Guidelines For Working With Pregnant Clients

Chances are, if you teach Pilates you will teach pregnant clients.  Today we revisit the best practices for working with pregnant clients and review the latest guidelines to build your knowledge and inspire confidence. Tune in!

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Show Notes:

ACOG Committee Opinion on Pregnancy and Exercise: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/04/physical-activity-and-exercise-during-pregnancy-and-the-postpartum-period

Surgeon general’s report on diastasis recti: https://link.springer.com/article/10.1007/s00464-017-5607-9

You can also check out Pilates Elephants episode #8 for more awesome pregnancy myth-busting. https://breathe-education.com/podcast/

Support the podcast:    

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Episode Music:

Tracks: Tobu - Good Times, Tobu & Itro - Sunburst 
Tobu Official YouTube: https://www.youtube.com/tobuofficial
Itro Official YouTube: https://www.youtube.com/user/officialitro
Released by NCS 
https://www.youtube.com/NoCopyrightSounds

Transcript

[00:00:00] Welcome to Pilates Teachers' Manual, your guide to becoming a great Pilates teacher. I'm Olivia, and I'll be your host. Join the conversation and the Pilates community on instagram at @pilatesteachersmanual and visit buymeacoffee.com/OliviaPodcasts to support the show. Today's chapter starts now.

[00:00:56] Hello, hello everybody. And welcome back to the podcast [00:01:00] today. We are kicking off season six, with everything you need to know about working with pregnant clients. This is based on a webinar that I hosted back in February and is also a revisitation and revision of an earlier episode about working with pregnant clients. And today I'll be discussing the guidelines, modifications, and some considerations for working with pregnant people in your class. 

[00:01:27] First some updates. I have been on hiatus for the month of March. I took that off to finish up two Certificate IV certifications in mat work and reformer with Breathe Education and also another certificate in training and assessment. So those are both Australian qualifications. So I'm now highly qualified to work in Australia, which is super fun. And I feel pretty proud of myself actually. A bit of work to do, but I feel proud to have done it. So there we have it. [00:02:00] I am excited to be back for more Pilates podcasting goodness. Pilates Students' Manual will return next week with new episodes as well.

[00:02:14] So working with pregnant clients. As I said, I'm revisiting this topic because I did do an episode way back in the day about it. Um, because I've bettered my understanding, and something that kind of stuck with me when Raphael Bender was on the podcast that he said was, you know, "When I'm wrong, I change my mind, and then I'm right." So I'm reworking this episode and the reason I hosted this webinar is because, like most Pilates teachers that work with pregnant clients, there's a lot of fear around it. And we're taught to think about pregnancy, like thinking about osteoporosis or like thinking about [00:03:00] spondylolisthesis, or thinking about, you know, osteoarthritis something that's wrong with someone and you have to think about that way. 

[00:03:10] Um, and there's also like a fear of injuring your client or the baby that, you know, you want to do the right thing, but you're not sure what the right thing is. And how do you know if the thing that you're doing is the right thing. And so I really wanted to do this episode again, to let you know that you don't need to be afraid of teaching pregnant people. And with these guidelines that I'm going to share with you, you'll be able to work with pregnant people with confidence. 

[00:03:39] So these guidelines are set forth, or at least the ones I'm sharing with you are set forth by the American College of Obstetricians and Gynecologists, which is ACOG. They are a committee of obstetricians and gynecologists that among other things, they review all of the [00:04:00] literature, all of the research published about working with pregnant people and pregnancy and exercise. And they go through these hundreds and hundreds of articles periodically, and they put forth a committee opinion that summarizes the findings of those articles and outlines the best practices. And they share these best practices with healthcare providers, and also with people like us, Pilates teachers. You can access their committee opinion online for free. I've linked it in the show notes so that you can check it out. They are using, you know, their professional opinion, their knowledge that we can then use in the Pilates sphere. 

[00:04:41] So these guidelines are for healthy, pregnant people that are cleared for group exercise. Of course, there are going to be outliers who have complicated pregnancies who have other stuff going on. This isn't for everyone, but it is for healthy, pregnant people that have received clearance to [00:05:00] exercise. 

[00:05:01] What the committee opinion shares is that it is extremely beneficial for pregnant people to exercise throughout the duration of their pregnancy, like up to their delivery, if that works for how they're feeling and things like that. But exercise itself has all of the benefits that exercise has for people who are not pregnant with the addition of decreasing the likelihood of needing a cesarean section in order to deliver the baby, decreases the likelihood of premature birth, I would also say decreases the likelihood of having gestational diabetes. So it is great to exercise while you are pregnant and it is totally fine to start a new exercise program while you're pregnant. 

[00:05:53] The mantra that we're going to come back to repeatedly is that pregnant people are people first and the same way [00:06:00] any person starting a new exercise system, you would start small and build them up. So if a pregnant person were to come to your class and they had never done Pilates before you would treat them in a lot of ways, the same way you would teach anyone who had not done Pilates before. And that's fine. 

[00:06:18] The pregnancy specific guidelines are to avoid supine after 20 weeks to avoid isometric holds, avoid fall risks and stay cool, hydrated, and comfortable for the duration of the exercise.

[00:06:34] So let's talk about the whys because I'm a big why asker, and I want to know why you can't lie on your back after 20 weeks. That idea of no supine after 20 weeks is that as the fetus develops and it gets bigger, for some people that fetus can compress the vena cava, which is a big vein that leads blood back to the heart, and it can compress it and restrict the blood flow. Not ideal. [00:07:00] So we're not going to have our pregnant clients after 20 weeks lie flat on their back. 

[00:07:05] Instead, we're going to prop them up. Maybe you use a bolster or a pregnancy wedge or a jump board on the reformer and keep them at an angle instead of lying flat. And you could also have them in other body positions. Instead of doing footwork lying on your back, do footwork lying on your side. Instead of the ab series lying flat on your back, you can do it on your forearms. Something like that. 

[00:07:29] For no isometric holds or avoiding isometric holds, isometric hold is any time you're holding a position under load. It has that like bearing down sensation, something like a plank or holding at the bottom of a squat, something like that is going to be something we want to avoid. And that's because when we hold a position and tense, our blood vessels constrict and get smaller. And then when you let go of that hold, the blood vessels dilate and get bigger. And that sudden [00:08:00] relaxation and that sudden expansion in your blood vessels can cause dizziness and fainting, which is a fall risk, which we are also avoiding. 

[00:08:07] The same goes for being in a hot environment, doing something like hot Pilates is not great to do while you're pregnant because of that blood pressure change. When the blood vessels change, it can cause fainting and we do not want that to happen. Avoiding fall risks kind of for everybody, but the risk is increased for a pregnant person because we don't want to injure our client. We also don't want to injure the fetus. So any exercises that do pose a fall risk, like standing on the reformer or high kneeling on the reformer, I'm thinking specifically of kneeling arms cause that's a big fall, even for a non-pregnant friends. We want to change that body position. Either have a seat or sit back in a low kneel or instead of, you know, front splits where you're standing on the reformer, one foot on the foot bar, one foot on the carriage. Maybe you've got one foot on the ground, one foot on the shoulder block, something [00:09:00] like that, that they have the foot bar to hold on to or a wall or something to help them with balance, to minimize that fall risk.

[00:09:07] And as far as staying cool and hydrated and comfortable, the cool component could be as easy as, you know, putting them in the part of the room where the fan is, or you know, where the air conditioning is blowing. Staying hydrated is important for everybody, but for pregnant people, especially, and, you know, being comfortable is, is really the underlying thing here. Every individual's comfort is going to be a little bit different, but even though it is not in the guidelines, things like lying on your stomach while you're pregnant, doesn't pose a danger to the client or to the fetus, but it doesn't feel good for a lot of people. It can make them feel nauseous. Then you would want a different body position or a different option for the exercise if that is an uncomfortable thing [00:10:00] for them. 

[00:10:01] Coming up after the break, I'll be talking about some things that aren't in the guidelines that might be myths or things you've heard about working with pregnant clients, things that I heard or thought I needed to do in order to work with pregnant clients, as well as other considerations to take while you've got pregnant people in your class. That's coming up next.

[00:10:28] Hi there. I hope you're enjoying today's chapter so far. There's great stuff coming up after the break, too. Be sure to subscribe wherever you're listening and visit buymeacoffee.com/OliviaPodcasts to support the show. There you can make a one-time donation or become a member for as little as $5 a month.

[00:10:47] Membership comes with some awesome perks, including a shout-out in the next episode, a monthly newsletter, a monthly zoom call with me and more. You can also visit [00:11:00] links.OliviaBioni.com/affiliates to check out some sweet deals on products I use and love. Now, back to the show.

[00:11:25] Probably the first thing I thought when I was reading about the guidelines for working with pregnant people and exercise during pregnancy were things that I thought were true, were things I needed to do with pregnant people, and it just didn't turn out to be the case. Some of it, I think is like a framing issue where I was under the impression that, you know, this is, uh, a hard rule when really it was a studio policy or kind of an interpretation of the guidelines. So let's, let's kind of talk about the [00:12:00] nuance of that. 

[00:12:00] So I was under the impression that pregnant people were not allowed to do inversions. That that was a dangerous thing. And what I will say is that some inversions do pose a fall risk, something like a handstand, potentially there is a risk for falling or a headstand. You know, there is a risk of falling, but again, we got to keep in mind that our pregnant people are people. So if they are a person who does headstands comfortable, For them that fall risk might be different than teaching a brand new to exercise pregnant person who's never done a headstand, a headstand. So there's like a different level in terms of what that person's ability was beforehand, what they're, what they're able to do before. But then also their comfort level with risk. 

[00:12:55] So someone who has been doing handstands their entire life might say, you know, like this [00:13:00] is something that I'm totally fine with. I X I understand how it works and all of that. It may not be something I would teach in a class, but it's not something that in itself being inverted is not dangerous. Doing a shoulder bridge is not dangerous for a pregnant person. 

[00:13:16] I thought that really intense inner thigh work was going to separate the front of the pelvis and like dislocate the pubic symphysis, because I had heard, you know, about this hormone relaxin and they were getting more flexible in order to deliver the baby, which makes sense. But it's really not dangerously flexible. Like clients may notice that they're slightly more flexible, but the amount of more flexible that they are is very, very small and the amount of force that you would need to actually dislocate your pelvis is extreme and not something you're going to do with a magic circle. And if we know that that relaxin hormone is present [00:14:00] everywhere in your body, like shouldn't we also be worried about pregnant clients dislocating their shoulders or their thumbs or their legs popping out of their hip sockets, but we aren't. So we don't need to really worry about that intense inner thigh work necessarily.

[00:14:14] I had heard that, you know, you shouldn't start exercising or you definitely shouldn't start doing Pilates when you were pregnant. And that is also not true. Once again, pregnant people are people, and if they are starting something new, you would treat them like any other beginner while also being mindful of the guidelines. So you'd want to start with exercises that are a little bit more stable, a little bit less complex, like let them, but they can still move on the reformer or on the mat. That's totally fine. And I feel a bit guilty about, you know, turning people away and saying, oh, well, you can't start doing Pilates while you're pregnant. You totally can. It's totally fine. 

[00:14:57] Also, I had heard that [00:15:00] you shouldn't do intense abdominal work or any sort of abdominal strengthening because you could split the Linea Alba. You could have a diastasis recti. You could, you could separate the abdominal wall. Right? So kind of fun stats that I can throw at you about that is that at the time of delivery, 100% of people have some degree of abdominal muscle separation. A hundred percent. If a hundred percent of people have that abdominal separation, it's not something we're trying to avoid. It's just something that happens. It is a totally natural part of the process. And two thirds of people, regardless of whether they do exercise or physical therapy or something to work on that abdominal separation, two thirds [00:16:00] of people's bodies heal on their own and the abdominal separation repairs itself. So that's another thing that we don't need to worry about necessarily. 

[00:16:12] Now comfort could come in to this part. Like maybe your pregnant client isn't interested in doing a thousand crunches, but to be honest, you know, neither am I. So we might think about other ways to incorporate that abdominal work that isn't making them feel uncomfortable, but the work itself is fine and can be beneficial. 

[00:16:32] So the great news is that's a bunch of things that we don't need to worry about. Instead, we can focus our energy on making any clients who come to our studio while they're pregnant, feel welcome, feel safe. We can share the guidelines with them so they know that we know what we're doing when we're working with them and that we have their safety and their comfort at the forefront of our mind. We can confidently give them modifications [00:17:00] so that they can continue working with the class and they can feel, you know, strong and they can move and be a part of things. 

[00:17:09] Something that I think about regarding that giving modifications is that we can give modifications that are in line with what the rest of the class is doing. I definitely am a culprit, or was a culprit, that it'd be like, oh no, we're going to do swan on the box. Well I'll just have them do bird dog. And then, you know, I'd be building up some swan layers and this poor pregnant person has been doing bird dog for like seven minutes. And I'm like, well, I could probably, uh, we could probably layer that a different way or give them more things to do. Uh, definitely. 

[00:17:44] But we can check in with them. We can- like pregnant people or people with voices and you can say, Hey, how does this feel? How do these springs feel? Like, does this feel all right? We can help them with things, like if we're doing feet and straps and they happen to [00:18:00] be lying on a jump board or a pregnancy wedge, we can help them get the straps because they're hard to reach when you're propped up like that, you know. So we can be considerate of their needs without being afraid of them or thinking that they're a burden. Right? 

[00:18:15] Another thing you can do that I think is kind of awesome is just teach the entire class prenatal friendly. Okay. We were going to do footwork on the reformer, but now we're going to do foot work standing with their hands on the foot bar. Awesome. Or we're going to do foot work on our side, or we're going to do foot work at the springboard or at the tower with, you know, hands in straps. Like we can do all of those things. It's totally fine. Um, we can be creative. 

[00:18:42] I shared some of the modifications that I would give for people, but you know, bird dog in itself is not a villain. But we could do bird dog while other clients are doing swimming. We could do exercises like cat and cow or down stretch instead of swan, [00:19:00] so that they're getting that nice extension. 

[00:19:02] Um, in terms of our isometric holds, if you are a teacher that likes to put holds in your foot work or holds in your long stretch, we just don't want our pregnant clients holding. So that could mean that they're flowing in and out of an exercise. So maybe instead of holding a plank, they're piking their hips up and finding like a downward facing dog shape and then going back into the plank instead of holding the plank. Maybe they're doing mountain climbers instead of holding the plank. For things like squats or footwork, instead of doing a hold, maybe we do pulses so that we don't get that, uh, change in blood pressure. You know, those are all things we can do. 

[00:19:39] Even inversions themselves are not the enemy. But if you think about where the resting position is in your inversion, if you were doing something like the rollover, I don't know, if you were, you're probably gonna rest lying flat on your back. The inverted shape is not an issue, but getting into the inverted shape might be an issue. So we just want to be mindful of [00:20:00] that.

[00:20:00] I think it's helpful to get comfortable working with pregnant people, or at least feel confident in what you're able to do with them and what you'd like to do with them. 'cause people have babies all the time. I feel like, like in waves, people have babies and it's so important that they do exercise. And if you can be a Pilates teacher that confidently works with pregnant people, there will always be pregnant people to teach. 

[00:20:27] And I would say, you know, my knowledge of working with pregnant people, like I don't have pregnant clients all the time. Frequently, there will be a person in a group class who's like, oh, you know, and I'm six weeks pregnant. And you're like, awesome. I'm so glad you're here. You're in the right place. I know the guidelines. These are the guidelines. This is a safe class for you to take. You're going to have a great time. Something like that. I hope that this information helps you feel a bit more confident about working with [00:21:00] pregnant people, because that is the goal that you can work with all types of bodies all the time. 

[00:21:06] I want to say a huge thank you to all my supporters on buy me a coffee. Thank you so much for continuing to contribute and be part of the community, especially while I was on hiatus. Big shout out to some new supporters, Yan, Allyson, Dayna, Mary Ann, Rebekah, and Kim. Thank you. Thank you. Thank you. I really look forward to this month's coffee chats. I hope that we're able to connect over coffee, and you can share what you're thinking about, what you're working on, and what you'd like to hear on the podcast. I really look forward to having that conversation monthly. If you want to be a part of that, definitely visit that Buy Me A Coffee page. And when you make a contribution, you can hang out with me and we'll talk Pilates, which is what we love to do.

[00:21:52] I hope you have a great couple of weeks and I'll talk to you then soon. [00:22:00] 

[00:22:03] Thanks for listening to this week's chapter of Pilates Teachers' Manual, your guide to becoming a great Pilates teacher. Check out the podcast Instagram at @pilatesteachersmanual, and be sure to subscribe wherever you listen. For more Pilates goodness, check out my other podcast, Pilates Students' Manual, available everywhere you listen to podcasts. The adventure continues. Until next time.