I will often get questions from those planning to conceive and those recently pregnant wondering if exercise is safe and which exercises are best during and after pregnancy. First, let’s bust the myth that we shouldn’t be exercising while pregnant. According to The American College of Obstetricians and Gynecologists (ACOG) April 2020 Committee Opinion, "physical activity in pregnancy is safe and desirable, and pregnant women should be encouraged to continue or to initiate safe physical activities" after being medically cleared with an examination.1 During pregnancy, women are encouraged to participate in at least 150 minutes per week of moderate intensity exercise that is ideally spread throughout the week.1 Moderate intensity can be gauged using the talk test, which means you are able to keep up a conversation during exercise.2 Additionally, adults are encouraged to perform strengthening exercise at least twice per week that involve all major muscle groups.2 The Australian guidelines for physical activity in pregnancy and postpartum that were updated this year (2022), specifically recommends muscle strengthening at least 2 days per week.3 Because I typically find that women are getting more aerobic activity than strength training in their weekly routines, I am going to focus on three pelvic floor exercises that emphasize strengthening during and after pregnancy.
Our pelvic floor muscles make up the bottom portion of our core in addition to our abdominal muscles, spine, back muscles and diaphragm. The pelvic floor performs important functions including sexual arousal, maintaining continence, and supporting our organs. The muscles in our pelvic floor are made up of two types. One type makes up approximately one-third and are made of sprinter muscles called fast twitch.4 The other type is the endurance component called slow twitch, which makes up the remaining two-thirds.4 It is important that both fiber types are challenged with exercise.
The first two exercises I would recommend during pregnancy and postpartum are called stationary pelvic floor contractions or kegels. These can be performed in different positions depending on your body’s ability. The easiest position is laying down and the most challenging is standing. Sitting is a midway level of difficulty. There is typically a decrease in perineal muscle strength from week 20 of gestation to 6 weeks postpartum.5 A systematic review of 675 women found that kegels during pregnancy significantly reduce the development of urinary incontinence from 6 weeks to 3 months after delivery.5 Additionally, ACOG has stated that pelvic floor exercises can be initiated in the immediate postpartum period.1
The first exercise is going to challenge the fast twitch or sprinter muscle fibers in the pelvic floor and is often called quick flicks or quick contractions. This is performed by squeezing and lifting the pelvic floor followed by a full relaxation as quickly as possible. When squeezing and lifting the pelvic floor, think of squeezing your anus or stopping the flow of urine. (Do not practice kegels while peeing or pooping as this is when the pelvic floor should be relaxed.) Start with 10 repetitions and increase by 5 repetitions every 1-2 weeks until you reach 50 repetitions. This would be performed no more than one time per day and remember to continue breathing normally.
The second exercise will challenge the slow twitch or endurance muscle fibers and is called a pelvic floor hold. Ideally, focus on taking a big, relaxed inhale and allow that inhale to travel into the rib cage and abdomen. After fully inhaling, squeeze and lift the pelvic floor while exhaling slowly. Start with a 5 second hold and gradually increase by 5 seconds every 1-2 weeks until you achieve a 20 second hold. Perform 10 repetitions no more than one time per day. If you run out of exhale but still need to hold the pelvic floor contraction, continue to breath normally until the hold time is complete. Follow by a full relaxation of the pelvic floor.
Remember that your pelvic floor is working while you are doing normal day to day activities! We don’t want to over fatigue the muscles by doing multiple sets of pelvic floor contractions per day in addition to its normal responsibilities. Also, a full relaxation in between repetitions is just as important as the strength of your contraction.
The third exercise to perform during pregnancy and postpartum is a squat. Squatting with a voluntary, or purposeful, pelvic floor contraction creates a 30% greater motor recruitment than an isolated pelvic floor muscle contraction.6 This means there is a 30% greater contraction when performing a kegel with a squat. Additionally, squatting is typically a movement that is performed daily while bending down to pick up objects and kiddos. Ideally when performing a squat, you will bring your feet about hip width distance apart in a comfortable stance. Begin to bend from your hips, knees, and ankles as if you are sitting back into a chair while inhaling and keeping your pelvic floor relaxed. Once you have reached the bottom of your squat, contract your pelvic floor while you simultaneously exhale and ascent back to a standing position.
If you are having pain with any of these exercises, start by reducing the frequency and intensity and gradually work your way back up. If they continue to aggravate, stop the exercises and seek out individualized care from a rehab professional, particularly a pelvic floor physical therapist.
While there is no one size fits all, these are a few wonderful go-to exercises during the pregnancy and postpartum period. These will increase your awareness and control of the pelvic floor muscles and increase your glute and quad strength for bending and lifting your new baby! Reach out to your local pelvic floor physical therapist if these exercises are bothersome or if you would like more individualized exercise recommendations. Remember, exercise is generally safe and helpful during pregnancy and postpartum so get moving mama!
Written by Jordan Schmidt, PT, DPT