You won’t believe what goes on inside your pregnant body without you even realising!
If you are still feeling sick hopefully it will start to get better over the next couple of weeks. Chances are you haven’t noticed any drastic changes to your waistline yet, but you may have a bit of a bump, everyone is different. If you are an experienced exerciser make the most of the next couple of weeks before you have to start adapting your routine. If you are not an experienced exerciser then try and make active daily choices and do your daily exercisers (pelvic floor, bum and ab squeezes, see 3-Plan) and think about starting more regular, appropriate exercise once you have had the OK from your 12 week scan.
Try to remember how remarkable your body is. The journey to motherhood is incredible if you look at how your body changes and adapts to make its environment just right for your growing baby. This week we are going to look at what hormones are released in pregnancy and how they impact on exercise and the other changes that are going on inside your body that you should be aware of and reassured about in relation to safe exercising in pregnancy.
Let’s look at four of the big players: relaxin, oestrogen, progesterone and insulin.
The role of relaxin is to relax the ligaments of the pelvis to enable the joints to separate to accommodate your growing baby. Later, for your pelvis to open up and your baby to be born.
However clever relaxin may be, it is not able to target the relaxing effect on just the pelvic area. It can cause joint laxity on ligaments and fibrous tissue anywhere in the body, including your back, hip joints, knees and ankles, which all become slightly more prone to injury. Its relaxing effect can also mean there is significant movement between pelvic joints which can range from mildly uncomfortably to excruciatingly painful.
Pregnant women may find that they have greater range of movement during pregnancy due to relaxin. This means it is really important not to overstretch when moving or stretching and stay within a normal range of movement. The effects of relaxin are less noticeable in first time mums; more so in subsequent and multiple pregnancies. It can take six months to return to normal levels (a small amount is always present in the body) but longer if you are breastfeeding, so relaxin is also a factor to consider in postnatal exercise prescription.
Oestrogen has many important functions in pregnancy, including promoting growth of various bits and bobs like your uterus, breasts and your left ventricle (how marvellous!) It also has roles in regulating progesterone, the development of your placenta and baby and colostrum production.
Oestrogen also contributes to the increase in your metabolic rate and oedema (fluid retention), which both have an impact on your exercise programme. Regular exercise can help reduce fluid retention. Be mindful of your increased metabolic rate; you’ll need to take on extra calories if you are exercising (200-300 a day from healthy foods) and also have a slightly higher core temperature, so take care when working out not to overheat.
The roles of progesterone, like oestrogen, are many and varied. Levels of both increase steadily as pregnancy progresses. A function which will have a significant impact on working out is the way progesterone makes smooth muscle relax. This includes your oesophagus, blood vessels and digestive system (the reason for some of the delightful pregnancy ailments such as heartburn, varicose veins and piles).
Also impacting your exercise programme is the fact that progesterone helps to stabilise your blood pressure by relaxing your blood vessels and reducing venous return, meaning you may feel dizzy or light headed due to lower blood pressure.
It also increases your sensitivity to CO2, increasing oxygen levels when you breathe through an elevated breathing rate. This means you shouldn’t try and continue at pre-pregnancy exercise levels as you may be panting before you start!
Finally progesterone has the essential role of stopping important things happening before they should, including lactation and contractions.
Insulin resistance increases in all women during pregnancy making their pattern of energy usage similar to that of a mild diabetic. This is actually your body’s way of making sure that blood glucose circulates for longer so that it can be properly absorbed by the placenta and the baby, so is not a bad thing! However, around 2-4% of women will develop gestational diabetes (which only lasts for the duration of the pregnancy) which may cause some birth defects and result in babies having to be delivered early by caesarean.
Gestational diabetes is usually treated through diet and exercise; overweight women are more likely to develop it. If you do suffer your Midwife will advise on treatment, but it will likely include healthy eating and regular exercise; what we should all be doing anyway!
The main thing to be aware of with exercise and pregnancy insulin levels is that regular training encourages increased insulin sensitivity, which could result in a drop in glucose being available to the baby during exercise. Just remember if you are working out to eat regularly and have a healthy snack before and after exercising.
If you have existing diabetes make sure you discuss your management plan with your Midwife so they can give you appropriate advice and support.
Your changing body during pregnancy
As you can see from our quick run down on the hormones there are lots of changes going on in your body during pregnancy, but this doesn’t mean you can’t be active. However, there are a few things to bear in mind. Just to make sure you have all the key information:
Cool as a cucumber During pregnancy your core temperature rises by approximately 0.6 degrees celsius. Your sweat point lowers, enabling you to dissipate heat from yourself and your baby. This, along with a slightly elevated breathing rate, means that you have a fab inbuilt cooling mechanism and overheating is unlikely.
Go with the flow Cardio exercise will not compromise blood flow to your baby. Provided you are working out at a sensible intensity and not for too long (i.e. over an hour and a half) your body will direct blood to your baby ahead of your working muscles. Stop if your muscles feel fatigued.
Added bonus You are still getting all the ‘normal’ benefits of exercise in addition to the ones related to pregnancy. You’ll be boosting your immune system, improving your cardiovascular and muscle fitness and endurance, releasing endorphins and, hopefully, improving your body image.
Put your hands up! Some people say that you shouldn’t raise your hands above shoulder height in later pregnancy, in case the umbilical cord gets wrapped around your baby’s neck. This is an old wives’ tale and you can ignore it. Carry on raising your hands as long as it feels comfortable. You only need to be cautious if you have issues with high blood pressure.
Don’t count on it An old school of thought used to say in pregnancy your heart rate during exercise should not go above 140 BPM. There’s no right or wrong and every woman is different. A bit of a sweat is OK, but try to keep your effort level moderate – at around 60–70 per cent of your maximum heart rate. Don’t measure your heart rate; go by how you feel and make sure you can still hold a conversation (see page xx)
Back in action If you lie on your back (supine) when your bump is big it may put pressure on your vena cava and affect blood flow, making you feel light-headed. This is called ‘supine hypotensive syndrome’. Avoid lying on your back for any length of time and try side and seated positions instead.
Full of hot air During pregnancy your need for oxygen increases, meaning your breathing rate rises. Later in pregnancy it also becomes harder to take a big breath as your belly expands. Moderate your workout intensity so you can breathe comfortably.
Huff and puff Progesterone is a hormone that relaxes smooth muscle and makes you more sensitive to CO2. This may mean your breathing rate increases and you get puffed more quickly. If this happens moderate your intensity.
Working overtime Your resting heart rate (HR) and blood pumped per beat will increase. This means that you should moderate cardio activity as pregnancy progresses. Keep your heart rate up, but make sure you are working at a sensible intensity and not pushing yourself too hard. Also, warm up gradually and steadily decrease intensity at the end of your workout – to bring your heart and breathing rates down gently.
Vascular underfill When you are first pregnant your body becomes less able to quickly divert your blood to where it is needed. This can make you feel dizzy and faint. If you do, adapt your exercise and avoid quick and frequent transitions (floor to standing etc) and being still for long periods.
Getting to grips with your abdominals: Changes, exercises, what to avoid and will I be able to shift my baby bulge?!
Now you are firmly into your second trimester it’s time to talk about your tummy. You may have a beautiful bump or your belly might still be as flat as a pancake, everyone is different. Whatever size you are as your pregnancy progresses there will be some significant changes to your abdominal muscles and we need to give special consideration to how we exercise them.
Exercising your abdominals safely in pregnancy
- Sit ups / crunches: Most experts agree that sit-up / ab crunch type exercises after Trimester 1 of pregnancy are not a good idea as these put too much stress on weakened surface abdominals and pressure on the blood vessels in your back as your bump grows. I would suggest you can carry these on to around week 16-18 if you have not experienced any abdominal separation (see below) and you still find them comfortable.
- Planks: I am really surprised to see fitness professionals recommending the plank as suitable in pregnancy. I would suggest a modified plank (on your knees) is still ok in Trimester 1, but would avoid any planks after this. This isometric hold simply builds up too much pressure behind your abs.
- Overstretching: As your belly grows your abs will get thinner and weaker and may separate. For this reason we don’t want to be stretching them beyond gentle moderate moves. Stretch your tum with caution.
- Twisting and turning: Exercises like twisting and side bending can make abdominal separation worse so avoid these after Trimester 1 too.
- Transitioning: Take care in between each exercise, especially if you are getting up and down off of the floor. A bit more about getting up is included below.
- Heavy lifting: I hope this is common sense, but try to avoid heavy lifting and straining during pregnancy – no weightlifting competitions!
However considering all these points, it is very important to keep your deep core muscles strong and exercise them regularly to have the best chance of achieving a flat tum again after you have had your baby and minimise the likelihood of getting any pregnancy back pain.
Work that TVA!
That what? The TVA (transversus abdominis) is your deepest abdominal muscle and the body’s ‘internal corset’. You can activate it simply by breathing in deeply and letting your chest expand, then as you exhale, pulling in your tummy all the way around and holding it in for a couple of seconds, then releasing. Gaining control over your TVA and working it as often as possible is key to having a flat tum after you have had your baby. It also plays an important part in pushing your baby out. This is called working your ‘core’.
If I can’t do all these things what can I do?!
You don’t have to do sit-up style exercises to be working your tum. There are lots of exercise you can do including ab squeezes and hollowing (engaging your TVA as described above) to maintain core strength in pregnancy. Pilates is also a great option. In the 3-Plan you will find four safe and effective ab and back exercises for each trimester of pregnancy and stage of postnatal recovery.
Also remember that by holding a good posture, keeping a neutral spine and your TVA drawn in throughout any toning exercises you do you can triple the good work you are doing. You will feel your tummy muscles working, particularly if you are using weights, when you are doing upper body and leg exercises. This really engages your core muscles. You can also maintain a good upright posture all the time!
Diastasis: what is that?
You may have some separation of the abdominal muscles during and after pregnancy (the technical term is ‘diastasis’, which sounds scarier than it is). Around a third of women experience this and it is more common if you are overweight, carrying multiple pregnancies or have had babies before. This is obvious when you think of how much your tummy needs to expand to accommodate your little babe. It is in effect your rectus abdominis muscles slightly moving apart to give your baby space to grow.
When you have had your baby, you will be able to feel whether you have this separation, or not, with your fingers. Lie on your back, with your feet on the floor, knees bent and head and shoulders lifted. Feel above and below your belly button to see if you can find a gully between your tummy muscles (see pictures in the 3-Plan). The gap may be above or below or both. The separation occurs at the linea alba, which is the line that runs down the middle of your tummy, which you can sometimes see in the later stages of pregnancy.
By doing the exercises in the 3-Plan, using a good technique, you will be able to gradually close this gap and get a toned, gorgeous tum that you will be proud to show off!
Diastasis separation varies from one person to another, so don’t worry if your gap feels quite wide. There are certain exercises that you won’t be able to do until the gap has closed to narrower than two finger-widths. Until then you can carry on strengthening your core and helping to close the gap. This is all covered in the New Body Plan.
Getting up from bed can place stress on both your back and tummy muscles if you do it in the wrong way. To minimize the stress, roll on to your side before you push yourself up using your arms. Don’t sit straight up forwards as this will make any ab separation worse/
I found it comfortable to wear an abdominal band to help support my tummy and back while I was exercising, but it is up to you whether you do or don’t. My first support was a stretchy band that covered my whole bump for the first six months of pregnancy. Then I switched to an under-the-bump band for the last three. I wore a support most of the time and never experienced any back problems, but do what feels right for you.
Will I be able to shift my baby bulge?
You might think that because you have had, or are going to have, a baby you can kiss goodbye to that flat tummy dream. That is simply not the case and you can look even better than you did before.
A good pregnancy exercise plan like the 3-Plan Pregnancy Plan (first half of the book) will help you to strengthen your deep abdominal muscles, surface abdominal muscles and pelvic floor muscles, ready for childbirth. By working on these before you have your baby you will have a much easier job getting them back into shape afterwards.
Following this a targeted postnatal; exercise plan like the 3-Plan New Body Plan (second half of the book) will help you work towards getting rid of your baby bulge. There are three things you need to do to get a flat tummy:
- Get rid of the fat over your tummy by doing cardiovascular exercise.
- Work the deep ‘core’ muscles to strengthen and tone your tummy and back (these ‘partner’muscles need to work together).
- Tone the surface abdominals.
The New Body Plan covers these three aspects, so stick with it and you will see results. If you have had a C-section you should wait until you have had the go-ahead from your GP and feel ready to begin. (I have used six weeks as a guide and it should be a long enough break for most women. You may choose to start very gently). Also, remember, you may still look pregnant for quite a while after you have had your baby. Again, this is perfectly normal, so don’t worry. Everyone’s different and it will take some people longer than others to get their figures back; the key is to stick with your ab workout and make exercise part of your routine. You are the one in charge of how you change your body and it will take effort and time.
guest blog from Rennie Downes
guest blog from Rennie Downeswww.pregnancypillows.org
Finding optimal quality rest is crucial during pregnancy, yet a 1998 poll by the National Sleep Foundation shows that 78% of women find it harder to sleep now than at any other time during their lives (even given the disturbed rest likely to follow in the near postpartum months). Why is this, and why is rest so important when we are expecting a baby? What can we do when poor sleep / sleeplessness strike?
Poor sleep during pregnancy
There are many factors that can contribute to inadequate quality or duration of sleep during pregnancy. Anxiety over the birth and our new role as mother – sometimes manifesting as 3am list-making! – can often become a factor in the development of insomnia. Difficulty getting comfortable thanks to changing curves and aching joints may also play a factor to disturbed rest, as can back pain – the latter affecting 50-80% of pregnant women (spine-health.com).
Many expectant mothers will experience vivid or disturbing dreams during their pregnancy, and some could be woken up by the movements of their unborn child. A tendency to feel “overheated” is common, and we are likely to require more frequent night-time bathroom trips as our trimesters progress. 30-50% of pregnant women will also experience heartburn and 26% will suffer from RLS (Restless Legs Syndrome), so it’s really not surprising when the quality of sleep plummets in pregnancy.
Risk of complications
Nevertheless, expectant mothers are “sleeping for two” and as such it is doubly important for the health of both mother and child that adequate rest is acquired. A study by the NSF found links between poor quality slumber and elevated blood pressure in pregnancy (as well as an increased risk of preeclampsia) while other studies show that women who sleep less than six hours per night are more likely to experience longer labors and give birth by Caesarean section.
Poor sleep, depression and a weakened immune system are all inexorably related (poor sleep causes depression and vice versa) and each increases the risk of pregnancy complications (Science Daily). Unfortunately sleep medication is usually not an option during pregnancy, but there are many methods you can use to try to improve the quality of your sleep.
Five ways to better sleep
1) Try not to worry
As hard as it may sound, lying in bed worrying about the fact that you cannot sleep is only going to make your problem spiral. If insomnia strikes, don’t wait it out in bed – you are actually more likely to get back to sleep sooner if you get up and move about, engaging in mild, relaxing activity until your head is ready to hit the pillow.
2) Know your enemy
Insomnia has multiple symptoms, the most commonly known being the classic issue of going to bed only to find sleep impossible. Waking up early, finding it difficult to wake in the morning or regularly waking during the night are all other signals of insomnia, but then again you may feel sleepy for entirely different reasons altogether.
Daytime drowsiness can just mean you need more sleep – but sometimes it indicates underlying medical conditions like anaemia or sleeping disorders such as sleep apnoea, so it is very important to get your fatigue checked out and diagnosed accordingly. Even if your doctor confirms that it is just another symptom of pregnancy, it’s worth being able to rule sleep apnoea etc out as these can have a detrimental effect on your pregnancy and birth.
3) Relax through exercise
Whether you’re new to exercise or already have a regime in place prior to getting pregnant, moderate activity can be helpful to you during pregnancy for several different reasons. If you suffer a bad back, exercising can help strengthen your core and ease discomfort while well-timed aerobic activity – not too close to bedtime – can be an excellent cure for insomnia.
If you struggle to sleep during pregnancy, why not consider using exercise as a form of relaxation? Classes in prenatal yoga and aquatic exercise are both very popular and widely available, but there are many other possibilities too.
In contrary to what you may have been told by your family and friends, pregnancy is not normally a reason to give up your daily dose of cardio. In fact, cardiovascular exercise can help your body to build a larger, more efficient placenta for your baby – and there are many other benefits too. You will need to take things carefully, though, and avoid certain activities like contact sports; if you are unsure which activities are classified as safe, consult your physician.
4) Sleep well-supported
As your trimesters progress you are likely to be spending more time in bed sleeping (or at least resting) every week, so it’s really important that you find a way to get comfortable when doing so. Being able to achieve an optimal sleeping position in which your bump, back and legs can feel relaxed but well-supported goes further than just attaining a good night’s rest – it may also affect your level of discomfort throughout the day, particularly in the case of RLS, back pain or PGP (Pelvic Girdle Pain). If your hips are aligned into a neutral position it could even help baby get into position ready for the birth.
As your uterus expands it will become more and more impossible to lie comfortably or safely on your back, so doctors tend to recommend that you sleep on your left side – yet even this can put a lot of strain on your spine if unsupported. It is therefore recommended that you purchase a suitable maternity pillow to ease the increased weight and strain being placed upon your joints; such pillows are extremely versatile and can help you achieve the best sleeping position during pregnancy. What’s more, with such a huge amount of choices available on the market, you are sure to find the right size, shape and price for you.
5) Speak to your doctor
If all else fails, you are feeling very anxious or just cannot seem to get any sleep, don’t suffer in silence while everyone else dreams! Consult your physician about the possibilities that are open to you during pregnancy – he or she may be able to suggest a suitable medication or other avenues that you’ve not yet explored. Remember that however tired you may be feeling now, it is only temporary and soon everything will change again. Try not to despair, but don’t be afraid to ask for help!
Guest post from Patricia Hogenes
Isn’t it an exciting time when you’re pregnant? While you are carrying, you want to think about exercise, because any fitness you build will help later on. For instance, doing bicep curls will be helpful when you are carrying the baby around the house. So what are the do’s and don’ts for pregnancy?
Do be moderate. If you exercised before the pregnancy, it is great to continue your workout routine, but just be moderate. If you used a weight workout regimen before pregnancy, it’s fine to continue that through the first trimester and even into the second. But by the third trimester, you’ll want to be cutting down on your use of weights. Here are some excellent resources with more information:
Do think of alternatives. If you were a runner before you were pregnant, but it’s now midsummer and really hot outside, maybe there is another way to get in a great aerobic routine, without facing the summer heat. Consider water aerobics. To replace the running, think about aqua walking. Just go to the community pool when the lap lanes are open and walk up and down the lap lanes. For more exertion, pick up the pace to aqua jogging. Do keep a water bottle at the end of the lane, to stay well hydrated.
Do use exercise for relaxation. With the stresses your body will be going through over the term of the pregnancy, exercise will function as a great relaxer. Your body sends out signals of calm and exuberance while you work out, and those will be transmitted to the baby, as well as making you relax more. You’ll be using that workout for double duty – keeping yourself peaceful, and helping grow a strong and happy baby.
Don’t overdo it. If you haven’t exercised much, and decide to start during pregnancy, it is perfectly fine to do that. A recommendation by the American College of Obstetrics and Gynecology is to engage in 30 minutes or more of moderate exercise per day, unless there is a complication. This is an excellent goal to strive for, but start by checking with your medical professional to make sure you’re cleared to begin exercise. Tell the doctor your plan, and make sure it will work for you. Begin with a low level of exercise, and gradually work up to higher levels over time. Don’t try to start with more than you can handle.
Don’t do really strenuous exercises. Be respectful of the changes your body is going through. Yes, it’s fine to exercise, but put some thought into the kinds of exercise which will be appropriate. For instance, there are some types of exercise that could put the belly at risk for trauma. Among those, off-road biking, horseback riding, gymnastics and downhill skiing are exercises that you might want to try later, after you’ve recovered from the pregnancy.
Don’t wait until later. With a lot of things happening in your world during the pregnancy, it would be easy to say “I do mean to work out, but I’ll just get started next week.” Putting things off is a common tendency, but during your pregnancy, time will be going fast, and it would be easy to quickly find yourself in the third trimester, not having worked out, and wishing you had. Start early, or if you’ve already been working out, don’t allow a break in your workout routine. You’ll be glad you did when it comes to the delivery, and after the child is born.
Smile when you think of your pregnancy, and how your exercise routine is making it a more powerful and positive experience.
Patricia Hogenes writes for AnApplePerDay.com, about kids, parenting, exercise and health. She is avid about her workouts, which have ranged from aqua jogging to marathon training to cycling. She and her husband also enjoy entertaining, and taking vacations with their kids.