So with all these things that pregnant women should not do, what does a pregnant client actually do? Traditional Pilates mat is not a good fit because almost everything would be contraindicated. However, in a Pilates studio they are able to do a wide array of exercises that will specifically address their changing needs while avoiding potentially problematic positions. There are several things that need specific focus on for the pregnant body including ribcage breathing, body awareness and conscious relaxation, pelvic floor awareness and control, postural balance, arm/upper back strength and foot strength.
In Pilates breath is well known to be important. Pilates utilizes what is called “ribcage” breathing or “posterior/lateral” breathing. The focus here is on keeping the downward motion of the diaphragm minimized and optimizing the outward motion of the diaphragm by moving the ribs. During Pilates with a regular client this is essential in order to maintain the transversus abdominis connection pulling the belly in during the abdominal work thus providing good core support to the back and rest of the body. For a pregnant client this becomes imperative because the option to “belly” or “diaphragm” breathe (where the belly bulges out during breaths because of the downward motion of the diaphragm) becomes impossible as the baby grows larger and takes up all extra space possible in the abdominal cavity. For them it is indispensable to learn how to move the ribs and develop the flexibility to allow the ribs to move as much as possible. Side bending and spine rotation exercises in Pilates develop increased flexibility in the intercostal muscles which will allow the ribs to move. These exercises include any Mermaid, Side Body Twist, Spine Twist, Side Bends and many other traditional exercises with rotation or side bending variations.
Often during pregnancy women notice they need a new bra with the band around the rib cage being larger, this is due to the body’s need to move the ribs more to get air in. Many women literally do not know how to breathe this way and feel like they cannot take a full breath and that they are constantly out of breath. Simple ribcage breathing exercises will allow them to take full deep breaths. Thus integrating traditional Pilates breathing into daily life will make a huge difference to them so focus should be on this in every session during every exercise.
Breathing is also a huge part of the labor process and many women take special classes to learn how to breath during labor. Much research shows that the traditional Lamaze panting breathing actually has a higher rate of hyperventilation which thereby causes fetal distress. The full, deep breathing that is practiced and learned during Pilates sessions is exactly what is needed according to the Bradley Method where natural childbirth is practiced.
The Bradley Method also teaches that with conscious relaxation the pain in childbirth is dramatically reduced. Therefore the body awareness that is taught in Pilates training is a perfect way to develop skills for conscious relaxation during childbirth. I personally will attest to this as I have had four babies without any drugs using the Bradley techniques and drawing on my Pilates skills. The difference when the contraction comes between unconsciously tensing up against it and consciously relaxing the body and allowing it are dramatic to say the least. Pilates instructors should focus on teaching pregnant clients how to turn muscles on and off with their own volition and bring their attention to whether or not they are accomplishing this accurately. This is done naturally every time an instructor corrects a client to “put your shoulders down” or “keep your legs together.” As every Pilates instructor knows, it is harder to turn muscles off often than to turn them on.
During pregnancy, the mother is being told to learn how to turn on the “Kegel” muscles which are called the pelvic floor in the Pilates studio. These muscles work to keep liquid, organs, gas, and babies among other things, inside the body instead of falling out as gravity would desire. Pilates incorporates pelvic floor work into its workouts with every client so nothing special needs to be done other than to highlight and emphasize it. Not only do pregnant women need to strengthen the pelvic floor muscles in order to counter the increasing weight put on them with the growing baby, but they also need to learn how to turn off on command which is important to actually let the baby out during delivery. A great exercise to do in order to practice turning on and off the pelvic floor as well as stretching it out in preparation for the delivery is the Russian Squats on the Tower from a 2nd position (wide leg stance with external rotation – aka grand plies in second). The pelvic floor also needs special attention and extra cueing postpartum as the muscles will be stretched out and need to regain their tone and elasticity. If this area is not addressed it can often lead to problems such as low back pain, pelvic pain, sacroiliac pain, incontinence and prolapsed pelvic organs later on in life. Helping clients find their “core” which is composed of the diaphragm, transversus abdominis, deep lumbar multifidi and pelvic floor muscles is a specialty of Pilates and should be the base of training of all clients especially pregnant ones.
Another specialty of Pilates is restoring postural balance which is extremely important to the pregnant client. During pregnancy the natural curves of the spine are amplified and women become kyphotic and lordotic if they do not specifically work on minimizing these curves. During pregnancy the hip flexors, low back, chest and neck extensors will be come overly tight although not necessarily strong and the hip extensors, abdominals, upper back and neck flexors will become loose and/or weak. Pilates can address these issues and work on minimizing these changes although they need to wait until after the baby is born to work on strengthening the abdominals beyond of transversus work as discussed earlier. Special focus should be on stretching the hip flexors (Eve’s Lunge, Down Stretch), the low back (Spread Eagle), chest (Sitting Triceps Press, Reverse Push Through) and neck extensors (Hamstring Stretches). Extra strength emphasis should be placed on the hip extensors (Leg Pumps Supine on Chair with Wedge, Standing Leg Spring Extension) and upper back muscles (Rowing Front, Standing Arm Springs).
Upper back strength as well as arm strength is also important for pregnant mothers in anticipation of holding that small baby which rapidly becomes a large baby. While the mother is pregnant she often times becomes kyphotic because of increased breast mass and once the baby is nursing the hunched over posture often worsens. Specific upper back strengthening that targets the mid and lower trapezius, serratus anterior, posterior deltoids, rhomboids and others will help counter this natural tendency and prevent future pain and/or injuries in the neck and shoulders. Hopefully the new mother will want to hold their child as much as possible so strong biceps and deltoids will be a necessity. While any of the arm work in Pilates is good for this, the Biceps Curls with the arm springs standing are particularly wonderful as they attain strong arms as well as keeping the chest open. There are also many advanced exercises for this that a pregnant woman can do safely that are great for developing arm strength and open chests like Long Back Stretch and Triceps Sit. The overhead reach phase of the Rowing Back 2 is also great for developing strong deltoids to lift that soon to be big bundle of joy. It is also good to encourage mothers to carry or wear their children rather than lugging them around in car seats as the heavy and awkward car seat often times causes serious shoulder injuries and postural imbalances for the mother.
There is a myth that during pregnancy mom’s feet will miraculously start growing again and they will need to buy a whole new shoe wardrobe. While some women may be excited to get new shoes, this is completely unnecessary and actually bad for the woman’s posture and future back and foot health. The hormone Relaxin is acting on the joints in the feet as well and as they get looser, if there is not enough strength in the musculature of the feet, the arches collapse which give the illusion they have “grown.” This can be prevented or restored by using Pilates equipment and exercises. Once the musculature is strong enough the arches will lift up as they used to and the foot will go back to its original length. It is just a matter of working the feet. If the arches are not strengthened the feet will tend to cramp (sign of weakness) and eventually develop problems like plantar fascitis, knee or back problems. The foot corrector is wonderful for targeting the arches of the foot along with exercises like Footwork toes wrapped, Stomach Massage (great for pregnancy with a ball for support behind the back) and just pointing the feet during other exercises. Lolita San Miguel, one of the few alive that was trained by Joseph Pilates, has a whole series of foot work that is fantastic for pregnant clients as well as the general population. Swelling of the feet can also cause the feet to “grow” wider and demand larger or more open shoes. Elevating the feet and working on increased circulation (Pilates) is great for managing or preventing edema which causes the wider feet.