Now You're Pregnant : Should I Go Swimming? Keeping active in pregnancy (part 1)

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I regularly go to the gym. I've just found out I'm pregnant—can I still go?

Many forms of exercise are safe during pregnancy. Regular exercise keeps you fit and healthy, so if you currently exercise then continue as before. Although you can continue to take part in most activities during the first trimester of pregnancy, you may need to stop vigorous exercise as your pregnancy continues. Tell your fitness instructor that you are pregnant, so she can tailor your program accordingly—pregnancy is not the time to break records or go for personal bests! Ideal exercise gets your heart pumping, keeps you supple, manages weight gain, and prepares your muscles for the hard work of labor and birth without causing undue physical stress for you or your baby.

Being active during your pregnancy can also reduce the physical discomforts of backaches, constipation, fatigue, and swelling, as well as improve your mood and even help you sleep more soundly.

The American College of Obstetricians and Gynecologists (ACOG) states that regular exercise in pregnancy promotes good health, so continue if you can.

Other forms of exercise recommended in pregnancy include swimming, walking, prenatal water exercise, yoga, and pilates, since these are not high impact so are less likely to injure your joints.

What's the best type of exercise during the third trimester?

Swimming is an excellent form of exercise and can be maintained safely throughout pregnancy. It improves circulation, increases muscle tone and strength, builds endurance, and is favored in late pregnancy since it makes you feel almost weightless. Many women find prenatal water exercise classes enjoyable—exercising while standing in water is gentle on the joints and helps reduce swelling in the legs, common in late pregnancy. Water exercise classes should be run by an exercise teacher trained to teach pregnant women.

Walking is a good form of exercise for this later stage since it keeps you fit without jarring your knees and ankles. Take some water to drink to avoid dehydration. Yoga and pilates are good if you can find a registered practitioner experienced in assisting pregnant women. Yoga teaches breathing and relaxation techniques that can help with the demands of labor and birth. Many pilates exercises are done in a “hands and knees” position, which is ideal for pregnancy since it takes stress off the back and pelvis and, toward the end of pregnancy, can help to position your baby for delivery.

Q:	I've had a previous miscarriage—should I avoid all kinds of exercise?
A:	Many experts feel that it is best to avoid all but the gentlest forms of exercise in the first 12–16 weeks of pregnancy if you have had two or more miscarriages, or have had vaginal bleeding during this pregnancy.

I'm not terribly fit, but would like to start an exercise regimen—any advice?

If you are unused to exercise, then moderate activities, such as walking and swimming, would probably be best for you and beneficial for your baby, whereas starting a new competitive sport or vigorous exercise program would not be ideal. Your body is already undergoing huge changes with your heart, lungs, kidneys, and virtually every other major body organ beginning to work much harder. Also, the pregnancy hormones progesterone and relaxin are softening the muscles and ligaments, so soft tissue injuries, back injuries, and abdominal strain become more likely, especially if you haven't exercised much before. Contact sports, vigorous team sports, and activities like diving and gymnastics carry the further risk of direct injury to your abdomen and uterus—especially as your uterus grows and rises out of your pelvis.

Is it safe to go jogging when you're pregnant?

Exercise is recommended in pregnancy to improve your circulation and energy levels, boost the immune system, and increase your stamina for labor. Although low-impact activities, such as walking, swimming, and gentle toning and stretching, are ideal, if you are used to jogging and your pregnancy is progressing normally, it is fine to continue in pregnancy. However, it is not advisable to take up jogging for the first time now, particularly since there is a risk of falling and hurting your abdomen, and you should avoid jogging if you have a high-risk or multiple pregnancy. Other sports and exercises to avoid include gymnastics, horseback riding, downhill skiing, and scuba diving.

When should I start doing Kegel exercises?

Kegel exercises can be started at any stage of pregnancy, but the earlier you start them the better. These exercises strengthen the pelvic floor, which is the network of muscles that support the bladder, uterus, and bowel. Strengthening these muscles helps reduce leaking urine while coughing or sneezing, known as stress incontinence. It is important that you know how to do these exercises and practice them regularly throughout your pregnancy and the postpartum period. As well as practicing the exercises shown here , another way to exercise your pelvic floor muscles is by inserting a finger into your vagina and tightening the muscles around it.

I'm very desk bound in my job—is it dangerous to sit for long periods of time?

During pregnancy, your circulation slows down and if you sit for long periods of time with the lower leg vertical, it can make it hard for blood to travel upward. Although this may increase the risk of a blood clot, known as deep vein thrombosis (DVT), sitting for long periods in itself is unlikely to cause a clot. Your degree of risk also depends on your level of activity at other times. Exercise is the best way to minimize the risk of a blood clot and taking a brisk daily walk is ideal since it exercises your legs. There are also simple measures you can take while at work to reduce the risk of developing a clot. Try ankle movements every hour, get up and walk around every 3–4 hours, take the stairs whenever possible, and walk over to see a colleague rather than email.

If you are especially concerned, talk to your midwife or doctor about wearing special hose that are designed to improve circulation. However, it is important that you get the right size, since hose that are too tight can add to the problem.

I've been getting lower back pain—could it be due to bad posture? I'm eight months pregnant.

In a recent review of current research, more than two-thirds of pregnant women reported back pain. This pain increased with advancing pregnancy, interfering with work, daily activities, and sleep. Lower back pain is caused by the forward pull of the growing abdomen, so as your baby increases in size and gestation, the strain on your back is greater. So although bad posture may not be the sole cause, adopting good posture is important to reduce the strain. Gentle exercise also helps to reduce the pain, and water aerobics is particularly beneficial.

Some women use a Transcutaneous Electrical Nerve Stimulation (TENS) machine in late pregnancy , which helps block the pain nerve impulses to the brain and stimulates the release of natural painkillers called endorphins. Other tips for lower back pain include a warm hand massage, a warm deep bath, and using cushions to support you when relaxing and in bed. Rocking the pelvis forward and backward may be especially comforting, and can be done while standing, sitting, or reclining.

Q:	I'm seven months' pregnant now and quite big. Should I adapt my swimming style?
A:	You may find that as you get very large toward the end of pregnancy, you need to alternate your swimming style to find the one that is most comfortable for you. Apart from this, a low-impact activity like swimming is ideal since the water provides resistance, there is a low risk of injury, and the mass of water relieves pressure on the abdomen and helps to ease lower back pain.

Are prenatal yoga and water aerobics safe during pregnancy?

Yes, low-impact activities such as yoga and water aerobics are fine in pregnancy. The teacher conducting the sessions should be able to advise you about the range of movement recommended to minimize any risk. As well as the benefits from exercise, these sessions help you meet other pregnant women and build new friendships in pregnancy. Many trainers offer follow-up water aerobic classes after the birth, which can be helpful for postpartum pelvic floor toning and weight loss.

What is pilates?

The pilates method of exercise was developed in Germany by a man named Pilates. This type of exercise is a core muscle workout that builds strength without bulking muscles and teaches you to balance strength with flexibility. The idea is to achieve harmony between mind and muscle, and it is taught using eight basic principles: relaxation, concentration, coordination, centering, alignment, breathing, stamina, and flowing movements.

Pilates is good exercise to do in pregnancy since it heightens your body awareness and is useful for control and confidence in labor and the postpartum period. It also incorporates Kegel exercises , which are especially useful. It's best to avoid lying flat on your back while exercising in the second and third trimesters since this can reduce the blood supply to your baby. If you are going to take classes, speak to your instructor about using a wedge, pillow, or bolster to keep your head higher than your belly while performing the exercises.

Is there an exercise that helps you avoid varicose veins?

Varicose veins are swollen, painful veins that are filled with an abnormal collection of blood that causes swelling (edema) in the affected area, which is usually the lower leg and calf . They are more common in women than men, with an increased incidence in pregnancy, and they also tend to be inherited. The most common symptoms of varicose veins and edema are pain, night cramps, numbness, tingling, heaviness, and aching. You can lessen the risk of varicose veins by getting regular exercise, such as a brisk walk, and try building pockets of exercise into your daily routine, such as using the stairs instead of the elevator, or parking farther from your destination if you regularly drive.

I booked a skiing vacation before I found out that I'm pregnant. Should I cancel?

Skiing is really not recommended during pregnancy, particularly if it is downhill skiing (although if you are used to the sport, moderate cross-country skiing may be fine). This is because of the high risk of a fall and subsequent trauma to your abdomen and the baby. The same risk is associated with ice skating too. During the first trimester of pregnancy, your baby's vital organs are developing and so it is important that this process is not jeopardized by any trauma to the abdomen, such as a fall.

In the second and third trimesters, your baby is growing and your uterus is higher up and no longer has the protection of the pelvis, so abdominal trauma could have serious effects on the baby and the placenta. Also in later pregnancy, falling on your abdomen can cause premature labor or separation of the placenta from the wall of the uterus, which is an emergency requiring prompt delivery of the baby.

Q:	Can I go horseback riding while I'm pregnant?
A:	Horseback riding is one of the activities that is not recommended in pregnancy. Even if you are an experienced rider, it is best avoided, particularly since a horse can be unpredictable if startled in any way. A fall may lead to significant complications in pregnancy. In addition, immobilization required after a fracture carries an increased risk for a blood clot formation in pregnancy.

We love going clubbing; will the loud music be OK for my baby?

There is evidence to suggest that babies can hear in the womb from about 16–20 weeks. However, your baby is protected by the amniotic fluid surrounding him, so most noises do not affect him. The ears of a fetus are often full of a protective greasy coating produced by the skin, known as vernix, so external loud noises would be muffled by the time they reach your baby. Your baby is most likely to respond to your reaction to loud music rather than the music itself.

There is a study that suggests that constant or regular exposure to noise can increase the risk of a small-for-dates baby, meaning your baby's growth is smaller than expected for his gestation. However, it is more likely that it is the environment and its effect on the mother that contributes to the baby's weight rather than the actual noise. Too much clubbing may mean lead to fatigue and expose you to second-hand cigarette smoke. It may also put you at risk by tempting you to consume alcohol. You should probably consider whether you are getting enough quality rest and ensure that you are not drinking any alcohol or exposing yourself to second-hand cigarette smoke, since this is more harmful to your baby than loud music.

We like walking, but should I cut down on the number of miles now that I'm pregnant?

Walking is ideal in pregnancy because it is low-impact exercise and can be maintained throughout your pregnancy. If you plan to continue lengthy walks and like to walk briskly, try combining this with a slower, more leisurely pace. It's important to control your body temperature so that you don't overheat and feel uncomfortable. To do this, drink plenty of water to avoid dehydration and wear layers that you can take on and off as required. As your belly grows, you may find hill climbing causes physical instability, as may hiking over uneven terrain, so stick to more level paths. If you find yourself getting out of breath, take a break.

Benefits of exercise Why you should aim to stay fit in pregnancy

There is no doubt that exercising during pregnancy offers numerous benefits to both mother and baby.

Regular exercise increases flexibility and suppleness, which will benefit you in labor.
Aerobic exercise, such as swimming, increases stamina, improving blood circulation and preparing you for labor.
Exercise releases endorphins, the body's natural painkillers, helping you to relax and lifting your mood.
Exercise keeps backache at bay.
An exercise regimen will help you to recover more quickly after the birth.

Kegel exercises Strengthening the muscles that support pelvic organs

Learning how to exercise your pelvic floor muscles is vital in pregnancy to help you avoid stress incontinence (leaking urine). This discreet exercise can be done any time. Kegel exercises involve squeezing your buttocks and pulling in your stomach muscles, then holding for 5 seconds and releasing. Repeat this 5–6 times several times a day. You could imagine your pelvic floor going up like an elevator, contracting your muscles a little more at each floor.

Locating your pelvic floor