Keeping fit during pregnancy

Exercising and maintaining your fitness during pregnancy is vital, not only for helping your body handle the extraordinary stresses and demands of pregnancy and childbirth, but to help your physical (and mental) recovery afterwards. This article offers an overview of how to exercise safely during pregnancy, and where to go for further information and/or help.

Pregnancy and the pelvic floor

When you announce you are pregnant, prepare to be inundated with stories – primarily bad – about stretchmarks, reflux, swollen ankles and the lack of decent maternity wear. What you won’t often hear though, are the stories of women losing control of their bladder and wetting their pants. It is something women should be told, given research shows one in three women who have ever had a baby will wet themselves (Chiarelli, Brown, & McElduff, 1999), and the more babies you have, the more likely you are to leak urine.

And while incontinence should not be considered normal or a natural part of having a baby, pregnancy can lead to its onset due to several factors.

One such factor is the production of the hormone relaxin, which softens the tissues in your body, allowing them to expand as your baby grows. It also allows your pelvic floor to stretch during birth.

The softening effect of relaxin, combined with the increasing weight of your baby places pressure on your pelvic floor muscles, making you more at risk of urinary leakage. The pelvic floor muscles and ligaments, which help to keep the bladder shut, are also stretched at birth and can be permanently lengthened. Caesarean deliveries have not been shown to offer protection against incontinence in the long term if the pelvic floor muscles have been affected during pregnancy.

The good news is incontinence can be prevented or cured in most cases, with health professionals recommending pelvic floor muscle exercises as the first line of defence (Fritel, et al., 2010; Price, et al., 2010). These exercises are important for all men and women, but particularly pregnant women and women who have had a baby.

So how do I exercise my pelvic floor?

Pelvic floor exercises can be done anywhere, seated or standing.

1. Visualise a muscular sling as the floor of your pelvis running from your tail bone to your pubic bone.
2. Lengthen your spine and relax your shoulders. Focusing on your back passage, lift and squeeze upwards and inwards as though you are trying to avoid passing wind, then bring that pelvic floor lift through to the front, as though you are also trying to stop the flow of urine.
3. Lift and squeeze your pelvic floor for as long as possible. Aim to hold for three seconds initially, building up to 10 over time. Make sure you breathe normally throughout and ensure your shoulders, buttocks, thighs, hands and feet remain relaxed.
4. Rest your pelvic floor for the same amount of time as your lift, before repeating. Aim for three to five, or even 10-second holds in one set. Repeat twice more throughout the day.

If you can’t feel your muscles hold or relax, or if you want to make sure you’re using the correct technique, make an appointment with a continence professional.

Pelvic floor muscle exercises work best in conjunction with other daily healthy bladder and bowel habits, such as drinking up to two litres of fluid (preferably water, especially if you are breastfeeding), eating a healthy, balanced diet, and undertaking regular exercise to maintain a healthy weight.

How do I exercise and maintain my fitness during pregnancy?

Regular exercise during pregnancy is an essential way of helping your body handle the increased demands on your joints, muscles, heart and lungs.

Regular exercise (at the right intensity) can help reduce back pain, improve or maintain muscle tone, reduce leg cramps, swelling and constipation, and improve sleep patterns. Women who exercise regularly often feel better about themselves and their changing body during pregnancy.

Ideal exercises during pregnancy (if no complications):

• Walking
• Low impact aerobics
• Water aerobics
• Pregnancy exercise classes
• Cycling (on a stationary bike)
• Swimming (freestyle not breaststroke)
• Light weight training (see your fitness instructor for assistance with your program)

Exercises to avoid during pregnancy:

• Heavy weights
• Bouncing – especially star jumps, or similar activities
• Contact sports
• Any activities or exercises that cause pain
• Excessive twisting and turning activities
• Exercises that require you to hold your breath
• Exercises that involve standing on one leg for a period of time
• Pushing off with one leg at a time when swimming – try to push off with both feet when turning
• Excessive breaststroke at the end of your pregnancy, as this puts stress on your pelvis
• Prolonged standing static exercises e.g. standing still and doing arm weights
• Highly choreographed exercises or those that involve sudden changes in direction
• Lifting your hip to the side while kneeling on your hands and knees
• Activities involving sudden changes in intensity
• Exercises that increase the curve in your lower back
• High impact or jerky movements
• Prolonged bouncing, as this can overstretch the pelvic floor muscles

Remember that pain or shortness of breath should not be felt at any time. STOP exercising and seek advice from your doctor or midwife if you experience any of the following:

• Dizziness, faintness, headaches, blurred vision, nausea or vomiting
• Any kind of pain or numbness
• Discomfort or feeling extremely tired after you have exercised
• Vaginal bleeding, contractions, leaking of amniotic fluid (the water around your baby), or reduced movements of your baby

Where can I get more information?

The Continence Foundation of Australia, in conjunction with The Pregnancy Centre, has developed a free Pregnancy Pelvic Floor Plan app, which guides women through safe exercising during pregnancy and the maintenance of bladder and bowel health.

The Foundation has also written a booklet, The Pregnancy Guide, a free resource for women and health professionals available in hard copy or downloadable from the Continence Foundation of Australia website.

The Pelvic Floor First website has further information on safe exercises, as well as more detailed information on pelvic floor muscle exercises and causes and symptoms of incontinence.

Women can also phone the free National Continence Helpline (1800 33 00 66), which is staffed by continence nurse advisors who can offer advice, resources and referrals to local clinics.

Find out more about Continence Foundation of Australia here