I recently took an online Pilates class with a very popular Pilates instructor who is soon expecting a child. I thought I was in for a nice prenatal class, and was prepared to do some gentle breathing, opening and strengthening work. I was surprised when the focus of the class was on abdominal contraction, via crunches and pelvic floor tightening. Unfortunately, this is a situation where Pilates' wonderful reputation for long, lean and "tight" bodies is not serving its pregnant practitioners well. When you think of birth, do you think you’ll be tightening and lifting? No! Lifting and tightening are paradoxical to birth, where the body needs to release and bear down. And as a doula and Pilates instructor, I’ve witnessed the difference in births between those who have exclusively practiced tightening as opposed to those who have practiced a more subtle release as well.
Now, as with all things to do with bodies and birth, this is, of course, nuanced and every body is different. Prenatally, it makes sense to want to be able to lift the weight of your baby and uterus to help support your belly and back, as well as to build strength for the intensity of birth. However, we must also practice the inverse of releasing and bearing down. Pilates, when taught and modified correctly for the prenatal period, also gives you the opportunity to understand more about breathing, birthing positions, and comfort techniques that you can use during birth.
How does Pilates prepare you for birth and why is Pilates actually a great modality for birth prep?
Pelvic Health: Pilates is a wonderful modality to build strength in conjunction with release in the pelvic floor, but here's the key: it needs to be modified for pregnancy. We shouldn't be doing intense abdominal loading and we shouldn’t be over-focusing on pelvic floor tightening. In fact, over-tightening the pelvic floor muscles is a leading cause of incontinence and can definitely make the moment of birth harder, because our pelvic muscles are being asked to stretch and lengthen—not contract and tighten. Imagine you’ve been exclusively doing hamstring curls all week and then you decide to hop into a weekend yoga class. I bet that first downward dog is going to be a little sticky for those hamstrings. Now consider the pelvic floor. It's unrealistic to think that you can contract and lift your pelvic floor muscles for 9 months (or probably more likely, many years), and then at the moment of birth know exactly how to let go of them all. The release is something that needs practice!
Flexibility and Strength: One of the major benefits of prenatal Pilates is that it's designed to match your flexibility with your strength. This is especially important prenatally when your body has more of the hormone, Relaxin, giving your joints more flexibility. While it may be exciting to have a new range of motion, it’s important to build strength to match this flexibility in order to prevent injuring joints—for example common SI joint dysfunction and pubic symphysis dysfunction. We also want to build strength and stamina for birth. Doing challenging movements with resistance from the springs in Pilates equipment is the perfect way to appropriately challenge your strength. The spring's resistance can be customized for your own body and strength level so that you don't have to take your entire body weight in every exercise, as you do in yoga. And while I absolutely enjoy, love and practice yoga myself, I've also worked with a lot of pregnant folks who have so much flexibility and so little strength to support it, that there is nowhere near the balance of both that is ideal for pregnancy and birth. This is not to stop you from practicing yoga, but to help you bring awareness to your practice so that you’re also building strength in equal measure to your flexibility. Pilates is a movement system that is designed to do this.
Breath: Breath is a cornerstone of both birth and Pilates. Ensuring that your breath is working functionally with your pelvic floor is essential for an easeful and efficient birth and is a key to regulating your nervous system (which you especially want to harness as your cervix is dilating). Breathing can also really change the actual birthing process. Did you know that instead of holding your breath and pushing (as seen in the movies), you can breathe slowly and deeply and birth your baby with less straining (and less shouting from the audience in the room)? An added benefit is that functional breathing also helps prevent hemorrhoids and helps you recover your pelvic and abdominal muscles in those early stages of recovery.
Positions: There have been some excellent studies in recent years that have provided insight into which positions cause the most perineal tearing and which cause the least. Simply put, lying on your back with knees pulled back (what we typically see in the movies) is shown to cause the most tearing. In that position your perineum is stretched taut so there is little give in the tissue for the baby. You’re also literally pushing uphill so it takes more effort. In contrast, side lying positions, with knees closer than ankles is linked to the lowest amount of tearing. When we get more anatomical, we see that it’s not only the tautness of tissues, but also the bony structure of the pelvis. In the position on your back, the outlet of the pelvis (which the baby exits from) is actually narrower than it is in side lying with your knees closer together than your ankles. It's a bit counterintuitive to think "knees narrow, pelvis wide" but it's something I teach a lot of in prenatal Pilates so that you will have a working knowledge of which positions give you the most space for your baby and which give you the feeling of having the most pushing power (see image below of the hands and knees position to get a visual of the pelvic outlet). Side lying Pilates exercises are also wonderful for building strength in the pelvis to help prevent common prenatal instability injuries. The next image of side lying is one of my favorite hip strengthening and awareness exercises for pre- and postnatal people.