Pilates and Exercise Instructors always have mixed feelings when working with pregnant women. It can be a love, hate, OMG she said what (!!)  kind of situation.  But working with pregnant women doesn’t have to a stress. It can be a very rewarding addition to your client base.

Yummy Mummy Syndrome is pushing more mums to “keep in shape” with flatter abs for longer in their pregnancy. More celebrities are posting skinny milinkey photographs on their instagrams and twitter posts. Giving the general public a false idealised image of pregnancy. So, unless you have a posterior uterus, (where the womb is tilted backwards and the baby likely to grow up towards your spine) it’s very normal and healthy to have a bump. As instructors we have certain degree of responsibility to help our client with the changes that pregnancy brings for both her and the baby. The baby needs space to move around and flat abs inhibit that. Don’t be a slave to fitness trends.

All clear ahead!! The pregnant body changes on a daily basis and it’s our duty of care to check the all clear to exercise. In your capacity as a Pilates teacher you don’t know your client’s gynaecological history. She may have had a few miscarriages before she conceived. This puts her in a higher risk category. She may have had IVF to conceive, which is quite a large stress on the body. She may even have an underlying pathology, such as a thyroid problem and pregnancy can affect her medication. Therefore, the moment you find out she is pregnant, modify her programme accordingly and check she has the all clear by her midwife, GP or Obstetrician.

PARQ here. Pregnancy changes a woman’s body every day. As well as doing a verbal screening at every class, keep your files updated with a pregnancy PARQ.  The PARmed-X for Pregnancy is a four page guidelines for health screening which your client can complete prior to participation in exercise.  It’s very comprehensive and covers some key areas like absolute and relative contraindications. It’s free just Google it.

It’s a good idea to e mail your client the PARQ in advance and ask them to contact you if there is anything they would like to discuss with you before class. Otherwise, keep a few spare copies with your teaching admin so you can whip one out just as she announces she is pregnant,  in the middle of doing 100’s ( true story). That way you are fully prepared and fully informed and can feel more confident about your teaching.

Who’s in charge here? A key question to ask your client is “Who is the main health care professional who cares for her?”  Midwifery led care means she is likely to be a low risk pregnancy but a woman under consultant led care has certain factors that you will need to take into consideration. Always get the all clear from her consultant and be advised by them before starting her programme. It’s professional.

Yikes it’s the 5 minute rule!! Several years ago there was an “exercise rule” that you could not lie supine in pregnancy for more than five minutes. An urban myth was built. Currently, we do not lie a pregnant woman on her back at all after 16 week, ever. Surprisingly, I hear teachers who still say its “safe” and “I did it so you will be fine.” Regardless of whether they will be fine or not, you are breaking best practice by choosing not to follow the guideline. At the end of the day, we are not medical professionals with full access to her history or previous births. There can be previous conditions we know nothing about. So keep it safe and avoid the risk of supine hypotensive syndrome.

Isometrics anyone? There are significant changes to the heart, lungs and circulatory system during pregnancy. Isometric exercise raises blood pressure.  A couple of studies performed on fit, healthy women to discover the effect of isometric exercise, found that blood volume returned to normal afterwards. However, one study used isometric hand grips and the other study didn’t state what method was used.

In Pilates we use high load, high intensity, isometric exercises which also specifically load the abdominal corset. Jospeh Pilates used to encourage these exercises to wring the toxins out of the intestines and detox. Intensive abdominal isometric loading is challenging both the compromised abdominal platform and blood pressure. Furthermore, the abdominals are trying to stretch during pregnancy, to help the baby get into a good position for birth.

At the time of writing this article I have found no studies that involve isometrics in pregnancy with the full repertoire of Pilates exercise. So protect the pelvis and ask yourself do we really want to be wringing our babies.

Attention soldier ! Safeguard the pelvis!  In the first part of pregnancy the baby is growing in the uterus inside the pelvis. Halfway through the second trimester, the baby goes through a rapid growth spurt. The uterus moves out of being a pelvic organ into an abdominal organ. It’s the only organ in the body that does this. This creates significant changes in the tensility and strength of the abdominal wall.

There will be also be changes in her centre of gravity (if they haven’t already happened) and the forces coming into the lumbar spine and pelvis change. You may even see a bigger shift into an excessive lordosis. Throughout the whole of the pregnancy the pelvic joint soften in preparation for birth. There is an increase of relaxin which affects the ligaments, muscles and the 3D matrix of the myofascial tissue. Avoid loading this area with long lever exercises and loading the lumbar.

Watch out for pain in the lower abdomen, pelvis and groin area as these can be signs of pelvic girdle pain or SIJ dysfunction. If your client is showing these flags always refer to a health care professional who is a specialist in this area e.g. an obstetric physio.

Let’s get connected.Transitions moving from position to position is the norm in our classes but we need to consider the changes in blood pressure for pregnant. Consider good body mechanics, her alignment and joint congruency when you move between the exercises. Give her time to think about the transition of her movement in relation to the changes in her pelvis. It’s a perfect opportunity to introduce breath exercises and give her a few moments of R and R. Or to talk about getting in and out of bed safely and effectively to maximise her movement and care for her back and pelvis.

Signpost. Find the other health care professionals in your area who specialise in pregnancy and postnatal care. Good client care and liaison with others is a great way to get known and take care of your client.

To stretch or not to stretch. As we have already discussed the hormonal system changes the elasticity of the body so we need to consider that. Avoid ballistic and progressive stretching, especially where there is force going through joint and the woman is stretching beyond a range that is normal for her. The effects of over stretching aren’t always immediately seen and can cause instability around the joints which become apparent in postnatal life or in subsequent pregnancies. Stretches should be simple and relative to her. Unilateral stretches in the hip flexors and hamstrings should be carefully considered and monitored. There should be an emphasis on safe technique, supporting bump and keeping in a safe range of movement. If in doubt, leave it out.

Finally….a word to the wise… if working with pregnant women isn’t your thing then don’t do it! Find the people in your area who do and refer them on. It shows great self – reflection and recognition of your skill set. Your client will thank you for it and you can build a stronger community of teachers in your area who begin to recognise the areas of expertise. That particular teacher may dislike working with scoliosis which happens to be your thing and so a more supportive and professional community can be created. Let’s work together and create consistent support for our clients and our business!! Let’s succeed!!

Rachel Rafiefar