Pilates and Pregnancy: A Safe Guide for Expecting Moms in Stuart, FL

Pregnancy changes the body in ways that make regular exercise routines risky, but Pilates is one of the few workouts built to move with those changes instead of against them. At Toned Body Pilates in Stuart, Florida, expecting clients work with instructors trained to modify every exercise for each trimester, protecting both mother and baby while keeping strength, posture, and flexibility on track. This guide explains why pregnancy changes the rules for exercise and exactly what to do about it.

Why Pregnancy Changes the Rules for Exercise

Pregnancy is a wonderful and exciting time for most women. There is a living human being growing inside the mother, and the accompanying changes to the mother's body are interesting to say the least. In order to help protect both the unborn baby and the mother, certain precautions need to be taken especially while exercising. In addition, there are many things that the mother can do in order to minimize the stress on her body during the pregnancy and maximize her rebounding effect after the pregnancy. All of this needs to be taken into careful consideration by her Pilates instructor in order to best develop a Pilates workout that addresses her changing needs. By understanding why these changes are taking place, the instructor can then tailor the exercise modifications to her specific needs at each stage in her pregnancy. This article will discuss the why behind each of the pregnancy contraindications as well as specific areas of focus for maximum benefit both during pregnancy and postpartum.

Ideally mothers would get their bodies in shape with Pilates and a nutritionally sound diet before even conceiving the baby. There is much research out there that shows dramatically that these things affect the unborn baby's health as well as the mother's health. However, even if the mother did not regularly exercise, the American Congress of Obstetricians and Gynecologists recommend regular exercise with their physician's approval. This is a change from their 2002 and earlier stance that women should not start any new exercise program once pregnant. This new stance allows Pilates instructors to train already pregnant clients although it is still a good idea to get clearance from the mother's doctor first.

Pilates has drawn attention from pregnant mothers because of its amazing ability to be tailored to each individual's needs as well as being very gentle on the body. It is ideal for pregnancy because of its gentleness on the body while reducing, if not eliminating, most unwanted side effects of the pregnancy including back pain, moodiness, poor posture, loss of muscle tone, poor sleep, edema, collapsing foot arches, and more. These and many other benefits draw pregnant clients to the studio where they are trained by instructors that understand the pregnancy contraindications and can work them safely. There are several contraindications that are very significant for the pregnant client including monitored range of motion, omitted intense leg adductor work, omitted prone exercises, omitted heavy abdominal work, omitted inversion exercises, omitted jumping/high impact activities, omitted supine exercises and limited hand weight bearing exercises.

What Not to Do During Pregnancy

From the beginning of the pregnancy the mother's body produces a hormone called Relaxin. This hormone is responsible for loosening the ligaments in the mother's body in preparation for the baby needing to pass through the pelvic cavity while being born. However, not only does it loosen the ligaments of the pelvic cavity but it also loosens all the ligaments in the entire body. Therefore, pregnant women often have a new found flexibility which should not be encouraged. This means that while it is wonderful for the pregnant woman to stretch and maintain flexibility, they should not work for developing more flexibility or use any new extreme ranges. If the woman does utilize these new ranges they may over stretch the ligaments which then may not be able to go back to their pre-pregnancy state once the Relaxin is not flowing through the woman's body. This means that they would then have lax ligaments and therefore unstable joints for the rest of their life. While this may or may not translate to immediate pain or problems with the pregnancy, it could mean potential injuries and/or pain later in life.

The Relaxin also can cause instability in the pelvic structure which may lead to sciatic pain or pubic symphysis pain and/or dislocation. Sciatic pain is a shooting pain that travels from one side of the back of the pelvis down the back of the leg. The sciatic pain needs to be addressed by a trained Pilates instructor or physical therapist that can assess any muscular imbalances particular to the pelvic structure (adductor/abductors, external hip rotators/internal hip rotators, hip flexors/hip extensors, abdominal/back muscles etc.). Any imbalance then will need to be addressed with exercises specific to the imbalance. This will vary case by case based on the individual's muscular imbalance – what works for one mom may hurt another. This is one reason it is important to do Pilates before the pregnancy to address these imbalances before they cause pain. However, it is good to know that this can be alleviated and is not something pregnant women just have to live with.

The unstable pregnant pelvis should also stay away from intense leg adductor work (aka super hard inner thigh work). While the Relaxin is in the body the pubic symphysis (aka pubic bone) is open to possible dislocation/separation or throbbing pain due to too much pulling or pushing on the joint. This does not mean that mild inner thigh work is bad but stay clear of hard work there which can lead to pain in standing and walking. Pilates examples of intense leg adductor work would be things like Horseback, Side Lunges on the Chair, Magic Circle between Thighs or Ankles with heavy circle, Standing Side Splits on light springs and etc. This is particularly challenging when pregnant women become aware of weight gains in their thighs. Encourage them that there is a time afterwards when it is appropriate to work on strengthening those muscles more intensely. This dislocation can also occur doing extreme range of motions opening the legs although we have already mentioned avoiding that previously for other reasons. Instructors should also know whether or not the client is breastfeeding as the Relaxin will stay in the mother's system while they are breastfeeding.

The easiest contraindication to remember is that after the first trimester the pregnant client should avoid prone exercises (aka lying on the belly). When it becomes uncomfortable to lie prone then omit exercises that involve that position. Some pregnant women avoid it earlier due to increased nausea while prone or due to simply the idea of "squishing the baby." This is fine to avoid earlier but not actually necessary until the woman is showing significantly which may vary from woman to woman. Exercises to avoid would include Swan, Breaststroke, Pulling Straps, Overhead Press, Swimming, Grasshopper, Single/Double Leg Kick and etc. Pilates exercises that involve lying prone include many extension exercises which means that if you need/want to work on extension you will need to focus on non-prone exercises like Spread Eagle on the Cadillac and Down Stretch on the Reformer (only if they are strong enough for this).

While every woman consciously knows that their belly is going to expand during pregnancy, some women worry that it may not go back the way it was before or fight this inevitable truth by insisting on doing a lot of hard abdominal work. This should be avoided from the beginning of the pregnancy as it will contribute to the occurrence of a diastasis recti which will ironically cause them to keep the pregnant look after they've had the baby.

In conjunction with the Relaxin that is softening the connective tissue, there is often times an over stretching or even a split in the linea alba which is the connective tissue that connects the two sides of the abdominals together. When this happens it is called a diastasis recti and there is a weakness in the support system for the back and the organs causing back pain and a "mummy tummy." This occurs in one-third of all pregnancies to one degree or another but is exacerbated and/or caused by heavy abdominal work. This separation can possibly be prevented or at least minimized by working the deep layer of the transversus abdominis which supports the new weight in the midsection instead of working the muscle of flexion, the rectus abdominis. If this separation is not closed after the first baby it will continue to get larger with each subsequent baby which is why many women "show" faster in their second pregnancy. Pilates exercises that should be avoided while pregnant would include any "crunch" type exercise, the famous Hundred, the Series of 5 (Single Leg Stretch, Double Leg Stretch, Single Straight Leg Stretch, Double Straight Leg Stretch, Criss-Cross), Backstroke, Teaser, Roll Up and etc.

In order to check for a diastasis recti the mother should lie on her back with her legs bent and feet on the floor. Then she should bow her head and shoulders up off the floor as if she was going to do the Hundred. While she is raised, the linea alba (mid-line) should be palpated to see if there is a vertical separation of the rectus abdominis, causing a gap of the muscles, and/or a bulge to appear. While some degree of widening may occur in all pregnancies, a one to two finger-width (two centimeter) gap is considered normal and not problematic. Sometimes the hole will close up on its own but often times simple Pilates transversus work will assist in closing it postpartum. This is ideally done immediately after the pregnancy as those tissues are the most plastic and it is easiest to heal up at that point. It is very important to make sure that postpartum women do not do abdominal work that is so difficult that they cannot maintain the transversus connection which will discourage healing of the diastasis recti. The transversus abdominis strengthening that is important both during pregnancy and postpartum can be accomplished in any Pilates exercise that is taught correctly and is appropriate to their level of strength.

The more controversial issue of inversions includes many Pilates (and yoga) exercises although it is not very applicable to traditional personal training or group exercise. An inversion is defined as any time the mother's pelvis is above her heart. There is talk about inversions causing rare air embolisms. This is where an air bubble can enter into the mother's blood stream through the uterus and cause a stroke. Not much evidence of this is available and most of what there is talks about a forceful entering of air which would be more than occurs in Pilates during inversions. There is also discussion on this being an issue postpartum as the air enters vaginal tears during delivery so it is best to avoid inversion until after eight to twelve weeks postpartum. Inversions also may need to be avoided because of the compression of the pregnant uterus on the vital organs (heart, lungs, etc.), the safety risk of an unstable sacro-iliac joint due to the Relaxin and a general decreased segmental control of the lumbar spine. There has also been discussion about avoiding inversions in the third trimester to avoid possibly turning an already head down baby upright and thereby possibly causing the need for a C-section because the baby is breech. However, while inversions are wonderful to turn a baby that is breech downward, there is no evidence that the reverse occurs.

Some midwives actually encourage specifically done inversions late in pregnancy to either turn a breech baby right-side down or to relieve tension on the ligaments that hold the uterus in place. This must be done in a controlled manner to avoid injury and the head must be kept tucked with the chin to the chest. On a personal note, I have used inversion both to turn a breech baby using a supported Bridge technique (Delaney's pregnancy- 2nd) as well as using inversion to release tense ligaments using an exercise similar to Cat on the Chair without the extension (Ainsley's pregnancy- 3rd). Pilates exercises that would be considered inversion would include Short Spine, Climb a Tree, Tower, Pull Up on the Chair, Hamstring Stretch Series on the Chair, Elephant, Pelvic Lift/Bridging, Long Spine, Airplane, Cat on the Chair, Snake/Twist, Handstand, Dolphin, Magician and etc. All inversions should always be avoided if there is an unusual amount of amniotic fluid around the baby, the abdominal tone is unusually loose (the mother has given birth before and not toned up after) or if the mother does not feel comfortable doing it. The bottom line is that pregnant women should avoid doing inversion unless they are working for one of the specific goals as mentioned above.

It may be obvious but it warrants mentioning that jumping is not suited for the pregnant woman. The jarring action can possibly cause injuries or problems as well as the possible injuries from falling while jumping. All Pilates exercises that are done on top of pieces of equipment or that require an element of balance should be done with caution to the mother and spotting during the exercise. Because of the changes occurring in the pregnant body, their balance is often unreliable. There is no exercise that is worth doing if the mother falls on her belly and has a miscarriage.

Around the middle of the second trimester, the baby will have grown large enough so that when the mother is lying supine, the uterine weight can collapse the mother's veins and arteries that lie beneath the uterus. When these veins collapse there is a positional low blood pressure that may result in the mother becoming dizzy and possibly passing out. Although true Supine Hypotensive Disorder occurs in less than 10% of all pregnancies, a good, safe rule of thumb is to avoid supine exercise after the first trimester. In order to avoid SHD when exercising, pregnant women should only exercise on their back for short durations only (a few minutes at a time) and watch for feelings of dizziness. Women who experience these symptoms always feel an urgent need to either roll over or sit up, which quickly relieves symptoms. Pilates exercises that are done supine can be modified to work for a pregnant client by incorporating the Pilates Wedge or the Pilates Arc (both made by Balanced Body) under the mom while they are exercising so that they are then at an angle of about 45 degrees instead of being flat. If using the Pilates Wedge or the Pilates Arc, it should be noted that a sticky underneath is important when not on the Reformer in order to prevent the Wedge or Arc from sliding. Pilates exercises that are done supine include Footwork on the Reformer, Supine Arm Circles, Feet in Straps, Frogs Supine on the Chair and Leg Springs Series among many others. It is good to note that the "traditional" start on the Reformer includes a long stretch of supine material that while it can be done with the Wedge or Arc, it may be best to think outside the box and find warm up exercises that are more suitable to the pregnant condition. Most women never have an issue with Supine Hypotensive Disorder but from a Pilates standpoint, you don't know if it will be a problem until it is – and that is not a good Pilates experience!

This positional low blood pressure can also occur during prolonged periods of standing while not exercising where the blood can pool in the legs which can be even more dangerous because of the risk of falling when passing out. Pilates can help prevent this with its focus on increased circulation and the many varied positions to exercise in. It is helpful to warn pregnant clients about this possibility and encourage them to change positions and to elevate their feet above their heart if they are having problems with this or excessive edema.

Pregnancy often brings unwanted water retention or edema, particularly in the extremities. While Pilates overall can help prevent and treat edema because of the focus on circulation, if a client has extreme edema other symptoms may occur such as carpal tunnel syndrome in the wrists. If carpal tunnel is a problem, it is wise to limit or eliminate the amount of exercise done with weight bearing on the hands such as in Long Stretch, Push Ups, Down Stretch and many others. Some women may be able to do some with breaks and focus on good alignment while others may need to eliminate all weight bearing on the hands altogether in order to not exacerbate the pain symptoms from the carpal tunnel.

What to Do During Pregnancy

So with all these things that pregnant women should not do, what does a pregnant client actually do? Traditional Pilates mat is not a good fit because almost everything would be contraindicated. However, in a Pilates studio they are able to do a wide array of exercises that will specifically address their changing needs while avoiding potentially problematic positions. There are several things that need specific focus on for the pregnant body including ribcage breathing, body awareness and conscious relaxation, pelvic floor awareness and control, postural balance, arm/upper back strength and foot strength.

In Pilates, breath is well known to be important. Pilates utilizes what is called "ribcage" breathing or "posterior/lateral" breathing. The focus here is on keeping the downward motion of the diaphragm minimized and optimizing the outward motion of the diaphragm by moving the ribs. During Pilates with a regular client this is essential in order to maintain the transversus abdominis connection pulling the belly in during the abdominal work thus providing good core support to the back and rest of the body. For a pregnant client this becomes imperative because the option to "belly" or "diaphragm" breathe (where the belly bulges out during breaths because of the downward motion of the diaphragm) becomes impossible as the baby grows larger and takes up all extra space possible in the abdominal cavity. For them it is indispensable to learn how to move the ribs and develop the flexibility to allow the ribs to move as much as possible. Side bending and spine rotation exercises in Pilates develop increased flexibility in the intercostal muscles which will allow the ribs to move. These exercises include any Mermaid, Side Body Twist, Spine Twist, Side Bends and many other traditional exercises with rotation or side bending variations.

Often during pregnancy women notice they need a new bra with the band around the rib cage being larger, this is due to the body's need to move the ribs more to get air in. Many women literally do not know how to breathe this way and feel like they cannot take a full breath and that they are constantly out of breath. Simple ribcage breathing exercises will allow them to take full deep breaths. Thus integrating traditional Pilates breathing into daily life will make a huge difference to them so focus should be on this in every session during every exercise.

Breathing is also a huge part of the labor process and many women take special classes to learn how to breathe during labor. Much research shows that the traditional Lamaze panting breathing actually has a higher rate of hyperventilation which thereby causes fetal distress. The full, deep breathing that is practiced and learned during Pilates sessions is exactly what is needed according to the Bradley Method where natural childbirth is practiced.

The Bradley Method also teaches that with conscious relaxation the pain in childbirth is dramatically reduced. Therefore the body awareness that is taught in Pilates training is a perfect way to develop skills for conscious relaxation during childbirth. I personally will attest to this as I have had four babies without any drugs using the Bradley techniques and drawing on my Pilates skills. The difference when the contraction comes between unconsciously tensing up against it and consciously relaxing the body and allowing it are dramatic to say the least. Pilates instructors should focus on teaching pregnant clients how to turn muscles on and off with their own volition and bring their attention to whether or not they are accomplishing this accurately. This is done naturally every time an instructor corrects a client to "put your shoulders down" or "keep your legs together." As every Pilates instructor knows, it is harder to turn muscles off often than to turn them on.

During pregnancy, the mother is being told to learn how to turn on the "Kegel" muscles which are called the pelvic floor in the Pilates studio. These muscles work to keep liquid, organs, gas, and babies among other things, inside the body instead of falling out as gravity would desire. Pilates incorporates pelvic floor work into its workouts with every client so nothing special needs to be done other than to highlight and emphasize it. Not only do pregnant women need to strengthen the pelvic floor muscles in order to counter the increasing weight put on them with the growing baby, but they also need to learn how to turn off on command which is important to actually let the baby out during delivery. A great exercise to do in order to practice turning on and off the pelvic floor as well as stretching it out in preparation for the delivery is the Russian Squats on the Tower from a 2nd position (wide leg stance with external rotation – aka grand plies in second). The pelvic floor also needs special attention and extra cueing postpartum as the muscles will be stretched out and need to regain their tone and elasticity. If this area is not addressed it can often lead to problems such as low back pain, pelvic pain, sacroiliac pain, incontinence and prolapsed pelvic organs later on in life. Helping clients find their "core" which is composed of the diaphragm, transversus abdominis, deep lumbar multifidi and pelvic floor muscles is a specialty of Pilates and should be the base of training of all clients especially pregnant ones.

Another specialty of Pilates is restoring postural balance which is extremely important to the pregnant client. During pregnancy the natural curves of the spine are amplified and women become kyphotic and lordotic if they do not specifically work on minimizing these curves. During pregnancy the hip flexors, low back, chest and neck extensors will become overly tight although not necessarily strong and the hip extensors, abdominals, upper back and neck flexors will become loose and/or weak. Pilates can address these issues and work on minimizing these changes although they need to wait until after the baby is born to work on strengthening the abdominals beyond of transversus work as discussed earlier.

Special focus should be on stretching the hip flexors (Eve's Lunge, Down Stretch), the low back (Spread Eagle), chest (Sitting Triceps Press, Reverse Push Through) and neck extensors (Hamstring Stretches). Extra strength emphasis should be placed on the hip extensors (Leg Pumps Supine on Chair with Wedge, Standing Leg Spring Extension) and upper back muscles (Rowing Front, Standing Arm Springs).

Upper back strength as well as arm strength is also important for pregnant mothers in anticipation of holding that small baby which rapidly becomes a large baby. While the mother is pregnant she often times becomes kyphotic because of increased breast mass and once the baby is nursing the hunched over posture often worsens. Specific upper back strengthening that targets the mid and lower trapezius, serratus anterior, posterior deltoids, rhomboids and others will help counter this natural tendency and prevent future pain and/or injuries in the neck and shoulders. Hopefully the new mother will want to hold their child as much as possible so strong biceps and deltoids will be a necessity. While any of the arm work in Pilates is good for this, the Biceps Curls with the arm springs standing are particularly wonderful as they attain strong arms as well as keeping the chest open.

There are also many advanced exercises for this that a pregnant woman can do safely that are great for developing arm strength and open chests like Long Back Stretch and Triceps Sit. The overhead reach phase of the Rowing Back 2 is also great for developing strong deltoids to lift that soon to be big bundle of joy. It is also good to encourage mothers to carry or wear their children rather than lugging them around in car seats as the heavy and awkward car seat often times causes serious shoulder injuries and postural imbalances for the mother.

There is a myth that during pregnancy mom's feet will miraculously start growing again and they will need to buy a whole new shoe wardrobe. While some women may be excited to get new shoes, this is completely unnecessary and actually bad for the woman's posture and future back and foot health. The hormone Relaxin is acting on the joints in the feet as well and as they get looser, if there is not enough strength in the musculature of the feet, the arches collapse which give the illusion they have "grown." This can be prevented or restored by using Pilates equipment and exercises. Once the musculature is strong enough the arches will lift up as they used to and the foot will go back to its original length. It is just a matter of working the feet. If the arches are not strengthened the feet will tend to cramp (sign of weakness) and eventually develop problems like plantar fascitis, knee or back problems. The foot corrector is wonderful for targeting the arches of the foot along with exercises like Footwork toes wrapped, Stomach Massage (great for pregnancy with a ball for support behind the back) and just pointing the feet during other exercises. Lolita San Miguel, one of the few alive that was trained by Joseph Pilates, has a whole series of foot work that is fantastic for pregnant clients as well as the general population. Swelling of the feet can also cause the feet to "grow" wider and demand larger or more open shoes.

Elevating the feet and working on increased circulation (Pilates) is great for managing or preventing edema which causes the wider feet.

Frequently Asked Questions

Is it safe to start Pilates for the first time while pregnant?

Yes, with your doctor's clearance. The American Congress of Obstetricians and Gynecologists now recommends regular exercise during pregnancy, even for women who were not previously active, as long as a physician approves.

Can Pilates help with back pain during pregnancy?

Yes. Pilates targets postural balance and core support, which directly counters the low back tightness and rounded posture that often develop as the pregnant body changes shape.

Do I need special equipment to modify supine exercises?

A Pilates Wedge or Pilates Arc is commonly used to prop the torso at an angle during exercises normally done lying flat on the back, reducing the risk of dizziness from Supine Hypotensive Disorder.

Should I avoid all abdominal exercises while pregnant?

Not all abdominal work, but avoid heavy flexion exercises like crunches, the Hundred, or Teaser. Gentle transversus abdominis work is safe and helps protect against diastasis recti both during and after pregnancy.

When can I return to inversion exercises after giving birth?

Most guidance suggests waiting eight to twelve weeks postpartum, since inversions during that window carry a theoretical risk related to healing vaginal tears.

Ready to Move Through Your Pregnancy with Confidence?

Every pregnancy is different, and the safest approach is training with an instructor who understands exactly how to modify each exercise for your stage, your history, and your body. Toned Body Pilates in Stuart, FL, builds every session around these pregnancy-specific principles, from ribcage breathing to postural balance to pelvic floor control, so expecting mothers can stay strong, comfortable, and prepared for delivery and recovery. All new clients begin with a private session, which is the ideal starting point for pregnant clients who need individualized guidance from day one. Schedule your private session today to start training safely through every trimester.