Pregnancy Pilates

Introduction

Definition and benefits of pregnancy Pilates

Pilates is a form of exercise that can strengthen the body, particularly the core muscles.¹ It is suitable for beginners as well as experts and is for all ages.¹ 

Like yoga, pilates involves a series of guided movements and positions, with a focus on the core muscles, which include the abdominal, back, and pelvic floor muscles.¹  

In pregnant women, pilates is a complete exercise, working the whole body deeply based on conscious breath, balance strength, mobility, and flexibility designed to specifically support the bodily changes that occur in pregnancy. In addition to preparing for  labour and delivery, pilates can help with recovery by promoting pelvic floor health and helping to prevent diastasis.^{2, 3}

Importance of effective exercise during pregnancy

If you are healthy and your pregnancy is normal, it is a good idea to continue or start regular physical activity if your doctor recommends this for you. With the guidance of your physician, physical activity need not increase your risk of miscarriage, low birth weight, or early delivery.⁴

It is very important to always discuss any exercise regimen with your gynecologist during your early prenatal visits. If they consider that everything is going smoothly and the state of your pregnancy is optimum, you can talk about what kind of activities you can engage in safely.⁴

There are several potential benefits to completing physical activity during your pregnancy, such as 

• Reducing back pain^1,6
• Decreasing your risk of gestational diabetes, preeclampsia, and cesarean birth^2,9,12
• Promoting healthy weight gain during pregnancy¹²
• Improving your physical condition and strengthening your heart-blood system¹⁵
• Helping you to lose the weight gained after your baby is born.

Overview of how Pilates can support the changing needs of pregnant women

During pregnancy, you will feel multiple changes in your internal and external body.5 Besides hormonal and psychological changes,  you may experience a faster heartbeat and breathing rate,  your breasts becoming tender and heavy, the enlarged uterus pressing against the bladder, causing the need to urinate frequently, and some pregnant women may suffer mood swings due to hormonal changes.⁵

Pilates may promote an improvement in all of these changes, making your pregnancy more pleasant, enhancing the circulatory system's good function, and improving your posture by aligning each vertebra of your back.^1,10,16 Pilates is a mind-body exercise where conscious breathing is a central feature. It can promote meditation, connection with your body, and relaxation of your senses.13 This may decrease the impact of the hormonal changes on mood changes during pregnancy.⁵

Understanding pregnancy pilates

How Pilates differs from traditional exercise during pregnancy

Pilates is a low-impact exercise that permits the protection of the good function of joints, bones, and muscles, avoiding excessive wastage and overextension, making it  more appropriate in pregnancy than aerobic exercises. Moreover, Pilates is an anaerobic exercise permitting the boost of stretching and strengthening work, which is important because it reduces uncomfortable changes generating good pregnancy health.

The principles of Pilates and how they apply to pregnant women

• Breathing 

One of the basic  tenets of Pilates  and other mind-body exercises is conscious breathing.⁶ This style of breathing  is founded in meditation, permitting mental and body relaxation from the inside out,  improving our respiratory system, heart-blood system, and immunity system among other things. 

• Improving body posture

Another of the main principles of Pilates is ensuring the correct body alignment during the exercises. This avoids injuries and promotes back health, which maintains fetal growth.

• Stretching and strengthening of muscles

Pilates  consists of a large range of exercises that permit strength of the pelvic muscles focused on the pelvic floor. Additionally, pilates encourages the stretching and strengthening of the leg muscles, which in turn supports the extra  weight gained  from pregnancy.

Safety considerations and precautions for practising Pilates while pregnant

 If you think Pilates might be the right exercise regimen for you, please  consider some additional caution: 

• First, ensure your instructor is certified to teach classes for pregnant women.⁶ Avoid high-impact exercises: Keeping good communication with your instructor means letting them know how you are feeling and if anything changes for you either e before, during, or after each session⁶ 
• Avoid getting hot during the class:  This protects the optimum temperature of your baby and also prevents you from getting tired too quickly.  Try to keep away from hotter and more humid rooms to practice pilates⁶ 
• The last important precaution is to avoid particular movements or poses during certain trimesters of your pregnancy. You  can discuss this with your instructor and modify any uncomfortable or potentially risky exercises ⁶

Benefits of pregnancy pilates

Strengthening and toning the pelvic floor muscles

Pilates classes specially designed for pregnant during all the trimesters include pelvic floor work. These exercises help to strengthen and tone the muscles that support your pelvic area, such as the buttocks, inner legs, and pelvic floor. These to be toned can stop accidental leakage of urine during pregnancy or after your baby is born.⁶

Improved posture and body awareness

One of the most important principles of Pilates is getting better body posture through conscious breathing, which permits us to be aware of the correct position of our body in space and feel its alignment.⁶

Enhanced core strength and stability

Pregnancy Pilates is provided by specific exercises that aim to build up strength in different groups of muscles,⁶ 

Reduced back pain and discomfort

Pilates helps to reduce back pain, depending on the position or type of pain you have. In pregnancy Pilates can also strengthen your back, helping to support the abdominal growing weight.⁶

 If you have back pain, be sure to let your pilates instructor know to evaluate it, whether it is a complex pain is preferable to check it with your physiotherapist or doctor.⁶

Preparation for labour and postpartum recovery

Pilates has been demonstrated to be useful in postpartum recovery and reducing rates of cesarean deliveries (known as C-sections), contributing to a lower rate of birth interventions, episiotomies, and preeclampsia.^2,5

The prenatal Pilates emphasized in the oblique abdominals, back, and pelvic floor work increases body awareness and prepares you for pushing.²

Acceptable pilates exercises for each trimester 

First trimester

The first trimester is the beginning of changes you start to feel in your body. The first notorious symptoms of fatigue and nausea normally make you ask your doctor. During this stage, the mood and hormonal changes start to appear, and your uterus begins expanding.^5,9

1. Breathing exercises and relaxation techniques

Most Pilates exercises are modified during this stage. Breathwork is one of the pillars of Pilates,  encouraging you into a meditation state and calming the mind. This intentional breathing reduces anxiety while oxygenating and energizing your body.⁹

2. Gentle stretches and mobilization exercises

Stretching work is very important in pregnancy pilates, focusing on the pelvic area and hips,  as well as the internal and external portion of the legs.

Pay special attention to your movement, trying not to overextend it. In pregnant people, the range of motion could be reduced, so work within the new limitations of your flexibility.⁹

Second trimester

During this stage, the symptoms of nausea and fatigue often disappear. Your pregnant belly is full of growth, and for that reason, your centre of gravity decreases, challenging your balance. ⁹

1. Modifications for abdominal exercises

One of the principal considerations in this stage of pregnancy is reducing the time spent lying flat on your back (supine position). Due to the growing uterus, this position can compress the vena cava and restrict the normal blood supply to the baby. To modify exercises in this position, the pilates instructor will elevate the upper body using accessories.⁹

Exercises that induce the formation of diastasis recti (separation of abdominals), such as full planks, should also be avoided.⁹

2. Pelvic floor exercises and hip stability work

One of the most important aims of pregnancy pilates is to strengthen the pelvic floor using Kegel exercises to improve the coordination of the pelvic floor muscles, contributing to their flexibility and strength.10 Another way to work the pelvic floor area is to focus on activation of the transverse abdominals muscles, which, together with the back posture and breathing, contribute to lifting the pelvic floor muscles when tensing and relaxing them. ⁹

Third Trimester

During this final stage, the pregnancy belly increases  to its maximum size, causing  back pain in many pregnant women, and you may start to worry about labour.^{9, 10}

1. Exercises to alleviate back pain and improve balance

Due to the changes experienced in this pregnancy phase, continuing with exercises that strengthen your back is vital as well as back pain as preventing lordosis (exaggerated curve into lumbar spine). The most popular prop used to help with spinal health is the fitball, commonly called a ‘birth ball’.’⁸ A wide variety of pregnancy pilates exercises can be performed with it. Just sitting on the fitball corrects your posture, minimizing back damage or injuries.⁸ The exercises completed on a fitball permit stretch and strength work of your back muscles, relieving the back pain.⁸ Furthermore, the pilates exercises on fitball are effective for building muscles and endurance, strengthening your transverse abdominals, and developing flexibility, stability, and balance, so they are fundamental in that phase of pregnancy.

2. Pelvic tilts and exercises for labour preparation

• Hip-opening exercises

Squat:  

Squatting is one of the comfortable positions for preparing for and giving birth; the exercises in this position promote the strengthening of thighs and help to train the muscles involving the opening of the hip.

Butterfly stretch:

This movement helps to open your pelvis and stretch your lower back and inner thighs. Always be cautious not to overstretch so as not to get injured.¹¹

• Back-stretching exercises

Pelvic tilt:

Commonly called ‘the angry cat,’ this exercise promotes the strengthening of abdominal muscles and relieves back pain during pregnancy and labour.

Back-stretch:

This exercise stretches the muscles along your spine and shoulders as well as the back of your legs. This type of stretching is effective in releasing  the tension in your back. It also helps to relieve muscle tightness during birth labour.

Child's pose:

The child's pose stretches harmoniously to your lower back and provides a mild hip opener, which helps to prepare for delivery.¹¹

• Pelvic floor exercises

Kegels:

The Kegel exercises strengthen the pelvic floor muscles that support your pelvic organs and also help in the prevention or treatment of urinary stress or incontinence problems.^10,11

Some studies suggest that having good control of your pelvic floor muscles could help during the pushing stage of labour, making it easier for your baby to be born and, at the same time, decreasing the length of delivery.¹¹

Perineal massage:

The perineal massage consists in softly massaging the tissue around the back of the vagina. Thus, it can stretch the area more easily when your baby is born. Normally done in the last weeks of your pregnancy to decrease perineal trauma during childbirth.¹¹

Pilates equipment and props for pregnancy

Recommended Pilates equipment during pregnancy

Contemporary pilates is divided into mat pilates and machine pilates; inside machine pilates, you can use several types of apparatus, most of which are used in pregnancy pilates the recommended are the Reformer, which promotes adaptable and soft exercises. The Wunda chair is another appliance widely used in pregnant women because it permits them to do a large range of exercises that strengthen the legs and pelvic area. The Spine corrector and Ladder Barrel are used to stabilize the posture and improve the stretch and strength of the spinal column.

Using props to modify exercises for comfort and support

Several types of props are used in pregnancy pilates as much machine pilates as mat pilates getting to modify exercises permitting a wide muscle work. One of the most popular is the Magic Circle. It provides feedback to your body to target your muscles and make the exercises major balance challenging. Other used props are the Overball, elastic bands, and hand weight. These last one, or two-pound weights add challenge to the Standing Arm Series and the Wall Exercises. ⁷

The role of stability balls and resistance bands in pregnancy Pilates

The Overball is a squishy inflated round ball that is typically nine inches in diameter and is used for legs, upper and lower back, and some pelvic area work. Pregnant women can use a ball behind the mid-back to avoid lying supine for an extended period. ⁷ The Swiss Ball is often used for fitness training as well as physical therapy, rehabilitation, pilates, and more. Principally works the stability. Therefore, it’s ideal for strengthening core muscles, improving posture, and better body alignment.⁸ Resistant bands are used principal to strengthen the scapular area with arm work and stretching hamstring work.⁷

Precautions and contraindications

Medical conditions or complications that may restrict Pilates practice

In some cases, physical activity is contraindicated in pregnant women, and Pilates practice is not an exception. Some of these states can be the mother's medical conditions or can develop with the pregnancy. These contraindications can be ‘absolute’ and are not compatible with any type of exercise during pregnancy, Examples of absolute contraindications are; ruptured membranes, active preterm labour, placenta praevia after 28 weeks, unexplained PV bleeding, and severe preeclampsia. ‘Relative contraindications’ describe those contraindications where the doctor recommends you begin or continue a moderate level of exercise program. Among them are moderate cardiovascular or respiratory disease, untreated Thyroid disease, preterm premature rupture membranes, and well-controlled type I diabetes, among others.¹²

Warning signs during exercises to stop and seek medical advice

There are some signs in which pregnant women should stop exercising and visit their doctor; these are:¹²

• Persistent excessive shortness of breath that does not resolve with rest
• Severe chest pain
• Regular and painful uterine cramps 
• Vaginal bleeding
• Persistent loss of fluid from the vagina indicating the rupture of the membranes
• Persistent dizziness, syncope, or faintness that does not resolve on rest
• Decreased fetal movement
• Muscle weakness affecting balance 

The importance of consulting with a healthcare provider before starting Pilates

When you get pregnant it is of vital importance to consult a healthcare professional to keep a follow on the baby and pregnancy conditions and verify that everything is going well. After examination, your healthcare provider will make a diagnosis about you and your baby's health, determining if you are capable of some physical activity, and giving you a certification that authorizes your exercise. All the Pilates studios require this medical authorization to start making a special exercise routine for you.

Tips for practicing pregnancy pilates at home

Creating a safe and comfortable exercise space

It is recommended for practising Pilates under the professional supervision of an instructor. If you are not capable of assisting a Pilates studio, there is the possibility of practising through online classes, It must be led by a Pilates instructor. He/she is setting the best exercises, poses, and props you can use during each session. To take Pilates online classes, you just need a stable internet connection, a comfortable space in your home, and a desire to learn. In accordance with your condition, your instructor could give you some exercises to practice alone in your home.

Setting a suitable exercise routine and frequency

After evaluating the medical recommendation, your Pilates instructor will set you a customized exercise routine, variations, equipment, and frequency according to your health condition.

Listening to the body and adjusting intensity as needed

Attempt good feedback with your instructor during each session. Thus, he/she can drive you better, making adjustments of frequency, intensity, and form to do each exercise, fitting your needs.

Finding a qualified pregnancy pilates instructor

The importance of a certified and experienced instructor

You must take all the necessary precautions before starting any exercise, starting with ensuring you have a certified Pilates instructor. Unfortunately, there is no legal requirement to register as a practitioner in some instances.¹  So, always check the Pilates studio's prestige as well as the studies and experience of the teachers who work there. Also, check that the pace of the class is right for you.¹ When you find the right  Pilates center, make sure you explain your condition and show your teacher the health certification in which your doctor authorizes you to practice  Pilates, then take a trial class and evaluate if it is suitable for you; if not, you may choose private classes. ¹

Questions to ask when selecting a prenatal Pilates class

If you are newly pregnant, or it is your first time practising Pilates, it is logical that you are confused about it, and you may have some questions. So, before putting you in any Pilates teacher's hands, you should ask 

• What are your pregnancy Pilates-specific qualifications?
• What fitness industry governing bodies or organizations, do you belong to?
• How long have you been teaching Pregnancy Pilates?
•  How many sessions do you recommend to me per week?
• Finally, ask some people for recommendations of pregnancy pilates instructors. ¹³

Online resources for guided pregnancy Pilates sessions

If you are unable to attend some Pilates studios, nowadays, it is very popular to take your sessions remotely. Just you need a wide and comfortable space, a stable internet connection a mat, and home props. This alternative can have pros and cons. On one side is comfortable having your classes inside your home, doing your exercises with more confidence, and without spending time and money unnecessarily, so for timeless moms is the perfect option. On the other hand, you do not have face-to-face corrections from your teacher; they are necessary to improve your body posture and do the exercises in the correct form, taking advantage of their benefits and avoiding injuries from bad posture. finally, the social compound you may have interaction with other moms in your same situation.

Combining Pilates with other prenatal practices

The benefits of combining Pilates with yoga or swimming

Swimming is one of the most complex exercises, as it improves our balance, control, coordination, body awareness, and mental focus.

The benefits you get from Pilates are in the same vein, but they work differently. Pilates and swimming give you the same benefits,  although they are different disciplines, they synergize and complement each other to maximize their advantages..¹⁴

For example, pregnant women would obtain the benefits from swimming to be a cardiological activity, they would improve their circulatory system functioning, decreasing the risks of suffering high blood pressure and diabetes. At the same time, obtaining the benefits from pilates, such as stretching, strengthening muscles, enhancing spinal health through posture work, and also getting better mental concentration through conscious breathing.

How to create a well-rounded prenatal fitness program

First, check your pregnancy conditions with your doctor; when you have received the green light for exercise, the next steps are to consider: 

• Your fitness level
• Your pregnancy symptoms
• How exercise feels for you
• If you are active before pregnancy or 
• If you are new to exercise, among others

If you are active before pregnancy, you are likely capable of continuing your exercise routine. Your instructor will make some modifications as your pregnancy progresses.

If you are new to exercise, start softly, just a few minutes a day, or just one or two days a week, and continue analyzing your progress with your instructor.

The most important is always to listen to your body, if you feel an unusual discomfort, ask your doctor.

The best prenatal workout plan should have¹⁶

• Cardio exercises to keep your endurance, which helps with labour 
• Strength training exercises to improve muscle tone and strength to help support the physical changes of pregnancy
• Flexibility exercises to help reduce pain and improve mobility
• Pelvic floor and core exercises specifically for pregnancy

Considering low-impact cardio activities to complement Pilates 

Pilates is an anaerobic discipline, working to stretch and strengthen muscles. It can be complemented with cardio activities to get a complete workout, as long as they are not working the same muscle groups. It is important to mention that the recommended cardio activity for pregnant women must be low-impact. Experts suggest a maximum cardio workout of twenty minutes before strength exercises in normal conditions, but for pregnant women is vital to always ask your gynaecologist, to give you authorization for both activities and receive advice on whether you can do these exercises together or on different days.¹⁵

Summary

To summarize, pilates is a discipline that helps maintain your mind and body health. Conscious breathing is the basis of meditation, promoting mental concentration, calm, and relaxation.  This reduces the levels of stress and anxiety and also stabilizes potential mood changes during pregnancy. All of this helps you to develop strength and endurance in the muscles involved in the labour, making it less painful and contributing to a speedier subsequent recovery.

Before you start practising Pilates, make sure you check with your doctor. Unfortunately, not all pregnant women can practice pilates during pregnancy. There may be underlying diseases or risk conditions that could increase the risk of pregnancy loss.

If your doctor authorizes you, the next step is to find a good Pilates studio and a licensed teacher experienced in prenatal  Pilates.

When you find the right teacher, you should discuss with them your pregnancy conditions and the exercise modifications necessary depending on your medical condition and the stage of your pregnancy..  Pilates is a versatile exercise program and can be adapted to your needs by your instructor using several props and pieces of apparatus. Among the props most used for prenatal pilates are the fitball (also called birth ball), overball, elastic bands, and hand weights.  The apparatus most used for pregnant women is the Reformer, Wunda chair, Spine corrector, and Ladder barrel.

Designing your optimal exercise program during pregnancy will need to consider many things, including your fitness level, whether you are new to exercising, and whether you experience any physical or medical difficulties during your pregnancy.

Finally, a well-rounded exercise program during pregnancy has to consider varied  exercises, each one with a different  target, so providing a complete range of benefits that can help you during your pregnancy and birth labour.