-by Tanya Rowenhorst, PT, DPT – specializing in women’s health at Orange City Area Health System Physical Therapy
Today I’d love to educate and share why I believe specific prenatal exercise is so important for every pregnant woman, and will share more about the postpartum exercise class later this week. When I talk about prenatal exercise, I’m not talking about going for a walk or a jog or a swim, though these are great for maintaining cardiovascular endurance and strength. I’m talking about exercises that will help you function better, help you avoid back and pelvic pain (common ailments during pregnancy), and help you potentially enjoy a smoother labor and delivery. If you’ve been pregnant before, you know the massive amount of change that your body goes through during 40ish weeks of gestation. As early as four weeks, the hormone Relaxin is released in the body, already causing laxity in tendons, ligaments, and connective tissue. I’ve seen many pregnant women just in their first trimester already experiencing back pain. This laxity, along with a more forward shift in posture due to the baby’s position, can lead to multiple issues in the spine, SI join pain, hip pain, sciatica (pain shooting down the leg), and pubic symphysis pain (groin pain). ACOG (American College of Obstetrics and Gynecology) has the following recommendations: 1. In the absence of either medical or obstetric complications, 30 minutes or more of moderate exercise on most, if not all, days of the week is recommended for pregnant women. 2. Women can continue to exercise from mild-moderate exercise routines. 3. Weight bearing exercises may be continued considering prior level of fitness. 4. Avoid exercise in the supine position (laying on back) after first trimester due to decreased cardiac output and prolonged periods of motionless standing, as well as exercise involving high risk of falling. So, we know that general exercise is beneficial and recommended. We also know that there are major changes going on in the body that may limit what we typically do for exercise and also predispose us to injury. I myself have had several bouts of pretty debilitating pain during pregnancy due to exercising beyond my limits, which made it hard to walk, bend over, and sleep well during the second half of my pregnancies. I can remember one specific pregnancy where I was in my third trimester and pregnant with my third child. My older two were not quite two and four at the time, and my almost two year old son was a particularly busy handful. My husband is a farmer and a seed salesman, and during the spring and fall, I do a lot of single-parenting. I was of course, by myself at home with my kids after a hard day (as in hard on my body) of work and was in a lot of a pain. I could barely stand or walk, and he was getting into absolutely everything. I ended up putting my kids in the car, putting on a movie, and just driving around for an hour (crying) until bedtime because I felt like I was unable to take care of him safely any other way. It was a horrible feeling and I felt like a failure as a parent. But this doesn’t have to be a norm for pregnant women. We often just accept that back pain is normal during pregnancy, and we just deal with it. If you are having pain that is affecting your function (your ability to do your job, take care of your kids, sleep well, clean, even go for a walk) I highly encourage you to see a physical therapist! There are SO many things that can be done for you and it’s been such a pleasure of mine to assist many women in getting through their pregnancies with less pain and improved function. But what if we could avoid debilitating pain all together? What if we could DO something during pregnancy to prevent getting to the point where we aren’t functioning well? That is the point and purpose of this class. I’m going to teach you how to strengthen specific muscle groups that will help decrease your chance of back and pelvic pain, including your deep core muscles that provide stability to the spine and pelvis in absence of the typical stability that our body has through tendons, ligaments, and connective tissue. Research shows that the transverse abdominis muscle, an important muscle for core stability, minimizing abdominal separation during pregnancy, and helping facility continence in conjunction with the pelvic floor, gets completely turned off during pregnancy. A 2005 study showed that strengthening the transverse abdominis during pregnancy was associated with a dramatic decrease in diastasis rectus abdominis (DRA), or abdominal muscle separation. I would say that clinically, at least 75% of postpartum women have a positive test for a DRA, which is a risk factor for postpartum back pain and injury. Next, many women experience stress urinary incontinence (SUI) during pregnancy (leaking of urine with an increase in intra-abdominal pressure, like when you cough/sneeze/jump) and many more experience SUI afterwards. SO many women I talk to consider this a normal part of having babies. They laugh it off and accept that it is just something they’ll have to live with. But that is simply not true. Though common, it is NOT something you have to live with. Who actually WANTS to leak urine? This seemingly minor issue is only going to get worse as you age if you don’t do something about it right now when you are young! In addition, 50 percent of women do not even do a kegel correctly! Teaching women how to properly use their pelvic floor is important for this reason and several others. Not only does it work in conjunction with the transverse abdominis to provide stability to the pelvis, but having a strong pelvic floor can help with labor and delivery! Other parts of this exercise class will include specific exercise and stretches that will help to prepare your body for this end result – giving birth to your child! The stats are significant – exercise during pregnancy can do the following: 1. Decreased risk of preterm delivery 2. Decreased risk of going past term 3. Decreased incidence of macrosomia (birth weight greater than 8 lbs 13 oz) 4. Mother tolerates stress of contractions better 5. Higher apgar scores The exercises that you will learn will help improve endurance during labor, cope with contractions, and overall help each mother feel more competent in dealing with labor, potentially reducing necessity of medical interventions. Your body was created to carry a baby and it was created to give birth. In fact, only about three percent of female pelvis’ are incompatible with vaginal birth, but c-section rates in our country are around 30 percent! There are many factors that contribute to that rate, and that is a topic for another article, but in general, our society creates a spirit of fear around childbirth, when actually, childbirth can truly be a beautiful and empowering experience when women have adequate preparation. Finally, here are a few more positive benefits of exercise during pregnancy that research has found: Maternal Benefits – 1. Maintain healthy body weight 2. Reduced weight gain 3. Improved sleep 4. Decreased musculoskeletal complaints 5. Improved posture and body mechanics 6. Reduced depression 7. Possibly eases labor with fewer complications of delivery and faster postpartum recovery. Fetal Response – 1. Heart rate responds favorably to sustained recreational exercise 2. Increased nervous system maturity 3. Enhanced cardiac autonomic function I am not a fitness instructor. I am a Doctor of Physical Therapy who has almost 10 years of clinical experience and specialized training in women’s health and working with the pregnant and postpartum population. I’ve given specific exercise instruction to hundreds of women. This will not be your typical fitness class as I will be teaching and educating while we exercise so that you actually know WHY you are doing what you are doing, HOW to do each exercise properly, and HOW this is going to help you. My goal is for women to feel empowered to walk confidently through pregnancy knowing that they can maintain function without limitations during pregnancy, feel prepared for childbirth, and experience a quicker recovery period postpartum! Please feel free to contact me at 712-737-7132 with any questions, and don’t forget to register ASAP by calling our Community Education department at 712-737-5367.