The changes a pregnant woman will be experiencing include joint hypermobility, increased mechanical stress on the joints, hyperlordosis, and compression of the pudental nerve caused by the change in pelvic positioning. A few other important considerations: Over the course of pregnancy, blood volume increases by 40%–50%, stroke volume rises by 10% and heart rate goes up by 20%.
Post Partum or Puerperium: commences immediately after birth to approximately 6 weeks (the time in which the woman’s body, including hormone levels and uterus size returns to prepregnancy conditions.) Varies from one woman to the next and is influenced by whether she breast feeds or not.
Lungs and respiration: The respiratory rate naturally increase in pregnancy. The diaphragm is elevated due to the changes in the rib cage placement; which may increase oxygen consumption by 15-20%. This increase makes the body work harder to deliver appropriate levels of oxygen to the developing fetus, which in turn alters the availability of oxygen to the woman for exercise, resulting in a decrease in endurance and a sense of breathlessness.
Joints: Hormonal changes contribute to joint laxity which can result in injury or weakness of soft tissue. The ligaments of the lower back and sacral area are most affected. The primary hormone of pregnancy is Relaxin which will affect collagen metabolism and connective tissue. Hormonal changes begin to occur in the first trimester and become more apparent as the pregnancy progresses. Ligament laxity may be problematic for some, due to the decrease in support of the form closure joints. The two most compromised ligaments during pregnancy are the Sacrotuberous (a lateral stabilizer of the sacrum) and the Sacrospinous (a lateral and torsional stabilizer of the pelvis). However it can affect any or all of the joints.
Body Temperature: avoid exercising in hot weather and pay careful attention to adequate fluid intake while exercising.
Incontinence: 64% of woman develop incontinence symptoms. This is a significant percentage. A woman may reduce her risk of incontinence by strengthening the pelvic floor. It’s the weight of the baby on the bladder that compromises the pelvic floor. Kegel exercises are very effective to help remedy or retard the issue. Pilate-based exercises emphasize the importance of the pelvic floor and encourage engagement fo the pelvic floor musculature is also helpful.
Additional conditions：
- Diastasis Recti: the sheath of connective tissue joining the two sides of the rectus abdominus, called the “linea alba”, can separate due to the increased stretch of the abdominal wall and the hormonal changes during pregnancy. Typically the separation will occur in the later stage of pregnancy but can actually occur from the 12th week onwards. Contraindicated movements would be flexion, extension, rotation. It is best to work in a neutral position, focusing on transverse abdomins engagement.
- Supine Hypotensive Syndrome: a condition where, when in the supine position, the uterus may compress the vena cava affecting oxygen flow to both the baby and mother. This condition can occur as early as the 12th week but is more likely to occur from the 20th week onwards throughout the second and third trimesters. While it is perfectly safe to do exercises lying on both sides, when there is any sign of lightheadedness have the client rest on the left side to minimize pressure on the vena cava.
- Symphysis Pubis Diastasis or Dysfunction: the pubis can separate or slide affecting the integrity of the pelvic girdle and the sacro-iliac joints. This is due to the hormonal changes and joint laxity. Avoid large range of motion stretches and actions of the abductors and adductors. Keep levers short and so small range of motion. In some cases sitting compromises the pubis and it may be best to sit elevated or on a stability ball so there is no excessive pressure or do four point kneeling to relieve pressure.
Balance & postural changes: Due to the normal weight gain and increased size of the womb, a woman’s centre of gravity shifts. There is also an increase in breast size. All of these changes affect posture, especially the natural curves of the spine. Women will experience an increased lumbar lordosis, and increased thoracic kyphosis. These changes will most typically result in increased tension in the muscles and joints.
- Lumbo-pelvic region is affected due to the normal weight gain and the growing fetus. The larger the womb the more balance is challenged.
- Rounded shoulders: due to enlarged breasts
Sources:
STOTT Pilates Prenatal Matwork Workshop
>>>Part 3. – Specific considerations and exercise during 1-3 Trimester
