ACOG Recommendations for Exercise During Pregnancy

For some time now, it has been reported that exercise during pregnancy is not only safe in most cases (consult with your care provider first), but beneficial. ACOG's paper reiterates that for uncomplicated pregnancies, regular physical activity does not cause miscarriage, poor fetal growth, musculoskeletal injury, or premature birth, as was previously believed by both doctors and expectant mothers (and is still sometimes believed, though inaccurate).  

Recently, the American Congress of Obstetricians and Gynecologists (ACOG) released a revised "Committee Opinion" paper on "Physical Activity and Exercise During Pregnancy and the Postpartum Period." The paper reflects the latest scientific research on the safety of, recommendations for, and reasons to avoid exercise during pregnancy and in the postpartum period.

As cited in the ACOG document, benefits of exercise before, during, and after pregnancy include:

• Increased physical fitness
• Prevention of excessive weight gain 
• Reduced risk of gestational diabetes, preeclampsia, cesarean surgery
• Decreased postpartum recovery time

The ACOG paper answers common key questions surrounding pregnancy and exercise, which we have extracted and summarized below. We encourage you to also read the complete paper for more in-depth information.  

When can I start exercising? 

After you talk with your care provider (doctor, OB, or midwife). ACOG states: "A thorough clinical evaluation should be conducted before recommending an exercise program to ensure that a patient does not have a medical reason to avoid exercise."

How much exercise is recommended?

150 minutes per week, spread throughout the week. That's roughly 20 minutes a day for 7 days, 25 minutes for five days, or 30 minutes for four days. 

What are the risks of not exercising during pregnancy?

ACOG says: "In pregnancy, physical inactivity and excessive weight gain have been recognized as independent risk factors for maternal obesity and related pregnancy complications, including gestational diabetes mellitus (GDM)."

Can I continue my pre-pregnancy exercise routine even if I participated in a regular high intensity exercise?

After consulting with your care provider, yes (unless you have any conditions that would make it unsafe). ACOG states: "pregnant women who habitually engage in vigorous-intensity aerobic activity (ie, the equivalent of running or jogging) or who are highly active 'can continue physical activity during pregnancy and the postpartum period, provided that they remain healthy and discuss with their health care provider how and when activity should be adjusted over time.'"

What about starting a new exercise routine if I was not active prior to pregnancy?

It's fine as long as you consult with your doctor and move into your pregnancy exercise routine gradually. ACOG states: "Pregnant women who were sedentary before pregnancy should follow a more gradual progression of exercise."

Are there exercises I should avoid?

Those that require laying flat on your back for prolonged periods of time (like certain yoga poses); scuba and sky diving; and exercises where the risk for abdominal trauma (injury to your abdomen) is high, like contact sports (hockey, soccer, basketball, football, some racquet sports, and boxing), and skiing, surfing, off-road cycling, gymnastics, and horseback riding. "Hot" or "Bikram" yoga or "hot Pilates" also should be avoided. 

What types of exercise are recommended?

Walking, swimming, stationary cycling, low-impact aerobics, yoga and Pilates (modified), running or jogging, some racquet sports, strength training.

What should I keep in mind to stay safe while exercising?

Many of the same safety precautions you would take during pre-pregnancy can be applied during pregnancy. Additionally, ACOG states: "During exercise, pregnant women should stay well-hydrated, wear loose-fitting clothing, and avoid high heat and humidity to protect against heat stress, particularly during the first trimester." It's also important to eat sufficiently and nutritiously before exercising. 

What kinds of warning signs should I look for that may signal a problem during exercise while pregnant?

Vaginal bleeding, regular, painful contractions, amniotic fluid leaking ("water" breaking), difficulty breathing prior to exercise, dizziness, headache, chest pain, muscle weakness that affects balance, calf pain or swelling. 

What conditions might make exercise unsafe for me during pregnancy?

Anemia, unevaluated maternal cardiac arrhythmia, chronic bronchitis, poorly controlled type 1 diabetes, extreme morbid obesity, extreme underweight, history of extremely sedentary 
(inactive) lifestyle, intrauterine growth restriction in current pregnancy, poorly controlled 
hypertension, orthopedic limitations, poorly controlled seizure disorder, poorly controlled, 
hyperthyroidism, and heavy smoker. 
What conditions would prohibit me from exercising entirely during pregnancy?

Hemodynamically significant heart disease, restrictive lung disease, incompetent cervix or cerclage, multiple gestation at risk of premature labor, persistent second or third trimester bleeding, placenta previa after 26 weeks gestation, premature labor during current pregnancy, ruptured membranes ("water" broken), preeclampsia or pregnancy induced hypertension, severe anemia. 

For more information, including a section on physical activity on the job and exercise during the postpartum period, check out the complete ACOG Committee Opinion document, "Physical Activity and Exercise During Pregnancy and the Postpartum Period."

Hot Yoga. Haute Mama. Practicing in the Hot Room While Pregnant

January 1st, 2013, just 4 days before I was to be induced, at the end of my pretty miserable pregnancy, I walked into my newish Bikram yoga studio. I'm calling it "newish", because I had been practicing there regularly since I relocated to Memphis at 32 weeks and anytime I visited the city, prior to that, including three times during my pregnancy. Before my move, I had been practicing in the hot room for 7 years, and up to 5 times a week during my pregnancy, at my first favorite studio, in Decatur, GA. 

Rebecca R., Still Hot Yoga Manager & Instructor

It was at that studio, where I saw my first teacher become pregnant, then practice and teach with amazing poise, health, and grace. Over the years, I witnessed two other instructors, and several students practice safely and beautifully. With an interest in pregnancy health, I asked the owner- who happens to be married to an amazing midwife- about the thermoregulation of mother and child. An increase in a pregnant woman's core body temperature may cause physiological damage to the developing embryo.

It was then, years before my own pregnancy, that I learned that even in the hot room, the core body temperature does not increase during the practice. Years before that, he had allowed a student, who was also a nurse, to leave class periodically in order to check her internal temperature. There was no increase throughout the 90 minute practice. The profuse sweating is thought to assist in lowering the core body temperature.

Before her own pregnancy, the studio manager happened to take a specialized and intimate training with Rajashree Choudhury, Bikram's wife, who modified the 26 postures for pregnancy. There, she learned about precautions and other techniques for expectant mothers. The pregnancy series is thoughtful, helpful, and simply amazing. With guidance, I began peppering in aspects of it at 8 weeks and continued with the full series throughout my entire pregnancy. 

Back to New Year's Day: As I stated, I had practiced in the studio numerous times while pregnant, but had not yet had the pleasure of meeting the owner... until this day, when he told me that I could not attend class, without a specific doctor's note. Since I had signed the studio's liability waiver- which even covers death, there was no legal need to require a special pregnancy waiver. I wouldn't win any case, if anything would have happened to me at that point, during or after class. 

Dejected and disappointed, with tears in my eyes, and a big baby in my belly, I returned home penned this note to the owner. 

I was very much looking forward to spending the first day of the year in Bikram's hot room, just as I have for the past 5 years.  Typically, I also run at least 5 miles on January 1, but being 39 weeks pregnant has made that difficult.  I am a very active woman, whom over the past months has had to relinquish hiking Stone Mountain (in GA), kettle bells, running half-marathons, and even walking long distances because of changes in my body.  Daily, I am so happy that I have been able to maintain a consistent yoga practice, specifically Bikram yoga, which I have practiced regularly for 7 years.  You may be able to imagine my disappointment when I was suddenly rejected from class today because I did not have a doctor's note stating that it were permissible to practice during my pregnancy. This had not been requested on any other day. 

After speaking with my doctor and presenting her with literature and testimonials regarding Bikram yoga during pregnancy, she verbally approved my participation in class- a written note was not necessary at my studio, as several teachers and students had practiced right through their natural and fast deliveries.  I have practiced since my 13th week of pregnancy, with Rajashree's modifications, needed or not.  I have practiced regularly at three different studios, including this one.  With running, walking and even sleeping becoming increasingly difficult, Bikram is one of the only times that my body feels normal and discomfort-free.  I feel better after yoga than I do after a massage, shower, of half-hearted foot rub from my husband.  The left SI joint and right rib that my child has gradually displaced become realigned during class, allowing me to move and breathe better.   

Holding standing bow for even 45 seconds makes up for how crazy I feel while losing my balance in the shower.  Rajashree's floor serious is nothing short of amazing for alleviating back pain and creating more space in my crowded abdomen. I am confident that the controlled breathing will help my physical and emotional pangs of labor. Especially in these last few days of my pregnancy, when I need my husband to help me roll out of bed to get to the bathroom, I feel strong and able in Bikram. I needed that feeling today. I ignored my fatigue and braved the cold to be chauffeured by my husband from Collierville (just in case) to make it  to the last class of the day.  I was completely blindsided and confounded by my denied class admission.  My studio in Atlanta was very supportive of practicing while pregnant, so I am not sure of all of these extra and unnecessary fears and road blocks.   

From a liability perspective, the language in your waiver should be so comprehensive that it includes anything happening in class from stubbing a toe to dying.  A well-written waiver should not have to highlight any specific "condition" including pregnancy, especially after the first trimester- the critical period. Your instructors are knowledgeable and supportive. A regular practitioner should have no issue listening to her body and following the pregnancy modifications, along with her doctor's/ midwife's advice.  Finally, you cannot presume that you care more about my child than I do.  Even after witnessing several women practice while pregnant, when it was my time, I completed AMPLE research to confirm my child's safety before I began practicing.  

I am well aware of the signs and symptoms of labor and would not risk my health or the health of my child for any reason.  In short, there was no good reason to be rejected from class today or on any day during my pregnancy. I recommend reviewing the "risks" and benefits of practicing while pregnant and consider revising your "policy" to reflect Bikram's and Rajashree's research, experience and viewpoints on the topic.  For now, I will turn up my space heater and go for what I know as I continue to move toward a peaceful delivery this weekend. 

The studio owner and I had a few more exchanges, following this note, but he did not change his perspective, and the next time I saw my doctor would be at my induction. There would be no Resolution Practice for me on that day, but in that year. Side note: at a million weeks pregnant, and facing a planned induction, I would have loved to have gone into labor at the studio, or on the way home. On January 6th, I birthed a healthy baby girl, after 23 hours of labor, and 7 minutes of pushing. I began teaching at a new hot yoga studio four months later, where we welcome, educate, and nurture hot mamas-to-be. 

New Year's Day 2013

39 Weeks, 2 Days

We always recommend that a pregnant woman be cleared for ANY exercise, by her provider, once she learns of her pregnancy. We never recommend that a woman begins hot yoga when already pregnant. Long time hot yoga practitioners, with low risk pregnancies, should have no challenges continuing with the practice as before. However, many physicians, fitness instructors, and mothers do tend to avoid moderate to heavy exercise during the critical first trimester, simply because so many things can happen during that time, and no one wants to take the blame for that otherwise natural process. However, there is nothing that happens to the body or the baby, in the hot room, that makes it unsafe. 

The room itself, is no hotter than the summer air in India, and all around the equator, where healthy mothers and healthy babies thrive every day. As with any pregnancy, and as with any regular hot practice, an expectant mother would need to maximize her hydration inside and outside of the class, listen to her body, and take breaks whenever necessary... also, take plenty of pictures. You're going to be om-mazed at what your new body can (still) do. 

This individual experience is not meant to override the advice of any provider, but may help to add some clarity about the physiology of practicing hot yoga while pregnant. 

Do you have an experience of practicing while pregnant? 

Running to Motherhood and Racing To Get My Post-Baby Body Back!

“At times you have to leave the city of your comfort and go into the wilderness of your intuition.  What you’ll discover will be wonderful.  What you’ll discover is yourself.”  -Alan Alda

Before I became pregnant, I had run 12 half marathons. On the day that my husband and I conceived my child, I had run a 5K (trust me, I'm sure). I ran another at 8 weeks, and continued to run 2or 3 miles until 16 weeks. At that point, it was taking 2 to 3 days to recover a short run. It wasn't worth it for me. I concentrated on yoga and water aerobics, forgoing my dreams of running 13.1 while pregnant. Check out the amazing Jocelyn Green, a Blossom Mom who did that and more! 

It was Sunday afternoon and I was in my bedroom unpacking my suitcase (I had just returned from a week long cruise with my family). I was sorting, putting away things, as well as, going through the list of things coming up the following week. At the top of the list was , running the Jacksonville Bank Marathon in Jacksonville, Fl. I was to run with my running accountability partner and friend, Wanda. As I continue to unpack, I come across a pack of up-opened tampons and my heart almost stops. I immediately check the calendar and realized I had missed my cycle. I calmed myself down and told myself not to worry, maybe my hormones were a little out of sync. Inthe previous weeks I had been working long hours as well as training for the marathon and so my body was probably a little off.

So I start my workday Monday as usual, trying not to worry. But by lunchtime, the worry had started to set in, so off to the store I went to get a pregnancy test. All the while I'm thinking, I'm suppose to run 26 miles in a few days!!! What if I am pregnant? Should I still run??? I can’t be pregnant, I'm just tired….a million things were going through my head! So I make it to the store, get the test, make it back to work, and decide to the test there in the restroom. The test came up positive IMMEDIATELY!!!! Lol I mean, there was no waiting three minutes! Anyway, I call my husband (fiancé at the time) and told him what I suspected, of course he was ecstatic. All I could think about was running 26.2 miles. So we decided that I would take another test when I got home and then call my doctor. I didn't wait…I had taken about five tests before he could get home and they were all positive…lol so the next day I made the call. I talked to my doctor, but unfortunately she wouldn't be able to see me until afteR the date of the marathon. But she gave me the okay to go ahead and run, since she knew that I was already a runner. She just told me to listen to my body and gave me a few things to be aware of….so began my journey of running while pregnant!

The morning of the race, I get up…of course nervous and prepare for my 1st marathon. Race begins and my partner Wanda has told me she would stay with me the whole race. She is one of few who knew I was pregnant. Race starts out great, I was able to run/walk the first 18 miles with no problems. But I did have a lot of time to meditate on how my life was about to change! Around mile 18 I started to feel some slight pressure in my pelvis so I decided to walk. To make a long story short, I completed the marathon injury free.

 Pre/Post Jacksonville Bank Marathon

Once I returned home the following week, I was able to see my doctor and was informed I was about 8 weeks pregnant!

As my pregnancy progressed I continued to run 6-7 days a week, an average of 3-6 miles each run. My running partner Wanda and my husband Demarcus were very supportive!!! Wanda was always with me on the runs making sure I was not over-doing it and being safe, while Demarcus was there for with emotional support…and food after each run!

I was able to run several “official” races throughout my pregnancy, along with the marathon. I ran the Disney Enchanted 10k, Jacksonville Gate River Run (15k), and the Publix Savannah 5k. Savannah was my last official run and I was a little over 5 months pregnant. I completed the race with a sub 35:00.

Official Races

By the beginning of my 6 month, I noticed several changes in my running. I was definitely slowing down, I was becoming short of breath, and I also started to experience increase sciatic nerve pain. But I didn't let this stop me from continuing my walk/run routine. I went on Amazon purchased a pelvic support band to aid with the pain and switched to more interval training, and increasing my walk to run ratio. I had to cut back on the official runs as well as it was heating up for the summer and I didn't want to get over-heated while running.

With some of my run pals!!!

By the end of my 8 months I had stopped running, but I continued to walk 4-5 days a week, an average of 3 miles. By week 38 I was definitely wobbling but was determined to stay as active as possible. I was also going to the doctor weekly and was anticipating my due date of August 23, in which I would be induced if I had yet to go into labor.

Aug 23…the big day! Just finishing my morning walk!

August 23 came, I got up and did a 3 mile walk in my neighborhood….it was to settle my nerves!!!! I went into the hospital at 6:00 pm and was induced, baby James Dean Henderson was born 23 ½ hrs later at 5:30 on August 24, 2015. What a wonderful feeling that was….I had become a new mommy!!!

Before I left the hospital, I followed up with my doctor on recommendations as to returning to exercise. Since I had a natural birth she stated I could return to walking at 2 weeks and return to running after my 6 week postpartum visit. While waiting for the two weeks to pass, I started some pelvic floor and light core exercises, as well as some upper body strengthening. At two weeks post-delivery, I begin walking 2-3 miles a day, 3-4 days a week until my 6th week. I was cleared by the doctor to begin running, so I begin to do slow walk/runs for 3-4 miles. I started with a 2:1 run/walk interval and am still in the process of getting my pre-pregnancy pace back.

I am currently a little over 3 months postpartum and I feel great!!! I try and jog with my little one as much as possible, but the weather is starting to get cold here (and he has been sick already). It has been a challenge getting adjusted to having and little one and not being able to just go on a run whenever I please, but I wouldn't trade it for the world. Baby James and I were scheduled for our first run this month, but I had to cancel (due to illness again), but we have plenty of races to run.

Throughout this journey, my goal was to stay active and as healthy as possible. I won't say I didn't receive any criticism, especially in the African-American community. It is almost taboo for black women to exercise/workout while pregnant. I had a lot of people including family telling me I was putting the baby at risk for exercising, but that is not so. My words of encouragement/advice would be to listen to your body!!! I feel that continuing to exercise helped in many ways, too many to name. But I also recommend to definitely discuss your exercise plans with your doctor as well.

For myself, I'm looking forward to continuing an amazing running journey with my new running partner Baby James!!!!!

A Note From Blossom

High level training during pregnancy can be safe in a low risk pregnancy, if your body was accustomed to moving at that level before your pregnancy. Be sure to check with your care provider before beginning any fitness regimen, especially when pregnant. 

Jocelyn is a full-time working mom, working in the field of physical therapy. She is from Panama City, FL and is a proud graduate of Florida Agricultural and Mechanical University.  She is a Disney fanatic, avid runner, traveler, and foodie. In her share time she blogs about a little of everything under the sun, including running and the joys of motherhood. She currently resides in the middle Georgia area with her husband Demarcus, and new baby James Dean. 

Instagram: Runningrattlermom 

Facebook: Runningrattlermom.facebook.com

Email: rattlerrunningmom@gmail.com

Fall in Love with Yoga During Your Pregnancy

"The moment a child is born, the mother is also born. She never existed before. The woman existed, but the mother, never. A mother is something absolutely new."   ~ Bhagwan Shree Rajneesh

Pregnancy is such a beautiful time in a woman's life. Not only does she have the miraculous privilege of creating a whole new life inside of herself, but she also has the opportunity and the inspiration to re-evaluate and re-invest in her own life. Pregnant women often find themselves creating new goals, tackling old fears, and giving their lifestyle a major overhaul.  

Whether it's taking vitamins, eating more kale, or trying a new exercise, an expectant mom is willing to do almost anything in order to create a safe, nurturing, and peaceful space for her growing child. 

Prenatal yoga can help to create the ideal physical and emotional space for an unborn child. Practicing yoga at anytime can help to relieve stress and alleviate depression, both of which many mothers-to-be are prone to. Practicing yoga during pregnancy can target special areas of concern, while also creating more space for the growing child and preparing the breath, abdomen, and hips for the actual birth. 

There are components of yoga that can be enjoyed during every phase of pregnancy. However, most women will want to discuss all physical activities with their specific care provider before partaking. A woman who has a regular yoga practice and is experiencing a typical pregnancy can continue her practice with minimal modifications, initially. As her body begins to change and the baby develops, a certified prenatal yoga instructor can guide the mother through the modifications necessary for each phase, ache, and ailment. 

One of the many fantastic attributes of yoga is that anyone can practice it at anytime. A mother-to-be can begin a yoga practice, even without any prior yoga experience, and still receive tremendous benefits, including increased flexibility, balance, strength, and pain management. 

Numerous studies support the purported benefits of prenatal yoga, from a decreased risk of prenatal depression to improved sleep to decreased backpain, and nausea, according to the Mayo Clinic. A 2012 study also found that prenatal yoga could decrease the likelihood of complications during pregnancy. The research showed that pregnant women who practiced yoga for one hour, three times per week, were less likely to have low birthweight babies, pregnancy-related diabetes and high blood pressure.

Breathe

Our breath is our life force. It's more important than food, water, and even love. It is the rare act that both happens automatically and is also controlled by us. Yoga helps us to focus on our breath and breathing in ways that we never have before. Virayoga founder and Art of Attention author Elena Brower says that the focus on breathing, in particular, can help moms-to-be decompress.

“When we practice when we’re pregnant, it makes a space in our bodies that we need ... for the baby and for ourselves," says Brower. "Breathing helps us create that opening inside of ourselves. Breathing helps us to see that we don’t have to react so quickly… Having that kind of space helps us be patient and helps us realize there’s time for everything.”

Stretch

Prenatal yoga includes specific postures that safely stretch the ligaments, tendons, and muscles that either become more taut during pregnancy, and/ or need to be released for an easier and safer labor and birth. Practicing yoga during pregnancy may help an expectant mom to better accept the beautiful and necessary changes (or challenges) that she and her body are experiencing. 

Strengthen 

Prenatal yoga can help to increase a mom's mental & physical strength and endurance in preparation for some of the toughest work that she will ever do- birth a child. Prenatal yoga classes may vary in intensity from very physically challenging to restorative. Additionally, moms within the same class may require varied modifications from each other, based on their previous level of physical fitness, current state of health, prescribed precautions, or daily energy level (women in their 2nd trimester typically have more energy than women in their first or late in their third). 

Love 

Whether a mom is having her first child or her fifth, her world is about to change dramatically with the birth of this miracle. Taking time out to practice yoga during her pregnancy may be the last selfish act that she will have the time for, and even it is not entirely selfish, since the yoga also helps with a developing fetus' brain and physical health. It is a time for the mother-to-be to connect with herself, as well as with her child. Each time she transitions to a more meditative state during yoga, she has the ability to experience her baby's flips and flutters more deeply. Finally, in a class or community setting, she has the opportunity to meet and gain support from other moms who are vibing with her pregnant self. These connections during pregnancy often blossom into lifelong friendships among the mothers and their children. 

Photo by Robyn Elicia

Prenatal yoga should be safe, enjoyable, invigorating, and empowering. There is no place for judgement or shaming, even within the mother's own head. It is a time to be wholly present with self, while falling  in love with her new self, her new body, and new baby. 

Tell us about how you fell in love with prenatal yoga experience. 

Photos: 1: Jada, 4 hours before going into labor at 40 weeks. 2: Jada, 29 weeks, still teaching and practicing yoga 

Attend a FREE Prenatal Yoga Class with Jada in Memphis during National Yoga Month!