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Archive for the ‘Pre Conception Health’ Category

Whilst exercise is suitable for most pregnant women, there are some conditions in which medical clearance from the relevant professional caregiver must be obtained. A sensible course of action would be to wait until clearance is received. However, the final choice ultimately belongs with you – the mother.

There are two forms of contraindications – absolute and relative.  An absolute contraindication is a situation which makes a particular treatment or procedure absolutely inadvisable.   A relative contraindication is a condition which makes a particular treatment or procedure somewhat inadvisable but does not rule it out.

Absolute contraindication

If one of the following is present (even a previous history) of absolute contraindications (The Physician and Sports Medicine 1996/ACOG 2004) then you should not exercise – discuss with your health care provider.

  • 3 or more miscarriages
  • Haemodynamically significant heart disease
  • Restrictive lung disease (would include asthma)
  • Incompetent cervix (weak/dilated cervix)
  • Bleeding or diagnosis of placenta previa after 26 weeks gestation
  • Multiple gestation at risk for premature labour
  • Persistent second or third trimester bleeding
  • Ruptured membranes – a condition in which the membranes that hold the amniotic fluid rupture before labour.
  • Premature labour or any risk of premature labour during this pregnancy
  • Placenta pathology (e.g., renal disease restricts the flow of blood to the placenta)
  • Foetal distress
  • Pre-eclampsia/pregnancy induced hypertension

Relative contraindication

(The Physician and Sports Medicine 1996/ACOG 2004)

  • Severe anaemia
  • Unevaluated maternal cardiac arrhythmia
  • Chronic bronchitis
  • Poorly controlled types 1 diabetes
  • Extreme morbid obesity
  • Extreme underweight (BMI<12), or overweight (BMI >33)
  • History of extreme sedentary lifestyle
  • Intrauterine growth restriction in current pregnancy
  • Poorly controlled hypertension
  • Orthopaedic limitations
  • Poorly controlled seizure disorder
  • Poorly controlled hyperthyroidism
  • Heavy smoker
  • Symptomatic cardiac disease

If you have answered NO to all of the above, you are classed as a ‘low risk pregnancy’.  If you have answered YES to any of the above you may still be able to take part in the class.  You need to contact your medical team and check that they are happy for you to continue to exercise.

However, should you have ANY cause for concern you MUST avoid exercise and seek professional medical advice.  Remember I am not medically trained, but I do know about Pilates and Pregnancy.

Above all you should enjoy the exercise you are doing—don’t force yourself just because you think you ought to be doing something.

Stop exercising IMMEDIATELY if:

You must stop immediately and contact your Health Care Provider if any of the following occur (ACOG, 2004):

  • Vaginal bleeding
  • Dyspnoea (breathlessness) before exertion, faint or dizzy
  • Prolonged or severe Headache
  • Chest pain or numbness down your arm
  • Muscle weakness
  • Calf pain or swelling (need to rule of embolism)
  • Premature labour
  • Decreased foetal movement
  • Amniotic fluid leakage.
  • You have pain down the front of your pelvis
  • You feel strong pains in your abdomen

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Pregnancy Pilates is designed to offer smooth flowing movements from a stable base. Each movement comes from a strong centre. The aim is to realign muscles and open up spaces between each vertebra.   Back stability is fundamental to any Pilates programme. Our core muscles affect the support of the spine, posture and they way we move. Correcting stability and increasing body awareness can benefit you at every stage of your pregnancy.             

In general you will gain:

  • Greater muscle strength and endurance improving both physical appearance and holistic well-being
  • Mobility and flexibility will be improved along with better posture and movement quality
  • In a world of fast living and high stress levels Pilates will help aid relaxation and reduce stress levels which will improve sleep and lifestyle
  • The function of the lungs may be improved along with general circulation
  • The function and efficiency of the pelvic floor often shows marked improvements
  • In general it can lead to fewer injuries and improvement in back pain

One of the main things that Pregnancy Pilates addresses is correct lifting technique and the ability to get up off and down to the floor safely. This becomes especially important during the later stages of pregnancy and also during the post-partum stage. Pregnancy leads to several major changes in the body, which affect it during exercise, some of which can be contraindicated.  Any activity undertaken should not be detrimental to either the mother or the growing foetus.  All exercises will be modified and adapted to suit each mum to be.

Changes to the maternal body include: 

  • Increased weight
  • Change of centre of gravity
  • Increase in blood volume
  • Joint instability

Benefits of Exercise include (ACSM, Clapp, ACOG):

  • Reduces the severity and frequency of back pain associated with
    pregnancy by helping maintain better body posture.
  • Provides a psychological “lift” that helps counteract the feeling of stress, anxiety, and/or depression that frequently occur during pregnancy.
  • Helps control weight gain, improves digestion and reduces constipation.
  • Produces a greater energy reserve for meeting the requirement of
    daily life.
  • Reduces “postpartum belly”.

 Benefits of Pilates:

  • Time out for you, the mum-to-be, pampering and allowing the mother to relate to the baby as she exercises
  • Improved posture
  • Possible decrease in back pain
  • Improved strength and endurance of the deep abdominals
  • Release of lumbar extensor and hip flexors with specific Pilates exercises
  • Improved circulation and blood flow
  • Fewer symptoms associated with pregnancy, i.e., leg cramps, swelling constipation and varicose veins
  • Increased body awareness and control
  • Enhanced mental well-being
  • Improved relaxation and possible improved sleep patterns
  • Improved self-esteem and confidence
  • Improved awareness and function of the pelvic floor
  • Improved muscular endurance to aid in labour (it is not thought that exercise in pregnancy will decrease the pain or time of labour but it will allow muscles to be better equipped to sustain a position)
  • Self-confidence in ability to cope with labour

Possible disadvantages of Pilates in Pregnancy

(NB all risks will be omitted where possible or minimised).

  • Possible hypertension
  • Possible reduction in blood flow to the foetus
  • Possible hypoglycaemia
  • Possible injury due to lax joints

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One piece of advice that is regularly given by nearly all health care professionals is to “do your pelvic floor exercises”.

Pelvic floor exercises help to strengthen the muscles of the pelvic floor which are placed under great strain during pregnancy and childbirth.  However due to the effects of the hormone relaxin combined with the weight of baby means these muscles need as much help as possible to maintain support and continence. It is essential to exercise them regularly.

These exercises can be done any time, any place, anywhere but always with the spine in an upright position – not slumped, like on the sofa! Nobody should be able to tell if you are doing them except maybe a lifting of the eyebrows!

Here are two to help your practice:

Slow exercise
This exercise strengthens the pelvic floor muscles.

Draw the two sides of the pelvic floor in towards the centre and wrap around the front passage as if to stop yourself having a wee. Lift up inside and hold for a few seconds, continuing to breathe, then release with control.
If you find there is nothing left to release and the contraction has been lost you’ve probably held it for too long. Start with just a couple of seconds and only progress when you can lower confidently without letting it drop. This is just the same as doing a biceps curl with a weight in your hand – you need to control both phases of the movement – the pelvic floor is no different!
 Gradually build up to a longer hold. Remember to keep breathing throughout and adopt an upright position.

 

Quick Exercise
This exercise will help prevent any embarrassing leaks when you cough, sneeze, laugh or lift something heavy.
Stand or sit in an upright position as before. Tighten and lift the pelvic floor in one quick contraction and release immediately Snatch the snatch! Pause before repeating four times.

NB: Aim to make your fourth repetition as strong and quick as the first. You may find this difficult to do initially but stick with it and monitor your own progress. It’s never to late to start but once you do it should be an exercise for life!

And yet another way!

Close up your back passage as if trying to prevent a bowel movement.  At the same time, draw in your vagina as if you were gripping a tampon, and your urethra as if to stop the flow of wee.  Do these both quickly – tightening and releases the muscles straight away, and slowly – holding the contractions for as long as you can before you relax.  Try to count to 10.

Try to do three sets of eight squeezes every day.  To help you remember, you could do them once at each meal time.

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When to start a family?

That is obviously a very personal question, but the NHS offer the following guidelines as to how long it might take to conceive.  Preconception care involves taking good care of yourself before you become pregnant, by ensuring that you eat healthily and exercise regularly.

  • Make sure that you are up to date with vaccinations, such as rubella (the virus that causes German measles) and varicella (which causes chickenpox and shingles).
  • If you are trying to conceive, your GP can provide you with further information and advice to ensure the best possible health for you and your baby.
  • In cases where a pregnancy is not planned, a woman will only begin to monitor her health in relation to the baby after she is already pregnant.
  •  However, for couples who plan their pregnancies, preconception care can help them to make the necessary changes well in advance.

How long will it take to get pregnant?
The length of time that it takes to become pregnant (conceive) is different for everyone but, on average, for every 100 couples who have sex two or three times a week:

  • 30 will conceive within one month
  • 60 will conceive within six months
  • 85 will conceive within one year
The remaining couples will take longer and some may need medical help to conceive. A small number of couples (about 5%) may not be able to conceive at all if one partner or both is infertile.The type of contraception that you have been using does not usually affect your ability to conceive or how long it takes to happen.
However, women who have been using the progestogen-only injection may find that their usual fertility is delayed, and that they cannot conceive for up to a year after their last injection. Other methods of contraception should not have an effect on your fertility once you stop using them.If you have had a miscarriage in the past, you still have a good chance of having a healthy pregnancy and baby.
However, if you have had three or more miscarriages in a row, your GP may refer you to a gynaecologist (a specialist in reproductive healthcare). They will be able to determine whether or not your miscarriages are being caused by an underlying health problem.

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