Antenatal Exercises

• Preventing and alleviating the early physical

stresses of pregnancy and childbirth, should
be taught as a priority,
• Common consequences of pregnancy and
child birth are the physical problems of pelvic
girdle and low back pain or incontinence.
 Purposes of antenatal exercise
• Antenatal exercise aims at preventing low
back pain and enhancing physical and
psychological preparation for delivery by
means of joint stretching and muscle
strengthening.
 Guidelines for antenatal exercise

• Breathe smoothly, work gradually according

to capability
• Work twice or thrice a day and repeat each
set of movements ten times in every session
• Antenatal exercise may begin when
pregnancy reaches 16 to 20 weeks
• Physiotherapist may make modifications to
the exercise according to physical conditions
• Always wear loose fitting clothes or clothes
that you are comfortable in.
• Drink lots of water before and after exercising
• Stop immediately if you experience pain while
working out
• Always avoid overdoing exercise
• Keep moving, Standing motionless at a spot
may decrease the blood flow and may make
you feel dizzy
 Various Benefits Of Antenatal Exercises:

• It improves the circulation in both mother and child

• It helps reduces pains experienced during pregnancy
like cramps and back ache
• It improves stamina and helps increase energy to meet
the growing demands of the body
• It helps you to control weight gain
• It also reduces stiffness in muscles, swellings, aches
and pains
• It increases circulation and thus decreases swelling of
varicose veins
• It is good for overall wellbeing of mother and child
 Contra indications
• Cardiovascular, respiratory, renal or thyroid
disease.
• Poorly controlled type 1 diabetes
• Risk of premature labour,
• Cervical incompetence,
• Risk of IUGR and premature labour reduce
activity after 12 weeks
• Placenta previa
• Sudden swelling of ankles, hands or face.
 Warnings
• Abdominal pain
• Leakage of amniotic fluid
• Pelvic girdle pain may lead to difficulty in
walking
• Vaginal bleeding
• Shortness of breath, faintness, tachycardia
• Calf pain
• Reduced fetal movements
 Position for Antenatal Exercises
 The position that pregnant women adopt for exercises should
be carefully considered .
 Women should not be asked to lie flat in the later second and
third trimesters because of the danger of supine hypotension.
 Supine hypotensive syndrome is characrerised by pallor,
tachycardia, sweating, nausea, hypotension and dizziness and
occurs when a pregnant woman lies on her back and resolves
when she turned on her side. The aorta and inferior venacava
are central vessels, the largest artery and vein.
 Instead, a half- lying position with the back raised to an angle
of approximately 35 degree can be used.
 Types of antenatal exercise

• (1) Pelvic floor exercise

• • Don’t hold breath.
• • Don’t clench buttocks.
• Tighten back passage as if you were trying to
stop passing wind. Now tighten the muscles
would use to stop a flow of urine.
• Do both together and should feel back passage,
vagina and front passage all lift and close at the
same time, exercise while standing, sitting or lying
down.
 Strengthen your pelvic floor muscles during pregnancy

The floor of your pelvis is formed by very

elastic muscles which act like a small
trampoline to support your baby during
pregnancy. These muscles may become weak
leading to a leakage of urine when you cough
or sneeze. Many women have this problem
during pregnancy. Exercise now to strengthen
your pelvic floor, do at least 80 exercises each
day.
 Each day you need to do:

• Slow exercises – tighten, hold (aim for up to 10 seconds) and

relax.
• Fast exercises – tighten and relax quickly. Repeat up to 10
times.
• How often? – Always do a mixture of fast and slow exercises
after you have emptied your bladder. Make this a lifetime
habit.
• Protect your pelvic floor: Make a habit now of always pulling
up pelvic floor before lift, carry, push or pull light to
moderate weights.
• Lift and squeeze as you cough or sneeze.
 (2) Back and abdominal exercise
• Abdominal muscles – ‘Nature’s perfect corset’
• 4 pairs of muscles arranged in 4 layers – it is only
possible to show 2 layers in the diagram: the Rectus
and Transvers muscles.
• The Rectus muscles run vertically up and down the
centre of tummy.
• The Transvers muscles are the deepest horizontal
muscles encircling your waist.
• The Oblique muscles crisscross diagonally on sides.
• These muscles work together to hold your spine firm,
tilt your pelvis upward and to pull your tummy in tight.
These muscles bend and twist spine.
• During pregnancy tummy muscles will soften,
separate and lengthen to accommodate growing
baby. This is a natural change due to pregnancy
hormones circulating in body. The gap (linea alba)
will gradually close after birth.
• Need to do tummy exercises to prevent over-
stretching and encourage closure of the separation
after birth.
• Weight gain in pregnancy
• Excessive weight gain results in storage of fat which
is hard to lose after the birth.
• Sit on a chair with back against the seatback
• ﹣ Breathe naturally
• ﹣ Tighten the abdomen and then press the pelvis
downwards to flatten low back against the
• seatback. Hold for 5 seconds, and relax this exercise
helps by correcting the low back and pelvic posture.
• It strengthens your abdominal muscles and prevents
back pain.
• Note: Practise good posture in daily activities
 (3) Ankle exercise

• ﹣ Sit on a chair with back against the seatback

• ﹣ Start with one ankle and turn the foot upwards and
downwards. Each up-and-down movement is counted
as one time. Repeat ten times
• ﹣ Rotate the ankle to draw an inward or outward circle.
Each circular movement is counted as one time.
Repeat ten times
• ﹣ Repeat the same steps at the other ankle
• ﹣ Ankle exercise helps reduce leg swelling and varicose
vein, thus alleviating the problem of leg cramps.
 Exercises to prevent backache
• Bad posture, stretched tummy muscles and
a growing baby can lead to backache during
pregnancy. Overstretched tummy muscles can
contribute to back pain and constipation.
Good posture
• Stand tall
• Bottom tucked in
• Tummy in - always
• Relaxed knees
• Pelvic floor up
 Standing

• For good standing posture, the centre of the

head, shoulders and hips should fall in a line
when viewed from the side. Standing tall,
with shoulders relaxed, tummy gently drawn
in and bottom tucked under, knees straight
but not locked, and weight evenly distributed
on both feet is advised.
 lying
• Sleep is a very valuable commodity during pregnancy and
health professionals can advise and help women to find a
comfortable position.
• Most women will choose to lie on their side to sleep.
Side-lying with pillows under the top forearm and knee is
usually a comfortable position, and a small pillow under
her waist supporting the increasing weight of her abdomen
will help to maintain lumbar spine and pelvic girdle.
 Sittting
• The pregnant mother should choose a
comfortable chair, which supports both her
back and thighs.
• She should sit well back and if necessary place
a small cushion or folded towel behind the
lumbar spine for additional comfort.
• Equal weight should be placed on each of
buttocks to prevent strain on the pelvic
ligaments
 Lifting and carrying
• Lifting heavy should be avoided during
pregnancy if at all possible. Twisting or bending
while lifting is a particularly high-risk activity.
• working activities
Women should be encouraged to make sure their
seating and workstation is suitable, particularly is
sitting for any long time. Regular changes positions
is beneficial. In case of constant standing she
should ensure she sits at regular break times and be
very careful if her work involves lifting or great
physical effort.
 These exercises can be done when kneeling, sitting or standing.

• 1 Transversus Abdominus - ‘Nature’s belt’

• Sit comfortably or kneel on all fours with a level
spine.
• Breathe in and out, then gently pull in the lower
part of the abdomen below the umbilicus
keeping the spine still and breathing normally .
• Hold for up to 10 seconds then relax gently,
repeat up to 10 times.
• 2 Pelvic Tilting or rocking
• Do this in a half- lying position, well supported
with pillows, knees bent and feet flat.
• Place one hand under the small of the back and
the other on top of the abdomen.
• Tighten the abdominals and buttocks, and press
the small of the back down on to the
underneath hand.
• Breathe normally, hold for up to 10 seconds
then relax. Repeat up to 10 times. Pelvic tilting
can also be performed sitting , standing or
kneeling.
 (3) Lower limbs relaxation exercise
• ﹣ This exercise enhances the flexibility and strength
of inner thighs and pelvic muscles. It helps mother
to get accustomed to the delivery position and
prevent thigh spasm during delivery
• ﹣ Sit on a stable low chair against a wall and spread
your thighs sideways. Hold for 5 seconds and relax
• Note: 1. It is suitable for pregnant women with
tight thighs
• 2. Do not pull apart the thighs
• 3. Please note that this exercise is not suitable for
those with pain over the pubic bones
 (5) Breathing exercise

• ﹣ Breathing techniques for pain relief

during labour. Exhale before inhale is
• suggested
• A. Abdominal breathing
• ﹣ Suitable for mild pain
• ﹣ Breathe in through the nose and feel
the abdomen expand. Then breathe
out through the mouth.
• B. Lower costal breathing
• ﹣ Suitable for medium pain
• ﹣ Put your hands on the lower
rib cage.
• Breathe in through the nose and feel
your chest expand. Then breathe out
lightly through the mouth
• C. Apical breathing
• ﹣ Suitable for severe pain
• ﹣ Cross your hands below the
• clavicles with your mouth slightly
open. Breathe in through the
nose and the mouth. Breathe
out lightly as if trying to flicker the
flame of a candle without blowing
it out, and feel the upper lungs
moving slightly up and down
During contractions, try to relax
and control your breathing
In between contractions, rest
and relax as much as you can in
the most comfortable position
 Simple ways of caring for your body
• DO
• • Rest as often as you can with your feet up
slightly higher than the level of your hips.
• • To get out of bed, draw tummy in, keep knees
together, roll on your side and push up on arms.
• • Take some exercise every day.
• Walk briskly for 20-30 minutes, if able. Swimming is
a very good
• exercise - swim at a comfortable pace. Stop and
rest often. Leave the pool after 20 minutes.
• DON’T
• • Do not stand still or sit for long periods.
• • Do not stoop. When lifting, should
• bend knees, keep back straight and pull up
pelvic floor as you take the weight of the object.
• • Do not lift or carry heavy weights.
• Toddlers can be too heavy to carry
• - encourage them to be independent.
 Stress, tension and relaxation
• Some people feel extremely tired, others develop aches and
pains which are not due to specific illness, but are related to
tension. Tension causes an increase in blood pressure,
• heart rate and rate of breathing which can lead to feelings of
panic as well as overloading the systems of the body. Knowing
how to prevent tension is a valuable skill which everyone
could use when life is more challenging than usual.
• Learning a relaxation technique and using it regularly has
been shown to reduce mildly increased blood pressure.
Women who learn and use it in labour generally cope better
with pain and feel more in control. During pregnancy,
practicing relaxation will help you to rest more effectively and
can also help you to get to sleep again if you wake during the
night.
 Planning a scheme of Relaxation

• Mother can relax in either a sitting or lying

position. Using a pillow, make sure head is
supported as well as your arms and legs.
• To be effective, relaxation must be practiced
regularly, and it is important.
 Squatting exercise
• The exercise stretches the perineal muscles.
• The mother must squat and keep her feet flat
on the floor. Do this 15 minutes per day.
 Tailor sitting
• This exercise stretches the perineal muscles and strengthens
the thigh muscles.
• A) sit flat on the floor with legs out stretched,
knees are gently pushed to the floor untill
the perineal muscles begin to strech.
• B). Hold this position for increased
amounts of time each time performed.
• Walking
• Walking is a good cardiovascular exercise and is
one of the best exercises for pregnant women as
this does not put much pressure on knees and
ankles. You can walk all through nine months and
it fits into your schedule easily.
• Jogging
• Running or jogging is the quickest exercise to work
up your body and heart. A 15 minute jog is also a
good exercise and depending on mother schedule
can extend run to 30 minutes also.
• Swimming
• It is considered as the safest exercise for pregnant
women by many fitness experts. It concentrates on
large muscle groups like arms and legs and is a good
cardio exercise. It also makes pregnant women feel
weightless even with the added extra weight.
• Yoga
• With all those postures and stretching, yoga helps you
to maintain muscle tone and makes your body
flexible. However, keep in mind not to overdo
stretching and don’t hold the postures for longer
duration as it is not healthy.