After the first trimester, it is recommended that pregnant women don't spend an extended amount of time on their back due to the pressure that the uterus can put on the Inferior Vena Cava. (The Inferior Vena Cava is the big vein in your belly that brings blood back to the heart)
Instead of giving up on doing all exercises that require you to be on your back, there are some modifications that can be used in order to reap the benefits of exercising in supine.
-Place a wedge behind your head and shoulders so that you are in a reclined position where your heart is above your navel
-Prop yourself up on your arms so that your head and shoulders are off the floor and your heart is above your navel.
*Exercises in modified supine target your core (abdominals, pelvis, obliques), thighs, legs, buttocks.
Expand for Exercise Pictures and Instructions
Don't really exercise? Don't know where to start? Have no fear, you don't actually need much in order to start exercising, becoming active, and beginning your journey to a healthier pregnancy for you and your baby.
-Yoga Mat or other type of non slip mat: I would recommend getting a non-slip mat because many simple and safe exercises can be done on the floor, and a non-slip mat will help cushion the area as well as protect your bony prominences (your spine, your buttocks). Having a non slip mat can make your workout safer, especially if you are exercising barefoot or in socks.
-Free weights: Starting out with light free weights are a great beginner tool because they can be used in a variety of ways for a variety of different exercises, and you can ramp up the weight as you get stronger! You can use free weights to target not only your arms, but also your back, your core, and add some extra weight to your other exercises for a full body workout.
-Therapy Ball: A therapy ball is another great tool, not only for exercise, but you can sit on it during the day and improve your balance as well as strengthen your core. You can use the therapy ball after birth to continue exercising and strengthening your core. You can also use therapy ball with your baby as a tool for them to be active and learn new skills. A therapy ball is one of the most versatile tools, and I have used it with not only adults, but also with infants, toddlers, and older children when exercising.
For more information, feel free to contact me or join my Facebook group: Healthy and Active Pregnancy for more discussions.
Once you are able to find your neutral spine in quadruped, there are TONS of exercises you can do in quadruped. Below I am going to post some very simple starter exercises that can be done in quadruped (in order of increasing difficulty)
Exercises in quadruped work on your balance, your core strength (abdominals, obliques, pelvic floor), your buttocks, your thighs.
Expand for Exercise Pictures and Instructions
What is Diastasis Recti:
Your abdominal muscles consist of a left and right side group of muscles called the Rectus Abdominis, and they are connected by a collagen structure of connective tissues going down the front of your stomach called the Linea Alba. A Diastasis Recti is a widening of the gap between the 2 sides of the Rectus Abdominis at the Linea Alba. Since the abdominal muscles play a large role in core stabilization, this separation can lead to core instability and a decrease in function.
What causes a Diastasis Recti:
During pregnancy, most women develop some level of Diastasis Recti simply because of how much the abdomen has to stretch, and because there is an increase in intra-abdominal pressure that is not being controlled properly. Many women continue to have this separation shortly after giving birth, but generally the muscles should go back after a few months. If the separation is wide enough and it is not treated, it may get worse, especially with subsequent pregnancies.
This can cause:
Functional issues- Constipation, urine leaking, back pain, difficulty breathing, and decreased stability. In severe cases, the tissue may tear and you may get a Hernia (abdominal organs stick out of the tear).
Aesthetic issues- Your stomach might stick out so that you have a small pooch, or you may keep looking pregnant long after having given birth because the muscles aren’t able to properly contract and pull in your abdomen.
How to Test for Diastasis Recti:
-Lay down on your back on a flat surface with your knees bent and feet flat on the floor
-While relaxed, with your palm facing you, place your fingers just above the belly button
-Lift your head and neck off the floor, slightly so that your shoulder blades are still touching the floor, and press your fingers down into your abdomen
-The gap that you feel is the diastasis recti, see how many fingers it takes to fill that gap.
*If it is 3 or more fingers wide, then you should see a specialist.
- Repeat this test 2 more times; once just above the bellybutton, and once a few inches below the belly button
*You should feel your muscles squeeze around your fingers if you try to contract the abdominals; if you do not feel the muscles tense up, then you need to work on reconnecting the abdominals and strengthening your core.
Things to Avoid:
-Straining the abdominals (pushing if you are constipated)
-Lifting heavy things without bracing your abdominals
-Improper exercise; If you have a Diastasis Recti you need to be careful with your exercises.
-Crunches, sit-ups, push ups, planks, some yoga positions (downward dog), backbends, spinal extensions, twisting the spine.
-Basically any exercise that makes you strain your abdominals and makes your stomach bulge out can cause the separation to get bigger if you are not doing the exercise properly and are not being careful.
Any exercise that makes you pull your stomach in (abdominal compressions)
-Pelvic tilt, bridge with belly scooping, heel slides
-Working on your obliques to help bring the abdominal muscles together
Always be sure to exhale when you are performing a straining activity so that you are not creating compression within the abdomen
What is neutral spine:
A neutral spine means that none of the joints are bent, the spine is aligned and not twisted. Most people have natural curves in their spine, it is not a straight line. A neutral spine is the optimal position of the curvatures in your spine.
-slightly arched lower back, slightly rounded upper back
Why is it important to have a neutral spine:
Many people tend to over exaggerate the curves in their spine, placing extra stress on the joints and leaving them exposed to injuries and pain. When you achieve a neutral spine, you will have the least amount of stress placed on your spine and the tissues surrounding it. With a neutral spine, you will be able to attain optimal balance, improve breathing, improve circulation to the tissues, and decrease your chances of injury
How to attain a neutral spine:
-Begin on your hands and knees with a straight spine
-Arch your lower back and move your stomach toward the floor
-Round your back as much as you can
-Repeat arching (full extension) and rounding (full flexion) your back a few times until you get comfortable, and begin narrowing in on a position between the two extremes that makes you feel the most pain free and balanced. That is your neutral spine.
Against a wall, in standing, or tall kneel.
-Begin with your back flat
-Arch your spine so that you stick your stomach out and your pelvis moves down and backward
-Round round your spine so that you are squeezing your stomach in and your pelvis moves up and forward
-Repeat arching and rounding your back a few times until you feel pain free and balanced.
*This is a great exercise for your pelvis and your core.
*To see videos about how to find your Neutral Spine, check out the Exercise section
Frequency (How often you should exercise)
This is determined by your pre-pregnancy activity level and other health factors.
-If you were very active before, then you should be able to continue your exercise regimen given that you are feeling well and are following appropriate safety measures.
-If you did not exercise before pregnancy, it is recommended that you build up your activity level to more frequent exercise. Once you are cleared by your doctor, you can begin exercising 2-3 time a week, and work your way up to exercising on most days of the week.
-It is recommended that you exercise for shorter periods of time, a few days a week rather than trying to fit in a long exercise session once or twice a week. This will help improve your muscle memory, your muscle tone and strength, your endurance, and balance.
Intensity (How hard you should exercise)
This is determined by your pre-pregnancy activity level and other health factors
-Low to moderate intensity of exercise is recommended for most women who did not exercise pre-pregnancy
-The point of exercising during pregnancy is not to lose weight, become a bodybuilder, or triathlete. You are exercising to keep your body strong and healthy while you carry your baby, to help during the birthing process, and to help you get back to shape once you have your baby. That being said, you don’t want to lift heavy weights, perform strenuous exercise, and do something that will leave you feeling breathless and uncomfortable.
-You want to exercise at a steady pace so that you are still able to talk while you are exercising. You want to be able to always control your breathing, so any exercise that makes you hold your breath or feel faint, is probably something you will want to make easier or discontinue until you can do it safely.
Time (How long you should exercise)
-Studies have shown that you get better results from shorter, more frequent sessions, rather than longer sessions once or twice a week.
-10-30 minutes of exercise a day is enough to leave lasting effects on your body.
-You can break up your exercise into 2- 15 minute sessions a day.
-Optimally you want to be exercising 5 days a week, 30 minutes a day
Type (What type of exercise is best for you)
-There are many types of exercises that are safe for pregnant women.
-Walking: Simple, can be done almost anywhere, easy on your joints
-Swimming: Helps keep your body toned, does not put extra weight or stress on your joints
-Prenatal Yoga: Easy on the body, helps with breathing
-Prenatal Pilates: Helps with core strengthening
-Dancing: Good way to get your heart rate up and keep active; avoid excess spinning and jumping
-Light weights: Help with muscle strengthening, muscle tone, muscle endurance
-Physioball exercises: Incorporates balance, strengthening, endurance, and provides an alternative to being on the floor while exercising
-Pelvic exercises: Helps improve pelvic floor muscles to help with incontinence (during and after pregnancy), help with labor and delivery
-Strengthening Exercises for large and small muscle groups are great for your body as long as you are being safe and do not put a strain on your body.
-Avoid any exercise that involves excessive jumping, hopping, or bouncing
-Avoid any exercise that has a risk of you falling or getting injured
-Stretching before, during, or after exercise is a touchy subject because your body is flooded with hormones (Relaxin) that help relax your muscles and joints, especially in your pelvic area. This can lead to instability and a higher chance of injuring yourself. If you chose to stretch, do so with caution and awareness that your body is already doing some of the stretching for you due to the hormones and changes you are going through.
-ALWAYS listen to your body. Do what feels good, and if it feels painful, uncomfortable, or something is not right, then stop what you are doing.
What to avoid during pregnancy:
-Activities that increase the risk of falling
-Activities that can cause trauma to your abdomen
-Intense jumping, bouncing, or hopping
-Intense stretching, or bouncing while stretching (your body is full of hormones that promotes relaxation of muscles, so its easier to get injured while stretching)
-Exercising in hot, humid conditions
-Holding your breath for an extended period of time, or not breathing correctly through exercises
-Exercising to the point of exhaustion; you should be able to keep a conversation while exercising, or not be out of breath during activities
-Laying on your back for prolonged periods of time; after the first trimester, your baby can put pressure on your inferior vena cava, and decrease blood supply to you as well as the baby itself
Tips during exercise:
-Drink plenty of water during and after activities
-Make sure you are eating enough calories to restore the nutrients and calories you are losing while exercising; you aren’t exercising to lose weight while you are pregnant, although exercising after the baby is born will help with weight loss.
-After activities, which require you to be on the floor, get up slowly to prevent dizziness
Important to remember:
-Your joints are more flexible due to hormones which cause muscles to relax, so be very careful if you chose to do some stretches.
-Center of gravity might be shifted due to extra weight from the front, which will affect your balance
-Extra weight and nutritional/ physical demands cause your body to work harder than before you were pregnant. This means that you will become tired quicker and have less energy. (Exercising will help improve your energy levels over time)
-When you exercise, blood flow shifts from internal organs to the muscles, lungs and heart. This means that less blood flow is going to your uterus (and your baby), so you need to be careful that you do not over-exercise and maintain a healthy heart rate so that your baby is still getting the proper oxygen amount.
While exercising and staying active during pregnancy is often encouraged, it is important that you check with your OBGYN first; especially if you have a high risk pregnancy or have not exercised prior to becoming pregnant.
If you normally get little to no exercise, walking 30 minutes a day is a good way to start getting active. Walking is usually safe because it does not put too much pressure on your joints and still gives you a full body workout.
Exercise helps with:
-Strengthening and preparing your body for all the changes it will go through (from pregnancy, birthing, to post-pregnancy)
-Regulating blood sugar
-Regulating blood pressure
-Easing back pain
-Strengthening your cardiovascular system (improved circulation helps prevent hemorrhoids, varicose veins, leg cramps, and ankle swelling)
-Strengthens the respiratory system
-Improving metabolism and digestion (helps prevent constipation)
-Improving sleep quality
-Preparing your body for a quicker recovery after delivery
Elina Skripochnik PT, DPT, CSCS
Elina is a Physical Therapist with experience in women's health and pediatrics. She aims to educate women on the importance of becoming and staying active during pregnancy, as well as to provide safe and easy exercises that can be done throughout pregnancy and beyond.