Our team of experts have talked to many women about their conversations with health care providers regarding exercise during pregnancy. We have found that in many cases, women and their health care team are not talking about exercise at all during this special time! Given how important it is to stay active while pregnant, and also how important it is to be safe, it is very important you talk to your doctor about any and all of your exercise plans. Your health care providers WANT to talk to you about exercise. They think it is important, but in the rush of their busy schedules and appointments, sometimes they forget.
Don’t hesitate to bring it up. Don’t hesitate to ask questions. The best way to ensure you get to talk to them about it is to bring it up yourself! And if they don’t feel like they can offer you specific ideas for exercising, ask them if they can direct you to someone who can!
And, you can use BumptUp to help you track your exercise routine and show it to them! They can give you feedback on what you are doing with the app.
Tinius, R. A., Lopez, J. D., Cade, W. T., Stein, R. I., Haire-Joshu, D., & Cahill, A. G. (2020). Patient and obstetric provider communication regarding weight gain management among socioeconomically disadvantaged African American women who are overweight/obese. Women Health, 60(2), 156-167. doi:10.1080/03630242.2019.1616044
Some pregnant women have jobs that require lifting things. Some of you may have older children that still require being held. Some of you may love lifting heavy weights at the gym. But, how much is too much? How much is safe?
The National Institute for Occupational Safety and Health created a model that can help determine the most weight that would be acceptable for the vast majority of pregnant women (90%) while at work; however, it can serve as a helpful guide for women who work from the home or do things at the gym as well. Keep in mind, there are some women who can do a little more and some who should do less. But we hope this will serve as a guide to help you make decisions about lifting things during your pregnancy!
To use the tool, start with the question in the first yellow box (“At work do you….”), then based on your answer, you will move through the figure.
Physical Activity and Exercise During Pregnancy and the Postpartum Period: ACOG Committee Opinion, Number 804. Obstet Gynecol. 2020;135(4):e178-e188.
Every pregnant woman has had the experience of someone offering (usually unsolicited) advice about their fitness routine. Although a lot of advice isn’t grounded in science and doesn’t reflect the vast amount of research findings showing the safety of prenatal exercise, it still can be disconcerting to hear.
Let’s break down some of the most common prenatal exercise misconceptions and provide you with medically-based responses that can ease your mind and enlighten the not so helpful advice giver!
Keep your exercise heart rate below 140 bpm.
This advice hasn’t been in use since 1994, when the American College of Obstetricians and Gynecologists dropped it from their guidelines. Research has shown that training heart rate isn’t the best way to monitor exertion during pregnancy because of the significant cardiovascular changes that occur. ACOG now advises that pregnant women keep their exercise intensity at a level that feels moderate to somewhat hard. A simple method for knowing you’re not working out so hard: keep your intensity at a level that feels challenging, but not so hard that you can’t carry on a conversation while exercising.
Running during pregnancy is not safe.
Many pregnant women can comfortably continue or even start a running program during pregnancy. The caveat is to pay close attention to how your body feels, drop your pace or the length of the run if you start to feel it’s becoming too difficult. It’s also a good idea to invest in a new pair of running shoes, as pregnancy can make your feet swell and even lengthen as a result of hormonal changes. Makes sure your shoes fit properly and think about swapping out the liners for a more cushioning gel liner. As your pregnancy progresses, you may notice that your round ligaments (they support your uterus) can become painful with weight-bearing exercise. Try wearing a pregnancy support belt while running to ease the tension on your round ligaments and keep your runs comfortable. Compression socks and shorts can also help with swelling and pain.
It’s dangerous to lift weights during pregnancy.
There’s no research that has shown that strength training during a healthy pregnancy is dangerous. Of course, you’ll need to modify your routine as pregnancy progresses (such as avoiding laying flat on your back during a lift after the first trimester) and reduce your weight level or resistance if a lift becomes uncomfortable or causes pain. Never hold your breath and bearing down as you lift —always exhale with the lift and inhale as you return to start position. Maintaining or even building strength during pregnancy will prepare your body for all the lifting required once your baby arrives, and helps avoid injury.
Avoid all abdominal exercises while pregnant.
As your belly grows during pregnancy, it becomes more difficult to perform a traditional “sit-up” type exercises. In reality, sit-ups aren’t very effective for strengthening abdominal muscles when pregnant. The key to effective prenatal ab exercises is to focus on exercises that work your transverse abdominal muscle, which plays a big role in abdominal support. Also, after your first trimester, avoid lying flat on your back for more than 5 minutes while doing ab exercises. The weight of your growing baby can reduce blood flow and cause you to feel lightheaded or dizzy if you are flat on your back. Instead, modify the exercise by using a wedge or pillows to raise your upper body. If you are laying on your back and get dizzy, immediately roll to your left side. This helps to take the weight of the uterus and baby off the major blood vessels in your tummy.
Keeping your abs strong will help provide support for your back and reduce low-back pain and help speed your postpartum recovery.
Don’t start an exercise routine during pregnancy.
If you haven’t been exercising pre-pregnancy, then starting once you are pregnant is a great way to gain the benefits prenatal fitness provides for you and your baby. Apps such as this one are a great way to have a “virtual trainer” to help you make sure that your exercise program is safe and effective. Daily walks are also a great place to start. Always check with your healthcare provider before starting any fitness routine, and if you have any concerns, follow up with your provider about them.
The healthy habits you start during your pregnancy will pay off during and after your baby is born, and hopefully encourage you and your family to make fitness part of your lifestyle.
You may have heard other pregnant women talk about using a doula and wondered what is involved with doula support. If you’re considering looking into hiring a doula, we’ve put together some tips that can help you make the best choice for your pregnancy, labor, and delivery.
A doula is a trained childbirth professional who offers pregnant woman assistance before, during, and after delivery. The support can range from emotional (offering encouragement) to physical (providing pain relief techniques during labor). A doula typically starts working with a pregnant client in her third trimester, allowing time for them to form a relationship and feel comfortable with each other and discuss birthing options and preferences.
Doulas are skilled at using a variety of techniques during labor that can help reduce anxiety, fear, and pain. The key role of a doula is to offer comfort, support, and help advocate for the birth experience her client desires. There’s even research that has shown that women who used a doula during labor and delivery bonded more effectively with their baby. Most doulas also provide antepartum support with breastfeeding and infant bonding—as well as helping new moms feel more confident about their mothering abilities.
If you’re thinking about hiring a doula, here are a few questions that you should ask to make sure you find a doula that will be a good fit:
Where did you receive your doula training?
Are you a certified doula?
What services do you provide?
How long have you worked as a doula, and can you provide references?
What are your fees, and what do they include?
What is your philosophy regarding childbirth?
Are you available for my due date?
Will you be on call 24/7 for my birth?
Will you meet with me postpartum, and what is covered during those visits?
For more information, check out the Doulas of North America website link below.
Whether your cesarean section was planned or a result of a birthing complication, it’s important to remember that you’ve had a major abdominal surgery that requires eight to ten weeks or more for recovery.
Although you may not feel like doing much the first few days post-surgery, specific exercises should be started right away to help speed recovery after anesthesia, and stimulate muscle function, and promote circulation.
Check with your healthcare provider before doing any of these exercises to make sure it’s safe for you to get started.
Cough five times each hour to help clear your lungs following anesthesia. You should support your tender abdomen by holding a small pillow or rolled towel against your tummy over the incision as you cough. If you are in the hospital, you can ask the nurse for an incentive spirometer. This is a special tool designed to help with breathing after a surgery. The nurse will show you how to use it.
Log roll to get in and out of bed. Log rolling is a technique that helps to decrease pressure on your belly. Start your back with your knees bent and feet flat on the bed. As you roll to one side, use your top arm to help roll and grab the side of the bed (or at least put the hand on the bed for balance support). Once on your side, knees still bend, use your top hand to help push you up as you gently swing your legs over the side of the bed with your body moving as a single unit or a “log”. Once you are up far enough, you can use your bottom hand to help push you up. Breath the entire time. If you need help with this technique, as the nurse to teach you or request a visit from a physical therapist in the hospital.
Lie or sit in a comfortable position and slowly pull your belly in towards your spine. Use your breathing by exhaling as you draw inward and inhaling as you relax. Work up to a set of five to ten repetitions every hour.
Lie on your back with the knees bent and arms out to the sides. Imagine that your tummy is the face of a clock, and gently press down at 12 o’clock, then to the side at 9 o’clock, down to 6 o’clock and then to the other side at 3 o’clock—reverse direction and repeat. Try and work towards a smooth movement of circles in each direction.
Once your anesthesia has worn off try walking a few steps with support. You can ask for a physical therapist to come see you in the hospital if you think you may need help or if you think you may need a walker for balance. Make sure you have someone holding you as you move as you may feel dizzy or unstable. You’ll prevent fluid retention and speed the return of bowel and bladder function by getting up and walking a few minutes every hour.
Strength training is a beneficial component of a prenatal fitness program. It can help your body compensate for all the physical changes of pregnancy and provide the strength needed for baby lifting postpartum. The changes in your body weight and posture during pregnancy can create stress on joints, but strong muscles can help prevent the development of pain and injury.
If you’re new to strength training, start with a low weight or resistance band routine that focuses on major muscle groups. You’ll be way ahead of the game by starting a strength training program during pregnancy, and better able to safely do all the lifting required once you have your baby.
Whether you’re new to strength training or have included it in your fitness program before your pregnancy, take a look at the tips listed below to help keep your routine safe and effective. It’s essential to listen to your body and incorporate modification (such as a reduced weight/resistance, repetitions, and sets, or lift positioning) if exercises become uncomfortable.
Before starting any fitness routine, check with your healthcare provider to make sure exercise is safe during your pregnancy.
You can continue your pre-pregnancy weight-training program once you become pregnant, but carefully monitor how you feel during and after training, and modify or eliminate exercises that cause pain or increased muscle soreness.
If you’re starting a strength-training program during pregnancy, begin with weight level or resistance that allows for one set of 10-12 repetitions without excessive strain. The weight amount and number of sets can be increased as the repetitions become easier.
Avoid maximal lifts. The force needed to perform maximal lifts makes this type of exercise unsafe during pregnancy.
Don’t hold your breath and bear down while doing your lifts. Always exhaling as you lift and inhale when returning to start position.
You can use strength training machines, free weights, resistance bands, or bodyweight in your routine. Use what’s readily available and within your budget.
Modification of weight training exercises (such as dropping down in weight level and repetitions and sets, or adjusting positioning) may be needed as the pregnancy progresses.
If a particular exercise causes pain or discomfort even after you’ve tried using modifications, it should be discontinued. If pain persists, stop your strength training routine and consult with your healthcare provider.
Avoid doing any strength training exercises while lying flat on your back (supine) after the first trimester. When you’re lying flat on your back, a large blood vessel that spans your abdomen can be compressed by the weight of your growing baby and can cause you to feel lightheaded and dizzy. Modify supine positions by using a wedge or pillows to raise your upper body so you’re not flat on the floor.
Caloric intake should increase by approximately 300 kcal/day during pregnancy. This value is derived from an estimate of 80,000 kcal needed to support a full-term pregnancy and accounts not only for increased maternal and fetal metabolism but for fetal and placental growth. Dividing the gross energy cost by the mean pregnancy duration (250 days after the first month) yields the 300 kcal/day estimate for the entire pregnancy.1,2 However, energy requirements are generally the same as non-pregnant women in the first trimester and then increase in the second trimester, estimated at 340 kcal and 452 kcal per day in the second and third trimesters, respectively. Furthermore, energy requirements vary significantly depending on a woman’s age, BMI, and activity level. Caloric intake should therefore be individualized based on these factors.
Concerning protein, the recommended dietary allowance is 71 grams per day, but realistically, 1.1 g/kg body weight is more accurate. Carbohydrates should comprise 45-64% of daily calories and this includes approximately 6-9 servings of whole grain daily. Total fat intake should comprise 20-35% of daily calories, similar to non-pregnant women.
Nutrition Postpartum when breastfeeding
When breastfeeding your baby, kilocalorie needs are 500 kcals for the first six months and 400 kcals for the second six months (Academy of Nutrition and Dietetics, n.d.). This amount could be a little less or a little more depending on how much milk you are producing. For example, if you doing a combination of formula-feeding and breastfeeding your baby, you likely do not need the full 500 calories; Or, if you are breastfeeding your baby and also pumping additional milk, you may need more than 500 extra calories. Try to get the extra calories from high-quality food sources (See list below).
It is also important to remember than when producing milk, your body may want you to keep a couple of extra pounds on you in order maintain milk supply. Do not worry about a few extra pounds! It is also not unusual for some women to lose weight when breastfeeding. Everyone is different. Don’t compare yourself to anyone else! Focus on keeping a healthy weight for you and your baby!
List of important nutrients for breastfeeding, and where to find them.
Calcium: milk; cheese; yogurt; fish with edible bones; tofu processed with calcium sulfate; bok choy; broccoli; kale; collard, mustard, and turnip greens; breads made with milk.
Zinc: meat, poultry, seafood, eggs, seeds, legumes, yogurt, whole grains (bioavailability from this source is variable).
Magnesium: nuts, seeds, legumes, whole grains, green vegetables, scallops, and oysters (in general, this mineral is widely distributed in food rather than concentrated in a small number of foods).
Vitamin B6: bananas, poultry, meat, fish, potatoes, sweet potatoes, spinach, prunes, watermelon, some legumes, fortified cereals, and nuts.
Thiamin: pork, fish, whole grains, organ meats, legumes, corn, peas, seeds, nuts, fortified cereal grain (widely distributed in foods).
Folate: leafy vegetables, fruit, liver, green beans, fortified cereals, legumes, and whole-grain cereals.
Women who breastfeed require approximately 500 additional kcal/day beyond what is recommended for non-pregnant women.68 The estimate is derived from the mean volume of breast milk produced per day (mean 780 mL, range 450-1200 mL) and the energy content of milk (67 kcal/100 mL).69 During pregnancy, most women store an extra 2 to 5 kg (19,000 to 48,000 kcal) in tissue, mainly as fat, in physiologic preparation for lactation. If women do not consume the extra calories, then body stores are used to maintain lactation. It is not unusual for lactating women to lose 0.5-1.0 kg/month after the first postpartum month.70
There are even less evidence-based recommendations for nutrient intake during breastfeeding compared to pregnancy. Lactation is considered successful when the breast-fed infant is gaining an appropriate amount of weight. The recommended daily allowance for protein during lactation is an additional 25 g/day.
Maternal factors such as stress, anxiety, and smoking can decrease milk production, but the quantitative and caloric value of breast milk does not change with dieting and exercise.76–83 Moreover, a woman’s weight, BMI, body fat percentage, and weight gain during pregnancy do not influence milk production.84–86
Reviewed and edited by Heather Emerson-Payne, RD, PhD, 2023.
References
Academy of Nutrition and Dietetics. Nutrition Care Manual. Comparative Standards, Breastfeeding/Lactation. https://www-nutritioncaremanual-org.wku.idm.oclc.org/topic.cfm?ncm_category_id=1&lv1=272980&lv2=144973&lv3=269509&ncm_toc_id=269509&ncm_heading=Normal%20Nutrition. Accessed July 12, 2023.
This is a hard question to answer as the “right” intensity will vary by from person-to-person. Some women desire to feel a tough physical challenge, while some prefer to take it easier. It is always a good idea to exercise at a level you enjoy and feel physically and emotionally comfortable at. The American College of Obstetricians and Gynecologists recommends to exercise at a level you self-rate as a 12-14 (somewhat hard) on the scale shown here. This is known as “moderate” intensity.
If you are someone who desires something more challenging, and you did more challenging exercises before becoming pregnant, you should be able to continue the exercise/s you were doing before (possibly at a lighter weight or slower speed than before, especially later in pregnancy). This is assuming you have a healthy pregnancy and permission from your doctor. While an upper limit of difficulty during pregnancy has not been established, research suggests that even difficult exercise late in pregnancy is safe for mom and baby. Pregnancy is probably not the best time to start a sport or activity that is very physically demanding for you.
If you do decide to participate in more challenging exercises, consider having close supervision and pay careful attention to drinking enough fluids, staying cool, and eating enough calories.
Physical Activity and Exercise During Pregnancy and the Postpartum Period: ACOG Committee Opinion, Number 804. (2020). ObstetGynecol, 135(4), e178-e188. doi:10.1097/AOG.0000000000003772
Beetham, K. S., Giles, C., Noetel, M., Clifton, V., Jones, J. C., & Naughton, G. (2019). The effects of vigorous intensity exercise in the third trimester of pregnancy: a systematic review and meta-analysis. BMC Pregnancy Childbirth, 19(1), 281. doi:10.1186/s12884-019-2441-1
Szymanski, L. M., & Satin, A. J. (2012). Strenuous exercise during pregnancy: is there a limit? Am J Obstet Gynecol, 207(3), 179 e171-176. doi:10.1016/j.ajog.2012.07.021
Congrats on deciding to exercise during your pregnancy!! You are making a great choice for you and your baby. That said, we do want you to know what are the things to look out for while exercising that mean you should STOP immediately and consult your doctor. If you are aware of these things, and do not experience them during exercise, you should feel confident to continue to stay active!
Vaginal bleeding: While some vaginal bleeding can be completely normal during pregnancy, we recommend stopping exercise and talking to your doctor before you continue. It can be a sign of something more serious.
Abdominal pain: Some minor aches and pains are par for the course with pregnancy; however, if you notice a change or increase in pain while exercising, stop and consult your doctor.
Regular painful contractions: Mild contractions can be normal during exercise; however, if they occur many times in a row and become painful, stop exercising and call your doctor.
Amniotic fluid leakage: This one is often confusing! Many women leak urine during pregnancy so could be leaking amniotic fluid without even realizing it! If you notice involuntary leaking, especially with a sudden onset, you should check. One simple way to check is to observe the fluid, if it is clear and odorless, it could be amniotic fluid. We recommend going to labor and delivery or calling your doctor. They can do a quick test of the fluid to see whether or not your water has broken.
Dyspnea (shortness of breath) before exertion and/or Dizziness: If you are feeling faint or dizzy at any point during or before starting exercise, you should stop and consult your doctor.
Headache: While a headache can be completely benign, a headache that begins or worsens during pregnancy could indicate a more serious condition or possibly hydration. You should stop and consult your doctor to report this new symptom.
Chest pain: Whether you are pregnant or not, if you ever experience chest pain you should stop exercising and call your doctor, or even head to the emergency room. Chest pain is a very serious concern! Note: You may experience some discomfort from enlarged breasts during exercise while pregnant. You should be able to tell the difference between tender breasts and chest pain.
Muscle weakness affecting balance: If you notice you feel weak or are having trouble balancing, you should stop exercising as this could increase the chance of a fall or injury.
Calf pain or swelling: If you notice any pain, tenderness or swelling in your calves at any time during pregnancy or exercise, consult your doctor immediately. This could be a sign of a serious health condition that requires treatment.
Physical Activity and Exercise During Pregnancy and the Postpartum Period: ACOG Committee Opinion, Number 804. Obstet Gynecol. 2020;135(4):e178-e188.
Physical activity is defined as any bodily movement produced by the contraction of muscles (American College of Sports Medicine). Exercise is defined as planned, structured physical activity. Both physical activity and exercise have been shown to improve fitness, help with weight status, and increase quality and quantity of life! During pregnancy, both have been shown to improve health for you and for your baby! Whether it is physical activity during your daily routine or planned exercise, finding ways to achieve 150 minutes of activity per week during pregnancy (and during postpartum) is very important!
The 150 minutes a week is recommended by both doctors and exercise experts. This a total of less than 2% of the total minutes in an entire week! While this number may seem intimidating at first, there are so many ways to get there! You can take a walk for 10 min in the morning and 10min in the evening. If you did this every day, you would already be at 140 minutes! If you want higher intensity and/or longer duration, you could simply do a 30-minute workout 5 days a week. The 150 min can be any combination of planned, structured activity (example: using one of the workouts in BumptUp) and movement throughout the day (example: you have to walk 8 minutes to get to your car after work). If you have older children, you probably spend a lot of time each day chasing and/or carrying them! This counts as physical activity! If you work all day long, consider having a meeting or two while walking. This can be a great strategy to knocking out two birds with one stone! We recommend finding a friend to include in your planned activities to help keep you accountable but also to make it fun! BumptUp is here to help you find fun and practical ways to get and stay active. 150 minutes per week- YOU GOT THIS!
Physical Activity and Exercise During Pregnancy and the Postpartum Period: ACOG Committee Opinion, Number 804. Obstet Gynecol. 2020;135(4):e178-e188.
