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Prenatal Exercise and Yoga

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General


Exercise during pregnancy: fetal responses to current public health guidelines.
Szymanski LM, Satin AJ.
Obstet Gynecol. 2012 Mar;119(3):603-10.

CONCLUSION: This study supports existing guidelines indicating pregnant women may begin or maintain an exercise program at moderate (inactive) or vigorous (active) intensities.

Physical Activity for Women During Pregnancy and the Postpartum Period - here are the guidelines from the U.S. Department of Health and Human Services referenced in the study.

Exercising in Pregnancy: What Advice Should be Given to Patients? [Medscape - Women's Health. 2014;10(6):547-548.]

Effects of Maternal Exercise on the Fetal Heart - New study shows exercise-exposed fetuses have improved cardiovascular activity throughout development

Light Resistance Exercise During Pregnancy Does Not Affect Type of Delivery CME

News Author: Pauline Anderson
CME Author: Laurie Barclay, MD

Women stay on active fitness routine during pregnancy [1/9/06]

Here are some of the benefits associated with exercise during pregnancy according to The American College of Obstetricians and Gynecologists:

Exercise ...

    * Helps prepare a woman for labor and childbirth, keeping her body in shape and ready for the endurance needed during delivery.

    * Helps new moms get back into shape after delivery.

    * Can offer some relief to the fatigue, swelling and back pain associated with pregnancy.

    * Can help prevent gestational diabetes.

    * Helps expectant women sleep better.

    * Helps women manage weight gain during pregnancy.

Benefits of Exercise During Pregnancy and After Pregnancy from BeFit-Mom.

Exercise during pregnancy 'should be encouraged'

Pregnancy-Related Changes in Physical Activity, Fitness, and Strength [Medscape registration is free]

Wholistic Pregnancy Exercises

Effects of physical activity on maternal plasma beta-endorphin levels and perception of labor pain.
Varrassi G, Bazzano C, Edwards WT.
Am J Obstet Gynecol 1989 Mar;160(3):707-12

"Exercise conditioning during pregnancy seems to be beneficial in reducing pain perception during labor . . . and in reducing stress levels during labor."

Exercise May Buffer Effects of Stress - [June 2, 2010] — Short bursts of vigorous exercise -- the kind that makes you really break a sweat and increases your heart rate -- may help buffer the devastating effects that stress can have on cellular aging, a new study finds.


Walking 10,000 Steps a Day Is Bad Advice, Finds New Report from bulletproof.com - second-time mothers often lament that they're not able to get in a regular exercise program because they're so busy taking care of young children. This report suggests that brief bursts of intense exercise are most helpful. Isn't that exactly what mothers of young children get? :-)

 According to a new study, maternal exercise during pregnancy has cardiovascular benefits for the developing fetus.

I especially like the approach offered in Julie Tupler's book, Maternal Fitness. She also offers a Maternal Fitness Program in some areas. Her Web sites has a nice page of exercise links.  [Her book makes frequent reference to a stretchy exercise strap/band, called the Dyna-Band.  You can also get the Thera-Band, a non-latex version, in bulk rolls.]

I've heard a few rave recommendations for this prenatal yoga video - "Baby & Mom Prenatal Yoga" - available from Acive Videos' Prenatal & Postnatal Exercise Videos!

Evidence Basis for Exercise Recommendations from someone who has studied both exercise physiology and midwifery.  She has some very useful insights into group aerobics classes for pregnant women.

'Eutokia' is a Greek word meaning happy childbirth. It is the application of the Alexander Technique to pregnancy and childbirth

Running on Full - Information about running while pregnant

Athlete With Child - Can You Still Play When You're Pregnant? - by Monique Cole

Physical Activity Throughout Pregnancy - from the Pregnancy and Postpartum Health pages of the Muskoka-Parry Sound Health Unit in Canada 

Exercise During Pregnancy

Exercise During Pregnancy  - From an old article in the Endurance Training Journal 

FitDay.com is an online diet and fitness journal; there is a calorie and nutrition counter, a weight loss tracker, an exercise log, analysis and reports.

One medical study by itself is  not  conclusive  but a 1998 American Journal of Public Health article reported something remarkable:
If a woman was is 'good physical shape' (i.e. conditioned) and did heavy exercise (> 2000 kilocalories/week) during  pregnancy, she  reduced  her risk of a very preterm birth by 96%. (Maternal Leisure-Time Exercise and Timely  Delivery, AJPH, Maureen  Hatch ( m_hatch@smtplink.mssm.edu ), et al., 1998;88:1528-1533).  What does 2000 kilocalories/week mean? Maureen Hatch informed me via email that this means about 7 hours/week of  brisk walking.  And they reported, "After  term,  conditioned heavy exercisers delivered faster than nonexercisers."  If later  studies  confirm  these findings, it offers more hope for women who believe in fitness.

About Weak Abdominal Muscles Predisposing to Face Presentations

So, what exercises can she do during PG to help her abs?  I know of pelvic rocks, and saw one the other day sitting in a chair, buttocks at front of seat and leaned back ~45degrees and lifting each knee and holding briefly.  Anything else?

Exercise Physiology in Women [Medscape registration is free] - This isn't about pregnant women, but it offers a lot of information that might be helpful.

Yoga

This is a fabulous article from Mothering Magazine:

Asanas for Mamas: The Pleasure of Prenatal Yoga
By Jo Ann Baldinger
Issue 116, Jan/Feb 2003


The Effects of Prenatal Yoga on Birth Outcomes: A Systematic Review of the Literature
Kelly Riley, Emily Drake

Results All studies found that prenatal yoga provided significant benefits, and no adverse effects were reported. Significant findings from the randomized studies included an increase in infant birth weight, lower incidence of pregnancy complications, shorter duration of labor, and less pain among yoga practitioners. Significant findings from the non-randomized and qualitative studies included decrease in pain, improved quality of sleep, increased maternal confidence, and improved interpersonal relationships among pregnant women who practiced yoga.

Birthlight: Simple Yoga Moves For Pregnancy, Birth And Beyond

Supta Baddha Konasana - Reclining Bound Angel Pose - excellent for opening up the hips during pregnancy.  Use bolsters!

Benefits: Frees energy flow in pelvic area
Increases vitality in digestive organs
Good for pregnant women in preparation for childbirth (use bolsters)
Quiets the mind
Relief from PMS and menopausal symptoms
Relief from mild depression
Stretches inner thighs and opens groins.

Prenatal Yoga May Result in Less Labor Pain, Shorter Labor

Yoga during pregnancy: Effects on maternal comfort, labor pain and birth outcomes
Complementary Therapies in Clinical Practice, 14(2), 105-115. [Abstract]
Chuntharapat, S., Petpichetchian, W., & Hatthakit, U. (2008)

Summary: In this trial conducted in Thailand, nulliparous pregnant women without previous yoga experience were randomly assigned to practice prenatal yoga (n=37) or to usual care (n=37). The yoga group attended a series of six 1-hour yoga classes every two weeks in the final trimester and were given a booklet and audio tape for self-study, which they were encouraged to practice at least three times per week. Daily diaries kept by participants and weekly phone contact from researchers helped ensure compliance. Participants in both groups completed a prenatal questionnaire to assess anxiety and collect demographic data.

Once in labor, pain and comfort were assessed every 2 hours in the first stage of labor (for a maximum of three measurements) and again 2 hours postpartum using multiple pain-measurement instruments that have previously been validated for use in laboring women. The researchers controlled for maternal age, marital status, education level, religion, income, and maternal trait anxiety.

Data were available for 33 of 37 women assigned to each group but the researchers provide no explanation for this attrition. Although this omission limits the reliability of the study, the strength and consistency of the researchers' findings suggest that attrition probably did not significantly alter results. The experimental group (yoga group) had significantly less pain and more comfort than the control group at each of the three measurement intervals during labor and at the postpartum measurement. This finding was consistent and significant across all three pain main measurement instruments used.

The researchers do not present data about mode of birth. However, the length of the first stage of labor and total duration of labor were significantly shorter in the yoga group (mean length of first stage = 520 minutes in yoga group versus 660 minutes in control group; mean total time in labor 559 minutes in yoga group versus 684 minutes in control group). There were no differences in length of second stage of labor, pethidine usage or dose given, augmentation of labor, newborn weight, or Apgar scores. Epidural analgesia was not mentioned so presumably it was not available.

Significance for Normal Birth: This study provides evidence that regular yoga practice in the last 10-12 weeks of pregnancy improves maternal comfort in labor and may facilitate labor progress. The researchers offer several theories for these effects. First, yoga involves synchronization of breathing awareness and muscle relaxation which decrease tension and the perception of pain. Second, yoga movements, breathing, and chanting may increase circulating endorphins and serotonin, "raising the threshold of mind-body relationship to pain" (p. 112). Third, practicing yoga postures over time alters pain pathways through the parasympathetic nervous system, decreasing one's need to actively respond to unpleasant physical sensations.

Prenatal strategies that help women prepare emotionally and physically for labor may help reduce pain and suffering and optimize wellbeing in childbirth by providing coping skills and increasing self-confidence and a sense of mastery. More research is needed to confirm the findings of this study. However, yoga's many health benefits and the lack of evidence that yoga is harmful in pregnancy or birth provide justification for encouraging interested women to incorporate yoga into their preparations for childbirth.

Let the Whole Birth Yoga Audio tape and CD guide you through a wonderfully relaxing and rejuvenating hour of yoga and meditation especially designed for pregnancy. Whole Birth Yoga Resources with Robin Sale.

Prenatal Yoga: A Complete Home Practice for a Healthy Mother and Baby DVD - this has 3 routines and 3 relaxation sessions.  This is an excellent balance of preparation.
 

Some yoga DVDs I like:

- Complete Prenatal Vinyasa Yoga & Short Forms 2 DVD Set - Jennifer Wolfe

- Sara Holliday: Prenatal Yoga Series - Sara Holliday

- Element: Prenatal & Postnatal Yoga - Elena Brower

- Prenatal Yoga - Shiva Rea

I would say the first two above are a bit more energetic than some of the slower paced prenatal yoga DVDs. I find going to most prenatal yoga classes is a good way to meet other pregnant Mamas, but pretty dull when it comes to the actual yoga. I may change my mind as I am further along in my pregnancy though (now at 23 weeks) and need to slow down the pace a bit.

You could have a look at the reviews on Amazon for each of the above DVDs to get a feel for the yoga practiced in each one.

I have been using Shiva Rae's CD's for several years and I love them, so I decided to purchase her prenatal DVD. I haven't done any other prenatal yoga so I can't compare, but I'm enjoying this one.

Pregnant Warrior - The breathing practice of yoga (pranayama) can become one of your greatest tools during labor helping you to relax through contractions, find relief from discomforts and put you in a place of feeling stronger and more present with your experience.

Prenatal Yoga Cards - The Prenatal Yoga Deck features 10 Breath Cards, a Healthy Sitting Reference Card, 5 Warm-Ups, 24 Posture Cards, and 10 Meditation Cards, all designed specifically for mothers-to-be.

Yoga & Childbirth

Pre-Natal Yoga from Tara Women's Healing and Yoga

Four Pregnancy Yoga Exercise Sets

Bikram Yoga or Hot Yoga


Pregnancy & Bikram Yoga from livestrong.com -

Bikram Yoga During Pregnancy - I can highly recommend Bikram Yoga throughout pregnancy with one major footnote. This is not the type of strenuous activity that you should start while you are pregnant. This is a practice to continue throughout your pregnancy IF you practiced Bikram yoga before you became pregnant. You should not start an exercise plan or a practice during a pregnancy.

Pregnancy Yoga from bikramyoga.com

Hyperthermia in pregnancy makes midwives and obstetricians nervous for a number of reasons.  When a pregnant woman gets very hot, she can cool herself a bit by sweating, but the baby cannot sweat.  A fetus is even more fragile than a young baby, and hyperthermia is certainly a stress.  The big question is how hot and for how long can a pregnant woman get without causing harm to the baby?

There is a lot of concern about hyperthermia in the first trimester and the risk of miscarriage.  We also observe during labor that when women are in birthing tubs that are too hot (more than 102 degrees), the baby's heart rate goes up, and there is some thought that this might be stressful enough to trigger the release of meconium.

Bottom line - there doesn't seem to be any specific research about bikram yoga and pregnancy, which is probably why it makes some healthcare providers nervous.

Then again, there's a lot of information that shows that internal body temperatures don't rise significantly, which should mean that it's not a problem for the baby.

Some of the concern is doubtless from the fact that many women who've had high fevers during pregnancy were also exposed to some kind of virus, which might have been the real cause of problems in the baby, not the high temperatures themselves.

We need more research!

From Will It Hurt The Baby? by Richard S. Abrams, M.D.: Hyperthermia has been suspected of causing birth defects when the temperature of the uterus exceeds 104 degrees F for at least one day during weeks three to seven of gestation.  In the absence of a severe infection, such high fever is very rare and in most cases fever above 102 degrees F can be reduced . . . Temperatures under 104 degrees F are unlikely to cause any harm.

Review: Hyperthermia and fever during pregnancy.
Edwards MJ.
Birth Defects Res A Clin Mol Teratol. 2006 Jul;76(7):507-16.

An episode of hyperthermia is not uncommon during pregnancy. The consequences depend on the extent of temperature elevation, its duration, and the stage of development when it occurs. Mild exposures during the preimplantation period and more severe exposures during embryonic and fetal development often result in prenatal death and abortion. Hyperthermia also causes a wide range of structural and functional defects. The central nervous system (CNS) is most at risk probably because it cannot compensate for the loss of prospective neurons by additional divisions by the surviving neuroblasts and it remains at risk at stages throughout pre- and postnatal life. In experimental animals the most common defects are of the neural tube, microphthalmia, cataract, and micrencephaly, with associated functional and behavioral problems. Defects of craniofacial development including clefts, the axial and appendicular skeleton, the body wall, teeth, and heart are also commonly found. Nearly all these defects have been found in human epidemiological studies following maternal fever or hyperthermia during pregnancy. Suggested future human studies include problems of CNS function after exposure to influenza and fever, including mental retardation, schizophrenia, autism, and cerebral palsy.

[Ed: You can check the related citations on the right side to see related articles.]

I would put it on the same category as saunas, hot tubs etc. Most will probably be fine, but increasing core body temp is known clear risk to fetus - I would advise against it in first trimester.

In the yoga teacher trainings I've done, I was always taught that if they've been doing it, pay close attention to their hydration, etc it's fine.  They need to pay close attention to their bodies, which most women who have regular yoga practices seem to be pretty connected.  I've had many clients over the years who have continued with their Bikram and Ashtanga practices and had great pregnancies and births.

I tell my clients that if they break a sweat on their face, whether in a hot bath or when exercising, then their body is too hot, and they need to cool down. I'm guessing that most bikram yoga classes are meant to break a sweat on the face.

For those who have practiced regularly before pregnancy it is safe IF they’re in a studio with capable teachers who give them appropriate modifications. There is an entire book on pregnancy and hot yoga.

Doing a bit of investigating, I found the core temp can go up to 103 in non pregnant women
Study examines the body's response to Bikram yoga [4/27/2015] - "The average highest core temperature was 103.2 degrees F for men and 102.0 degrees F for women."

Hot yoga creates increased flexibility that clearly has led to more injuries, add that to pregnancy hormones that relax ligaments and it can be a recipe for long term over stretched ligaments.

Having had personal experience with getting very injured during hot yoga (specifically Bikram) when not pregnant, I generally recommend other forms of yoga while pregnant. The joints are already mobile enough in pregnancy, adding heat to the equation just exacerbates the possibility for over extending and injury. There are lots of other options for yoga, why risk it?

I just was counseling a client yesterday! Not good for joints in general and especially not good in pregnancy.

Another concern is dehydration and electrolyte balance.

I have told clients that we don't really know, that the concern is elevation of core body temp and that if they choose to do it, they may want to check their temp to see how it affects them individually

I've been looking for some solid evidence on safety, and it seems it's mostly speculation. I've seen recommendations to check temperature during a class to make sure your temp isn't elevating too high, I've seen suggestions that the negligible rise in core body temperature shouldn't be an issue, and then I've also seen that a lot of providers recommend skipping it out of caution because we don't really know.

Hot yoga and pregnancy: fitness and hyperthermia [Full text]
Justin Chan, Aniket Natekar, Gideon Koren
Can Fam Physician. 2014 Jan;60(1):41-2.

Question: One of my pregnant patients wishes to continue her hot yoga exercises during pregnancy. Is this practice safe?

Answer: With the increased risk of neural tube defects and possibly of other malformations among fetuses exposed to excessive heat, pregnant women should avoid practising hot yoga during pregnancy.

Squatting

My reference to avoiding deep squatting in the last 4-6 weeks came from Janet Balaskas' book Easy Exercises for Pregnancy, although there is no explanation.  It is also mentioned in Teaching & Understanding Optimal Foetal  Positioning by Jean Sutton and Pauline Scott, with a little  explanation; basically (as I understand it) that a deep squat temporarily increases the angle between the spine and  the pelvic brim enough for the head of a baby which is not  aligned correctly to enter the pelvis in the wrong (e.g.:  posterior) position. If I understand what you said  correctly, this can be corrected providing the posterior  positioning is picked up and the baby encouraged to  disengage and turn to the correct position, but it seems  that in many areas here not much emphasis is placed on  encouraging the baby to position itself correctly beforehand and if the head was engaged in a posterior position it  probably would not turn on its own before labour started.

Thanks for the reference.

Basically, a posterior baby that isn't held in place by cord entanglement or some odd placement of limbs is fairly easy to move to an anterior position anytime before 4cm dilation.  Given the tremendous potential advantage of squatting during labor and pushing, it seems odd to discourage squatting simply because it might cause something that is easily undone.

It may be that if a woman is working with a care provider who doesn't pay any attention to posterior positions, she might be better off not doing anything that could possibly get her into trouble with a posterior baby.  But babies turn posterior all the time - one very common cause is any semi-reclining position.

Maybe there's something big that I'm just not getting here, but if their concern about squatting is the issue of posterior, why don't they spend a little time on teaching an awareness of the baby's position and making sure the baby isn't posterior before practicing squatting?

Anyway, this injunction just doesn't make any sense to me.  In fact, I think squatting is one of the ways that nature helps babies come on time; before we had chairs, people mostly rested in a squatting position.  This happens to be a great way of making sure the baby's head goes INTO the pelvis when it fits easily - if it happens not to come out again because it's a snug fit, then it will help form the forebag and help baby come while the head is still flexible and IN the pelvis.

Kegels


If kegel exercises are not effective, I would bet money that they are being done incorrectly. I had a nurse that works in a colo-rectal clinic tell me, "You childbirth teachers all teach people to do kegels wrong." I asked her how she would recommend doing them and this is what she said:

Imagine that you are out for a night on the town with your husband's boss and his wife. You are dressed up in a very slim fitting, tight dress. And you have gas! You have to hold it in, but because of the tight dress, everyone's going to see you tense up your tummy and legs, so you squeeze only the one muscle in your bottom that will hold in the gas without everyone seeing.

The basic idea is to squeeze it without assisting it with other muscles. A lot of women will assist the kegel muscle by tensing their butt, thighs abdomen, etc. If you are doing that, your not working the kegel muscle effectively. It is easiest to isolate this motion while sitting in a recliner.

Our local PT recommends that women imagine cinching all the apertures in the pelvic floor, i.e. the urethra, vagina and anus.
 
 

 

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