The Active Glow: Exercising Safely During Pregnancy: Part 2

“Doing anything is better than doing nothing. Feel reassured that anything you can do within the limits of what your obstetrician or doctor has prescribed, is going to be good for you and the baby”

In this episode, Dr Rangi is joined again by pelvic floor physiotherapist and researcher Professor Helena Frawley, to discuss exercise in pregnancy, labour, postpartum and beyond.

This topic has been split into 2 episodes, this episode is all about a safe, realistic, and empowering return to movement after pregnancy. 

We’ll revisit the idea that “something is better than nothing,” and how finding movement you enjoy - within your limits -can support both physical recovery and mental wellbeing. 

Resources mentioned in the episode include:

• RANZCOG: Exercise During Pregnancy
• RANZCOG: Pelvic Floor Health
• RCOG: Physical activity and pregnancy
• MHW Physiotherapy department

Transcript

SPEAKER_03 0:01

Welcome to Prepare, the Mimessi Pro Inhabitable podcast dedicated to helping parents prepare for the journey of pregnancy, childbirth, and early parenthood. Mimesy Pro Inhabitable would like to begin by acknowledging the wonder why we were wrong people, the traditional custodians of the lens on which we gather today, and also the traditional custodians of the lemons in which you're listening from today. We'd like to pay our respects to the elders past, present and emerging, and we extend that respect to Aboriginal and Torres Strait Islander peoples listening today.

SPEAKER_00 0:32

Hi everyone and welcome back to Prepare. I'm Dr. Rangi DeSilva, an obstetrician and gynecologist and researcher here at Mercy Perinatal. Today we're continuing our discussion of exercise in pregnancy with the wonderful Professor Helena Frawley, who's a pelvic floor physiotherapist and senior researcher at the University of Melbourne. In this part, we shift to the postpartum period with a brief revisit to pregnancy, focusing more on how to return safely to exercise after you've had a baby, what's normal when it comes to pain and discomfort, how to manage and when to seek help. We'll revisit the idea that something is better than nothing and how finding movement you enjoy, importantly, within your limits can support both physical recovery and mental well-being. We'll also share some practical ways to stay active with your baby after they're here and where to find trusted resources. This episode is all about a safe, realistic, and empowering return to movement after pregnancy. Thank you so much for joining us, Selena, again. To start off, in terms of postpartum recovery, would you say it's safe to start exercising, not just the pelvic floor muscle, but in general, pretty soon after birth? And what would you say are the recommendations with timelines?

SPEAKER_02 1:42

It's a a little rubbery or flexible because every birth is different. So there's no set guideline, but generally you can start pelvic floor muscle exercises within a day or two of birth. Really? And it's a good idea to gently start contracting the pelvic floor muscles and relaxing soon after birth because that will help reduce the swelling around the vaginal area. So a muscle contraction is like a pump and it will pump some of the swelling and the inflammation away. And provided it's comfortable, causes no pain, it's completely safe and it's a good idea. So the sooner you resume pelvic floor muscle exercises, the better. The longer you leave it, the harder it will become. Any muscle that you don't contract regularly forgets how to exercise and it weakens. By doing nothing, it actually gets weaker, it doesn't stay the same. So we do want our pelvic floor muscles to start exercising gently as soon as you're comfortable after birth. And to build that up so that by six weeks postnatal, your pelvic floor muscle exercise program is at about the same intensity as just before birth.

SPEAKER_00 2:51

Okay.

SPEAKER_02 2:51

So if you've done pelvic floor muscle training during the pregnancy, you'll build it up to a really good level by the time you have your baby, and then give yourself a good six weeks to get back to that level after birth. That might be a bit longer if you've had a difficult birth and the muscle needs a little bit more time and encouragement to recover. Could go up to 12 weeks. But for the majority of women, six weeks is a good guide for pelvic floor muscle exercise to be back at the level it was before. In terms of the other two types of exercise, general exercise, walking for your heart and lungs, and muscle strengthening. Fortunately, that's really easy to achieve with walking. And that's the easiest thing to do, postnatally, walking with your baby. So mum and bub walking together is a great way to get back into exercise gently, slowly, building up. So initially you might be doing a 10-minute gentle stroll, and by six weeks, hopefully you can do a good 30 minutes at a moderate intensity. Okay. So again, give yourself that six weeks to build back up to where you were just before birth, but give yourself a bit longer if you need it because of a more difficult birth and which takes a bit longer to recover from. In terms of resuming any exercise in the water, such as swimming or aquaerobics, that would usually best be delayed till you've had your postnatal checkup to make sure everything's healed internally, so there's no risk of infection. In terms of walking, yes, you can increase your pace, so the speed that you're walking, the time that you walk for, and the intensity. Other exercise that's more impact, such as running or resuming a sport that you might have played before, such as tennis or netball, that might need to be done over a slightly longer period of time, depending on how well your pelvic floor muscles have recovered from the birth. Because you put yourself at a little bit of risk with more impact. If your pelvic floor muscles haven't yet recovered, you may feel some pelvic floor weakness. And that can show in symptoms such as some leakage of urine or a feeling of pressure or bulging in the vagina. So that's why it's a good idea to do that prep work, put in the preparation for the first six to twelve weeks before you start to load up your body with more impact.

SPEAKER_00 5:13

That makes sense. And I suppose it's also listening to your body, as you said before, if you try some of those things and they're uncomfortable or you have some of those effects like leakage of urine or that feeling of pressure in your vagina, you probably can slow down a bit and ease up a little bit.

SPEAKER_02 5:32

On the impact and the activity, exactly. But you would probably then want to concentrate more on your pelvic floor muscle exercises. And that's a good time to perhaps see a women's health physiotherapist or a pelvic health physiotherapist to make sure that you're exercising your muscles the best way, the right way, and that you're improving. If you're not improving, then you can get some more advice and treatment. But the most important thing is that your body allows you to get back to the type of exercise that you enjoy doing because that's good for you as a mum, it's good for weight maintenance or weight regulation, it's good for muscle strength and helps you cope with all the challenges of motherhood, the mother load.

SPEAKER_00 6:12

Yes, which is it's a huge load. It's a real thing. And I think that's such an important point because we focus so much in society and in general knowledge uh on the pregnancy and the and often the baby, but then postpartum and the baby, of course, but not enough on mums and motherhood and recovery and and being strong for yourself and your baby as they grow.

SPEAKER_02 6:41

Absolutely, because you'll be able to care for your baby better if your own body is working optimally. So it's not being self-indulgent, it's really important to prioritize and carve out some time to get well postnatally. I know it's challenging, you're exhausted, sleep deprived, feeding difficulties, there's a whole range of things that can seem like they are the most important priority. And in the short term, absolutely they are, but it don't drop off your own health and well-being. Try to keep a little bit of exercise going every day, even if it's a little bit, something's better than nothing.

SPEAKER_00 7:18

I think that's really good advice. And as you said, that has to be something that you enjoy.

SPEAKER_02 7:22

Exactly. That's what will motivate you to continue doing it. If somebody tells you, go join this XYZ class, it's fabulous, we really love it, but it's not your thing, then you won't stick with it. And then you'll feel disappointed in yourself.

SPEAKER_00 7:36

Yes, that's right. And that's definitely not what we want. We don't want people to be feeling guilty that they're not exercising enough. Because there will be some circumstances where that just might not be possible. But that's right, access to certain venues, weather restrictions, cost. Exactly. All of those barriers. Yeah, but but as you mentioned before, there are lots of potentially easier and cost-effective ways to get in some daily enjoyable exercise, even if it's going for a walk. Absolutely. Yeah. And that can be with a friend or a parent's group or your partner or just with your baby.

SPEAKER_02 8:14

Absolutely. The social networks are really important during pregnancy and postnatally. So if you have a buddy that you can exercise with, it gives you more motivation to turn up. You've made a commitment, you'll turn up and you'll both enjoy it.

SPEAKER_00 8:27

Yes, I can certainly relate to that. Um a lot of people get concerned about injuries in pregnancy and specific pain or areas of their body that they might be experiencing trouble with. So things like back pain is a very common problem in pregnancy, pelvic girdle pain, pubic symphysis pain, even neck and shoulder pain because of the postural changes, the weight that might change, hormonal changes, all of those things. What would you say are some specific things that could be done to help some of the most common ailments in terms of our muscles and joints in pregnancy?

SPEAKER_02 9:07

Yes, it is a big thing and affects a lot of pregnant women. First thing is to identify can you pinpoint anything you're doing that's aggravating it? So, for example, if it's going upstairs, aggravating your pelvic girdle, your joints, the joint at the front you mentioned, the pubic symphysis or the joints at the back, the sacroiliac joints or your low back, just due to the strain, the increasing weight and size of your baby. Try to identify to yourself what actually specifically makes those pains worse and try to minimize or avoid them. So that could be the reason to take the lift, not the steps, if it's actually better for your body and pain levels. Twisting and turning activities are particularly difficult for the pubic symphysis and sacroardiac joints. So that could be related to sport or exercise that you're doing, and that would be another reason to modify your exercise to avoid the twists and the turns. But it could actually be something as simple as getting out of a chair or getting out of bed, rolling the wrong way, and you get a catching pain. So generally think of your body as a log and that you would roll with your whole body together rather than rotating your legs around and twisting your spine to get up out of a chair or bed. Think of doing a log movement where you can then contract the muscles in your tummy and brace yourself so that your pelvic joints are better supported. So there are some very simple tips and tricks. Exercising in the water can actually give great relief for back pain and pelvic girdle pain. So that's particularly good, not just for the exercise benefit, but for the pain relief benefit. But if none of those things seem to be helping, it's a good idea to see a women's health physiotherapist because they can give you specific advice and tailor what you need to do depending on your lifestyle and your family life and whether you have stairs, etc., all of those things can be tailored to make it specific for you. Sometimes wearing a support belt or a brace can be helpful to give an extra external layer of support to help your own muscles support the pelvis and the back. So there are quite a few different things that can be tried. So you should seek help early because if your back pain or pelvic pain progresses, it can be very debilitating and difficult to get back under control. So seek help early if you're not improving with modifying your activities yourself.

SPEAKER_00 11:39

And would be able to reassure people that if those things don't considerably improve in pregnancy, they will be likely to improve after the baby's born?

SPEAKER_02 11:49

Yes, for the majority of women, for the majority of the conditions, because if they're caused by the hormonal changes affecting the stretchiness of the ligaments and the muscles, that should resolve postnatally and depending on your hormonal changes with breastfeeding, etc., you will get back to a point where your body is no longer being influenced by those same hormones. Also, the weight relief, so after the baby's born, you won't have quite so much gravity and weight causing pressure on the pelvic joints. So those two factors will make a big difference for a lot of women. However, if the back pain and the pelvic pain during the pregnancy was fairly severe and impacted your ability to exercise, then you might find you have lost some muscle strength and fitness. And that needs to be regained postnatally. So even though your hormonal levels will be settling and the the extra weight from the baby's gone, you start one step back with weaker muscles. So that needs some strengthening. Yes, the two big factors are weight, and it's like if you put on a lot of weight, your body is under more strain and you're working harder just sitting at rest because your heart is having to work harder and your body is having to hold that load, and that is a challenge. Yeah. The hormonal influence as well will is preparing your body for pregnancy and birth, and that's a good thing. So we don't want to see the weight gain and the hormones as bad things. They're really good things and they're helpful. But for some people, and we actually don't know the precise reason for any one person why their back pain or pelvic girdle pain is worse than somebody else's, it might be a combination of uh genetic influences, how they were pre-pregnancy, particular fluctuations during their pregnancy. And so the hormonal factors are outside our control, so there's not much we can do about them. But the musculoskeletal or the body, the muscles and the joints, they're partly outside our control, but there are some things we can help to do to help support our body through exercise, correct movement, posture, reducing excessive load, and receiving treatment to help the pain and build up the appropriate level of muscle support and control.

SPEAKER_00 14:45

Obviously, you talking about the huge benefits of exercise in pregnancy and that we can debunk that myth that it's dangerous in most circumstances. Are there any specific circumstances where it's particularly beneficial, for example, like diabetes in pregnancy or other things like that that we we know of?

SPEAKER_02 15:05

Yes, so there are some women who have special risks or conditions during pregnancy. Gestational diabetes is a really good example. And we've done some research on that ourselves, and indeed, exercise is hugely beneficial for controlling excessive weight gain and is enjoyable. So women who perhaps have been diagnosed with gestational diabetes often feel that they've got to shut down all their activity because they're in a risky category. But no, the opposite is true. It's very important that they do exercise. And they can struggle with getting the right advice. So if you do have a diagnosis of gestational diabetes or one of those other risk groups, you can feel quite vulnerable to misinformation because you it feels scary and you don't understand it yourself. So it is important to seek good advice on that, and the evidence is quite strong that exercise is good for gestational diabetes.

SPEAKER_00 16:00

That's great, that's really good to know. I know that there's some pregnant women who just won't be able to even get out of bed certain times in their pregnancy. Sometimes in the first trimester, it can be so exhausting. There are some women that suffer from nausea and vomiting, hypermisis rabidarum, which is severe nausea and vomiting in pregnancy, or even if they're in that circumstance where their cervix might not be acting as strong as it should, and they're recommended to stay in bed. Yes. I know these women will particularly be concerned about the lack of exercise that they're getting. Yes. Is there anything that they can still do whilst they're in that circumstance to make themselves strong or even maintain their strength?

SPEAKER_02 16:44

Yes, it is challenging because if we don't maintain, we do go backwards. So we might have to accept that there will be a little bit of loss of muscle control and cardiovascular fitness during a pregnancy that has severe activity restrictions. However, that putting the safety of the baby as the priority is the most important thing. And your own exercise and fitness you can make up later. So when you weigh up the the two, the considerations, it's far more important to have the safety of the baby and your own safety put as the top priority. But if you are under very severe restriction of bed rest, and so you can't be uh up and about, you can actually do bed exercises. So while you may not be getting as much aerobic challenge, you can still contract your muscles. So a physiotherapist would be able to design a program for you to do as much as you can safely while you're resting in bed by doing contraction and relaxation exercises and resistance exercises. So you're still getting the strengthening and benefit. Having said that, there are only a few conditions where you must have total bed rest, where you're not allowed to have any activity at all. So that extreme restriction would only apply to a small group of women. For others, it might be a moderate degree of restriction of activity. And then we come back to minimal impact exercise. So if it's a short walk several times a day, that's better than nothing, and will definitely be better than not doing anything at all. So even though you've you may feel you're not meeting the optimal guidelines, the best outcome, doing anything is better than doing nothing. So feel reassured that anything you can do within the limits of what your obstetrician or doctor has prescribed is going to be good for you and the baby. It also helps you feel mentally better as well. So we've talked a lot about the physical benefits of exercise, but the mental health benefits are really important too, and we've got good evidence that exercising during the pregnancy can reduce your risk of postpartum depression.

SPEAKER_00 18:59

That's really important.

SPEAKER_02 19:00

That's really important to know. So not only does it help you feel better in yourself during the pregnancy, better mood, less anxiety, you have the social connection, so you're getting stimulation and motivation from your exercise. We now see that it actually does reduce the risk of depression afterwards. So it's really important for both your physical well-being and your mental health.

SPEAKER_00 19:24

That's a really important message. How do you recommend other than walking? I mean, there's so many exercise options that are out there for mums and babies. Um, are there any common ways that you can incorporate your baby into your exercise routine postpartum that you've seen? Yes.

SPEAKER_02 19:43

Walking in the pram is always a great one. And there are some fabulous classes. Uh, mums and bubs used to be a class I was involved in. So mums would bring their bubs to the class and the exercise routine would incorporate playtime with the baby. So that's great fun for mums and bubs, and you still get a good exercise benefit. So you don't have to consider that you'll always have childcare costs.

SPEAKER_00 20:08

Yes, because that's it, that can be a huge barrier with with little support to maybe mind your baby while you feel like you need to go and do a 30-minute, 60-minute class or something like that. If you can bring your baby along, that's great.

SPEAKER_02 20:20

Absolutely. So I think look at the baby-friendly venues and groups that will welcome your baby into the exercise environment, and that saves you money. And as you say, if you don't have a very big or strong network of people that can help you with childcare, that's going to be a bonus for you. Definitely.

SPEAKER_00 20:39

Speaking of money and costs, I think unfortunately, cost can be such a barrier to for some people to access physiotherapy and even some of these exercise options, aside from the cost-free option of walking. For those people who just cannot get in to see a public physiotherapist because the wait lists are so long and can't afford to see a private physiotherapist either in pregnancy or postpartum, are there any resources that can help them during this time?

SPEAKER_02 21:11

Absolutely. Hopefully, if you're a public patient at a maternity hospital that that has a women's health physiotherapy department, certainly here at the Mercy, the physiotherapists are able to offer telehealth appointments. So if your barrier is distance or transport, that doesn't prevent you from having an individualized specialized consultation with a women's health physiotherapist to give you good advice on changing your exercise throughout the pregnancy and postnatally what's safe to resume. There may well be a waiting list, but it's good to get on that waiting list. And in the meantime, as you say, what other options can you explore until you have that individualised tailored appointment? Of course, there's a lot of information available on the internet. We need to caution. Correct. The volume is difficult and the quality is variable. So that's some of the feedback we received in our research with women with gestational diabetes. They were overwhelmed by the the quantity and the conflicting advice on the internet. And often that leaves you paralyzed. You do nothing because you don't know is it safe? Is it right? So it's good to go to credible sources. And the credible sources are the ones that are health professionals who are trained in this area. So there are some excellent resources from the Australian and New Zealand College of Obstetricians and Gynecologists, and the same with the British, the UK websites. So you can get these lovely infographics and guidelines which give you an overview of exactly what to do, what's safe, how many minutes of exercise, what intensity, how many days of the week, what to avoid, what are the signs to look out for to modify what you're doing. So there is good information out there, and we can certainly add links to our podcast to help direct you to that. The Mercy Physiotherapists here, they have excellent YouTube videos on exercise in pregnancy and exercise in the postpartum with your bub. So while you're waiting for your telehealth appointment or your outpatient appointment, you'll be able to look at their videos and get very good clear advice.

SPEAKER_00 23:24

Oh, that's fantastic. That's really good to know because I think there can be such an overwhelming plethora of barrage of resources on the internet. And it's really difficult to know what's evidence-based and what is accurate. Um, so that's important. We'll put those in our show notes definitely so people can access those. Um just lastly to finish off, I think just to summarize this important chat on exercise in pregnancy. I feel like we can safely say it's very beneficial, and not just physically, but for mental and emotional health in pregnancy and afterwards as well. That no amount is too small, that you can start slow and take it easy on yourself. I think listening to your body is really important. So if something's not feeling right or not feeling comfortable or safe, slow down, rethink what you're doing. Um, and there's always a way to do some exercise, no matter what circumstance you're in, if you enjoy it. So finding something that's enjoyable sounds like the key as well. Absolutely. And there's lots of health professionals definitely here at The Mercy, but also at many of your um maternity care providers that will be able to guide you if needed. Um, and there's lots of resources that we can definitely um give people access to to help with that as well. Is there anything else you think we should add to this? No, I think that would be called.

SPEAKER_02 24:56

That's a great summary, Rangi. I think you're right. It's we need to remember that it's good for uh the pregnant person, the mother's well-being, helps you control weight gain during pregnancy, reduce high blood pressure, prevent diabetes, improves your fitness, your sleep, and your mood. So what pill would give you all of those benefits?

SPEAKER_00 25:16

That's true.

SPEAKER_02 25:17

As we a very successful pill if someone was to invent that. That's right. We now say if um uh if exercise was a pill, everybody would be prescribed it. So nothing else will give you all of those benefits during pregnancy in the postpartum. So that's why exercise should be a really top priority. But as you said, don't be overwhelmed. If you've not been previously physically active, start gradually. If you've been active, keep going. Yes, there might be some modifications to make as your pregnancy progresses. So try to do two sessions a week of strengthening your muscles and five days a week of aerobic exercise so that you're adding up both the heart, lung, and the muscle benefit and your pelvic floor muscle exercises as well. So the evidence is really strong. There's no evidence of harm to your body if you're doing exercise correctly and well supervised, but do listen to your body, modify things if you need to, and be careful of anybody bumping your bump. Protect the bump. Protect the bump, indeed. Okay.

SPEAKER_00 26:22

Fantastic. Thank you so much, Helena. That was so useful. And I know that many, many people find it extremely informative and reassuring to know that we can safely, enjoyably exercise in pregnancy. But also not to make feel people feel guilty if they don't feel like they're exercising enough, but that there's always lots of help you can seek and information we can we can get about it.

SPEAKER_02 26:48

Absolutely, yes. Anything's better than nothing. Yes. There are guidelines to aim for on a good day or a good week. You might make them. You may not every week, but that's okay. Be happy and satisfied with what you are doing. It's good for you and your baby.

SPEAKER_03 27:02

Every pregnancy is unique. The information provided in today's podcast is for educational and general purposes only. It is not intended to be substitute for professional medical advice. It is important that you always seek the guidance of qualified health professionals with any questions you may have regarding your health, pregnancy, or any medical conditions.