The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Prenatal Exercise and Yoga

Subsections on this page:

• General
• Yoga
• Squatting
• Kegels

General

Nutrition and Exercise - a resource list from Auburn University

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

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."

 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

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

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.

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

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

Kegels - from the Web page for the book, Pregnancy & Childbirth Tips

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.