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Certified Perinatal Fitness Instructor ©2010 Healthy Moms®, Sheila S. Watkins www.HealthyMomsFitness.com

WBF Prenatal & Postpartum Training Guide: Our 3 Main Goals of Exercise & Pregnancy

1) Maintain highest level of fitness
2) Prevent physical stress
3) Prevent excessive weight gain Click here to read more

» Click here to read more.

Pregnancy + Exercise = Healthy Baby!

An increasing number of women are hiring personal trainers to help keep them fit and healthy before, during and after their pregnancy…and Whole Body Fitness welcomes all new moms! Our fitness team works hard to continually gain knowledge in specific fitness industry fields so that their clients benefit from the most up-to-date information!

All Whole Body Fitness Trainers have completed the

Healthy Moms® Advanced Perinatal Fitness Instructor Training
Project Pregnancy: Pre-conceptual Planning and Care
Training for the Main Event: Pregnancy and Exercise
Postpartum: Returning to Your Fitness Goals

Healthy Moms is an industry leader in perinatal fitness education, training, and certification for fitness and health professionals who care for women throughout the childbearing year since 1987.

» Click here to read more about our training courses.

Prenatal & Postpartum Services:

Suggested One-on-One Package Specials (Lisa Dougherty, Master Trainer)

Payments due at time of service. Discounts apply only to packages paid in advance.

Above discounted rates are based on 60-minute private session rate of $95.00 with Master Level Trainer.

Suggested One-on-One Package Specials (Robin Rutherford, Elite Trainer)

Payments due at time of service. Discounts apply only to packages paid in advance.

Above discounted rates are based on 60-minute private session rate of $85.00 with an Elite Level Trainer.

Suggested One-on-One Package Specials (TBD, Professional Trainer)

Payments due at time of service. Discounts apply only to packages paid in advance.

Above discounted rates are based on 60-minute private session rate of $75.00 with an Professional Level Trainer.

Important Notes:

• All new pre- and postnatal clients must obtain a medical release from their doctor provided by Whole Body Fitness before participation in an exercise program with Whole Body Fitness.
  
  
• A Polar Fitness Heart Rate Monitor is required for training to continuously monitor your heart rate with an alarm function to keep you in a specified zone. It will also track calories burned, exercise time, time in zone and much more! It is a great tool to use after your pregnancy. Please ask us how to get one.

All Pre- and Postnatal training packages include:

• Learn about your lifestyle exercise habits, health history and your fitness goals based on questionnaires that you complete.
  
  
• Produce a realistic and effective "fitness program" that is conceivable and achievable based on your fitness levels.
  
  
• Support and motivation!

Prenatal Packages also include:

• A complimentary copy of Nine Months Strong: Shaping up for Labor and Delivery and the Toughest Physical Day of Your Life. (Lifeline Press 2004)

Postnatal Packages also include:

• Included with the purchase of 16+ sessions is a hydrostatic body fat composition test by FitnessWave with 6-page detailed analysis. Whole Body Fitness will pay for one (1) body fat composition test with FitnessWave per 12 month period either for training or for Lifestyle weight Management Program.
  
  Learn more about FitnessWave and Hydrostatic Weighing.

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Testimonials

» Click here to read letters from our pre- postnatal clients

Perinatal Resources

» Click here for perinatal resources.

WBF Prenatal & Postpartum Training Guide: Our 3 Main Goals of Exercise & Pregnancy

3 Main Goals of Exercise & Pregnancy

1) Maintain highest level of fitness
2) Prevent physical stress
3) Prevent excessive weight gain 2010 Healthy Moms®
Certified Perinatal Fitness Trainers

Exercise recommendations for prenatal women:

• Warm-up – needs to be 10-12 minutes long as pregnant women tend to have less synovial fluid in their joints
  
  
• Cardiovascular Conditioning
  • Frequency – ACOG recommends moderate-intensity physical activity on most, if not all, days of the week
    
  • Intensity – ACOG no longer recommends a maximal heart rate of 140 BPM
    
  • Duration – Individualize according to prior fitness level, stage of pregnancy, etc. ACOG recommends that pregnant women who have been cleared to exercise by their physicians engage in at least 30 minutes or longer of cardiovascular activity in order to see exercise-associated benefits
    
  • Mode – Research has shown that weight-bearing exercise that is regular and sustained is the best type of exercise for pregnant women because it compliments the adaptations to pregnancy
    
    
• Muscular strength and endurance – this type of training strengthens muscles around the “loosened’ joints to help prevent injury, relieve discomforts from postural changes and prepares the body for the “tasks of mothering” (i.e., carrying the baby, car seat, diaper bag, etc.)
  
  • 2-3 times per week, ideally, on non-consecutive days
    
  • Strength training helps avoid muscular strain brought about by the added weight (up to 25-40lb).
    
  • Proper form is the first priority. Incorrect form in pregnant women can quickly lead to injury due to their increased joint laxity and cause unnecessary stress to the body.
    
  • Avoid supine and prone exercises
    
  • Cool down – stretch the muscles that were strengthened during the session.
    
  • Pay special attention to muscles that are “tight” during pregnancy (i.e., low back, hip flexors, etc.)
    
  • Use caution when stretching hip adductor muscles due to potential stress on pubic symphysis.

Anatomical changes of pregnancy:

• Lordosis (“Swayback”) gravity shifts upward & forward, abdominal muscles lengthen & stretch, back extensors & hip flexors shorten this can result in abnormal curvature of the lumbar spine, which is responsible for a large amount of the low back pain experienced by pregnant woman.
  
  Counteractions:
  
  • Strengthen abdominal muscles (rectus abdominus, external & internal obliques & transverse abdominus) these muscles are used during the pushing stage
    
  • Stretching of lower back muscles and hip flexors
    
  • Avoiding hip flexor overuse
    
    
• Kyphosis (Rounding Shoulders) enlarged breasts, shortened pectorals and serratus anterior muscles along with weak upper and mid back muscles. Chin juts forward (cervical lordosis) caused by weak (stretched) cervical flexors and shorted tight cervical extensors due to the stress placed on them by the rounding shoulders.
  
  Counteractions:
  
  • Stretching of pectoral muscles
    
  • Strengthening of trapezius, latissimus dorsi, posterior deltoid and rhomboid muscles to help bring shoulders back into their proper alignment improving posture
    
  • Stretching cervical extensors via the chin tuck
    
  • Strengthening the cervical flexors by applying a small amount of upward resistance while doing the chin tuck.
    
    
• Diastasis Recti (vertical separation of the rectus abdominus). The connective tissue known as the linea alba softens due to the hormones of pregnancy. This soften coupled with the increased pressure from the growing baby make cause the 2 recti to separate around the area of the naval.
  
  Counteractions:
  
  • Pregnant woman should be checked for separation after 20th week or when they begin to show and every 1-2 weeks after initial assessment
    
  • If mom has a separated rectus muscle, she should avoid rotational oblique work as this could encourage further separation. It is necessary to splint the seam
  • by crossing the hands over the lower abdomen while doing abdominal work.
    
    
• Pelvic Floor Laxity – The softening hormones of pregnancy & weight of growing baby, placenta, etc., place an increased workload on the pelvic floor.
  
  Counteractions:
  
  • Perform Kegel pelvic floor exercises for better support of the uterus and other pelvic organs
    
  • Benefits of strengthening the pelvic floor
    
    • Prevention of stress incontinence (i.e., leaking urine) when coughing, sneezing, laughing, and jogging
      
    • Making the muscle more supple allowing for a smoother progression of baby’s head down the birth canal during delivery and a faster return postpartum
      
    • Increased circulation to pelvic floor may decrease the incidence of hemorrhoids and will improve healing of the perineum after an episiotomy
      
    • Prevention of future GYN problems urinary incontinence, painful intercourse, or surgeries to correct a prolapsed (sagging) uterus or bladder
      
      
• Pubic symphysis movement – hormonal softening of the connective tissue along the pubic area can cause a grating or rubbing movement at the pubic symphysis that radiates along the inner thighs. If Mom is experiencing this type of pain:
  
  • Avoid exercises that abduct the thigh and stretch the adductors, such as seated butterfly stretch.
    
  • Avoid single leg weight bearing exercises as they put too much pressure on the weakened and stretched pubic symphysis.
    
    
• Round Ligaments stretching – There are 2 round ligaments that attach from wall of uterus to the labia. During pregnancy these ligaments stretch from approximately 2 to 12 inches at full term in order to support the uterus. Discomfort due to these changes may be described as a “catch” or “pulling” in this area
  
  Counteractions:
  
  • If Mom is symptomatic avoid quick directional changes as it may illicit round ligament pain
    
  • Keep the hip bones in line when doing lateral movements
    
    
• Nerve compression syndrome – fluid retention during pregnancy can cause:
  
  • Carpal tunnel syndrome – compression of median nerve as it runs through the carpal tunnel in the wrist. Symptoms include numbness, tingling and or pain in the thumb, index or middle fingers with thumb weakness possible
    
  • Ulnar nerve compression – manifests itself as numbness, tingling and or pain in the 4th and 5th fingers.
  
  Counteractions:
  
  • Avoid hyperextension of wrists (i.e., floor and wall push-ups, hands and knee exercises, etc.) may aggravate the above symptoms and may need to be modified.
    
  • The “all-fours” (hands and knees) position could be modified for short periods by putting more weight on the knees and placing the knuckles rather than the palms on the floor to keep the wrists straight.
    
  • Mom may also support her upper body with her forearms in a chair or on a ball and her knees on the floor as another alternative to the “all-fours” position

Generally avoid:

• Supine and prone exercises if uncomfortable
  
• Overstretching
  
• Hip abduction more than 45 degrees like the seated butterfly stretch or side lying positions (since connective tissue is softened abduction can cause pain in
• pubic area)
  
• Single leg exercises that can aggravate the pubic symphysis
  
• Quick directional changes like pivots, hops, turns (can cause ligament pain in pubic area)
  
• Hyper extending the wrist like pushups and hands/knee exercises since fluid retention can cause carpal tunnel
  
• Motionless standing

Conditions Healthcare Providers watch for:

• Preeclampsia (dangerous rise in blood pressure & fluid retention) - Rapid swelling in the face or hands. Refer to health care provider for possible preeclampsia
  
• Abdominal separation (diastasis recti) – Checked by having mom in supine position with knees bent, raise head & shoulders off floor while reaching for knees. If more than 1 finger can fit vertically into the gap of the linear alba corrective exercises can be given.

Absolute contradictions to exercise:

• Hemodynamically significant heart disease
  
• Restrictive lung disease
  
• Incompetent cervix/cerclage
  
• Multiple gestation at risk for premature labor
  
• Persistent second or third trimester bleeding
  
• Placenta previa after 26 weeks of gestation
  
• Ruptured membranes
  
• Preeclampsia/pregnancy-induced hypertension

Warning signs to stop exercising:

• Pain of any kind
  
• Cramps or pelvic pressure
  
• Faintness or dizziness
  
• Shortness of breath
  
• Vaginal bleeding
• Rapid heart rate or palpitations
  
• Difficulty walking
  
• Temperature extremes of very hot or cold and clammy
  
• Nausea and/or vomiting
  
• Gush of fluid from the vagina
  
• Marked swelling or fluid retention
  
• Decreased fetal movement

General physiological changes during pregnancy:

• 30-50% increase in blood volume
  
• 40% increase in cardiac output
  
• 15-20% increase in heart stroke volume
  
• Heart enlarges to pump more blood
  
• Increased ability to dissipate heat (thermal adaptation) – heat generated by exercise will not be transferred to the fetus
  
• Decreased blood pressure
  
• Diaphragm is displaced upward by growing uterus, thereby reducing the depth of chest cavity
  
• Exercising throughout early and mid pregnancy increases placenta size and improves function resulting in increased oxygen and other nutrients to the baby.

Postpartum

Postpartum training with Whole Body Fitness

1) We offer clients a progressive exercise program to return them to their pre-pregnancy fitness levels or better!
2) We educate clients to familiarize them with the physical and psychological changes occurring during the postpartum period and their exercise implications
3) We offer individualized programs due to the wide variation in fitness levels and based on their post-partum conditions

Physical changes:

• Total recovery time varies form individual to individual
  
• Mom’s post-delivery body - Mom will look 6 months pregnant after she delivers. Abdominal and pelvic organs must rearrange in order to lose pregnant look
  
• Body Alignment - “S” curve in spine still remains and will need to be corrected through exercise
  
• Uterus - It takes about 6 weeks for the uterus to contract back to its normal size. Mom may experience “after pains”. Breast feeding can also cause a faster return of the uterus to its pre-pregnancy size.
  
• Vaginal bleeding (Lochia) – usually last 2 to 8 weeks. If a Mom’s bleeding returns to bright red after it has started to fade, she has “done too much” with regard to her activity level.
  
• Relaxed Ligaments - It takes approximately 6-16 weeks to see a reversal in the effects of Relaxin and progesterone on Mom’s connective tissue and joints, however in a nursing mom these effects may be present for a lot longer.
  
• Sore Breasts - It is recommended that a Mom nurses her baby before she exercises. She may be more comfortable in a supportive bra (or two). Traditional nursing bras do not provide the support needed during exercise.
  
• Fatigue - It takes a great deal of energy to recover from the stress of labor and delivery. Mom also has a demanding new schedule to deal with.
  
• Hot flashes – due to hormonal fluctuations Mom may experience hot flashes, especially at night. This usually subsides within 6 weeks.
  
• Cardiovascular changes – (i.e., increased heart rate, increased coronary output, etc.) of pregnancy persists for approximately 4 to 6 weeks.
  
• Abdominal muscles – abdominal wall lengthens and stretches a great deal during pregnancy and must be shortened before mom can start traditional strengthening exercises postpartum. These exercises should begin 24 hours after birth. (see handout)
  
• Diastasis recti – Mom should be checked for this separation after the 3rd postpartum day

Other considerations:

• Caesarian birth – leads to “guarded posture” (i.e., shoulders hunched, torso forward, chin to chest, etc.), which can in turn misalign the spine. One of the first tasks of mom is to work on her posture
  
• Moms who have had a vaginal delivery should wait 2-6 weeks before returning to a regular fitness setting
  
• Moms who have had a Caesarian birth minimum time to wait before returning to a regular fitness setting is 6-8 weeks
  
• “True” postpartum depression – interferes with activities of daily living, lingering sadness, feelings of hopelessness and helplessness, insomnia, guilt, appetite changes and anxiety

Emphasize:

• Extra warm up time
  
• Kegels
  
• Pulling in abdominals & belly breathing

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Perinatal Resources

409 12th St., SW Washington, DC 20006 202-638-5577 www.acog.org info@HealthyMomsFitness.com tel. 866-672-MOMS(6667) www.healthymomsfitness.com www.lunabar.com Bassinets & Blueberries 283B E. 17th Street Costa Mesa, California 92627 tel. 949-650-2244

Fit Pregnancy Magazine www.fitpregnancy.com Yoga Center of California 445 East 17th Street, Suite I Costa Mesa, CA 92627 tel. 949-646-8281 info@yogacenter.org www.yogacenter.org www.myorangecountybaby.com

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Testimonials: Regina Keil
September 21, 2007

I have been training with Lisa for three years, before, during and after my pregnancy. I can’t stress enough how much of a difference she’s made. I was fortunate enough to find Lisa through an internet search and stumbled on her website. After meeting and training with Lisa, it was very clear that fitness, health and nutrition is truly her life’s passion. I had worked with trainers off and on for the past 10 years, but never anyone like Lisa. She is the most professional, genuine trainer and person I’ve ever met. It is no wonder why she is such a success both in her personal life and professional career.

Prenatal Experience
While every mother’s experience is different, I had an easy pregnancy for which I attribute to my fitness training and prenatal training with Lisa. I continued my running and strength training exercise according to the heart rate guidelines my doctor wanted me to stay within. Women at the gym would tell me that I was doing the best thing for myself and baby. I had numerous mothers tell me how quick and relatively painless their deliveries were without an epidural. They each attributed it as a direct result of exercising and maintaining good muscle tone throughout their pregnancies. Lisa showed me how to exercise without getting hurt or hurting my baby. Based on feedback she asked for and my heart rate during our sessions, she was able to adjust my workouts according to my level and how many weeks gestation I was at.

Even with all the regular exercise, I still gained a healthy 23 pounds. I trained with Lisa right up until the day before I delivered.

Birth Experience
My labor was a total of 2 hours from my water breaking to delivering my full-term baby boy. While I didn’t plan on going it without an epidural, things progressed so quickly that by the time I made it to the hospital an hour later, it was no longer an option. While waiting for my OB to arrive, the labor nurses couldn’t believe the control I had in blowing through contractions to slow things down while I waited and then pushing through contractions when my doctor finally arrived. I believe this control is a direct result of the modified strength training and breathing technique Lisa emphasized during my personalized prenatal workouts. My OB commented to the nurses that I had exercised throughout my entire pregnancy and that had contributed to how smoothly and quickly things were progressing. I never asked for pain relief because I simply didn’t need it. An hour after delivering, I was able to get off the bed on my own and push my baby to my room. It was such a freeing sensation to be able to move, something I would not have been able to do with an epidural.

Postnatal Training
I was allowed to begin post-natal exercise after 6 weeks although I felt I could’ve started earlier. Lisa had already planned for several areas for me to work on as part of my postnatal reconditioning. She helped me check for abdominal separation, a common postnatal condition, and emphasized the type of abdominal exercise to help close the gap and avoid certain exercises that might exasperate the condition. She emphasized the importance of pelvic floor strengthening and demonstrated neutral spine (proper posture) to counteract the postural changes caused by pregnancy.

After 10 weeks of postnatal training, I was back at my pre-pregnancy weight and under 18% body fat.

If you are contemplating a prenatal fitness plan, consider all the health benefits that come with staying fit during this special time, and consider training with Lisa. She will be the most devoted and committed trainer you will ever train with.

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This website is for educational purposes only.  The information provided should not be used for diagnosing or treating any prenatal health problem.  It is not a substitute for professional care.  Healthy Moms® and Whole Body Fitness does not engage in rendering medical advice and/or make referrals for professional medical services.  If you suspect that there is a health problem, you should consult your personal healthcare provider."

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