advice and exercises during pregnancy - health and … from side to side, performing a pelvic tilt...

Advice and Exercisesduring Pregnancy

Advice and exercises during pregnancy physio team A5 2 colour booklet.indd 1 05/11/2013 14:03

This leaflet contains some advice and exercises which you may find useful during pregnancy and labour. If you are experiencing any medical or pregnancy-related complications please seek further advice to make sure the following information is suitable for you.

Back and pelvic care

Some women can experience back and/or pelvic pain during pregnancy. Your pelvis forms a ring with one joint at the front and two joints at the back. Any or all of these joints can be affected during pregnancy. Your back is also under more strain during pregnancy.

• Pregnancy hormones allow ligaments to become more lax therefore joints have less support than usual• As your bump increases in size your centre of gravity changes putting extra strain on your back and pelvis • Your tummy muscles, which support your spine and pelvis, become stretched and weakened.

For these reasons it is important to listen to your body, pace yourself as pregnancy progresses and pay particular attention to your posture.

Posture

In standing

• Contract abdominal muscles gently• Tuck tailbone under and lengthen through your spine• Ears, shoulders and hips should all be in line.

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In sitting

• Avoid slouching• Sit into the chair so that the chair supports the length of your thigh• A rolled up towel in the small of your back helps provide support• Sit so your knees are level with your hips• Avoid crossing your legs. This position decreases circulation.

If you do experience back or pelvic pain you may find some of the following advice helpful:

Activities of daily living

• Keep body symmetrical when you move• Carry shopping equally in each hand• Avoid twisting eg. carrying babies on your hip• Avoid lifting - if you need to, bend your knees and keep items close.

• Use the shower rather than bath• If bathing, sit on the edge and swing legs over.

• When getting into a car keep knees together, sit down first and then swing legs in together• This can be made easier by putting a plastic bag on the seat. Just remember to put it behind you for driving• Avoid carrying baby car seats, if necessary carry it in front for short distances only.


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• Plan the day so that your have as few trips up and down stairs as possible• Go up with your good leg and down with the bad one (weak/sore)• Avoid sitting/standing in one position for too long• Heat.

You may find that a hot water bottle or heat pack are soothing to achy areas and can be particularly useful if you have areas of muscle tightness.

• Sleep with a pillow under your bump and between your knees• If you are experiencing discomfort in your hips it may help to place a spare duvet under your bed sheet to provide extra cushioning and relieve pressure.

If your pain does not become manageable with the above advice you may benefit from a physiotherapy assessment.

For further advice:

• www.pelvicpartnership.org.uk • Association of Chartered Physiotherapists in Women’s Health (ACPWH) - http://acpwh.csp.org.uk/publications/pregnancy-related- pelvic-girdle-painfor-mothers-be-new-mothers

The following exercises are designed to help you reduce the strain on your body and make you more comfortable during your pregnancy.

Remember to always listen to your body and stop if you are:

• Uncomfortable• Fatigued• Feeling unwell.

Antenatal exercises


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1. Pelvic Floor Exercises

Pelvic floor muscles stretch like a hammock from the pubic bone in front to the tailbone at the back. They support all the organs of the pelvis and during pregnancy they are under extra strain to support your growing uterus, baby and amniotic fluid which can weaken these muscles.

Pelvic floor contraction

This exercise can be done lying, sitting or standing.

Imagine you are trying to stop yourself from passing wind, and at the same time trying to stop the flow of urine. The feeling is one of ‘squeeze and lift’, closing and drawing up the passages between your legs.

Strong pelvic floor muscles are essential to prevent leakage of urine when you sneeze or cough, for enjoyable sexual intercourse and to give you complete control of your bowels therefore it is important to get into a good habit of exercising them – it’s never too late to start!

Long contraction

Tighten your pelvic floor muscles as previously described and hold for as many seconds as you can (up to 10 seconds).

Let the muscles completely release and rest for several seconds.

Repeat this long contraction as many times as you can (up to 10 times).


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Short contraction

Now squeeze and lift more firmly and then release completely straight away. Repeat this as many times in a row as you can (up to 10). Practise these exeercises at least 3 times daily.

Be careful not to hold your breath, tighten your leg muscles, tummy muscles or buttocks while doing these exercises.

Knack - tighten your pelvic floor muscle before lifting or coughing.

2. Transversus Abdominus (TVA)

This is your deepest tummy muscle that provides support to your lower back and pelvis. It is often weakened during pregnancy and inhibited by pain, therefore needs to be exercised.

Try this routine:

Place your fingertips on your lower tummy under your bump. As you breathe out gently contract your lower tummy muscles drawing your bump away from your fingertips. Hold for 5 - 10 seconds as you continue to breathe into the top part of your chest and rib cage then relax.

Once you have mastered this, try this exercise whenever you know changing position is uncomfortable, for example getting up out of a chair, turning over in bed and going upstairs.


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3. Pelvic tilt

• Lying with 2 - 3 pillows behind you to ensure you aren’t lying flat• Lie with knees bent, feet resting on bed• Pull in tummy muscles and press lower part of back into bed• You may feel your tailbone begin to peel off the bed slightly• Relax• Repeat 5 times.

This exercise can also be performed in sitting and standing.

4. Chest stretch

Place hands at base of spine and draw your elbows together stretching out the front of your chest.

5. Gym ball exercises

When sitting on a gym ball your hips should be in line with your knees. You may find it quite comfortable simply sitting on the ball during your pregnancy as it can help relax tight muscles.

Exercises to perform on the ball include gentle bounces, rolling your hips from side to side, performing a pelvic tilt on the ball, and circling your hips in both directions.

General exercise advice

Provided you do not suffer from any medical or obstetric complications light to moderate exercise is recommended during pregnancy as it can help your body cope with the stresses and strains of pregnancy and also prepare you for labour and motherhood.


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• Avoid high impact or contact sports• It is best to avoid starting any new, vigourous activity during pregnancy• Use the ‘talk test’ as a good guide to ensure you aren’t pushing yourself too hard ie. you should be able to carry on a conversation while exercising• If participating in an exercise class inform your instructor once you become pregnant so that they can adapt any of the exercises suitably for you if required• Avoid exercising flat on your back after 16 weeks• Swimming/walking/pilates/yoga are all excellent forms of exercise during pregnancy• As your breathing and metabolism change during pregnancy it is important to spend longer warming-up and cooling down • You may need to drink more water than usual when exercising and pay attention to make sure you avoid overheating while exercising• Listen to your body – it is normal to slow down as your pregnancy progresses.

Leg cramps

These are due to changes in body chemistry and changing pressures in the abdomen.

Avoid wearing high-heeled shoes or sitting cross-legged as this can make leg cramps worse.

Some women find that it helps to exercise their feet before going to bed: - Circle them at least 10 times briskly in each direction - Try stretching the legs out straight and pulling your feet and ankles hard up towards you, keeping them pulled up for a few moments.

Minor aches and pains


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Rib pain

You may experience discomfort in your ribs as your baby gets bigger and pushes your rib cage up and out of its normal position. It can help to sit and bend your upper body sideways away from the side of pain and raise the arm of that side up and over your head.Hold for a few seconds and then return to normal sitting position.

Carpal tunnel syndrome

With increased fluid volume during pregnancy some women experience pain, numbness or tingling in their hands caused by the extra fluid putting pressure on nerves in your wrist. This is known as carpal tunnel syndrome.

Tips: - Run your wrists under cold water - Rest your hands on your bump so that they are elevated above your elbows to encourage fluid drainage - Massage the fluid away from your hands by using long sweeping strokes in one direction from your hand to your upper arm with a moisturiser - Circle your wrists in one direction and then the other - Your physiotherapist can provide you with wrist splints to wear at night if necessary.

Swollen ankles - Paddle feet up and down briskly/circle ankles a few times in both directions - Spend some time sitting or lying with your feet propped slightly higher than your hips.

If possible, avoid being on your feet for prolonged periods, especially standing still.


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Early 1st stage

• May be still at home – good to be upright and mobile• Warm bath/shower may help• TENS – if using put on early• Massage – use firm pressure - Circular movements using heel of hands at back of pelvis - Long sweeping movements up either side of the spine along the top of the shoulders• Relaxation.

Positions of ease:

• Avoid lying flat on your back where possible as this position narrows the pelvic outlet and makes it harder for the muscle of your uterus to work effectively• Gravity-assisted and squatting positions make it easier for the baby to progress down into the pelvis• Rocking your hips from side to side or in a circular motion can also be very effective at helping labour to progress more quickly.

Breathing

- Muscle of the uterus is working hard, baby being compressed slightly with each contraction therefore important to focus on keeping breathing under control to

Coping in Labour

Leaning against wall

Forward lean sitting/sit backwards

on chairHigh supported

kneelingUsing birthing ball


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2nd Stage

The more upright you are the easier it is to push!

Positions to adopt if not using an epidural:

stay relaxed and maintain good supply of oxygen to both you and baby - Start with long sighing breaths – think of ‘blowing the contraction away’ - Go into ‘rib breathing’ ie. slow controlled breaths expanding ribs - Then using the top part of the chest - either slow breaths in top part of chest or ‘pant, pant, blow’ depending on the severity of the contraction.

Transition - (Not dilated far enough but now getting the urge to push) - Pant, pant, blow.

Head crowning

• Asked to pant again to allow babies head to crown slowly• Then back to pushing when instructed by the midwife.

Congratulations! Now you can relax and enjoy your new baby

Stand forward lean Kneeling on all fours High kneeling Half sitting


Designed by Communications Department

If you have any questions or concerns please feel free to contact the

Physiotherapy Team:

Mrs O Lawson/ Mrs M CharterisPhysiotherapy Department

The Ulster HospitalDundonald

BelfastBT16 1RH

Tel: (028) 9056 4707

Louise Kerr / Vicky Pierce / Ciara McAteerPhysiotherapy Department

Lagan Valley Hospital39 Hillsborough Road

LisburnBT28 1JP

Tel: (028) 9266 5141 Ext: 2039

Roisin RooneyPhysiotherapy Department

Downe Hospital2 Struell Wells Road

DownpatrickBT30 6RL

Tel: (028) 4483 8053

Contact details


advice and exercises during pregnancy - health and … from side to side, performing a pelvic tilt...

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