$Unique_ID{PAR00419} $Pretitle{} $Title{Pregnancy: The Second Trimester: For You and Your Baby} $Subtitle{} $Author{ Editors of Consumer Guide Ellis, Jeffrey W Ellis, Maria} $Subject{Second Trimester Exercise exercises Activity muscle tone strength weight posture circulation discomfort discomforts fit fitness First-Time Exerciser exercising swim swimming walk walking Caution Cautions eating water nutrition overheat overheating overheated overexertion nausea vomiting headache light-headed light-headedness dizzy dizziness breath shortness chest tightness perspiration strain jumping hopping skipping bouncing Clothing clothes bra shoes Aerobic Workout Routine warm-up cool-down Stretches stretching} $Log{ Calf Stretch: Step 2*0041901.tif Deep Calf and Tendon Stretch: Step 3*0041902.tif Back, Calf, and Hamstring Stretch: Step 2*0041903.tif Pelvic Tilt: Step 1*0041904.tif Pelvic Tilt: Step 2*0041905.tif Leg Raising: Step 3*0041906.tif Curl-Up: Step 2*0041907.tif Bridging: Step 2*0041908.tif} Miracle of Birth The Second Trimester: For You and Your Baby Safe Exercise and Activity Proper exercise during pregnancy can provide you with a host of benefits. It can improve your muscle tone and strength, which will help you adjust to your increasing weight and changing posture. It can help improve the circulation of blood in your arms and legs and help you deal with some of the minor discomforts of pregnancy. It can prepare your body for labor and delivery by increasing your flexibility and strength. It can improve your self-image and sense of well-being. And it can make getting back into shape after delivery easier. Fortunately, you don't have to train like an Olympic athlete to achieve these benefits. Rather, you can choose and follow a regular pattern of exercise and activity that suits both your pregnancy and your lifestyle. Where to Begin Becoming physically fit and maintaining that fitness during pregnancy requires engaging regularly in safe, moderate, and sustained exercise. Of course, pregnancy is not the time to embark on a rigorous new sport or engage in strenuous workouts. On the other hand, even if you have never exercised regularly before, you can safely begin a workout program during pregnancy (see the Exercising Caution section for exceptions). The First-Time Exerciser Women who have not exercised regularly before pregnancy are encouraged to begin a program of moderate exercise as soon as possible. If you're beginning your program late in your pregnancy, however, you may need to choose your activity more carefully and start out more slowly because of alterations that may have already taken place in your ligaments and muscles. Discuss with your doctor the appropriate type of exercise for each stage of pregnancy. The safest and most productive activities during pregnancy, especially for the woman exercising for the first time, are swimming and brisk walking. They are best because they can usually be continued until almost the day of delivery and because they carry little risk of injury that would harm the pregnancy or prevent further exercising. All you need before beginning is a sound program, appropriate clothing, and a health clearance from your doctor. Continuing Your Current Program Women who were engaged in an exercise program before pregnancy are usually encouraged to continue during pregnancy, as long as the activity does not involve much risk of falls or other injuries. In general, sports that carry a high risk of falling or getting hit--for example, skiing, skating, horseback riding, basketball--are not recommended. Discuss your current exercise plan with your doctor; she will tell you if there are any restrictions that she wants to place on your activities. You may find that you need to modify or slow the pace of your usual exercise program due to fatigue in early pregnancy or due to added weight and the normal softening of joint ligaments in late pregnancy. Your body is your best guide and usually responds with pain or fatigue if an activity becomes inappropriate. Exercising Caution No single exercise program is suitable for all pregnant women. In some cases, exercise will be modified or even prohibited if the woman has certain medical conditions, complications with the current pregnancy, or a history of complications with a previous pregnancy. It is particularly important that you not begin exercising without your doctor's approval if: - You have any type of heart or lung condition. - You have diabetes that developed before or during pregnancy. - You have high blood pressure. - You have a history of premature labor. - Your placenta is implanted completely over or near your cervix (placenta previa). - You have physical impairments or diseases of the muscles or bones. - You have had more than three miscarriages. - You have experienced cramping, spotting, or bleeding during this pregnancy. - You are carrying more than one baby. Should any of these conditions apply to you, consult your doctor and follow her guidelines. Guidelines for Safe Exercise In addition to your doctor's advice, the following general guidelines can help make exercise during pregnancy safe and enjoyable. Exercise regularly. Plan ahead and give yourself specific times during the day to dedicate to exercise. You can't make up for lost time, so don't push yourself too hard to catch up. Instead, make exercise a habit from the start. Stop if you feel pain. Modify your exercise program if necessary or substitute other forms of exercise. If pain persists or is severe, check with your doctor immediately. Finish eating at least one hour before exercising. Exercising too soon after a meal can cause burping and abdominal discomfort. Drink water before, during, and after a workout. You will need to keep adequate amounts of fluids in your body to prevent fatigue. Also, during pregnancy you maybe more likely to faint if you are dehydrated. Exactly how much fluid you will need depends on the climate you are in and the type of exercise you are doing. In general, you will need to drink at least one extra glass of water for every hour that you exercise. Maintain adequate nutrition. When you are pregnant, you are advised to add 300 extra calories to your daily diet. If you exercise in addition to performing your everyday activities during pregnancy, you will need even more. In general, you may need as many as 150 to 300 additional calories for each hour that you exercise. Don't get overheated. Avoid exercising in a hot room and avoid exercising outdoors if the temperature is above 90 degrees Fahrenheit. Stop exercising if you develop symptoms of overexertion. These include nausea, vomiting, headache, light-headedness, dizziness, extreme shortness of breath, tightness in the chest, and extreme perspiration. If any of these symptoms occurs, stop exercising immediately and call your doctor. Exercise gently and respect your body. Always warm up slowly and avoid strain (see Your Workout Routine). Limit the amount of time that you spend lying flat on your back. In this position, the heavy uterus is pressing down on the major blood vessels within your abdomen that return blood to your heart. Avoid exercises and activities that require you to lie on your back for more than five minutes at a time, especially during the third trimester. Avoid exercises that put a strain on your lower back, hips, or pelvic joints. Among the exercises to avoid are double leg raises, full sit-ups, and any exercise that requires you to arch your back inward. Sit up and lie down slowly. This is important in order to avoid straining your back. When raising or lowering your body, roll over to one side and use your arms and legs to do the work. Avoid exercises and dance movements that require good balance and quick moves. Your changing size and shape will make such refined movements difficult and will increase your chance of falling. Avoid jumping, hopping, skipping, and bouncing. Bouncing while stretching does not effectively condition muscles and can lead to back injury. Exercises that involve a lot of jumping, hopping, and skipping put a strain on the joints and increase the likelihood of falls. Avoid raising both legs off the floor at the same time. This, too, may strain the lower back muscles. Exercise on a supportive surface. Avoid lying on flat, hard surfaces. To better cushion your body, always exercise on either grass, carpet, or a foam mat. Do not remain at peak exercise capacity for longer than 15 minutes without being supervised. It is not advisable for your heart rate to exceed about 120 beats per minute for long periods of time. Check with your doctor before starting any exercise program. Your doctor can advise you about the type, intensity, and duration of exercise that is appropriate at various stages of pregnancy. Have fun when you exercise. A well-planned exercise program should be enjoyable and should promote a sense of well-being. Exercise at a pace that is comfortable for you. Clothing When you exercise, it is also important that you wear appropriate clothing, not only for comfort, but also for safety. The following are general guidelines. Wear loose-fitting, comfortable clothes that allow perspiration to evaporate. Comfort is more important than glamour. Wear a good support bra while exercising. In pregnancy, your breasts are larger, and the supporting tissues may be somewhat relaxed due to hormonal influences. For exercising, an adequate bra should provide firm support and limit bouncing. It should be sturdy and nonchafing and should fit well, especially around the edges of the breasts beneath the arms. "Sports bras" that meet all of these requirements are available in large sporting-goods and department stores. If your breasts are very large and heavy, wear two bras for extra support and comfort during your workout. Wearing a nursing/maternity bra beneath a sports bra (or vice versa if that's more comfortable) works very nicely to minimize bouncing and increase comfort. Wear good shoes. Walking and aerobic dancing involve contact with relatively hard surfaces. Proper shoes provide protection, support, cushioning, traction, and flexibility. What you will need is a good pair of walking shoes or aerobic shoes with adequate arch supports, heel cushioning, and lateral (side) support. They're generally available in sporting-goods stores. Prenatal Exercises Exercises that you perform during pregnancy can be conveniently divided into prenatal exercises, which are intended to maintain general physical fitness and well-being, and childbirth exercises, which are intended to provide you with strength, coordination, and control of the muscles that you will use during labor and delivery. When choosing a prenatal exercise program to build and maintain physical fitness, you'll want to find an activity that provides your body with a good aerobic workout. What's an Aerobic Exercise? An activity or exercise is aerobic if it creates an increased need for oxygen over a sustained period. In other words, it should make your heart work harder and make you breathe more deeply and rapidly than usual over an extended period of time. Examples of aerobic exercise include lap swimming, brisk walking, jogging, biking, rowing, dancing, and cross-country skiing. Benefits of Aerobic Exercise Engaging in regular aerobic exercise during pregnancy can provide a variety of health benefits. Aerobic exercise can: - Strengthen and tone the walls of your blood vessels, which enhances circulation. - Increase your lung capacity, providing more oxygen for the uterus, the placenta, and the baby. - Increase your stamina and endurance, enabling you to do more without tiring as quickly. This will be especially important to you during the strenuous process of labor and delivery. - Help make recovery after delivery easier, since physically fit women generally recover more quickly. Choosing a Safe Aerobic Exercise Many popular recreational activities qualify not only as good aerobic workouts but also as safe prenatal exercise. For example, lap swimming is one of the best activities that pregnant women can do to safely develop strength, coordination, and aerobic fitness. It's also easy on the joints. All of the standard strokes are safe to use. If you decide to swim for exercise, always remember to swim in an uncrowded area to avoid being kicked or bumped. Brisk walking, too, provides excellent exercise for the pregnant woman. You'll need to choose an area where you are unlikely to trip and fall and where you will not have to overexert yourself on steep hills. You'll also need to walk at a pace that's quick enough to get your heart pumping faster without being uncomfortable. A good guide to follow is the "talk test." You should be moving at a pace that makes you breathe more rapidly, but you should still be able to hold a conversation as you walk. If you can't, slow down. Discuss with your doctor the pace and duration of exercise that's right for you at each stage of pregnancy. If you jogged before pregnancy, you may be able to continue, but you should limit yourself to less than two miles a day. It's best to discuss this with your doctor. If you were not an active jogger before pregnancy, now is not the time to take up the sport. You may also be able to find a specially designed prenatal aerobics class in your area. Aerobics, however, are not recommended during pregnancy except under a supervised program that has been approved by your doctor. Your Workout Routine No matter which aerobic activity you choose for maintaining your physical fitness during pregnancy, each of your workouts or exercise sessions should consist of three parts: a warm-up period, an aerobic workout, and a cool-down period. The warm-up. No aerobic workout should be started with a "cold" body. Warm-up moves tell your body that more vigorous activity is coming and help prevent injury by releasing muscle tension and making the body more flexible. Spend at least five to ten minutes stretching and limbering up before each workout. (You'll find three simple stretches in the section that follows.) Stretch just to the point of mild tension (not pain) and then hold the stretch for a slow count of ten. Don't bounce; it will only make your muscles tighter. Release and repeat each stretch three times in all. Concentrate your stretching mainly on the lower body (legs, ankles, hips, knees), but don't completely neglect the upper body (arms, shoulders, neck). Once you've stretched adequately, spend five more minutes moving slowly (for example, walk slowly or do a few leisurely strokes in the pool) before increasing your pace. The aerobic workout. Before beginning your aerobic exercise program, ask your doctor about an acceptable heart rate that can be sustained during your workouts. Once you have stretched your muscles and warmed up your body for your workout, you can gradually increase your pace until you've reached the target heart rate recommended by your doctor. Spend 12 to 15 minutes exercising at this level. The cool-down. Once you complete your workout, slowdown your activity gradually over a five-minute period. Stretch again for five to ten minutes. Stretches to Get You Started Here are three stretches that you can use to limber up the muscles in your back and legs. They're especially useful to do as part of the warm-up and cool-down for your aerobic workout. Hold each stretch for ten seconds. Calf Stretch 1. Face a wall. Stand a short distance from the wall and rest your forearms on the wall. Place your forehead on the backs of your hands and keep your back straight. 2. Bend one knee and bring it toward the wall. Keep the back leg straight and the back foot flat on the floor. 3. Create an easy feeling of stretch in your calf muscle, hold for ten seconds, then release. Deep Calf and Achilles Tendon Stretch 1. Start in the same position described in the first step of the Calf Stretch. 2. Bend one knee and bring it toward the wall. 3. Lower your hips as you bend your other knee slightly. Be sure to keep your back straight and your feet flat on the floor. Your back foot should point either straight ahead or slightly inward during the stretch. 4. Hold this stretch for ten seconds, then release. Back, Calf, and Hamstring Stretch 1. Sit on the floor with one leg stretched straight out in front of you; the back of the knee should be flat on the floor. Rest the other leg on the floor with the knee bent and out to the side. 2. Stretch easily, then lean forward from the hips to increase the stretch. 3. Hold for ten seconds, then release. Childbirth Exercises In addition to participating in regular prenatal aerobic exercise, you can also engage in exercises designed specifically to prepare your body for labor and delivery. These so-called childbirth exercises, when performed regularly throughout pregnancy, can help you strengthen your abdominal muscles, improve your coordination and flexibility, and relax the muscles that are important in both labor and delivery. Pelvic Tilt The purpose of this exercise is to strengthen the abdominal muscles and stretch the lower back. 1. Get down on your hands and knees on the floor. Your hands should be directly below your shoulders and your legs should be directly below your hips. Be sure to keep your back straight; never let your back sag downward. 2. Exhale as you tighten your abdominal muscles and buttocks and press up with your lower back. 3. Hold this position for three seconds. Inhale and relax. Repeat five times. Variation 1. Lie on your back with your knees bent and your feet flat on the floor. 2. Exhale as you tilt your pelvis back by pulling in your abdomen and pushing the lower part of your back against the floor. 3. Hold this position for a slow count of six. Then inhale and relax, allowing your back to return to the resting position. Repeat this ten times. Leg Raising The purpose of this exercise is to increase abdominal and leg strength and coordinate breathing with muscular activity. 1. Lie on your back, then bend one knee and place your foot flat on the floor. Keep your other leg straight. 2. Exhale as you push the lower part of your back against the floor and pull in your abdomen (as in the variation of the Pelvic Tilt). 3. Inhale and raise your straight leg up toward the ceiling; do not point your toes. 4. Lower your leg slowly while exhaling through your mouth. Make certain that you maintain the pelvic tilt throughout the entire exercise. Repeat the exercise raising the opposite leg. Repeat five times for each leg. Curl-Up The purpose of this exercise is to strengthen your abdomen. 1. Lie on your back with your pelvis tilted, your knees bent, and your feet flat on the floor. 2. Stretch your hands toward your knees and raise your head and shoulders off the floor as you breathe out through your mouth. 3. Slowly relax, breathe in, and resume your starting position. Repeat five times. Bridging The purpose of this exercise is to strengthen your hip muscles and maintain flexibility. 1. Lie on your back with your knees bent and your feet flat on the floor. 2. Lift your hips off the floor while keeping your back straight. 3. Hold for three seconds, then relax and resume your starting position. Repeat five times. Pelvic Floor Contraction (Kegel Exercise) During pregnancy, the weight of the baby and the uterus strains the muscles of the pelvis. Furthermore, during delivery, these muscles are stretched even more as the baby passes into the vagina. Since these same muscles are important for keeping your bladder and reproductive organs in their proper positions, specific exercises should be performed during pregnancy to preserve their strength and tone. These exercises will also increase your awareness of your pelvic muscles so that you can consciously relax them during delivery of the baby. 1. Sit, stand, or lie down comfortably. 2. Think about your vagina and anal area and tighten these muscles in the same way that you would to stop urination midstream. 3. Hold as tightly as possible for a slow count of five while breathing normally. Relax completely, then repeat. Once you have an awareness of these muscles, Kegel exercises can be done anytime and anywhere. You should try to do at least a few repetitions every day throughout pregnancy.