in jeopardy, and this is true even if you're asleep. (Although don't these warnings make you wonder why doctors prefer women to labor on their backs? Hmmm?) My take on the issue is, don't freak out if you need to perform a stretch or abdominal exercise on your back, particularly earlier in pregnancy. As your pregnancy progresses into the second trimester, cut out vigorous activity that has you lying on your back (such as weight lifting or intense yoga), just in case, and substitute it with something similar in a different position.
    Running on the beach
  • Include the other little ones. If you already have children and don't have access to someone who could watch them while you work out, find ways to bring them along. You can pop a baby or toddler into a wrap or stroller while you take a brisk walk (or jog, if your stroller and older baby are up for it). You can find a mommy-and-me class that lets two of you exercise at once. Some gyms have free nurseries if your child doesn't mind a new environment. There are many DVDs geared for prenatal exercise at home; maybe your child would like to practice maternal yoga alongside you, or else you could save it for naptime or after the kids have gone to bed.
  • Make sure to fuel your activities. Drink plenty of water, and eat when you're hungry. Your body will tell you what it needs.
  • Wear what makes you feel comfortable. First of all, if the girls have gotten bigger and you're doing anything bouncy, make sure you get a decently supportive bra. I have had the worst time finding sports bras that fit my enhanced boobage (due to nursing as well as pregnancy), but I need something to keep my chest from hitting my chin during flying leaps, so I've been squeezing into the largest compression bras I have on hand. As for the rest of your bod, they make some stylish active wear for pregnancy now, so if you need something special, you can likely find it. If price is a consideration, check children's consignment shops for their maternity section. And I scored my maternity leotard off eBay!





Exercise and pregnancy loss

I had a chance to test out my belief that exercise during pregnancy is safe when my very first pregnancy ended in miscarriage — and the initial bleeding started just after my ballet class. I knew then that the ballet hadn't caused the bleeding; it had just sped up its descent. You might have noticed this phenomenon when waiting for your period to begin — sometimes vigorous activity can kickstart the flow. (In fact, that was Sam's and my first improvised pregnancy test this time around: having intercourse to see if my late period would come!) I knew when the bleeding started after my ballet class that the miscarriage was going to happen or not regardless of whether I'd been active that day. Even so, I rested on my left side as much as possible in the coming weeks, and I skipped my ballet classes, out of a psychological fear if nothing else. I did end up miscarrying finally at 10 weeks. When I got pregnant with Mikko, I forced myself to go back to ballet — even though I furtively checked my underwear after each class!

From that experience, I learned a couple things about a comfort level with exercise during pregnancy:
  • If it's uncomfortable to you, you can stop. Even mid-class or -workout, it's all right to say you're overheated or crampy and take a rest or quit for the day. Drink plenty of water and get some fresh air or lie down on your left side as you need to.
  • If you miscarry, it's pointless to blame yourself. Miscarriages happen all the time, usually early on because of genetic defects that can't be helped. No matter what all those old movies show about women who would ride their horses during early pregnancy! That said, if you would feel guilty about a possible connection between a pregnancy loss and your exercise regimen, it's fine for you to slow down or stop your activity level. For instance, if you've had miscarriages or spotting before and it would make you more comfortable to take it really easy your first trimester, you do what you have to, emotionally speaking.

Weight and exercise

Now, I wouldn't normally talk about weight gain when discussing exercise and pregnancy, except that the Becoming Mamas article I referenced did. So I just want to give my own take on the exercise and weight gain connection during pregnancy, and that's not to worry about weight gain at all. I have a perspective of having midwives (in my last pregnancy) who didn't bother worrying about weight gain one bit. I was never weighed by them, and they never asked me for any numbers I'd gotten at home or on the scale that was near the bathroom. I liked keeping track, for curiosity's sake, and I gained 33 pounds, which — if you're playing along at home — is over the recommended weight gain for overweight women. To which I wave my paw and say, bah. I lost it all within 2 weeks after the birth. And I had a healthy, almost-12-pound baby. Clearly, that was the weight my body and my baby needed to gain. I don't give my specific numbers to say you should match those anymore than you should match an arbitrary chart based on averages — I give them to encourage you to eat competently, listen to your body's cues, and let the numbers be what they are.

The only caveat I have is to be cautious if you're losing a lot of weight through exercise. Some women lose weight during pregnancy, or lose net weight, and the baby is fine. My mother, for instance, gave birth to 10-pound darling me but gained only 5 pounds in that pregnancy. Her metabolism simply sped up, and she couldn't get in enough food to combat the increase in calorie burning. Others, particularly in the first trimester, might be so sick they absolutely cannot keep food down. If a symptom is that common, I simply can't believe it to be universally harmful to fetal health. Sometimes people naturally gravitate toward healthier food choices during pregnancy and thereby lower their caloric intake without trying. So I don't want to overstate the risks of low weight gain or weight loss in pregnancy. That said, there might be a risk to the fetus from the release of ketones into the bloodstream, which happens when a person loses fat stores. Another potential risk is that our fat is where toxins build up, and losing fat during pregnancy will release those toxins into the bloodstream as well. Usually, if you lose weight gradually, your body can process these toxins. But, generally speaking, rapid or excessive weight loss during pregnancy (or a presumed net loss like my mom's) is a cause for concern and should be evaluated to make sure you and the baby are healthy. For instance, you might take a ketone urine test. If there are still concerns after testing, it might be a question of slowing down the fitness plan or increasing caloric intake, particularly healthy fats and proteins. If you have a psychological block to gaining weight, you might need a therapist's help.

Remember, fat is good: for you and the baby. A lot of weight gain happens late in the pregnancy as the baby quickly increases in size to be healthy enough to survive on the outside. And a lot of pregnant women will find they don't gain weight on a steady trajectory but through leaps and lulls, and that's OK, too. I barely gained any weight until the third trimester last time, even though my belly grew early on, and after that it was a race as Mikko put on his own pounds. Just check in with a supportive and well-informed health professional if you have a concern over your weight gain or lack thereof.

When exercise and pregnancy might not mix

Based on the ACOG list, and to be thorough, here are people who should definitely seek medical advice before starting or continuing exercise during pregnancy:

  • People with non-pregnancy-related health conditions that affect exercise safety, such as health conditions linked with heart failure or respiratory distress.
  • Anyone at risk for premature labor, particularly with a multiple gestation. Diagnosis might include incompetent cervix, placenta previa, or ruptured membranes. (I can just see someone whose water's broken saying, "No, no! I need to get to my aerobics class! Just hand me a pad.")
  • People suffering from pregnancy-induced high blood pressure.
  • Anyone for whom exercise is going to be tough, such as those who are extremely sedentary, extremely underweight or overweight, or suffering from certain limitations such as high blood pressure, poorly controlled diabetes, severe anemia, swelling, balance issues, breathing issues, etc.
  • I'm also going to add, anyone with an unresolved or reemerging eating disorder or exercise obsession. Being monitored by someone qualified to help you psychologically through the weight gain and body changes of pregnancy will be invaluable, for your health and your baby's.
  • Anyone who displays warning signs during exercise:
    • Vaginal bleeding
    • Severe shortness of breath
    • Worrisome dizziness or headache
    • Chest pain
    • Worrisome muscle weakness
    • Calf pain or swelling
    • Anything suggesting preterm labor or fetal distress, such as preterm contractions, leaking amniotic fluid, or decreased fetal movement

the most beautiful pregnant woman everIn general, exercising during pregnancy is safe and beneficial. Just use your head, find a helpful professional to help you with any questions and concerns, and then go enjoy the burn!

And now, if you'll excuse me, I have to go start Week 7 of Couch-to-5K!

What's been your experience or plan regarding exercise during pregnancy? If you exercised during a previous pregnancy, how did it affect you?

Disclosure: This post is not
intended as medical advice.
Please consult your health care
professional and your common
sense if you have any concerns
about exercising during pregnancy.
Product links might be affiliate links.
See my full disclosure policy here.

Photos of active pregnant lovelies, from top, courtesy
lewishamdreamer, Elsie Escobar, kptice, Ernst Vikne, and Ben McLeod (cc)

10 comments:

Kelly Hogaboom said...

I did all the activities and exercise I did before I was pregnant, while I was pregnant (which included walking, running, swimming, basketball, bike-riding). I was fortunate in that I could and I didn't have any pregnancy complications. I was as active as I was before and it was great.

I have found running is also helpful on my Lady Days. Takes the edge of the cramps for me. The only time I can't run or I caution myself is if I have a hangover, which is basically a state of dehydration.

Sybil said...

I don't have a gym membership! Though I have been seriously toying with joining the Y because it's no joining fee this month. What I love to do is swim, too, but I'm not in love with the Y's pool. If you ever want to swim together, let me know! I go to a pool in Burien.

Andrea!!! said...

I was a slug before and during my pregnancy with Ella and I feel like I really paid for it - my self esteem was low, I had so many aches and pains, it was rough. With my next pregnancy (soon I hope!) I plan on continuing my current exercise routine for as long as I can. For me, the numbers on the scale don't matter so much as how I feel - I could weigh the same, but if I'm not exercising, I just don't feel as good in general.

I think it's great you're doing the C-to-5K program! I have been following the same program off and on this summer and can now easily run 4 miles!!! That is approximately amazing for me (a fellow non-runner!)

Laura said...

I ran quite a bit during my first pregnancy, but not as much as I was before I was pregnant. I loved James Clapp's book, Exercising Through Pregnancy. But all my research then aligns very closely with what you outlined here.

Whitney said...

I went horseback riding daily while pregnant, even past my due date. Granted, I've been doing so for years open years and ride a horse trained by me. I galloped, I jumped, I did everything as usual. Surprisingly, I found that a lot of the women at my barn rode through pregnancy, too. Not many people talk about it though. Perhaps because the warnings for horseback riding aren't necessarily geared toward regular riders but more of the "what a fun vacation, let's go horseback riding!" kind of riders? I'm not sure. What I do know is that my likelihood of injury due to horseback riding was much lower than my risk of injury in a car accident (I assessed this by how many times I've ever been injured by horse versus car accidents that were not caused by me).

My doctor was totally fine with me riding as well. But he was confident in my ability to do so.

I ran, lifted, slept on my back... and gave birth to a healthy little girl without any complication.

I will admit - I was hoping the horseback riding after my due date would shake her on out, but it didn't happen. ;)

Because of my intense exercise during pregnancy, I feel that my labor and delivery was extremely easy. I only gained six pounds throughout pregnancy (I'm considered overweight for my height) and lost it and then some within the first two weeks.

beth said...

I was very active before and after my pregnancy, but one of the things I hated most about being pregnant was that I couldn't keep up the activities I loved. My pelvis just totally gave out on me, starting around 7 weeks pregnant.

I play roller derby and knew I couldn't keep that up the whole time, but it was sad at 7 weeks not being able to skate laps without pain. I also like to run and I couldn't do that either; about the only thing that didn't hurt was swimming freestyle, so I did that, even though it was kind of boring. About 2 weeks before the kid was born, I discovered that DDR (a dancing video game) didn't hurt at all, so I bought some new discs for it but delivered the baby before I had a chance to open them!

I would like another baby someday, so my plan for next time is to keep in touch with my derby friends - maybe I can coach or do other jobs from the sidelines - and try to find a way to get excited about swimming.

Marilyn (A Lot of Loves) said...

I had a lot of pelvis issues with my pregnancies that resulted in me being barely able to walk so there was no exercise for me. I always admire and am awed by women who are able to exercise or work throughout a pregnancy. I was off work from 6 months on.

I've been offline for a bit on vacation and then dealing with sick kids so I missed your pregnancy announcement. Congratulations! That's really exciting to hear.

Kat said...

Great post! Exercise during pregnancy is so important and can help with so many things. I just love how you've listed all the things to consider to make it safe and enjoyable for pregnant women to exercise :-)

mamapoekie said...

Did I not know you were pregnant? Anyway: congratulations!!! wow that's great!!! Yay! Happy dance

Mama Wants said...

Intriguing post on the assortment of different pre-natal exercises. Concentrating on different areas of the body in small increments will aid in firming and strengthening without causing any damages to the growing fetus.

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