Pregnancy, Childbirth, and the Newborn: The Complete Guide, 4th Ed.

CHAPTER 5 Feeling Good and Staying Fit

To have a healthy pregnancy, it’s important to eat well, get enough rest, and avoid hazards. As your body changes to meet your growing baby’s needs, it’s also essential to exercise regularly, maintain good posture, and move your body with care. Regular exercise helps improve and maintain your overall health and well-being, and it can help prepare you for the physical challenges of childbirth and postpartum recovery. Maintaining good posture helps prevent back pain and reduce fatigue. Moving comfortably and safely reduces the likelihood of becoming injured or exacerbating any existing discomforts.

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In this chapter, you’ll learn about:

• Safe ways to move as your body adapts to pregnancy

• Benefits of exercise and keeping fit

• Guidelines for aerobic exercise, anaerobic (non-aerobic) exercise, sports, and other physical activities

• Exercises for the areas of your body most affected by pregnancy and birth

• Ways to ease common discomforts

Maintaining Good Posture and Moving with Care

As your belly grows and your center of gravity shifts forward, maintaining good posture is essential for keeping your balance, preventing back pain, and reducing fatigue. When you’re standing, sitting, or lying down, gravity exerts a force on your joints, ligaments, and muscles. Good posture distributes that force evenly throughout your body, preventing excess stress to one or more parts. When someone has good posture, her body is in alignment. That is, if viewing her from the side as she stands, you see that her ears, shoulders, hips, and ankles are in a straight line. (See illustration below.)

As you move your changing body, you protect your muscles, joints, and bones by adjusting how you stand, sit, lie down, lift objects, and so on. Moving with care can reduce fatigue, prevent strain, and minimize common pregnancy discomforts.

STANDING

To stand with good posture, begin by imagining you’re wearing a crown. To keep it in place, position your head so the crown is parallel with the floor. Then use your neck muscles to pull your head back until your ears are in line with your shoulders. Lengthen your spine and let your hips and ankles align with your ears and shoulders. Remind yourself throughout the day to keep the crown on your head.

During late pregnancy, avoid standing for long periods. Prolonged standing may slow blood flow from your legs to your heart and head, making you feel faint or lightheaded. If you must stand for a long time, shift your weight from leg to leg, march in place, rotate your ankles, or rock back and forth.

To help prevent back pain while standing, place one foot on a stool, chair rung, or opened drawer. After a while, switch to your other foot.

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SITTING

When sitting, follow the same directions for standing with good posture to align your ears, shoulders, and hips.

As your belly grows, you may find that sitting in a straight-back chair is more comfortable (and easier to get out of) than sitting in a low, deep chair. For additional comfort, place a small, firm pillow at the small of your back and a low stool under your feet. To prevent straining your back when rising from a chair, move to the seat edge, lean forward, then push against the arm rests or seat and use your legs to raise your body.

During late pregnancy, avoid sitting for long periods. Prolonged sitting can affect blood circulation in your legs. If you must stay seated for a long time, shift your position often, rotate your ankles, and avoid crossing your legs at the knees. To help decrease swelling, sit with your feet propped up and calves supported on another chair or ottoman.

LYING DOWN

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As your pregnancy progresses, staying comfortable while lying down can become more challenging. For example, you may experience heartburn or shortness of breath while lying on your back, especially near the end of pregnancy. To help alleviate these discomforts, lie on your side or use pillows to prop yourself in a semi-reclined position. You can also place pillows or a long body pillow under one shoulder, hip, and leg to tilt your body from the back to one side.

Lying on your back can make you feel dizzy or lightheaded. If this happens, roll to your left side or sit up. For some women, lying on their backs in late pregnancy causes supine hypotension, in which the uterus presses on the abdominal vein (inferior vena cava) that carries blood from the legs to the heart and causes a drop in blood pressure. Extended supine hypotension can reduce blood flow to the placenta and restrict oxygen to the baby. For this reason, health care providers recommend that pregnant women lie on their sides after the twenty-sixth week of pregnancy.

When lying on your side, place a pillow between your knees and another under your head to keep your body in alignment. In late pregnancy, you may need to support your abdomen with a small pillow, a wedge-shaped pad, or a long body pillow.

Some women find lying on their sides more comfortable when they roll their bodies slightly forward. To get into this position, place a firm pillow on the side you’ll roll toward. As you roll to this side, keep your lower leg straight and bend the knee of your top leg to rest on the pillow. Rest your lower arm behind you and bend your upper arm at the elbow, setting it in front of you so your hand is near your face.

Lying on your side can cause sore hips. To help manage any pain or swelling, apply an ice pack on the sore area. Also consider supplementing your mattress with a deep foam pad or a pillow-top mattress cover.

GETTING UP AFTER LYING DOWN

Getting up from lying on the floor or in bed also becomes more difficult as your pregnancy advances. Before your belly started to grow, you got up by sitting straight up, then rising. As your pregnancy progresses, however, this movement may strain your abdominal and lower back muscles.

To get out of bed safely, roll onto your side, put your lower legs over the edge of the bed, push yourself to a sitting position, and stand up. To get up from the floor, follow these steps:

1. Roll onto your side and bend your hips and knees. Use your arms to raise your upper body.

2. Get onto your hands and knees. Place one foot on the floor in front of you, while keeping the opposite knee on the floor.

3. Use your legs to stand up. For balance, place your hand on your knee or a stable object.

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LIFTING OBJECTS

During pregnancy, hormones cause your ligaments to relax and soften, and the muscles supporting your posture and core (abdominal, pelvic floor, and back muscles) adapt to your changing shape. As a result of these changes, lifting heavy objects while pregnant increases the likelihood of back injury. To help prevent back injury, avoid heavy lifting whenever possible. For example, teach your toddler to climb into his car seat or onto your lap instead of picking him up.

When lifting any object from a low surface (even a sheet of paper), protect your back by following these guidelines:

1. Get as close to the object as possible.

2. With your feet shoulder-width apart, squat while keeping your back straight and sticking out your buttocks for balance.

3. Grasp the object and hold it close to you. Try not to twist at your waist.

4. As you rise, tighten your abdominal muscles, and squeeze your pelvic floor muscles upward and exhale (instead of holding your breath) to prevent straining your perineum. Use your legs instead of your lower back to raise your body. Keep your back straight.

5. Avoid twisting your spine to turn or set down the object. Instead, move your feet in the direction you want to go.

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Exercise in Pregnancy

When pregnancy makes you feel overwhelmingly tired, uncomfortable, and moody, the last thing you want to do is exercise. But exercise can be just what you need to feel energized and healthy.

Regular, moderate physical activity during pregnancy improves or maintains your muscle tone, strength, and endurance. Exercise also protects against back pain, reduces the intensity of common pregnancy discomforts, and boosts your energy level, mood, and self-image. During the last trimester, regular exercise increases your body’s production of endorphins (natural pain relievers), which can help you cope with labor.

HOLISTIC BENEFITS OF EXERCISE

During the childbearing year (from pregnancy through three months after the birth) and beyond, regular physical activity does more than keep your body fit. Exercise also benefits your mental, emotional, spiritual, and social well-being. All these benefits help you meet the demands of pregnancy, childbirth, and motherhood.

Physical benefits

Appropriate exercise strengthens the muscles most affected by pregnancy and childbirth, including those in the pelvic floor, abdomen, and lower back. Exercise during pregnancy helps maintain good respiration, circulation, and posture. It can also ease common discomforts of pregnancy, such as constipation, heartburn, shortness of breath, leg cramps, fatigue, swollen ankles, and insomnia.

In addition, maintaining your fitness during pregnancy and the postpartum period more easily helps you recover your energy level, strength, and prepregnancy size after the birth.

Mental and emotional benefits

Regular exercise helps decrease mental stress and fatigue. Aerobic activities release pain-relieving endorphins that improve your sense of well-being, help stabilize hormone-driven mood swings, and can decrease the risk or severity of depression and mood disorders during pregnancy and afterward.

Spiritual benefits

Whatever your spiritual beliefs, regularly finding time to meditate, relax, or pray lets you clearly and peacefully think about what’s important to you, honor the changes you’re experiencing, and connect with your baby. An ideal time for meditation, relaxation/visualization exercises, yoga, or prayer is after aerobic exercise, when your body experiences calmness.

Social benefits

During the childbearing year, you increasingly need others to offer you support and validate your feelings. Taking a prenatal exercise class lets you connect with other pregnant women, and you may learn about pregnancy, birth, the postpartum period, and newborn care through shared experiences.

FINDING YOUR MOTIVATION TO EXERCISE

Throughout pregnancy, your motivation to exercise may ebb and flow as your energy level rises and falls. At times, you know you should exercise, but find any excuse not to. When this happens, reminding yourself of the benefits of physical activity can give you the push you need to keep a regular exercise regimen.

If you need additional help getting your body moving, there are other tricks to try. For example, you’re much more likely to do an activity if it’s something you enjoy. If you love to dance, consider taking a dance class or dancing at home to some invigorating music.

Find what time of day works best to exercise and schedule that time for physical activity. Depending on what trimester you’re in, you may need to work around certain physical symptoms. For example, if you have intense heartburn after eating, choose another time to exercise (or eat a lighter meal and bring antacids with you when you exercise).

Sometimes hearing or reading encouraging words or listening to your favorite music can motivate you. Even an activity you might not enjoy, such as housecleaning, can become a fun exercise session if you play your favorite CD or playlist, warm up with some light dusting, then mop and vacuum vigorously before ending with some gentle stretching. If encouraging words or music motivate you, consider sharing this information with your labor-support team to give them ideas for motivating you during labor.

If you don’t want to exercise because you’re feeling down or your back aches, remind yourself that exercise can help relieve these and other emotional and physical problems. If you have trouble making time to exercise regularly on your own, consider signing up for a class, hiring a personal trainer, or scheduling a regular appointment to do a physical activity with someone. The extra commitment may prompt you to make the time to exercise.

Visit our web site, http://www.PCNGuide.com, to download a work sheet to record your fitness goals. If you try every trick to get yourself to exercise but are unsuccessful, be kind to yourself and try again the next day.

EXERCISE OPTIONS

Aerobic exercise is physical activity that increases your heart rate for an extended time, which improves endurance and strengthens your heart and lungs. Anaerobic exercise focuses on strengthening certain muscles and improving balance and flexibility. Both kinds of exercise benefit your health.

How much you should exercise and what kind of activities you should do depend on your general health, the health of your pregnancy, your fitness level, and your usual activity level. Physical changes during pregnancy directly affect your tolerance for exercise. Hormonal changes cause your ligaments to relax and your joints to become more mobile. Your growing belly shifts your center of gravity forward. Changes in your cardiovascular system increase your heart rate more quickly, and your body temperature and metabolic rate (the rate at which you burn calories) are higher.

As you become more aware of these changes, you can better sense when something doesn’t feel right and can remedy the problem. For example, if an activity leaves you excessively tired, do it more slowly next time or do a less demanding activity instead. Responding to your body’s signals when exercising also prepares you to respond to physical cues in labor and after the birth.

To ensure that an exercise regimen is appropriate for you, consult with your caregiver before starting or continuing to exercise.

Aerobic Exercise

In general, low-impact aerobic exercise is best for pregnant women because it doesn’t involve movements that can strain joints, such as jumping. Low-impact activities include brisk walking, cross-country skiing, cycling, and low-impact aerobics. Dance classes, including belly dancing and Nia (visit http://www.nianow.com for information), can also provide appropriate total-body workouts. Elliptical machines and stationary bikes offer safe workouts as well; however, be aware that spinning classes can quickly elevate your heart rate and body temperature.

Swimming or taking a water aerobics class provides a total-body workout with the lowest possible impact, because the water reduces the force of gravity on your body. In addition, standing or sitting in water that reaches your shoulders reduces swelling (edema) by pushing tissue fluid into your circulation (and eventually out of your body through urination).

Ideally, you should do some kind of aerobic exercise at least three times per week. Aerobic exercise regimens for pregnant women should include the following:

1. At least a five-minute warm-up, consisting of slow, smooth movements and stretching

2. About thirty minutes of aerobic exercise of moderate to vigorous intensity

3. At least a five-minute cool-down (until your heart rate returns to what it was before you began the workout), consisting of mild activity and possibly exercises for strength, flexibility, and relaxation

If you’re just beginning an exercise regimen, start slowly and gently. To determine whether you’re exercising too hard, take the “talk test.”1 If you can talk without gasping while exercising, your heart rate is at an acceptable level. If you can’t talk without gasping, slow down until you can.

Anaerobic Exercise

The following exercise practices don’t increase your heart rate as much as aerobic exercise does, but offer other health benefits.

Yoga

This practice promotes self-nurturing and harmony of the mind, body, and spirit. Yoga also strengthens core muscles (abdominal, pelvic floor, and back) and postural muscles, and improves flexibility, balance, breathing, and mental focus. (See page 100.)

Pilates

Pilates is a system of conditioning exercises that strengthens core and postural muscles and improves flexibility and mental focus. During the childbearing year, avoid doing advanced abdominal exercises. They can aggravate or cause abdominal separation. (See page 341.)

Tai Chi

This system of exercises emphasizes balance, focus, meditation, and smooth, fluid movement.

Weightlifting

Weightlifting strengthens the targeted muscles and core muscles (when you contract them to stabilize your body). If you lifted weights regularly before becoming pregnant, you can continue working with light weights. If you didn’t lift weights before pregnancy and want to begin a regimen, do so only under the direction of a professional trainer knowledgeable about pregnancy.

Gyms, community centers, and even some hospitals offer beginning or prenatal yoga, pilates, tai chi, and weightlifting classes. You can also find many excellent classes on DVD.

Sports and High-intensity Activities

Pregnancy isn’t the time to take up a new sport or activity that requires good balance or sudden movements, or puts you at risk for falling. If before becoming pregnant you played sports such as tennis or softball, or engaged in activities such as vigorous swimming or cycling, you may continue doing them while pregnant for as long as you feel comfortable and if your pregnancy remains low-risk.

In late pregnancy, avoid downhill skiing, water-skiing, snowmobiling, and horseback riding, regardless of your skill level. These activities require excellent balance (which you might not have), and your likelihood of falling increases if you participate in them.

Throughout your pregnancy, avoid potentially dangerous activities such as skydiving, scuba diving, springboard diving, surfing, rock or mountain climbing (especially at elevations higher than 6,000 feet).

To decide whether the benefits of a particular athletic activity outweigh the possible risks, ask yourself the key questions on page 10. If you have further questions about an activity’s safety, talk with your caregiver.

General Guidelines for Safe, Effective Exercise

• Exercise three to seven days per week. Try to do a variety of activities. Always include a warm-up and a cool-down.

• Build your strength and endurance gradually. In the beginning, keep the intensity of your workout low to moderate. As your strength and stamina increase, so should the intensity. Toward the end of pregnancy, decrease the intensity as needed.

• Modify exercises so you can do them safely. If taking an exercise class, let the instructor know you’re pregnant and welcome any exercise modifications.

• Lying flat on your back in pregnancy can cause supine hypotension. (See page 89.) If you feel dizzy, short of breath, or lightheaded while on your back, roll onto your left side until you’ve recovered.

• To prevent dizziness and to avoid increased pressure on your pelvic floor and abdominal muscles, don’t hold your breath while exercising.

• Use the “talk test” (see page 93) to ensure you’re not exercising too vigorously.

• Eat enough to meet the caloric needs of pregnancy as well as your exercise regimen. Not eating enough can put you and your baby at risk for complications. (See page 117.)

• Drink water before, during, and after exercising to replace fluids lost through perspiration and respiration. Keep a water bottle with you.

• Don’t exercise vigorously in hot, humid weather or when you have a fever. Your body temperature shouldn’t exceed 101°F (38.3°C).

• Stop exercising if you experience pain, headache, nausea, severe breathlessness, dizziness, blurred vision (or you see spots), vaginal bleeding, or continuing strong uterine contractions. (See below.)

• Be flexible and patient as you work to meet your fitness goals. Pay attention to how your body feels and adapt your exercise regimen accordingly.

• Consult your caregiver if you have questions about exercise.

When Not to Exercise

Avoid or stop exercising if you have the following conditions:

• Vaginal bleeding

• Persistent Braxton-Hicks contractions

• Increased risk for preterm labor

• Preeclampsia

• Premature rupture of membranes (loss of fluid from your vagina)

• Placenta previa diagnosed after the twenty-sixth week of pregnancy

• A baby with intrauterine growth restriction (IUGR)

• A baby whose movements have noticeably decreased

Consult with your caregiver about exercising if you are pregnant with multiples, are on bed rest, or have high blood pressure, diabetes, chronic heart problems, thyroid disease, or joint disease or injury.

Core Exercises to Prepare You for Labor

Core muscles include the abdominal muscles, pelvic floor muscles, and back and hip muscles—all of which provide stability, balance, and posture. Giving birth relies on these muscles, and conditioning them during pregnancy prepares them for labor and promotes their speedy recovery afterward.

CONDITIONING YOUR PELVIC FLOOR MUSCLES

Your pelvic floor muscles are attached to the inside of your pelvis and act like a sling to support your abdominal and pelvic organs. These muscles form a figure-eight around your urethra, vagina, and anus.

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Regularly exercising your pelvic floor muscles is essential to maintain tone and improve circulation during the childbearing year and throughout your lifetime. During pregnancy, the increased weight of your uterus and the relaxing effect of hormones may make these muscles sag. Hemorrhoids may emerge. Exercising the pelvic floor muscles during pregnancy can reduce the heavy, throbbing feeling you may experience in the area. Exercise (and perineal massage—see page 235) also prepares you to work with the muscles surrounding your vagina as they stretch to let you push your baby out. When these muscles are toned, they can return to their original length after being stretched, which helps with postpartum recovery.

Regular exercise of your pelvic floor muscles may also prevent incontinence (leaking urine or feces) during pregnancy or later in life. If incontinence becomes a problem even after exercising your pelvic muscles, consult a physical therapist who specializes in nonsurgical treatment of incontinence.

As an added benefit, exercising your pelvic floor muscles can increase your ability to control your vaginal muscles, which can make sex more enjoyable for you and your partner.

To check the strength of your pelvic floor muscles, try these exercises:

• While urinating, partially empty your bladder, then stop the flow. If you can’t, your muscles are weak.

• Insert one or two fingers into your vagina and tighten your pelvic floor muscles until you feel them squeeze your fingers. The tighter the squeeze is, the stronger your muscles are.

• During intercourse, have your partner tell you how strong your pelvic muscles tighten around your partner’s penis or fingers.

If your muscles are weak, don’t worry. They strengthen quickly with the following exercises.

Pelvic Floor Contraction (Kegel or Super Kegel Exercise)

Aim: To maintain the tone of your pelvic floor muscles, improve blood circulation in them, decrease the incidence and severity of hemorrhoids and incontinence, and support your uterus and other pelvic organs.

Starting position: Any position is fine.

Exercise: Without holding your breath, tighten the muscles around your urethra and vaginal opening as if you’re stopping the flow of urine. (Try not to tighten the muscles in your buttocks, thighs, or abdomen.) You should feel your pelvic floor lift slightly and become tense. Hold tightly for ten seconds.

At first, you may notice the muscle tension diminishing or fading without your control before ten seconds has passed. If this happens, tighten the muscles again until time is up, then relax and rest for ten seconds before tightening for another ten seconds.

When you can steadily contract the muscles for ten seconds, try a Super Kegel. For this exercise, you hold the contraction for twenty seconds, tightening the muscles when the contraction begins to fade.

Repetition: Try to do several sets of ten Kegels or Super Kegels throughout the day.

Pelvic Floor Bulging

Aim: To prepare for pushing your baby out (the second stage of labor). Make sure your bladder is empty when practicing this exercise!

Starting position: Tailor-sit (sit cross-legged on the floor) or get into any birthing position (see pages 222–223).

Exercise: Consciously relax your pelvic floor muscles. Hold your breath and bear down gently as you do when having a bowel movement, letting your pelvic floor muscles further relax and bulge outward. Don’t bear down or strain forcefully. (Put your hand on your perineum to help you feel the bulge.) Hold for three to five seconds, then stop bearing down. Inhale, contract your pelvic floor muscles, then exhale and rest. After you can do this exercise while holding your breath, try it while exhaling.

Repetition: Do this exercise one to two times per week.

CONDITIONING YOUR ABDOMINAL MUSCLES

Conditioning your abdominal muscles during pregnancy helps you maintain good posture, keep your core stable, avoid back pain, push your baby out more easily, and recover your abdominal strength after the birth. The four layers of your abdominal muscles work together with other core muscles to bend your body forward or sideways, rotate your core, tilt your pelvis, help with breathing, and stabilize your body when you lift objects.

Because your growing uterus already stretches your abdominal muscles, doing traditional exercises that work these muscles puts you at risk for back and abdominal strains. In late pregnancy, avoid doing double leg lifts or abdominal crunches (traditional sit-ups). The following exercises condition your abdominal muscles without causing excessive strain.

Transverse Abdominal Contractions

Aim: To strengthen your innermost abdominal layer (transverse abdominis), which provides core stability and lets you actively push your baby out. After the birth, this exercise begins flattening your abdomen and closing any muscle separation. (See page 341.)

Starting position: Sit upright with your back supported against a straight-back chair or a wall.

Exercise: Inhale deeply, letting your abdomen expand. Slowly exhale, bringing your belly button toward your spine. (Put your hand on your belly to ensure you’re doing this movement.) Hold the contraction for twenty seconds without holding your breath.

Variation: During the twenty seconds, pulse the contraction by releasing it slightly as you inhale and tightening it as you exhale. Pulse ten to twenty times.

Repetition: Begin with two sets of ten repetitions and add repetitions as you become stronger. Expect this exercise to become more difficult in late pregnancy, but make sure to resume it after the birth.

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Pelvic Tilts I, II, and III

Aim: To strengthen your abdominal muscles, improve posture, and relieve back pain.

Starting position: Lie on your back, get on your hands and knees, or stand. (See following sections for further directions.)

Exercise: With an exhalation, tighten your abdominal muscles, and hold the contraction for five to ten seconds. Imagine that these muscles are hugging your baby. Contract your lower abdominals to tilt the front of your pelvis upward. Relax, then repeat.

Repetition: Do ten pelvic tilts each day.

I. Pelvic tilt on your back

Starting position: Lie on your back with knees bent and feet flat on the floor. When contracting your abdominal muscles, the small of your back flattens onto the floor. Don’t push with your feet or tighten your buttocks. Placing a hand under your lower back may make it easier to feel that the small of your back is flattening. Note: If you feel dizzy or lightheaded while on your back, roll onto your left side and try pelvic tilt II or III instead.

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II. Pelvic tilt on hands and knees

Starting position: Get on your hands and knees. Keep your back in a neutral position (neither sagging nor arched) and your knees hip-width apart. As you tighten your abdominal muscles, your pelvis curls under and your lower back arches.

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III. Pelvic tilt when standing

Starting position: Lean against a wall with knees slightly bent and feet apart and 12 to 15 inches away from the wall. Let your buttocks and shoulders touch the wall. As you contract your abdominal muscles, your back presses against the wall.

After you’ve mastered the pelvic tilt while leaning against a wall, try it while standing upright. As you tighten your abdominal muscles in this starting position, your pubic bone tilts upward, tilting the top of your pelvis backward. To feel this movement, put your hands on your hips.

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Common Q & A

Q: I know it’s good to squat during pregnancy, but I’m having trouble getting up from the position. What can I do?

A: To rise from a squat more easily, add an exercise to strengthen your thighs and buttocks, such as wall-sitting. Stand with your back resting against a wall and your feet 12 inches away from the wall. Bend your knees so they’re directly above your feet, letting your back slide down the wall. Remain in that position for up to one minute. Try to rise from this position without using your arms. Repeat this exercise five to ten times each day. As you become stronger, place your feet farther from the wall, until you can bend your knees 90 degrees and your thighs are parallel with the floor.

MOBILIZING YOUR PELVIC JOINTS BY SQUATTING

During late pregnancy, squatting helps condition your pelvic joints. To birth your baby vaginally, the joints of your pelvis need to be flexible enough to allow him to move from your uterus through your vagina. As you approach the end of pregnancy, this exercise becomes even more important. During labor, squatting can be a comfort position for you. (See page 222.) When you push your baby out, squatting can help your baby descend into your vagina.

Caution: If you have problems with your hips, knees, ankles, pelvis, or have hemorrhoids, avoid squatting.

Aim: To increase the flexibility of your pelvic joints, stretch the muscles of your inner thighs and calves, and increase comfort when squatting.

Starting position: Stand with your feet about 2 feet apart.

Exercise: Keeping your heels on the floor, squat by lowering your buttocks toward the floor and letting your lower back curve. For better stability and more of a curve in your lower back, distribute your weight evenly between your heels and toes. Hold the position for as long as is comfortable, then use your legs to rise slowly. As you become stronger, increase the amount of time you hold the position to ninety seconds, which is roughly the length of a long labor contraction.

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If you have trouble squatting, try stretching the muscles of your inner thighs by tailor-sitting with your soles touching. If you can’t maintain your balance when squatting, hold on to a stable piece of furniture, the doorknobs on either side of a door, or your partner’s hands. You can also try this position for stability or if squatting causes pain in your legs or pubic area: Have your partner sit on a chair. Facing away from your partner, stand between his or her knees. Then squat, leaning back with your arms over your partner’s knees.

If it’s difficult to keep your heels on the floor when squatting or if your feet roll inward, your calf muscles are tight. Try squatting with your feet farther apart, wearing shoes with heels of moderate height, putting a book under each heel, or placing a rolled-up mat or towel under your heels. Many birthing beds in hospitals have bars to grip while squatting.

Repetition: Starting at about the thirty-fifth week of pregnancy, squat ten times each day.

Postural Exercises to Align Your Body

Your postural muscles keep your body in proper alignment. As your baby and uterus grow, your center of gravity shifts forward, which requires you to make an extra effort to maintain good posture. (See page 88.)

The normal changes of pregnancy also stretch your abdominal and upper back muscles and tighten your pectoral (chest) muscles and hip flexors (the muscles in the front of your hips). Strengthening and stretching these muscles helps relieve lower back pain and other discomforts that can arise when your body is out of alignment.

POSTURE CHECK

To maintain correct postural alignment, prevent back pain, reduce fatigue, and allow your body to function normally, it’s important to check your posture several times throughout the day. Follow the instructions on page 88 to ensure good posture when standing or sitting.

Shoulder Circles

Aim: To release tension and put your shoulders into correct postural alignment.

Starting position: Stand or sit with your back straight. Keep your arms relaxed and your chin level.

Exercise: Raise your shoulders toward your ears, then slowly roll them back and down, then forward and up. Feel the tension release. End with your shoulders in a relaxed back-and-down position.

Repetition: Circle your shoulders as many times throughout the day as feels comfortable.

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PECTORAL STRETCH

Aim: To lengthen your pectoral muscles, which naturally shorten during pregnancy or with poor posture. This exercise also may help you breathe more deeply.

Starting position: Stand with good posture in a doorway.

Exercise: With your elbow at shoulder level, rest your forearm on the doorframe. While pulling your shoulder blades down your spine, turn your body away from the doorframe until you feel your chest stretch. Breathe deeply, letting your ribs expand with each inhalation. Hold the stretch for fifteen to thirty seconds. Relax, then repeat on your other side.

Repetition: Stretch your pectoral muscles twice on each side.

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HIP FLEXOR STRETCH

Aim: To stretch the muscles in the front of your hips that naturally tighten in pregnancy.

Starting position: Stand with your right leg forward (knee slightly bent) and your left leg back (knee straight). Keep both feet flat on the floor and about hip-width apart. You can hold on to a stable chair for support.

Exercise: Contract your left buttock and pull the front of your pelvis upward (as you do with the pelvic tilt—see page 97) until you feel a stretch in the front of your left hip. Hold the stretch for fifteen to thirty seconds. Relax, then repeat with your left leg forward and your right leg back.

Repetition: Stretch your hip flexors twice on each side.

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Yoga Poses to Align Your Body, Mind, and Spirit

Yoga builds strength and stamina, improves flexibility and balance, encourages mindfulness, increases energy, and promotes meditation (which calms the mind and nourishes the spirit).

Unlike many other forms of exercise, yoga focuses on practicing movements, not mastering them. Even if you practice yoga regularly, you may feel flexible and strong one day and less so the next—and that’s okay. Letting go of expectations and self-criticism is essential to the practice of yoga.

This section features yoga poses that especially benefit you during pregnancy and birth. It also includes a sequence of poses that mimics the rhythm of labor, by alternating poses that require exertion with those that call for relaxation.

While doing these poses, make sure you control your movements and pay attention to your body position, mental activity, and emotional reactions. What you learn may help you work with your body in labor. For more guidance, consider taking a prenatal yoga class or following a class on DVD.

If you feel dizzy when in a pose, lie on your left side to recover.

CAT POSE

Aim: To strengthen your abdominal muscles and stretch your back. This pose may help your baby assume a head-down position for birth.

Starting position: Get on your hands and knees.

Exercise: Inhale and relax the muscles in your back while lifting your tailbone and breastbone. As you exhale, round your mid-back, letting your head, tailbone, and breastbone sink toward the floor. Flatten your mid-back with your next inhalation, making sure your belly doesn’t sag.

Repetition: Do this pose for five inhalations and exhalations, keeping the movements smooth.

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Opposite-limb Extensions

Aim: To strengthen your core and postural muscles and help you coordinate your breathing with muscle exertion.

Starting position: Get on your hands and knees. In early pregnancy or after the birth, you can lie on your stomach.

Exercise: Extend one leg back, with your toes on the floor. Tighten your abdominal muscles to pull your belly button toward your spine. Inhale and tuck your tailbone as you lift your straight leg behind you, then exhale and reach the opposite arm out in front of you. Breathing evenly, lengthen the stretch by reaching toward the wall behind you with your heel and the wall in front of you with your fingertips. Keep your gaze on the floor and your back in a neutral position. Lower your arm and leg after a few breaths, and repeat with the opposite arm and leg.

If you have trouble extending an arm and leg at the same time, extend them one at a time.

Repetition: Do this pose five times for each side.

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CHILD’S POSE

Aim: To widen your pelvis, stretch your groin and torso, and provide active relaxation between more challenging poses.

Starting position: Kneel on the floor with your knees in a wide V, then rest your bottom on your heels.

Exercise: Keeping your torso straight, slowly bend forward from the hips, using your arms to guide yourself forward onto the floor. Fold your arms on the floor and rest your head on your forearms. (If this position causes too deep of a stretch, prop yourself up on bent elbows). If your buttocks have risen, try to return them to your heels. Rest your forehead on the floor and breathe deeply and evenly.

For more of a stretch, rest your forehead on the floor and extend your arms out in front of your head. Use your fingers to pull and lengthen your torso.

Duration: Remain in this position for five inhalations and exhalations, or for as long as it takes to relax.

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DOWNWARD-FACING DOG

Aim: To stretch your calf and hamstring muscles (which become tighter as pregnancy progresses), reduce fatigue, and improve circulation in your legs. This pose also helps relieve tension in your shoulders and spine, and helps improve upper body strength while stretching your chest.

Starting position: Get on your hands and knees.

Exercise: Spread your fingers wide with the middle finger of each hand pointing straight ahead of you. Tuck your toes under and inhale deeply. As you exhale, make an inverted V with your body by lifting your tailbone toward the ceiling, straightening your legs, and lengthening your spine. Let your head hang and breathe evenly. Position your feet so they’re hip-width apart and your toes are facing forward. Try to rest your heels on the floor.

To release the pose, lower your knees or get into child’s pose to rest completely.

Duration: Hold this pose for five inhalations and exhalations.

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HALF-DOG POSE

Aim: To stretch your back, release tension in your shoulders, and stretch your hamstrings. You can use this pose as an alternative to downward-facing dog.

Starting position: Stand facing a wall, then lean forward and place your hands shoulder-width apart on the wall. Walk your feet backward as you bend forward from the hips, sliding your hands down the wall until your back and arms are parallel with the floor. Keep your head in line with your arms and gaze at the floor.

Exercise: Inhale and push your hands into the wall. As you exhale, elongate your spine by stretching your tailbone straight out behind you. To keep the natural curve of your spine, rotate your sit bones (the bones you sit on) upward to keep your lower back from flattening.

Duration: Hold this pose for five to ten inhalations and exhalations.

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CORPSE POSE

Aim: To completely relax while remaining awake and attentive. This restorative pose nurtures the mind-body-spirit connection and helps you connect to your baby.

Starting position: Lie on your back with your legs extended, your arms by your side (but not touching you), and your palms up.

Exercise: Actively lengthen your body from your heels, through your arms and head. Then relax all your muscles. End the pose by rolling onto your side and into a fetal position. Stay in this position for a few moments, until you feel ready to sit up.

If you become lightheaded, dizzy, or short of breath while on your back (common in late pregnancy), do this pose by lying on your left side and cradling your head with your arms or placing pillows under your head and between your legs.

Duration: Stay in this pose for five to ten minutes.

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FIVE-MINUTE MEDITATION

Aim: To nurture your mind-body-spirit connection as well as your connection to your baby, and create time to release tension and focus on what’s important to you. This exercise lets you release your need for control and embrace “going with the flow”—an important mind-set for pregnancy, childbirth, and parenthood.

This exercise can follow or be integrated into corpse pose.

Starting position: Because you can do this exercise anywhere, choose a position that works in the moment and one that you can comfortably maintain for five minutes. Options include tailor-sitting, lying on your back or left side, legs-up-the-wall pose (see page 106), sitting in a chair, or lying in a warm bath.

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Yoga Practice for Labor Preparation

This sequence of poses mimics the rhythm of labor (contractions followed by periods of rest) by alternating poses that require exertion with those that call for rest.

1. Tailor-sit with eyes closed while focusing on your breathing, quieting mental distractions, and concentrating on being with your baby.

2. Cat pose

3. Child’s pose

4. Opposite-limb extensions

5. Child’s pose

6. Downward-facing dog

7. Child’s pose

8. Half-dog pose

9. Final pose for relaxation or meditation: Choose corpse pose, side-lying, legs-up-the-wall pose (see page 106), or tailor-sitting.

Note: Adapt your yoga practice to accommodate how you’re feeling. If at any time you become dizzy or fatigued, rest in child’s pose or lie on your left side.

Exercise: Quiet any distracting thoughts by focusing on your breathing. With each breath, let your body and mind release any tension and expectations so you can completely relax. Take this time to thank your hardworking body, send your baby loving energy, and honor yourself as well as your partner and family. This exercise can clarify your hopes and fears, and can reveal any gaps in your childbirth preparation or support system. You can also use this time to practice the visualization techniques discussed on page 208.

Duration: As the birth approaches, you may want to meditate for longer than five minutes, and you may want to meditate more often.

Comfort Measures for Common Discomforts in Pregnancy

Even if you consistently maintain good posture, move with care, and exercise moderately, you may still experience discomforts during pregnancy. This section explains the causes of some common discomforts, offers ways you can prevent or minimize them, and suggests treatments to relieve them.

LOWER BACK PAIN

Over the course of your pregnancy, your abdominal muscles lengthen up to 120 percent. To maintain your balance and alignment, your lower back muscles and hip flexors shorten and tighten, which may cause lower back pain. Here are ways to help prevent lower back pain:

• Maintain good posture. (Poor posture often contributes to back pain.)

• Move with care to prevent straining joints, ligaments, and tendons (which soften and relax from hormonal changes).

• Use positions and exercises that stretch tight muscles and strengthen abdominal muscles.

Relieving Severe Back Pain

If you have severe back pain, ask your caregiver to refer you to a physical therapist or chiropractor who specializes in perinatal issues. This expert can provide treatment that may include ice packs, heat, hydrotherapy, massage, techniques to mobilize joints, and an exercise regimen designed to address your specific problem. Your caregiver may recommend that you wear a special garment or belt to support your abdomen and lower back.

To relieve pain from muscular tension, use a heating pad or hot-water bottle, or take a warm bath or shower. Use an ice pack to decrease inflammation and relieve pain. For enjoyable relief, get a professional massage or have your partner give you a soothing backrub.

Here are exercises that can relieve lower back pain:

• Half-dog pose, cat pose, or child’s pose (See pages 99–102.)

• Pelvic tilt on hands and knees (See page 97.)

• Tailor-sitting (Sitting in this position can keep your lower back relaxed.)

• Squatting (See page 98.)

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Another good exercise to try is the knee-to-shoulder exercise. Here’s how to do it: Lie on your back. Draw one knee toward your chest and hold that leg behind your thigh with one hand, then do the same for your other leg. Keep your knees apart to avoid putting pressure on your belly. Keeping your head on the floor, gently pull your knees toward your shoulders until you feel a slight stretch in your lower back. Hold for a slow count of five, then release without letting go of your knees. Stretch your lower back this way five times. Then lower your feet one at a time. Roll onto your side after you’ve finished the exercise.

Notes: In late pregnancy, you may wish to pull only one leg at a time. If this exercise makes you dizzy or lightheaded, don’t do it.

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UPPER BACK PAIN

As your pregnancy progresses, your breasts become heavier and your pectoral (chest) muscles shorten as your upper back muscles lengthen. Your shoulder and neck muscles may try to compensate for these changes by working harder. To prevent or relieve upper back pain, try to maintain proper posture, stretch your pectoral muscles regularly, and do movements to reduce tension in your shoulders, neck, and jaw. Several times a day, take a deep breath, relax your jaw, and roll your shoulders back and down. Massage and the relaxation exercises described in Chapter 11 can also help ease upper back pain.

Shoulder circles (see page 99) and half-dog pose (see page 102) help increase circulation, stretch tense muscles, and decrease back pain. An upper body stretch can also help. Here’s how to do this exercise: Sit in a chair, tailor-sit on the floor, or stand. Raise your arms (palms down) in front of you to shoulder height. Cross them at the elbows; feel your upper back stretch. While inhaling slowly, raise your hands toward the ceiling and gradually uncross your arms (as if pulling a shirt over your head). Reach upward to feel the stretch in your entire upper body. Keeping your arms extended, exhale as you lower them in an arc along each side of your body until your hands are about 12 inches from each hip. Point your thumbs behind you and tilt your head to look up. Feel the stretch across your chest and upper arms. Maintain this stretch as you breathe deeply, allowing your rib cage to expand. Release your arms to your sides and relax without slumping. Repeat this entire sequence five times.

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TINGLING OR NUMBNESS IN YOUR ARMS OR HANDS

Especially during the night or in the morning after awakening, excess tissue fluid in some pregnant women puts pressure on the nerves and blood vessels, causing tingling or numbness in the arms or hands. If the symptoms are confined to the hands, the condition is called “carpal tunnel syndrome.” If symptoms involve the entire arm, it’s called “thoracic outlet syndrome.”

To prevent or treat the problem, try the following suggestions:

• Lie on your side in a position that supports you without lying on your arm. Or use pillows to support you. (See page 89.)

• Try doing shoulder circles and the upper body stretch. (See pages 99 and 104.)

• Several times a day, stretch one arm upward. Wiggle your fingers for a slow count of five. Lower your arm and repeat with your other arm.

• If you have severe carpal tunnel syndrome, wear a wrist splint to hold your wrist in the best position to prevent tingling and numbness. (Your caregiver can tell you where to get a splint.)

• For thoracic outlet syndrome, try raising your arms to shoulder height, then bending your elbows and placing one hand on top of the other on your forehead. Note: Wearing a wrist splint doesn’t relieve thoracic outlet syndrome.

ACHING LEGS, SWOLLEN FEET AND ANKLES, OR VARICOSE VEINS

Hormonal changes and increased body weight often affect the blood circulation in pregnant women, causing aching legs, swollen feet and ankles, or varicose veins. To promote better circulation and ease or prevent these discomforts, try these suggestions:

• Avoid prolonged standing or sitting; sit or walk intermittently.

• Several times a week, take a walk, swim, or use a stationary bike or treadmill.

• When sitting, elevate your feet. If you can’t, rotate your ankles and don’t cross your legs at the knees. If you plan to sit for a while, try rocking in a rocking chair to exercise the muscles in your legs and feet.

• When resting during the day, lie on your side or elevate your feet.

• Do a pelvic tilt on your hands and knees. (See page 97.) This exercise reduces the weight of your uterus on the blood vessels in the pelvis and abdomen. The rocking movement promotes blood flow.

• Walk (or play) in deep water for an hour every other day. The weight of the water presses on your swollen tissues, reducing swelling and promoting urination to void excess fluid. These benefits last for about forty-eight hours. If you use a hot tub, make sure the water temperature doesn’t exceed 99°F (37.2°C).

• Wear support stockings, especially if your job requires a lot of standing. The best time to put on the stockings is before you get out of bed in the morning, because the swelling is at its minimum after you’ve been in a horizontal position for an extended time.

To decrease swelling while relaxing, you may want to try the legs-up-the-wall pose. To do this yoga exercise, place a folded blanket 6 inches from a wall. Sit on the edge of the blanket so your side is parallel with the wall and your hip is touching it. Bend your knees. As you lean backward, bring your knees to your chest, then extend your legs up the wall as you rotate your body 90 degrees. Your buttocks now should be on the blanket and your legs should be relatively straight. Hold this pose for five minutes. If you like, instead of having your legs straight up the wall, stretch your inner thighs by separating your legs into a V shape.

To get out of this pose, bend your knees, then roll onto your side. Stay on your side for a few breaths before sitting up. Note: If you feel dizzy, short of breath, or uncomfortable in this pose, roll onto your left side and remain there until the symptoms disappear.

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LOWER LEG AND FOOT CRAMPS

Cramps in the calves or feet commonly occur when women are resting or asleep. Several things can cause cramps, including pressure on leg nerves, dehydration, impaired circulation, fatigue in calf muscles, or a mineral imbalance in the blood (that is, too little calcium or magnesium, or too much phosphorus, which is found in foods such as soft drinks and processed foods).

To prevent cramps, eat well, drink plenty of water, and avoid pointing your toes or standing on your tiptoes. Right before going to bed, try the following exercises to stretch your calves or hamstrings.

Relieving Lower Leg Cramps

Stand with your weight on the cramped leg. Step forward with your other foot and bend the knee of that leg. Keeping the knee of your cramped leg straight and the heel on the floor, lean forward to stretch the cramped muscle.

If the cramp is severe, you may need help from your partner. Sit on a chair or bed and have your partner hold the knee of your cramped leg steady with one hand and, while gripping your heel with the other hand, use his or her forearm to gently press your foot and toes up toward your knee.

Relieving Foot Cramps

A cramp in your foot tightens the muscles of the arch and curls the toes. To relieve the cramp, stretch your toes up and back toward your shin.

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SUDDEN GROIN PAIN

Round ligaments connect the front of your uterus to each groin, the crease or hollow that connects your inner thigh to your trunk. These ligaments contract and relax like muscles, but much more slowly. When you’re in labor, this design is beneficial. As your uterus contracts, these ligaments contract and pull the uterus forward, aligning it and your baby with the vagina for efficient birthing.

Because these ligaments stretch and contract slowly, they work to prevent sudden overstretching. When you stand up quickly or when you sneeze or cough, you may stretch the ligaments too quickly, causing them to contract rapidly (stretch reflex) and causing pain in your lower abdomen or groin.

You can prevent this pain by moving slowly, letting the ligaments stretch gradually. Before sneezing or coughing, try to flex your hips to bring your thighs near your belly to reduce the pull on the ligaments.

Key Points to Remember

• Maintaining good posture and moving with care increase your comfort during pregnancy and promote a faster recovery from birth.

• Regular exercise during pregnancy improves or maintains your muscle tone, strength, and endurance. It also protects against back pain, reduces the intensity of common pregnancy discomforts, and boosts your energy level, mood, and self-image.

• Most pregnant women should do various physical activities three to seven days per week to reap the benefits of moderate exercise.

• Exercises for your core and posture are essential during the childbearing year to condition your muscles for effective birthing and promote a speedier postpartum recovery.

• Align your mind, body, and spirit and connect with your baby through yoga and meditation.

• It’s never too late to start an exercise regimen. Set reasonable fitness expectations and celebrate your successes.