Lecture 2

Magdalena Korżyńska-Piętas
The American College of Obstetrics and Gynecology (ACOG)
issued a technical bulletin in 1985 stating that the
maximum heart rate during pregnancy should not exceed
140 beats per minute and women should not take part in
strenuous exercise for more than 15 minutes.

In 1994,ACOG released a new bulletin removing specific

limitations and prohibitions regarding exercise during
pregnancy. ACOG said, ‘‘there are no data in humans to
indicate that pregnant women should limit exercise
intensity and lower target heart rate because of adverse
effects.’’
They still recommended that women avoid exhaustion
during exercise
 In 2002, ACOG published ‘‘Exercise During Pregnancy and
the Postpartum Period: ACOG Committee Opinion 267.’

‘‘in the absence of contraindications, pregnant women

should be encouraged to engage in regular, moderate
intensity physical activity to continue to derive health
benefits during their pregnancy as they did prior to their
pregnancy’’
Myths
1. In the past physicians used to think that exercise during
pregnancy would result in high core body temperature that
might damage the embryo or developing fetus.

Current medical science shows that pregnant women actually

moderate their core body
temperature better than nonpregnant women.
2.Exercises lead to premature birth because of the
catecholamine, or adrenaline,response.

While there is a transient elevation of fetal heart rate

following exercise of the mother, it quickly
returns to baseline heart rate.
3. Exercise reduces the rate of oxygen and nutrient
delivery to the developing fetus because of the shunting of
blood away from internal organs during exercise.

The normal physiologic adaptation to pregnancy is increased

cardiac output and blood volume.
Additionally, the placenta develops in a way to ensure constant
nutrient delivery during a healthy pregnancy.
There is no retrospective evidence to suggest that exercise
leads to fetal distress, premature delivery, or low birth weight
Despite the safety of exercise during pregnancy, it is
important to know the contraindications
Absolute Contraindications to Exercise During Pregnancy
(Adapted from ACOG Committee Opinion 267, 2002)
 Hemodynamically significant heart disease
 Restrictive lung disease
 Incompetent cervix or cervical cerclage
 Multiple gestation with risk for preterm labor
 Persistent second or third trimester bleeding
 Placenta previa after 26 weeks of gestation
 Premature labor during the current pregnancy
 Rupture of membranes
 Pregnancy-induced hypertension
Relative Contraindications to Exercise During Pregnancy (Adapted
From ACOG Committee Opinion 267, 2002)
 History of sedentary lifestyle
 Intrauterine growth retardation
 Poorly controlled hypertension
 Poorly controlled seizure disorder
 Poorly controlled insulin-dependant diabetes
 Severe anemia
 Chronic bronchitis
 Maternal cardiac arrhythmia
 Poorly controlled thyroid disease
 Extremely overweight (morbid obesity)
 Extremely underweight (BMI 12)
 Orthopedic limitations
 Heavy smoker
Exercise Recommendations During Pregnancy
Avoid
 scuba diving
 high altitude activities
 activities with risk of fall
 activities with risk of abdominal
 Trauma

 What do you think about:

 Riding a bike in pregnancy?
 Riding a horse
 Playing tennis
 Playing volleball/ football
 Swimming
 Running
FITT principle (frequency, intensity, time, and type)
For sedentary women
 Frequency = minimum of 3 per week
 Intensity = moderately hard perceived exertion (PE)
 Time = 30 minutes
 Type = low impact
For regular exercisers
 Frequency = 3 to 5 per week
 Intensity = moderately hard to hard PE
 Time = 30 to 60 minutes
 Type = low impact and any prior safe activities
For elite athletes
 Frequency = 4 to 6 per week
 Intensity = 70% to 80% maximum heart rate or hard PE
 Time = 60 to 90 minutes
 Type = competitive activities as tolerated during pregnancy
Exercise should be terminated immediately if a woman
develops any of the following problems:
 vaginal bleeding,
 difficulty breathing before or during exercise,
 dizziness,
 headache,
 chest pain,
 muscle weakness,
 calf pain or swelling,
 uterine contractions,
 decreased fetal movement,
 clear fluid from the vagina
 It is well documented that exercise positively affects
pregnancy, labor, and possibly pregnancy outcomes

 More than 90% of women who exercise during pregnancy

will continue to exercise afterwards

 During pregnancy, women who exercise experience

fewer musculoskeletal problems than their nonexercising
counterparts. This includes less back and pelvic pain,
which are very common during pregnancy
 Exercise increases maternal cardiovascular fitness, body
image, and well-being
 It can prevent gestational, or pregnancy-related, diabetes
and it can assist in the treatment of women with
diabetes.
 exercise during pregnancy can reduce delivery time and
complications
 exercising mothers tolerate the stresses of labor well and
are more alert and less irritable in the immediate
postpartum period
Recommendations:
1) All women without contraindications should be encouraged
to participate in aerobic and strength-conditioning exercises as
part of a healthy lifestyle during their pregnancy
2)Reasonable goals of aerobic conditioning in pregnancy
should be to maintain a good fitness level throughout
pregnancy without trying to reach peak fitness or train
for an athletic competition.
Women should choose activities that will minimize the risk
of loss of balance and fetal trauma. Brisk walking,
stationarycycling, cross-country skiing, swimming cause less
trauma to the joints and ligaments and less bouncing up and
down of the centre of gravity than running or jogging .
Warm-up and a cool down is a must!
3) Women should choose activities that will minimize the
risk of loss of balance and fetal trauma.
There is less evidence on strength conditioning and weight
training in pregnancy. Some women may experience
symptomatic hypotension from compression of the vena
cava by the pregnant uterus and should modify these
exercises to avoid the supine position after approximately
16 weeks’ gestation. The ability to perform abdominal
strengthening exercises may be impeded by the
development of diastasis recti and associated abdominal
muscle weakness.
Deep breathing exercises

 Breathe in deeply through your nose.

 • Sigh out through your mouth.
 • Repeat 5 times.
 • Do this exercise 6 times a day.
Foot and ankle exercises

 Keep your knees relaxed for both exercises.

 Bend and stretch your ankles vigorously up and down for
30 seconds.
 Circle both feet 10 times in each direction.
 Repeat both of these exercises 10 times a day.
 They will help to reduce swollen ankles and varicose
veins.
How to do pelvic floor exercises
 Sit with your knees apart.
 • Don’t hold your breath.
 • Don’t clench your buttocks.
 Tighten your back passage as if you were trying to
stop passing wind. Now tighten the muscles you
would use to stop a flow of urine. Do both together
and you should feel your back passage, vagina and
front passage all lift and close at the same time.
You can do this exercise while standing, sitting or lying
down.
 Protect your pelvic floor: Make a habit now of always
pulling up your pelvic floor before you lift, carry, push or
pull light to moderate weights.
 Lift and squeeze as you cough or sneeze.
Back pain
 Sitting
• Do sit with your bottom to the back of the chair so that your
back is well supported by the chair.
• Do use a small cushion to support your back, but do not make
your back arch.
• Do try to keep your feet flat on the floor or on a small stool.
• Your back is less likely to ache if you change your position
regularly.
• Avoid slouching as this puts more strain on your back.
• Avoid crossing your legs and feet.
• Avoid leaning to one side of the chair or putting your feet up
on your chair.
• Practice the correct sitting posture as often as you can.
Resting positions
• Pelvic joint pain—pubic symphysis or sacro-iliac joint
(SIJ) or sciatica Grinding/grating, severe aching,
sudden stabbing pain, unable to take weight, limping,
muscle spasm, “sciatica”, pain on movement including
walking, pain on lifting one foot up such as putting
shoes or underwear on.
• Rectus diastasis—separation of the abdominal
muscles. A bulge appears in the central line of the
abdomen as patent gets up, changes position, lifts,
cough, etc.
• Lower back, thoracic (mid back) or neck pain.
• Bladder control problems—accidental loss of urine with cough,
sneeze, or movements or bladder urgency or frequency.
• Problems with constipation and/or straining to empty the
bowels.
• Carpal tunnel syndrome—numbness, pins and needles,
tingling or pain in the fingers and hand or wrist.
• Localised muscle tension or cramps.
Relaxation
 Breathing
 Music theraphy
 Yoga
 Aromatherapy
Picture of a Labor Position to Manage
Labor Pain:
Knee Press Sitting
Intradermal injections of 0.1 mL of sterile water in the treatment of women with
back pain during labor. Sterile water is injected into four locations on the lower
back, two over each posterior superior iliac spine (PSIS) and two 3 cm below and 1
cm medial to the PSIS. The injections should raise a bleb below the skin.
Simultaneous injections administered by two clinicians will decrease the pain of the
injections.
Pregnancy massage
 is a catch-all term for any hands-on massage during
or after pregnancy (prenatal or postnatal massage).
 A pregnancy massage typically lasts an hour. Some
practitioners use a pregnancy massage.
 Postion: not on the back
• Lowered anxiety
• Decreased back and leg pain
• Improved sleep
• Decreased levels of the stress hormone
norepinephrine
• Increased levels of the "feel-good" hormones
serotonin and dopamine
• Decreased levels of cortisol, an indicator of stress
• An overall improvement in mood
Common types of massage
• Deep-tissue massage, with firm strokes pressing
deep into muscles
• Swedish massage, with long strokes to muscles and
attention to joint mobility
• Shiatsu with pressure and tapping
on acupressure points to stimulate the body's natural
energy (called qi)
 Pelvic floor exercise, or Kegel exercise consists of
repeatedly contracting and relaxing the muscles that form
part of the pelvic floor, now sometimes colloquially
referred to as the "Kegel muscles". Several tools exist to
help with these exercises, although various studies
debate the relative effectiveness of different tools versus
traditional exercises.Exercises are usually done to
reduce urinary incontinence, reduce urinary incontinence
after childbirth, and reduce premature
ejaculatory occurrences in men, as well as to increase
the size and intensity of erections.They were first
described in 1948 by Arnold Kegel.