Pregnancy and postpartum

Physical therapy for expectant moms and new moms

Why exercise matters before and after birth, what changes during each trimester, and how TENS can help with labor pain.

1. 1First trimesterHormones loosen ligaments, so you may feel clumsy. Nausea, fatigue, and breathlessness on activity are common.
2. 2Second trimesterHormones level off and fatigue eases. Posture changes begin to stress the joints and spine.
3. 3Third trimesterJoint laxity rises, and swelling can cause numbness or tingling. Avoid lying flat on your back.
4. 4After birth: the fourth trimesterJoints stay loose for 6 to 8 weeks. Fatigue raises the risk of injury, so build activity up gradually.

Benefits of prenatal and postnatal exercise

• Improved circulation and less swelling
• Meeting the physical demands of pregnancy and motherhood more easily
• Greater awareness of your body and how it functions
• Improved mental attitude and stress reduction
• Less physical discomfort in late pregnancy
• Preparation for labor, a very physical event
• Shorter recovery time after labor and delivery

Important elements of a program

Pelvic floor exercise (Kegels)

Improves support for the baby and internal organs from below, prepares you to learn relaxation during labor and delivery, and improves recovery time of vaginal tissues after birth.

Trunk strengthening

Improves support for the baby and organs, protects the spine from the increasing weight of the growing baby, and makes pushing more effective in the second stage of labor.

Flexibility and stretching

Improves your ability to adapt to the postural changes of pregnancy, reduces stress on joints, ligaments, and muscles, and prepares you for childbirth.

Postural awareness and body mechanics

Protects joints, ligaments, and muscles from injury as they meet the increased demands of pregnancy and motherhood.

Breathing and relaxation techniques

Prepare you for labor and delivery, reduce stress, and enhance your sense of well-being.

Physical changes during pregnancy and their effect on exercise

First trimester

Hormonal relaxation of tendons and ligaments may cause clumsiness and increase the risk of injury. Nausea and vomiting occur partly as a reaction to increased hormone levels, especially HCG. Dilution anemia from increased blood plasma may cause general malaise and fatigue. Breathlessness on activity comes from increased sensitivity to carbon dioxide and a greater demand for oxygen.

Second trimester

Hormones level off, so there are fewer problems with fatigue and joint laxity. Postural changes from the growing baby increase stress on joints and ligaments, especially of the spine. Fainting may occur because of a fall in blood pressure.

Second and third trimesters

Postural changes continue to increase stress on joints and ligaments. Urination becomes more frequent because of pressure on the bladder. Heartburn, gas, and constipation result from hormonal softening of the smooth muscles of the sphincters.

Third trimester

Joint laxity increases because of higher levels of relaxin and estrogen preparing for birth. Water retention causes swelling in the ankles, legs, and hands, and the extra fluid may press on local nerves, causing numbness and tingling in the hands and feet. Swollen joints have a limited range of motion. Increasing weight and postural changes can stretch nerves in the arms, causing numbness and tingling in the arms and hands.

Fourth trimester (after birth)

Hormone levels remain for six to eight weeks after birth, so joint laxity continues and the risk of injury stays higher. Fatigue from changed sleeping patterns, recovery from labor, and the new full-time job of motherhood increases the risk of injury and accidents. Vaginal bleeding is normal for up to six weeks, and increased bleeding is a sign that activity increased too quickly.

To learn the basics of pelvic floor exercises, see Kegel exercises.

TENS for labor, delivery, and after a Cesarean

TENS (transcutaneous electrical nerve stimulation) has been shown to significantly reduce pain during labor and delivery. It can also decrease pain after a C-section.

How does TENS work?

Electrical impulses from the TENS unit stimulate low-threshold nerve fibers and mechanoreceptors. This reduces the excitability of pain fibers traveling to the brain, so fewer pain messages are sent from the uterus, cervix, and low back.

What are the benefits?

TENS is comfortable, affordable, non-invasive, and easy to use, with no known side effects. You control the on/off switch and intensity throughout labor. You may need less pain medication, which lets you stay more alert during labor and delivery. TENS has also been shown to reduce pain at the incision site after a C-section.

How do I get my own unit?

Ask your OB/GYN for a prescription that reads “Evaluation and instruction in the use of TENS for labor and delivery.” Then contact Physical Medicine Center of Marin for an appointment with a women’s health physical therapist, and bring your labor partner for the demonstration. At your visit you will receive a TENS unit, along with instructions for each stage of labor.