This week I will be briefly looking at some conditions that as a Mum-to-be you may experience during pregnancy.
It won’t be an exhaustive list, but I think they are worth a mention. If you develop one of these, you may have to adapt or entirely alter your current exercise programme. I will stress that any time you feel pain, nausea or experience lightheadedness, stop and rest. If symptoms persist, consult your HCP (Healthcare Provider).
So let’s take a look at the major physical problems first.
Symphysis Pubis Dysfunction (SPD)
First off, a little anatomy lesson…
SPD is a problem with the Pelvis, which is mainly formed of two public bones that curve round to make a cradle shape. The front of the pelvis is where the pubic bones meet at a firm joint called the symphysis pubis. A dense network of tough tissues (ligaments) makes this joint’s connection strong but during pregnancy, swelling and pain can make the SP joint less stable. This causes SPD.
PGP = Pelvic Girdle Pain
The medical profession, such as Doctors and physiotherapists, term pelvic pain that occurs during your nine months, as pelvic girdle pain (PGP). SPD comes under this category as one type of PGP.
So what are the symptoms of SPD?
- Back pain, in the back of your pelvis or hips
- Pain, accompanied with a grinding or clicking sensation in your pubic area
- Some pain between your legs or down inside the thighs
- Pain that increases when parting your legs, walking, going up/down stairs or moving around in bed
- Experiencing pain that interrupts your sleep. Getting up to visit the loo during the middle of the night can be especially painful
When can SPD occur?
Anytime throughout pregnancy or after giving birth. You may notice it for the first time around the second trimester onwards.
So what causes SPD?
As I have mentioned in previous blogs, during pregnancy Mum will produce relaxin. This wonderful hormone softens your ligaments and joints to help you during the birth of your baby, so that he or she can pass through the pelvis. As a result, your pelvic joints naturally become more lax. However, it’s not necessarily this flexibility that causes SPD. In most cases the nerves and muscles are created naturally to adapt and compensate for this greater flexibility in your joints. So your body should be able to cope well with changes to posture whilst the baby is growing.
Instead SPD is thought to occur when the body doesn’t adapt to having ligaments that are stretchier and more flexible.
SPD can be caused by the following:
- Joints within the pelvis move about unevenly
- Muscles changing the way they work to support the pelvic girdle joints
- One pelvic joint dysfunctioning, causing a ripple effect or knock-on pain to the other joints of the pelvis
Result? Your pelvis will not be as stable as it was made to be, hence SPD.
The best way to treat SPD is through Physiotherapy. I recommend The Mommy MOT or Adore Your Pelvic Floor – women specially trained in women’s health. Why? Because it is about the relationship between your muscles and bones, instead of how flexible / lax your joints are.
Also note that you are more likely to be prone to SPD if you have experienced any of the following:
- Pelvic Girdle Pain or Pelvic Joint Pain before conception
- Previous injury to the pelvis
- Experienced PGP in a previous pregnancy
- High BMI (Body Mass Index) and being overweight prior to becoming pregnant
- Hyper-mobility in all the joints
Whilst exercising you need to avoid excessive stretching and avoid any activity that asks for the legs to be taken out wide. For example, squats, abductor exercises, breaststroke, as such activities may exacerbate and cause greater pain. Also exercises that are fast and involve quick changes of direction or position should be avoided, together with exercises that require unstable position and use of balance.
Instead concentrate on exercises that help condition the deep abdominal core muscles. Not sure what or how to do this? Then start with your local Women’s Health Professional moving onto a Personal Trainer (like moi!). Strengthening the pelvic stability muscles will prevent separation of the pelvis, and help the stabilising muscles of the body to remain strong. The pelvis will remain supported throughout your pregnancy and after you have given birth.
Low Blood Pressure:
During the early stages of pregnancy the hormonal changes can, in some cases, lead to low blood pressure. If this does occur, then great care is needed when changing positions, or getting up / down to the floor during your exercise sessions. Low blood pressure will usually return to normal once Mum enters the second trimester.
High Blood Pressure:
If a Mum-to-be suffers with High Blood Pressure then I’m afraid ALL exercise is off the menu!
Instead, Mum will be under constant supervision – as this condition can be life-threatening to both Mum and baby. It is known as pregnancy-induced hypertension. Related symptoms are blurred vision, sudden swelling and ‘stars’ before your eyes, severe headaches and, at times, pain in the side. If you have any of the above symptoms then consult your HCP immediately.
I would like to point out that during exercise, particularly cardiovascular, blood pressure (BP) will rise. This is perfectly safe and normal as long as it is only the systolic figure (top figure) that is affected. Such an increase can remain after exercise has ceased, but it should subside and return back to normal around 15 minutes later.
Supine Hypotensive Syndrome:
This may occur during your 12th week of pregnancy, but it is more likely to happen when the pregnancy is more advanced around 16-20 weeks or even into the third trimester.
So what is SHS?
It is also referred to as Inferior Vena Cava Compression Syndrome.
It is caused when the gravid uterus compresses the inferior vena cava. This is the vein that is responsible for returning blood to the heart from the body and legs. It can happen when a pregnant woman is in a supine position (such as exercising), and leads to decreased venous return centrally.
Whilst laying on your back, restricted blood flow may cause symptoms such as dizziness, nausea and claustrophobic feelings, breathing difficulties, or fainting. Such symptoms should never be dismissed. Restricted blood flow to Mum-to-be’s brain can also mean a reduction of blood supply to the foetus. Should you experience any of these symptoms then immediately turn on to your left-hand side. Stop any exercise that involved laying on the back, until after birth and your 6-8 week check-up.
Mums need to be aware of SHS throughout their pregnancy. This condition can also have an affect when you are sitting or standing for some time. If you are still for too long, your circulation will eventually slow down and blood will then pool into your legs. This in turn can restrict blood flow around your body and to the foetus. At this point, you may faint, which is the body’s clever way of getting you to lay down so that blood can once again circulate, restarting the blood flow to your baby.
So when exercising ensure that you do not stand still for too long.
For example, when doing upper-body exercises sit rather than standing. Especially as you get bigger and heavier. Or alternate upper-body with lower-body exercises. When in a yoga or Pilates class, which can involve many standing postures at one time, make sure that you move your legs whenever you can to maintain circulation. Choose an instructor trained in Pre & Postnatal yoga or Pilates, as they will have lots of modifications depending on which trimester you are in. Same applies for a Personal Trainer.
This is the complete separation of the rectus abdominis, more commonly known as your ‘six-pack,’ which meet at the midline of the stomach.
Diastasis recti is very common amongst Mums-to-be and following birth. This is because the uterus stretches the muscles in the abdomen to allow for your growing baby. The split tends to happen around the belly button moving either upwards or downwards dependant on how the Mum-to-be is carrying her baby. However, this separation sounds a lot worse than it actually is. It is just the connective tissue that joins both sides of the abdominals that is moving apart.
However, if the abdominals do part, this will mean your back will not be well supported. The pelvis will be weakened and your posture will change too. It can also cause constipation and bloating. Whilst this will not cause a problem for baby it could mean that Mum experiences back pain.
So if you do experience diastasis it is very important that you know how to manage this condition. This is why I encourage new Mums-to-be to do the following regular core exercises:
- On all-fours (level 1)
- ‘Cat Pedals’; On all-fours (level 2)
- Knee lifts; On all-fours (level 3)
Stability Work on an exercise ball
- Hip hinge
- Foot lifts
- Reverse bridging
Be mindful that after 12 weeks if you are doing the wrong sort of abdominal exercises, or using the wrong technique, this can mean more harm than good and exacerbate the problem of diastasis. If you are unsure of what to do then ensure you get advice and help.
This can occur during any stage of pregnancy (but specifically in the early and late stages). Some exercise will need to be modified, particularly if Mum-to-be experiences breast tenderness, and to accommodate the growing size of the breast.
When performing any type of exercise (apart from swimming) ensure that you choose a good supportive sports bra. You may also require breast pads towards the end of your term. Never exercise without a bra.
Avoid wearing an underwire bra whilst pregnant, as the breasts will be a lot heavier than usual. There is a greater chance of stretching the Cooper’s ligaments, which help support the breasts.
Carpal Tunnel Syndrome
I had this condition during my last pregnancy with Michael and it continued after. Caused by the effect of pregnancy hormones on the body, which creates changes in the blood volume. This in turn causes swelling of the wrist(s), applying pressure on the nerves.
It can cause pain or tingling in the wrists and hands. There can be times when it is hard to pick up objects or open jars. My symptoms were worse first thing in the morning and late at night. At the time I didn’t know what this sensation was. In hindsight, the Body Pump class I was teaching was not the best choice! But I didn’t realise. Many of the exercises I taught resulted in my hands bearing much of my body weight, or resistance weights.
So if you continue to exercise ensure that you use lighter dumbbells instead of tubing or resistance bands. Using weight-training gloves can also help if you happen to do rowing or indoor cycling activities.
Consult your HCP
If you are suffering any of these symptoms you need to consult your Healthcare Professional. Leaving them to continue can be detrimental to your health. Left-unchecked, they can lead to weakness and lack of coordination in the fingers and thumbs.
Worse case scenario is a wrist operation. In fact, I was scheduled to have both done after trying splints, and icing wrists for 10-15 minutes once or twice an hour. I relieved night-time pain by gently shaking my hand, clenching my fists, or simply hanging my hand over the side of the bed. Not ideal! But I was told about Bowen Therapy (Stella Carswell based in Wadhurst) and can highly recommend it as if you want to avoid surgery. Check it out for yourself – not only for Carpal but many other ailments too. Stella is trained to treat pregnant Mums. As with all therapies I recommend do your homework and make sure you are well informed. I coupled this treatment with homeopathy and found that both have helped my Carpal considerably.
Braxton Hicks Contractions:
These are practice contractions. They are tightening of the abdominal area with mild period-type pains in the lower abdomen.
They are a normal and necessary symptom of pregnancy and can happen at any time. However, when they do occur exercise should be avoided. Some exercise can bring on these contractions – no one can explain why – so it should be monitored and, if necessary, the exercise adapted.
This condition can greatly affect your health and the well-being of your baby. Plus it can cause a lot of extra work during your pregnancy. You will need to check your blood glucose levels on a regular basis, and have injections and so forth.
Exercise is extremely beneficial but it needs to be managed and guided by a GP or personal trainer. However, research and documentation has shown that regular exercise can help in controlling diabetes. Increasing the maximum oxygen intake helps decrease blood pressure. Both effects can help in the control of blood glucose levels.
This is a normal and necessary factor during pregnancy. But remember that the weight gained is not permanent. However, most Mums-to-be already know it is extremely important not to put too much excessive weight on during pregnancy.
Remember that each Mum is different and weight gain is no exception. We carry our babies differently and we look different. Whilst pregnant we all ‘bloom’ in our own unique way.
Recommendations state how much weight Mums-to-be should be putting on during the first two months of pregnancy i.e. three to four pounds (around 1-1.4kg). However, this cannot be set in stone as some Mums will lose weight due to Morning Sickness. Others may put on more weight in the early stages with very little in the last few months. Some may not gain much weight at all. Everyone, as I said, is different.
So the bigger picture to look at is the overall weight gained during pregnancy. I have recapped below the recommended guidelines for weight gain during pregnancy (connected to a Mum-to-be’s BMI) which I covered in an earlier blog entitled ‘Weight is but a Number’:
The BMI guidelines are as follows:
- Less than 18.5 is considered underweight. For women in this category, their ideal pregnancy weight gain would be 28-40lb (12.7-18.1kg).
- Between 18.5 and 24.9 is considered a healthy weight. The ideal pregnancy weight gain would be 25-35lb (11.3-15.9kg).
- 25 to 29.9 is considered overweight. Ideally gain 15-25lb (6.8-11.3kg).
- More than 30 is considered Obese. Gain 11-20lb (5-9.1kg).
Research has concluded that Mums-to-be that exercise whilst pregnant gain less weight and less body fat than those Mums who don’t and only engage in normal, daily activities. The exercising group was also shown to gain a normal, healthy amount of weight. I experienced this myself. During my first pregnancy, I put on a lot more weight than when I was pregnant with my second. I know this was down to the amount of exercise I was involved with second time around. Plus I had that carefree attitude of ‘eating for two!’ I wasn’t in the industry during my first, but I did witness and experienced the results firsthand and can state there is truth behind the science.
Being Under or Overweight
On a final note, being overweight or underweight both have risks. For example, babies can be born early, with a reduced birth weight of less than 5.5 pounds. This can lead to health issues later on. As for being overweight, this can be very dangerous indeed. Those who are overweight before pregnancy, and/or gain excessive weight can leave themselves open to high blood pressure, pre-eclampsia or even gestational diabetes. So be mindful and seek advice if you need to.
That’s all for today…
So acquaint yourself with the above, but don’t freak out over them!
Knowledge is power.
There are many Mums-to-be who experience little or none of the above. Personally, I developed Carpal Tunnel Syndrome, and looking back I wish I had read up more. But being a Pre & Postnatal Trainer now I have NO excuse and every reason to know and understand these conditions. So I can spot any signs for those wonderful Mums-to-be that I train and spend time with.
My next blog will cover minor physical problems.
Happy Body, Happy Baby, Happier Healthier You!