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Once upon a time, and as recently as a decade ago, exercise and pregnancy were deemed a bad combination. Conventional wisdom held that women needed to take it easy for the baby’s sake and avoid any exertion that might put the fetus at risk.

Times have changed, and so has this thinking. It’s now common to see pregnant women running endurance races, lifting weights, and practicing yoga (not to mention hoisting heavy toddlers into shopping carts without hesitation) throughout their pregnancies. Search Instagram for #fitpregnancy, and it’s hard to believe pregnancy was once considered a time for women to rest.

This cultural shift comes on the heels of research suggesting that most exercise during pregnancy is safe — and actually offers a number of health benefits. Staying active can help reduce common discomforts (such as back pain), lower the risk of complications like ­gestational diabetes and preeclampsia, reduce stress, boost energy, and improve sleep. It can also help the body prepare for and ­recover from childbirth.

Yet, while more women may feel at ease, practical advice on how to exercise during pregnancy in a way that supports long-term health is hard to come by. Physicians seldom discuss conditions such as diastasis recti, pelvic-floor dysfunction, preeclampsia, hyperemesis, and other conditions until they become an issue, despite ample evidence that women can take proactive steps to reduce the risks of their occurrence.

Even markers of an easy and uneventful pregnancy — the release of relaxin, a hormone that relaxes joints and ligaments in the pelvis, and an increase in overall blood volume and flow — usually aren’t considered when hitting the gym.

On top of these physiological changes, which vary widely, expecting to maintain your fitness during pregnancy and “get your body back” as soon as baby arrives can prove harmful to your mental health.

Women’s health practitioners and fitness experts agree that prospective mothers need more guidance. “Listen to your body” is a solid starting point, but there are plenty of other ways to safely and effectively stay active through each trimester and into the postpartum period. Our guide can help you find your just-right level of pre- and postnatal activity.

First Trimester: Weeks 0 to 12

Respect early symptoms of pregnancy and be willing to adapt. Take this time to understand your body and prepare for the changes ahead.

The first trimester of pregnancy is often viewed as a time to maintain fitness, with little need to modify your workouts — but there are some adjustments worth making now.

“Just because you don’t look pregnant yet doesn’t mean you don’t have a reason to adapt,” says California-based coach Brianna Battles, MS, CSCS, founder of the Pregnancy and Postpartum Athleticism program. “It’s important to start out with a mindset of adaptability and willingness to honor your varying energy levels.”

Rather than trying to commit to a rigid routine and pushing through fatigue or nausea, give yourself a break. Choose exercises that require little preparation; take extra time to transition between movements; stay well hydrated; and prioritize sleep.

“You’re exhausted and you may not feel good,” but those things aren’t visible, says Stephanie Winters, NASM-CPT, a personal trainer and instructor at Life Time Academy in Chanhassen, Minn. “You have to remind yourself that you’re growing a human. It’s like running a marathon every day.”

The first trimester is also a time to plan for changes you’ll experience later. “It’s a good idea to start being more aware of your posture and daily activities that may be adding more stress to your spine and to your pelvic floor,” says Theresa Plasencia, MPT, a Twin Cities–based women’s-health physical therapist. “It’s also an ideal time to learn how to engage your core and connect with your breath.”

Strive to understand your tendencies during exercise, Battles advises, and learn how to address them before the baby gets in the way. When some women attempt to engage their core during exercise, for example, it may result in bearing down or pushing the pelvic floor downward. During exertion, you want to instead feel a gentle lift of the pelvic-floor muscles.

Additionally, some women put pressure into the linea alba — the connective tissue that supports the abdominal wall — which looks like your belly is pushing out, or in the case of diastasis recti, coning at the center of the abdomen. The harder your core has to work during an exercise, the more you should feel your belly drawing in and tightening.

“Knowing how to connect with breathing strategies can support you during the rest of your pregnancy and postpartum,” Battles says. (For more on this, see “Connect With Your Core” at the end of this article.)

A proactive approach now can also help stabilize the pelvis and prevent symphysis pubis dysfunction (SPD) and sacroiliac joint dysfunction (SJD) later in the pregnancy.

“Typically, women don’t experience issues such as SPD or SJD in the first trimester, but it’s good for them to use exercise to start stabilizing their pelvis early on,” explains Lindsay McCoy, an exercise physiologist in Minneapolis and cofounder of the One Strong Mama program. McCoy recommends incorporating moves that strengthen the hips, such as lateral-band walks.

“Prehab before rehab,” she advises. “It’s much more effective.”

Exercises to Try

Kettlebell Deadlift: The functional movement of lifting a heavy object off the ground is a huge part of motherhood and life, as well as a great way to strengthen your posterior chain and dial in good breathing strategy.

Kettlebell deadlift illustrationIllustration: James Carey
  • Stand straddling a moderately heavy kettlebell. Inhale as you hinge at your hips and bend your knees to lower your arms toward the kettlebell, keeping your shins vertical.
  • Grip the handle, then exhale and drive through your heels to rise to standing.
  • Inhale as you return the weight to the floor.
  • Perform three sets of 10 to 12 reps.


Dumbbell Overhead Press:
The first trimester is a good stage to start building upper-body strength to prepare for all the time you’ll soon spend carrying the baby.

Dumbbell overhead press illustrationIllustration: James Carey
  • Hold two dumbbells at shoulder height with palms forward. Check in with your alignment, setting your ribs directly over your hips. Inhale.
  • Exhale, then press the weights overhead, keeping ribs stacked over hips.
  • Inhale as you lower the weights to the starting position.
  • Perform three sets of 10 to 12 reps.


Internal and External Hip Rotation:
 This exercise strengthens the musculature around the hips, which can minimize and prevent hip discomfort and low-back pain.

Internal and external hip rotation illustrationIllustration: James Carey
  • Lie on your right side with hips and ankles stacked and knees bent at 45 degrees.
  • Keeping your ankles together, lift your left knee to externally rotate your left hip.
  • Then bring your knees together and lift your left foot to internally rotate your hip.
  • Continue internally and externally rotating your hips for one minute, then repeat on the opposite side for one minute.
  • To make it harder, place a ball between your knees or have a partner gently give resistance for you to push against.

Second Trimester: Weeks 13 to 26

Just because you can doesn’t mean you should: Continue to strengthen areas of your body that will support you during and after pregnancy — but beware of pushing too hard.

In the so-called honeymoon trimester, you may start to feel more energetic and less prone to morning sickness.

“The tendency is to think, Oh, I feel good now! and then start pushing boundaries,” says Battles. But this sense of invincibility is what causes some women to overlook signs that they’re doing too much.

“Instead of asking, ‘Could I?’ you need to be asking, ‘Should I?’” says Jessie Mundell, MS, a pre- and postnatal fitness specialist in Alberta, Canada. “You’re really weighing the risk versus the benefit to determine if a movement is good for you.”

Even if you’re feeling great, your body — and the baby’s — is changing drastically. That includes the “belly pop,” when you begin to look recognizably pregnant, and other shifts that need to be navigated.

Beginning now, and continuing throughout your pregnancy, pay close attention to your breathing while you exercise. Focus on the exhale, using it to guide each movement.

You’ll also want to pay attention to your belly and notice if the abdominal wall is straining or bulging, which can be a sign of diastasis recti. This occurs when the linea alba, or connective tissue between your rectus abdominis muscles, starts to pull apart.

Your pelvic floor also changes throughout pregnancy and in the postpartum period. If you are experiencing excess pressure, pain, or the urge to urinate either during or after exercise, avoid that movement or lessen the load.

Maintaining mobility is important, but be aware that the release of the hormone relaxin — which relaxes the ligaments in the pelvis in preparation for childbirth — can cause overstretching and injury. Limit your range of motion to your pre-­pregnancy range, even if you feel you can go deeper.

As the growing baby puts more pressure on your abdominal wall and pelvic floor, be especially careful when performing high-impact activities, such as running and jumping, and dynamic moves like Olympic lifts.

Mundell recommends prioritizing glute-based exercises, which can help prevent lower-back and hip pain while also indirectly supporting the pelvic floor by shifting the pelvis into better alignment. “You’re really trying to support the pelvis as best you can by building stability through the trunk region,” she explains.

Strengthening your upper body prepares you for the physical demands of motherhood. Winters advises working the backside of the body with rows and other pulling movements.

The most important piece of advice — now and continuing through postpregnancy — is to immediately stop any exercise that causes pain.

Exercises to Try

TRX Row: This move strengthens the upper back and back of the shoulders, promoting better posture through pregnancy and beyond.

TRX RowIllustration: James Carey
  • Hold the handles of a TRX or other suspension trainer and lean back with arms straight and palms facing inward. Adjust your feet to find a challenging angle.
  • Exhale, then pull both handles toward you, squeezing your shoulder blades together at the end of the movement.
  • Inhale as you slowly reverse the movement to return to the starting position.
  • Perform three sets of 10 to 12 reps.


Stability-Ball Banded Hip Thrust:
This exercise strengthens your glutes, core, and lateral hip muscles to help support the pelvis.

Stability ball banded hip thrust illustrationIllustration: James Carey
  • With a flat resistance band around your legs just above your knees, carefully position yourself on a stability ball so that your head and shoulders are on the ball and feet are flat on the floor, with knees bent at 90 degrees.
  • Inhale as you lower your hips toward the ground, keeping the ball still.
  • From this position, exhale, then drive your heels into the ground to lift your hips, keeping your pelvis neutral: Do not tuck your tailbone as you lift, or squeeze your glutes at the top.
  • Perform three sets of 10 to 12 reps.


Breathing With Strap:
This move improves expansion of your rib cage, which supports better breathing and also creates more space for baby.

Breathing with a strap illustrationIllustration: James Carey
  • Wrap a yoga strap or tie around your lower rib cage, crossing both ends of the strap in front of you to form an X. Pull the strap tightly against your chest.
  • Inhale into the strap, focusing on moving it outward in all directions.
  • Exhale and gently lift your pelvic floor, as though you’re trying to stop the flow of urine. You should notice the strap drawing in tighter as your belly tightens.
  • Perform one set of 10 to 12 reps.

Third Trimester: Weeks 27 to End of Pregnancy

If you stay active and support your body’s needs, you’ll improve your mindset prior to labor and boost your chances of a smoother postpartum recovery.

By the time most women reach the third trimester, they’re starting to think more about labor.

A 2018 University of Madrid study found that women who performed aerobic exercise during their pregnancies had shorter labors than those who did not. And we know that strengthening the transversus abdominis and pelvic-floor muscles will support the pushing phase.

That said, your fitness is not a direct indicator of how quickly or smoothly your labor will go. “The only predictable thing about childbirth is that it’s very unpredictable,” says McCoy. Still, women can stack the cards in their favor.

Balancing the pelvis can be par­ticularly helpful if you’re experiencing discomfort or dysfunction in this area, Plasencia says. “Issues such as pelvic-girdle pain and sacroiliac joint dysfunction may indicate imbalances in your pelvis, spine, or hips. If we can address these things, it might promote a better scenario for delivery.”

Mobility work to release tension in the pelvis, as well as strength training to build stability in the hips and pelvis, is crucial. A physical therapist (PT) or chiropractor trained to work with pregnant women can help make adjustments to maintain alignment and reduce pain.

Plasencia also recommends practicing different labor positions — such as squatting, being on hands and knees, and leaning over a stability ball.

Still, training for labor shouldn’t be your only motivation to work out during the third trimester. “In my last pregnancy, I wasn’t training for birth, or even for my baby’s health, but for my own health,” explains Mundell. “I always bring it back to feeling comfortable in my own body — ensuring that I was mentally, physically, and emotionally healthy to show up in my own life.”

Exercises to Try

TRX-Supported Squats: This move helps train both relaxation and engagement of the pelvic-floor muscles to help support labor and recovery.

TRX Supported SquatsIllustration: James Carey
  • Hold the handles of a TRX or other suspension trainer and step back until the straps are taut.
  • Inhale as you lower into a squat, maintaining a neutral pelvis.
  • Pause at the bottom of your squat, exhale and then take another inhale, focusing on relaxing your pelvic floor.
  • Exhale, then rise to standing.
  • Perform three sets of 10 reps.


Pallof Press:
This core-focused move helps you safely continue to stay connected to your deep core muscles while promoting good alignment.

Pallof pressIllustration: James Carey
  • Anchor a medium to heavy resistance band to a secure surface at about chest height. Take the unattached end of the band and step sideways, away from the band’s anchor point, stopping when you feel resistance.
  • Assume an athletic posture with a neutral pelvis and ribs stacked over hips. Hold the handle of the band at your chest.
  • Inhale. Then exhale and press the handle directly in front of you. Avoid rotating at your torso, and maintain good alignment.
  • Inhale as you return the handle to the starting position at your chest. Take an extra inhale before the next repetition, focusing on relaxing your pelvic floor.
  • Perform 10 reps. Face the opposite direction to switch sides.


Iliacus Release:
 This move releases tension in the front of the pelvis to ease lower-back pain and help baby engage in a better position for delivery. Note: Experts consider it safe to be on your back in the late stages of pregnancy — for short periods, and as long as you feel comfortable. If this move is uncomfortable, skip it.

Iliacus release illustrationIllustration: James Carey
  • Lie on your back with knees bent, feet on the floor, and place a bolster or yoga block under your hips, positioning it so that your tailbone gently tucks. Rest here for a few minutes.
  • Bring one knee up toward your chest and straighten the opposite leg. Gently move your outstretched leg a few inches from side to side for about 30 seconds. Switch sides.

Cardio Considerations

It’s generally safe to continue doing most types of cardiovascular exercise during pregnancy, experts say, but some women may experience uncomfortable symptoms, such as pelvic pressure and an increased urge to urinate, during high-impact activities like running or jumping.

If you’re experiencing any concerning symptoms during or after pregnancy, it’s a good idea to switch to a lower-impact movement, such as walking uphill, climbing stairs, swimming, pool running, cycling, and lifting lighter weights for higher reps, says Winters.

Women were once advised to keep their heart rates below a maximum of 140 beats per minute, but experts no longer impose a limit. Rather, it’s important to pace yourself, stay hydrated, avoid exercising in extreme temperatures, and stop if you feel dizzy or lightheaded.|

Fourth Trimester: 12 Weeks postpartum

Respect your body’s recovery time, see a women’s-health physical therapist, and gently ease back into a fitness routine.

In 2018 the American College of Obstetricians and Gynecologists (ACOG) revised its recommendations for postpartum care, reinforcing the importance of the so-called fourth trimester.

ACOG now recommends that all women see their ob-gyn or midwife within three weeks after the baby’s birth, receive ongoing care as needed, and follow up with another visit within 12 weeks. This can help identify and address recovery issues.

Childbirth, whether by vaginal delivery or C-section, presents a major challenge for the body: The pelvic floor and abdominal wall may be stretched, weakened, or damaged, and the pelvis may fracture or become misaligned.

With this in mind, weight loss or “getting your body back” ought to be the last thought on your mind. Movement can be a powerful healing tool during the fourth trimester — if you consider it just that.

“The point of postpartum exercising is taking care of yourself — physically, mentally, and emotionally,” says Mundell. “Ask yourself, ‘Am I able to do activities of daily life in a way that my body is able to support?’ That is the most appropriate mindset during the fourth trimester.”

Taking the first postpartum week to completely rest allows your body to undergo its natural healing process. “It’s important to prioritize sleep, make sure you’re eating enough and staying properly hydrated, and not trying to push through,” explains Winters.

Depending on your type of delivery, you can then try gentle movements and breath work to help yourself reconnect with your core muscles, says Plasencia, who recommends seeing a pelvic-floor specialist or women’s-health PT before ramping up workouts. “If you can see a PT early on, you can get back on track so much faster.”

In addition, a PT can examine bones, joints, and muscles around your pelvis and address imbalances. If you’ve had a C-section, your PT might do scar-tissue mobilization after six weeks to prevent adhesions.

If you’re cleared for strength training during the weeks after delivery, focus on rehab, with an emphasis on reconnecting to the core during movement and restoring alignment. No single exercise will heal diastasis recti, mend pelvic-floor muscles, or restore core strength. Results come from consistently applying good strategy, gradually increasing load, and willingly adjusting your regimen if concerns arise.

“You’re not picking up where you left off third trimester or before pregnancy,” says Battles. “Remind yourself that this is all temporary and that you have the rest of your life to get back into fitness.”

Exercises to Try

Heel Slides: This exercise helps you reconnect to your deep core muscles and strengthen your posterior chain.

Heel slides illustrationIllustration: James Carey
  • Place a pillow under your head and shoulders, lie on your back with knees bent and feet on the floor, and maintain a neutral spine.
  • Bring your right knee to a tabletop position, just over your hips. Inhale, letting your rib cage expand and your belly stay soft.
  • Exhale and lift your pelvic floor, as though trying to stop the flow of urine. Continuing to exhale and stay engaged, extend your right heel until it hovers above the ground and then return your leg to tabletop. Inhale and relax at the top.
  • Perform six reps, then switch sides.


Glute Bridge With Ball Squeeze:
 This move will strengthen your glutes and hips, including your side-butt, which will protect your pelvis and lower back. It can also help strengthen your pelvic-floor muscles as you heal postpartum.

Glute bridge lift with ball squeezeIllustration: James Carey
  • Lie on your back with knees bent and place a squishy ball or other soft object between your knees. Exhale, then press your feet into the ground to lift your hips, maintaining a neutral spine. Inhale and relax your abdomen and pelvic floor muscles.
  • Staying in a bridge position, exhale and lift your pelvic floor as you squeeze the ball between your knees. Then gently relax your pelvic floor as you inhale, still in a bridge position with the ball secure.
  • Perform 10 to 12 reps.


Pec-and-Shoulder Release:
This stretch helps release the tension in the front of the body that many new moms have due to holding a baby for so many hours of the day. .

Pec and shoulder releaseIllustration: James Carey
  • Place a folded blanket or towel on one end of a foam roller and lie on your back lengthwise, using the blanket as a bolster for your head.
  • Bend your knees and keep your feet flat on the ground. Maintain a neutral spine.
  • Bring your arms to your sides in a field-goal position.
  • Stay there for at least one minute and allow gravity to release the tension in your upper body.

This originally appeared as “Fit for Two” in the April 2019 print issue of Experience Life.

WEBEXTRA

Connect With Your Core

Exercising safely during and after pregnancy is less about choosing specific movements and more about applying good strategy to how you move.

One of the most important choices you can make is to connect with your deep core muscles — particularly your pelvic floor, transversus abdominis (TA), and diaphragm — so they can support you during exercise. Following is a quick tutorial for connecting with these muscles.

  • Practice good alignment: When you’re properly aligned, your pelvic floor, TA, and diaphragm communicate better and can more effectively stabilize your core, support your pelvic organs, and prevent leakage. While exercising, aim to keep your rib cage stacked over your hips and maintain a neutral pelvis. Avoid flaring your ribs or clenching or tucking your bum.
  • Use your breath: Inhale deeply through your nose and focus on expanding your rib cage (as opposed to letting your chest rise or pushing your belly out), which will cause your diaphragm to expand and your pelvic floor and TA to gently relax. Then exhale through pursed lips, as if blowing out a candle. Your diaphragm will contract, your pelvic floor will gently recoil, and you’ll feel tension in your abdomen as your TA engages. It is just as important to be able to inhale and relax your pelvic floor and abs as it is to exhale and engage them.
  • Coordinate your breath with movement: When performing a lift or exercise with a distinct work or concentric phase, exhale to connect with your core just before the work phase. Continue to exhale and stay engaged through the work, then inhale to relax on the movement’s eccentric or rest phase. If you feel you need more support in the eccentric phase, or if you find that you’re not relaxing your pelvic floor when you inhale, you can alternatively exhale through the entire rep and inhale between reps. The more demanding the exercise, the more you may need to intentionally recruit your pelvic floor and TA to support you. If an exercise has no distinct work or rest phase (such as running or holding a plank), focus on maintaining good alignment and breathing at your rib cage.

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