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? 

When Pregnancy Coaching Becomes Personal

"A friend is like a good bra: hard to find, comfortable, supportive, always lifts you up, makes you look better, never lets you down or leaves you hanging, and always close to your heart."

I asked one of my dearest college friends to talk about her amazing pregnancy and brilliant child, who just happens to be my goddaughter. I wasn't expecting this. Thank you so much, Kimberly Ward, for trusting me and allowing me to witness your miracle. 

I thought it would be fun to surprise my friend and wellness coach with the news of my pregnancy in person. I invited her to lunch, explaining that I had a pregnant friend who I wanted to refer. I planned for the exchange to go a little bit like this: She would order wine. I would pass on the wine (which I never do) and wait for her to ask me “why?”  But… I just couldn’t wait! Instead, as she was ordering our favorite sushi, which I could no longer eat, I sprang the news on her. She was in disbelief. We both squealed and cried. 

You see, I had watched her from the sidelines for years helping mothers with everything from diet and yoga to breastfeeding. I’d witnessed her getting ready to give expectant mothers massages and knew that I wanted that to be me when I got ready to bring a child into this world.

I knew that I wanted her knowledge and experience to enhance my pregnancy, however, I did not realize that I would so heavily depend on the advice of the coach. I was becoming increasingly sensitive to various odors, sluggish and nauseous. One evening, I ate fish a dinner, and had the worst morning after ever. I needed help. Seeking the help of my pregnancy coach started a journey that would change my life and the life of my child forever.

I shifted my focus to my growing baby and met about the pregnancy to discuss my expectations and to share my early concerns.

First I wanted to become a vegetarian

After the incident with the fish, I wanted to learn as much as I could about the effects of meat on the pregnant body.  My doctor though it was not a good idea to take meat from my diet stating that I needed the nutrients that the meat would provide.  So as you can image this was the first concern I passed with my coach.  She helped me to understand the nutrition facts and gave me a list of iron and protein rich, plant-based foods to review with my doctor at my next appointment. He was impressed and approved the change. I went through the duration of the pregnancy eating only fruits, vegetables, and grains and I felt wonderful. I got in the habit of juicing every morning and found my self feeling stronger and more alive than ever.  

Next, I needed to figure out why I was so sensitive 

I switched my household cleaning products to natural ones to avoid the sickening odors and harmful fumes. This transition was easier than I imagined.  I first started cleaning with vinegar and water and found that I only needed to add a few other items to keep the house clean. My life was changing. It was becoming more simple and a lot healthier.

Then, I started to focus on our health

I meet with the pregnancy coach once a week, where we did prenatal yoga and talked about how my child was developing in the womb.  And OMG! there was a so much going on in there.  During yoga, I would take in deep breaths of air and she would let me know how each breath was increasing her brain development.  It was fascinating to me. I found myself taking in breaths during my day and smiling a little each time knowing that was helping her brain development. 

The Good News Continued

My pregnancy coach was full of knowledge. One of the best pieces of advice, and there were many was her recommendation that I use the Baby Plus Early Learning System when I reached 18 weeks.  I’m sure there has been some talk here about the system. Maybe you’ve heard about it and compared  it to other systems or methods.  But the reality is, there is no comparison.  My child is a living example of all that’s great about the Baby Plus system.  She has been reading full words and sentences since she was 3 years old. I won’t go on about it now, but you can follow her journey here.  

There have been a lot of pregnancies amongst my friends since then.  I’ve seen some them follow in my pregnancy wellness steps and having amazing pregnancies and others who shrug off the advice and struggle through the first few years of their child’s life.

My pregnancy coach even helped with breastfeeding and postpartum fitness after my daughter was born.

Our Bight Future

It’s been six years since I first started working with a wellness coach and I am still reaping the benefits of the investment. I am now raising an independent, intelligent, well behaved,  fruit & veggie loving, rock star of a child. She continues to exceed the expectations of the teachers and the coaches who pour into her life. As for my health, I have continued my regimen of juicing, smoothie-ing, plant-based nutrition, meditation, and gentle movement. The effects have been far reaching, unimaginable, and greatly appreciated. 

A Note From Blossom

A pregnancy coach is a life, health, or wellness coach, who is also a birth professional such as a childbirth educator, doula, midwife, or doctor. A pregnancy coach meets with you, typically via phone or email, to answer your questions and help you have the pregnancy or birth experience you’re hoping for. She provides education, mentoring, counsel, and insight and is your go-to for all things pregnancy-related before, during, and after pregnancy. If you’re looking pregnancy tips or other prenatal advice, schedule a session with a Blossom Pregnancy Coach today! 

Kimberly Ward is the CEO of Kimberly Ward Inc., which is the parent company for Kimberly & Cameron Interiors, Pink Eggshell, and Iconic Home Magazine. Kimberly was recently named one of "Five Creative Women to Watch" by Mississippi Magazine, and has been nominated to the Leadership Mississippi class of 2015. Follow her brands on Facebook, Twitter, and Instagram!

Kimberly Ward

KimberlyandCameron.com

Pinkeggshell.com

404-806-0791

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!

Here We Grow Again

Three years ago, almost to the day, I left my job in corporate healthcare in order to work for myself, full time, in my own wellness company, One Touch Wellness, Inc. All year, I had prayed for the strength, finances, discipline, faith, and favor to abandon my comfy direct deposit, health insurance, and 401K, to pursue a desire that had been burning within me since I was in college, 10 years earlier. My fiance', at the time, encouraged me, almost daily, to take the leap. After a month long yoga retreat in Costa Rica, I finally did.

Over the next week, I went on an organizing, workout, cleansing, and cleaning spree. By the end of the week, I was exhausted... I was also nauseous, emotional, and "tender". So, before beginning another week in that condition, on Mother's Day 2012, I took a pregnancy test, and passed with flying colors- pink, to be exact. It turns out that the strength, stability, discipline, faith, and favor needed was not for my business, but for my child and my family.

I had just begun teaching sunrise yoga at a fitness bootcamp. I continued teaching through my 32nd week. I also continued to hike up Stone Mountain and practice Bikram yoga. In my second trimester, I started taking pregnancy yoga, pilates, and water aerobics. I also quickly found another job and moved our planned December wedding, to August. My entire life was spinning out of my control. My everything was revolving around my child's embryonic development, as well as her future.

My daughter was healthy and so was I, but I had an unmanageable and constant nausea throughout the entire pregnancy, known as hyperemesis gravidarum. I also had a new husband who was living 3 states away, who was not privy to much of my misery. At the beginning of my third trimester, I moved to be with my husband, left my home, left my mother, and ultimately, left my business. 

I loved being with my husband and I loved caring for and nursing my child. My adjustment to a new space, new routine, new financial status, little support, and little social outlet was a lot to handle at once. I declare that my success with breastfeeding, after a challenging pregnancy is the major reason that I did not fall into the throws of postpartum depression.

My overall experience with pregnancy, childbirth, and breastfeeding is what has driven me to create Blossom Health and Maternal Wellness.

I believe that I am purposed to help women to create a greater life for themselves than they are currently living. However, 2 years into motherhood, I found myself living a fraction of the life that I had been called to live. My life is more than 3 minute showers, skipped lunches, workout excuses, and 3 pair of yoga pants to last all week... without any yoga. I was not meant to study women's anatomy, physiology, and mental health, only to keep the information between random Facebook posts and me. It was becoming painful to not be doing more... saying more, teaching and helping more.  

Women have children every day, but each life is truly a miracle, and each mother needs to and deserves to be supported in each pregnancy. That need for support should not be discounted by family, friends, physicians, or the mothers, themselves, simply because everyday is someone's BIRTH day. The fitness, nutrition, education, and rehabilitation that we provide helps to support new and expectant mothers, so that they can spend more positive energy caring for their child. 

While I was in the initial stages of creating Blossom, there was all kinds of confirmation that this was to be. From phone calls to friends sharing news of their pregnancy to pictures of me nursing my daughter being plastered all over the city, the time is definitely now. In church, on Mother's Day 2015, three years after discovering my "YES", my pastor talked about women living in and believing in their own destiny. I am doing that through Blossom Health and Maternal Wellness, starting now, with your help. 

Happy Mother's Day, today and every day!

and the day came when the risk to remain tight in a bud was more painful than the risk it took to BLOSSOM. ~ anais nin