Beyond eating well and keeping antenatal appointments, staying active is one of the most important things you can do for your pregnancy. Historically, pregnant women were considered fragile and told to avoid physical activity, but now we know that it comes with mental health benefits and that the right kind of exercise can help you to stay strong, as well as help with back and pelvic pain and a variety of other health issues.

The general exercise recommendation for pregnant women is 150 minutes per week. You’re more likely to stick to exercise you actually enjoy, so if you’re walking or doing some daily activity that you know is safe, stick to it! This article will explore some easy things you can do to prepare for pregnancy physically, as well as inform you about perineal massage, which is a technique to help reduce the risk of having a perineal tear during vaginal delivery.

Is it always beneficial to exercise while pregnant?

Yes, being active and exercising is beneficial throughout pregnancy, in all trimesters. However, this can feel more challenging in the first trimester, when many suffer from nausea and sickness, and in the third trimester, when we feel larger and tired. Though it can feel hard to consider how to manage 20 minutes of activity every day, it is key to know that all activity counts. It doesn’t need to be a traditional workout. Walking, doing yoga, or taking the stairs are all great ways of keeping active.

There are some contraindications to exercising during pregnancy. Please always ask your doctor or midwife about your individual case; the following is general guidance:

You cannot exercise at all if:

Your waters have broken.
You have unexplained persistent vaginal bleeding.
You have a low-lying placenta after 28 weeks.
You have pre-eclampsia or an incompetent cervix.

Intrauterine growth restriction
Uncontrolled hypertension, type 1 diabetes, or thyroid disease.

Any other serious cardiovascular, respiratory, or systemic disorders.

Exercise with caution and medical guidance if:

You experience gestational hypertension.
You have symptomatic anaemia
You have a mild or moderate cardiovascular or any other significant medical issue.
You’ve experienced recurrent pregnancy loss.
You have a history of spontaneous preterm birth.
You may be malnourished in any way.
You have a history of or an active eating disorder.

The most important general principles to follow are:

Don’t do anything that bumps your bump.
In the 3rd trimester, minimize time lying on your back and move out of this position if you become breathless.
Use the ‘talk test’ to gauge the correct effort put into exercise. You should still be able to hold a brief conversation while exercising.

Stop exercising if you experience any of the following:

Vaginal bleeding or leaking fluids
Uterine contractions
Dizziness, headache, or chest pain
Muscle weakness that affects balance
Calf pain or swelling

What sort of exercise can I do in my third trimester?

These gentle exercises are third-trimester-approved, so you can do them at any point in your pregnancy. If you are postpartum, please wait until you are medically advised, or at least six weeks from your birth, to attempt exercise.

Warm-up

It is always important to warm up when we are exercising, especially when pregnant. This might include marching on the spot or going for a walk around the block. This will help prepare your body for the mobility and strengthening exercises you are going to do, as well as be a great way to be active.

Disclaimer: These exercises are general exercises. If you are experiencing back or pelvic pain, then please seek individualised support.

Mobility exercises

Child's pose

Kneeling on a mat, with your knees slightly apart, walk your hands forward.
Allow your bump to rest between your legs.
Sit back onto your heels with your arms stretched out in front of you.
As you rest in this position, gently breathe in and out.
If you have pain in the front of your pelvis, this might not be the best exercise for you.

Thread the needle

Start by coming into a four-point kneeling position on a mat.
Your hips should be above your knees, and your wrists should be under your shoulders.
Take one arm and reach it through the gap created between the opposite arm and leg. The free arm is the thread, and the gap is the eye of the needle you are threading it through.
Reach the free arm all the way through. You can rest it on the floor and hold a stretch before bringing it back through and reaching up towards the ceiling. Allow your head and neck to move around with the free arm.

Seated glute stretch

Sit comfortably on a chair.
Lift one leg up and place the ankle on top of the other leg, just above your knee.
Place one hand on the knee of the leg that is lifted.
Then lean forward from your hips (not rounding the upper back).
Hold for 30 seconds, then swap sides.

Pelvic tilts

Sit tall on the edge of a chair with your feet comfortably placed on the floor.
Tilt your pelvis backwards, then grow back tall.
Repeat this 10 times, slowly and controlled.

Strengthening exercises

Sit to stand.

Stand in front of a chair or sofa.
Start with your feet shoulder-width apart, toes pointed forward, and arms in a relaxed position. Make sure your feet are planted on the floor and behind your knees.
Sit back by bending your knees to tap your bottom onto the chair or sofa.
Then push through your heels into a standing position, keeping your knees out (don’t let them fall in).
Try not to hold your breath. Instead, breathe in as you lower down, and then exhale as you stand up.

4 point kneeling arm lifts, leg extensions, and then supermans (as able)

Start by coming into a four-point kneeling position on a mat.
Your hips should be above your knees, and your wrists should be under your shoulders.
Start by lifting one arm up, reaching it away from the body as you exhale.
Keep your back totally flat. Imagine there is a tray of your favourite drinks on there that you don’t want to spill.
You should feel your tummy muscles gently engage as you lift one arm up.
Then try sliding one leg away as you exhale, keeping both arms on the mat. Follow the same principle of keeping your back totally flat.
Then try lifting the leg slightly. Make sure that as you lift the leg, your back doesn’t drop down.
Once you feel confident lifting the arms and legs separately, you can try lifting the opposite arm and leg together. Keep focused on not allowing the back to drop down or your body to rotate.

Cool-down

If you are doing exercise that has you lying down, get up slowly to allow your blood pressure to adapt and avoid dizziness. The cool-down is as important as the warm-up; this can be great to practice some diaphragmatic breathing and pelvic floor exercises.

What is my pelvic floor, and how do I know I’m doing pelvic floor exercises correctly?

Pregnancy is often the first time we have been introduced to our pelvic floor, but this important group of muscles is something we should consider throughout life. Your pelvic floor muscles stretch from the pubic bone at the front of your pelvis to the coccyx (at the base of your spine) at the back. They have five key roles: to keep us continent, to help support our pelvic organs, to contribute to sexual pressure, to provide stability to the spine with other muscles in the core, and to help pump blood and fluid around the pelvic area.

Before we start thinking about our pelvic floor muscle contractions, we need to first think about our breathing. Our diaphragm and pelvic floor have a close relationship. As we breathe in, our diaphragm moves down, and our pelvic floor naturally lengthens and releases. As we breathe out, our diaphragm moves up, and the pelvic floor naturally recoils upwards. Pelvic floor health is not all about strength and contractions; it is about flexibility, endurance, and coordination as well.

The best cue for activating the pelvic floor muscles is to squeeze around your back passage as though you’re holding in the wind, and then bring this contraction forward to your pubic bone. Check that you’re not holding your breath and that your tummy muscles aren’t working too much. Make sure, after every contraction, you fully relax the pelvic floor muscles. There are two types of exercise we want to practice. Short and long.

Short: contraction, and then fully relax the muscles without holding. Repeat x10

Long: contract and hold the contraction for up to 10 seconds (while you breathe) and then relax. Repeat x10.

Ideally, we are aiming to do x10 short and x10 long three times a day, but you can build up to this over time.

It is important to exercise your pelvic floor muscles during and after pregnancy to keep them strong. Doing pelvic floor exercises during pregnancy has been shown in research to reduce the risk of experiencing incontinence during pregnancy and postpartum. They may also help to reduce the length of the second stage of labour, which is the stage where the baby passes down the birth canal and is born, and reduce the severity of perineal tears.

You can exercise them at any time of day, wherever you are, without anybody knowing. You could try doing them every time you put the kettle on. If you are not sure if you are contracting your pelvic floor correctly, you can pop one finger on the perineum (between the vaginal opening and the anus), and you should feel the muscles tightening and lifting away from your finger. You can also have a look at the vulva with a mirror, and you should see the vaginal opening closing as you contract. You can also seek individualised assessment with a specialist pelvic health physiotherapist.

How can I prevent tearing during vaginal birth?

Tearing is often a first-time mum’s biggest fear about vaginal birth, which is so understandable. The reality is that around 90% of first-time mothers will experience some degree of perineal tear during vaginal delivery. You may also worry about needing an episiotomy.

Using a technique called perineal massage 3–4 times a week can help reduce the risk of having a tear, the need for an episiotomy, or the severity of any tear sustained. It can be started at 34 weeks of pregnancy. Here’s a guide to how to do them:

Wash your hands and make sure your nails are short and not sharp.
Use a natural oil or lubricant and apply it to the vulva and your thumb.
Place your thumb a couple of centimetres inside the vagina.
Start by sweeping along the perineum from side to side 10 times. This should feel slightly stretchy and allow your vaginal tissues to get used to touch.
Then think about the vulva like a clock. Twelve o’clock at your pubic bone, six o’clock at your anus, three and nine o’clock towards each of your legs.
Hold and stretch towards your anus (six o’clock) for 30 seconds. It should feel like an intense stretch, but not painful. Then complete this stretch in each direction from three to nine o’clock, holding in each direction for 30 seconds.
As the weeks go on, you may feel able to use both thumbs inside the vagina to increase the stretch that you feel.
Try to relax your body and pelvic floor muscles while doing this, which can be easier said than done.

Please note: If you have any vaginal bleeding, if concerns have

been raised about your cervix or placenta during pregnancy, your

If your waters have broken or you have a vaginal infection, please don’t

complete perineal massage. Seek advice from your medical team.

How can I prepare for giving birth physically (incl. perineal massage)?

Staying active in the third trimester is extremely important. Unii tells you how to do it safely.