Posts Tagged ‘labour and delivery’

The end of pregnancy

When will I start my antenatal classes and what types are there?
Antenatal, or parent education, classes start around 32 weeks and, if you are attending classes run by your local NHS trust, are free. The classes may run for 4-6 weeks, or some trusts have a monthly afternoon session. Some hospitals provide women-only classes evening or weekend classes and yoga and pilates classes (see p 60). There are also private or independent, midwives in most areas who may offer antenatal classes on a one-to-one or small group basis.
Antenatal classes are also available from the National Childbirth Trust (NCT), run by trained NCT teachers Classes are usually held in the evenings, making them more accessible to partners and friends, and they often provide ongoing postnatal support for up to six months after the birth. There is a fee, although in some cases a reduced fee or assisted places may be offered
Aquanatal classes are also popular These are gentle exercises in the swimming pool along with other pregnant women and often the teacher is a midwife who also provides antenatal information. Also many obstetric physiotherapists run relaxation and breathing technique sessions; your hospital antenatal clinic may have information on these.
What will I learn in my hospital antenatal classes?
Antenatal classes usually cover a different topic each week, including the physical changes that occur in pregnancy, the three stages of labour; hospital, home, and water births; pain relief, which should include breathing and relaxation techniques; breastfeeding; postnatal care of the baby; and changes in your relationships The most popular topics tend to be the stages of labour and pain relief, along with a tour of the maternity unit
Is it useful to learn and practise breathing and relaxation exercises before the birth?
Preparation before labour and delivery is
for most women and their partners, and breathing relaxation techniques in particular help you to focus on your breathing. which in turn can help you to fee- less tense and increase your confidence for dealing with the contractions Antenatal classes teach you
specific techniques and antenatal yoga (see p 60) also helps you to gain control through breathing
Should I practise positions for labour and birth beforehand?
Practising for labour is a good idea as you may find some positions suit you and others don’t (see below). This information can be documented in a birth plan (see p.149) so that it is available for your midwife to discuss with you. It’s also good for your partner to know your preferred positions during labour
Do you have any suggestions for labour positions?
Some popular positions for labour area
* Leaning on a work surface or the back of
a chair. Putting your arms round your partner’s neck or waist to lean against.
•    Leaning on to the bed in the delivery room
•    Kneeling on a large cushion or pillow on the floor and leaning forwards on to the seat of a chair * Sitting astride a chair and resting on a pillow placed across the top
* Sitting on the toilet; leaning forwards, or sitting astride. leaning on to the cistern.
•    Kneeling on all fours.
•    Kneeling on one leg with the other bent
•    Rocking your hips backwards and forwards or in a circled this can also be done using a birthing ball Ally of these positions can make your contractions Breech presentation
Breech position is when your baby is bottom first instead of head first. Breech babies lie in one of three positions: a flexed, or ”complete’ , breech, when the hips are bent, the thighs against the chest, and the knees bent with the calves against the back of the thighs and feet above the bottom; an extended. or
‘frank”, breech when the hips are flexed or bent the thighs against the chest, and the feet by the ears; and a ”footling” breech, like a flexed breech, but the hips aren’t so bent and the feet are below the bottom If your baby is breech at term, your doctor may recommend delivery by Caesarean section
more efficient and help you feel in control When you are in strong labour, you may find that you don’t want to move around much and will find a position that suits you If possible, keep rocking, leaning forwards during contractions, and straightening up in between. If you get tired, lie down on your left-hand side, rather than propped up on your back, which stops the pelvis being able to open effectively. Lying on your left side is much better for your baby than lying on your back because he receives more oxygen, and the contractions are still effective in this position. If you feel rested after a while, push yourself up with your hands into a sitting position and get up again
I’m 36 weeks and my baby is breech. Is this a concern?
Breech position is when your baby is bottom first instead of head first (see above) Quite a lot of
babies sit in the breech position in pregnancy and there is still a chance your baby will turn. It’s not until about 37 weeks that your midwife or doctor will focus on your baby’s position.
Is there anything I can do to help my baby turn?
If your baby is breech towards the end of pregnancy there are some exercises you can try in an attempt to turn your baby A ‘knee-chest” position can help To do this, kneel on your bed with your bottom in the air and your hios bent at just over 90 degrees Try to keep your head, shoulders and upper chest flat on the mattress Adopt this position for 15 minutes every two waking hours for five days If you feel nauseous or light-headed, do not continue. Positions in which the buttocks are elevated can also help, and sleeping with a pillow under your buttocks or kneeling on all fours so the weight of your pregnancy is unsupported may help You can combine ”all fours’ positions with household chores, such as cleaning the floor. If these are not successful, there are other ways to try to turn your baby (see below).
I’ve heard about doctors “turning” breech babies. How does this work?
Some obstetricians may try to turn a breech baby in late pregnancy, known as external cephalic version (ECV), which has a success rate of around 50 per cent. During an ECV, an obstetrician gently moves your baby by pressing his hands on your abdomen, using an ultrasound as a guide You may be given a drug to relax the uterine muscles You will be scanned first and if the baby is in an awkward position the procedure may not continue. Also, if your baby is large this can affect the procedure, as can the amount of fluid around the baby, as a low amount of fluid offers less protection to the baby, If you are Rhesus negative, you will have an injection of anti-D after the ECV (see p.79) because of a small risk of a bleed around the placenta An ECV is not recommended if you have a multiple pregnancy, have had bleeding in pregnancy, your placenta is low-lying, your membranes have ruptured, or there is a known problem with the baby
The procedure is not without risk and some think it only works with babies who would have turned anyway. If your baby remains breech, a Caesarean may be advised, although some obstetricians are willing to try a vaginal delivery You are not obliged to have an ECV and should discuss your options.
Finally, a form of acupuncture called
I f moxibustion”is sometimes used, whereby a fragrant herb is held over an acupuncture point, the aim being to relax the uterine muscles to help the baby turn Talk to your doctor or midwife before trying this and seek advice from a qualified acupuncturist.
What triggers labour?
While there are many theories, no one really knows what triggers labour One is that the mother’s pituitary gland secretes oxytocin, the hormone that
stimulates contractions, when the baby is ready to be born Others now believe that the baby starts labour by sending a signal to the mother’s body One theory is that a baby’s lungs secrete an enzyme when they are developed that causes a substance called prostaglandin, which triggers contractions, to be released into the mother’s body. Another theory is that, when the baby is ready to be born, its adrenal glands produce hormones; these cause hormonal changes in the mother that start labour
I don’t want to go overdue. How can I help labour to start?
Various methods have been tried, although none is proven. Popular methods include having sex, as the prostaglandins in semen are similar to the ones used to induce labour; stimulating your breasts to trigger the release of the hormone oxytocin, which stimulates the uterus; eating spicy food to bring on a loose bowel movement, thought to stimulate labour (see p 48) ; and taking long walks to help the baby move down in the pelvis and put pressure on the cervix Homeopathic remedies are also available; consult a registered practitioner for advice.
I’ve heard that raspberry leaf tea can start labour. Is this true?
Unfortunately this is a misconception as raspberry leaf tea doesn’t actually help to bring on labour, but it may help to reduce the length of labour In a study m Sydney, 192 first-time mums were given either a 1.2g raspberry leaf tablet or a placebo twice a day from 32 weeks. The tablet had no harmful effects. and the women who had taken the supplement had a shorter second stage of labour and a lower rate of assisted delivery (19.3 per cent to 30.4 per cent).
Raspberry leaf tea contains an alkaloid, ”fragine”, said to strengthen and tone uterine muscles, helping them to contract more efficiently. You should start taking raspberry leaf tea during the last eight weeks of pregnancy At 32 weeks, you could have one cup of raspberry leaf tea a day, gradually increasing to four cups or tablets a day (depending on the strength of the blend). The tea can be sipped in labour, too.

Fetal positions
Your baby in the uterus
Your baby can lie within your uterus in many different positions. Your midwife or doctor will palpate your abdomen (gently feel your tummy) to identify which way your baby is lying. There are two main positions in which your baby will lie: with his head downwards (cephalic presentation) or with his buttocks downwards (breech presentation). Occasionally your baby will lie across your uterus in a transverse position or even diagonally across you in an oblique position, particularly if there is too much fluid around the baby or you have had several babies previously. In about 17 per cent of cases, the midwives and doctors do not identify a breech presentation until the labour itself
What is LOA and ROA? Once your midwife has identified how your baby is lying, she will also try to determine whether the baby is lying on your right or left side The midwife will track where
Your baby’s position
your baby’s back is, and you will generally feel kicks on the opposite side. The midwife will describe your baby as being LOA or ROA, which stands for left or right occipital anterior -the occiput being the back of your baby’s head facing forwards, so your baby is actually facing backwards These are the best positions for your baby to lie in for labour.
What if the baby isn’t anterior? Sometimes babies lie in a posterior position, which means that their back is lying against your back and they are looking upwards This position may prolong your labour, which can be tiring If this is the case, you can try the same exercises for turning a breech baby (see p.143) to encourage your baby to turn to be in an anterior position towards the end of pregnancy Sometimes your baby will only turn with the help of strong, effective contractions when you are in fully established labour.

What is the “nesting instinct” and is this just a myth?
The nesting instinct is a well-documented natural phenomenon In the final weeks of pregnancy, many women have an uncontrollable urge to clean their house and to prepare and make the ”nest’ safe for the new arrival This is a primal instinct and females of the animal kingdom are all equipped with this need. Just as birds make their nests preparing for their young, mothers-to-be do exactly the same.
The act of nesting puts you in control and gives
•    sense of accomplishment You may also become
•    homebody and want to retreat into the comfort of your home and familiar people The nesting urge can be an indicator that labour is not too far away If you have the energy, take advantage and get on with tasks that you won’t have time for after the birth
Is it true that first babies are often late?
Birth normally occurs at a gestational age of 37 to 42 weeks and, while it certainly isn’t the case that all first babies are late, many do arrive after the predicted
due date. From the point of view of waiting if you approach the end of your pregnancy expecting your baby to be a couple of weeks late, then you may avoid feelings of frustration. It is worth considering that your body has never done this before and that your “due date” is an estimate, the majority of babies do not arrive on this date
I’m 39 weeks and my baby’s head isn’t engaged. Should I be worried?
Not all babies engage into the pelvis before
the beginning of labour It is likely, from about 36 weeks onwards of -your pregnancy, that you may experience your baby moving lower down in your abdomen, causing your baby’s head to enter the pelvis. This process is known as ”engagement’I and simply means that the leading part of the baby has ”engaged” the pelvic brim (see p.148) This is normal and helps to position your baby in preparation for the birth later on.
Engagement often happens earlier with first
babies because the uterine muscles have not been
Your hospital bag
Although hospital visits tend to be short, with many women staying around 24 hours or less after a normal delivery you will need a few essential items. Many mums have a bag for themselves and one for the baby, while others organize a labour bag and postnatal bag for mum and baby. It’s up to you. Basic requirements include:
•    Clothing for labour (including socks and/or footwear).
•    Nightwear.
Toiletries
A towel, sanitary pads disposable pants and a bra.
iIc Music, books, and magazines, as well as money, telephones, phone numbers, and cameras.
* A food bag with nutritious snacks to keep you going
For your baby you will need:
* Clothing, cleaning materials, and some clothes for returning home * Nappies (check with your midwife if the hospital provides these or whether you need to supply your own).

Engagement
Engagement is when your baby’s head starts to move down into the pelvic brim in preparation for birth, and this can occur any time from around 36 weeks until the start of labour In the last weeks of pregnancy, your midwife will palpate your abdomen to see if the head has started to engage. The degree to which a baby’s head is engaged is measured in fifths. If three- or four fifths of the head can be felt above the pubic bone, then
the baby is not engaged If only two-
fifths of the head can be felt, then the baby is said to be fully engaged, and if just one-fifth is felt, the baby is recorded as being deeply engaged.
previously stretched and so they tend to exert more pressure on the baby, moving it down into the pelvis earlier: whereas a second or third baby may not become engaged until your labour actually starts. When your baby’s head engages can also depend on other factors, such as the position in which your baby is lying within the womb (see p.145) and the shape of your pelvis
Am I likely to feel any different once my baby’s head has engaged?
Many women report feeling more physically at ease following the engagement of their baby’s head as there is a release of pressure within the abdomen As a result, you may find that it feels easier to breathe, sleep, and walk around
On the other hand, sometimes when the baby’s head engages this can increase the pressure on your bladder and you may experience a sensation of fullness and pressure between your legs. Many women also report shooting vaginal pains. Engagement is also likely to affect bowel sensations.
My midwife mentioned checking the position of the placenta. Is this normal?
This is not routine, but if your 20-week scan indicated that the placenta was low-lying, known as placenta praevia (see p.92), your midwife would suggest a further scan at 34 weeks to see if the placenta had moved up and away from the cervix.
My baby isn’t moving so much now - should I be worried?
There is some natural reduction in the range of your baby’s movements towards the end of pregnancy as he has less room to stretch his limbs However, you should still be familiar with your baby’s pattern of movement in later pregnancy as this is a good indicator of your baby’s health and is just as important as the number of movements a day (see p.103) You may find at this stage that your baby is developing a pattern for waking and sleeping, often different to yours, so your baby may be awake when you go to bed and may start kicking Or your baby may get the hiccups and you will feel the jerk of each hiccup, a sign that your baby is preparing for life after delivery. If your baby’s movements have reduced or stopped, contact your maternity unit. You could also try things like having a cold or hot drink, having a bath or shower or massaging your tummy. A formal assessment may be recommended and if there are concerns, you will be asked to make a conscious effort to increase your awareness of when your baby moves. There should never be fewer than 10 individual groups of movements a day between 9am. and 9pm. Some areas have walk-in antenatal day units (ANDLJ) where you can have a cardiotograph (see p.192) to record your baby’s movements.
I’m practically incontinent. Is there anything I can do to stop this?
During pregnancy, many women find that they leak urine slightly when they cough, laugh, exercise, bend over, or lift something. This is known as stress incontinence. The pelvic floor muscles are under strain during pregnancy as they have to support the weight of your growing uterus and cope with the changes caused by pregnancy hormones. As a consequence, a sharp increase in abdominal pressure when you cough and so on may be too much for the muscles to hold back the flow of urine. Stress incontinence may happen at any time in pregnancy, but is more common towards the end.
The best treatment for incontinence is regular pelvic floor exercises to keep the muscles toned (see p.57). Taking some gentle exercise each day can also help and, although you may not make a full recovery during pregnancy, regular exercise now will minimize the problem and help you towards a full recovery after your baby is born. Stress incontinence is often worse for a few days following the birth, when the muscles of the pelvic floor and other structures are recovering If it does not get better after this time, talk to your health visitor or doctor as you should not have to suffer long term without help.
Ask your midwife to refer you to your obstetric physiotherapist, who can review the problem and offer you advice and monitoring.
Birth plan
Stating your preferences for labour and birth
The purpose of a birth plan is to communicate your wishes for labour and birth.
Your plan can be as detailed or as brief as you like Do bear in mind that circumstances may dictate that not all of your preferences are met Discuss this plan with your midwife before the birth. Here are some suggestions of what to include:
* You may want to state who your birth partner will be, whether you want more than one birth partner, and if you want them present throughout. * You could include your preferences for managing labour pain Do you want to labour naturally (maybe using a birthing pool), or do you have a preferred type of medical pain relief? *You can state which positions would you like to use in the different stages of labour? Do you want to be active in the first stage, and in which position would you prefer to deliver your baby?
* Do you have concerns about being strapped to a fetal monitor? If so, do you want to request that this be done intermittently only?
* State your preferences for after the birth. Do you want your baby delivered on to your tummy, and how soon do you want to breastfeed?

Keeping active in pregnancy
I regularly go to the gym. I’ve just found out I’m pregnant -can I still go?
Many forms of exercise are safe during pregnancy Regular exercise keeps you fit and healthy, so if you currently exercise then it’s fine to carry on as before Although you can continue to take part in most activities during the first trimester of your pregnancy, you may need to stop more vigorous exercise as your pregnancy continues Do tell your fitness instructor that you are pregnant, so they can tailor your programme accordingly — pregnancy is not the time to break records or go for personal best! Ideal exercise gets your heart pumping, keeps you supple, manages weight gain, and prepares your muscles for the hard work of labour and delivery without causing undue physical stress for you or your baby.
Benefits of exercise
why you should aim to stay fit in pregnancy
There is no doubt that exercising during pregnancy offers numerous benefits to both mother and baby.
* Regular exercise increases flexibility and suppleness, which will benefit you in labour, * Aerobic exercise, such as swimming, increases stamina, improving blood circulation and preparing you for labour. * Exercise releases endorphins, the body’s natural painkillers, helping you to relax and lifting your mood
•    Exercise keeps backache at bay.
•    An exercise regime will help you to recover more quickly after the birth
Being active during your pregnancy can also reduce the physical discomforts of backache, constipation, fatigue, and swelling, as well as improve your mood and even help you to sleep more soundly. The Royal College of Obstetricians and Gynaecologists (RCOG) states that weight-bearing exercise in pregnancy can reduce the length of labour and may decrease delivery complications. So continue if you can.
Other forms of exercise recommended in pregnancy include swimming, walking, aquanatal classes, yoga, and pilates, as these are not high impact so are less likely to injure your joints.
What’s the best type of exercise during the third trimester?
Swimming is an excellent form of exercise and can be maintained safely throughout pregnancy
It improves circulation, increases muscle tone and strength, builds endurance, and is favoured in late pregnancy as it makes you feel almost weightless. Many women find aquanatal classes enjoyable
exercising while standing in water is gentle on the joints and helps reduce swelling in the legs, common in late pregnancy Aquanatal classes may be run either by a local midwife or by an exercise teacher trained to teach pregnant women.
Walking is a good form of exercise for this later stage of pregnancy as it keeps you fit without jarring your knees and ankles. Take some water to drink to avoid dehydration Yoga and pilates are good if you can find a registered practitioner experienced in dealing with pregnant women. Yoga teaches breathing and relaxation techniques that can help with the demands of labour and birth. Many pilates exercises are done in a ”hands and knees” position, which is ideal for pregnancy as it takes stress off the back and pelvis and, towards the end of pregnancy, can help to position your baby ready for delivery.

I’ve had a previous miscarriage - should I avoid all kinds of exercise?
Many doctors feel that it is best to avoid all but the gentlest forms of exercise in the first 12-16 weeks of pregnancy if you have had two or more miscarriages, or have had vaginal bleeding during this pregnancy
I’m not terribly fit, but would like to start an exercise regime - any advice?
If you are unused to exercise, then moderate activities, such as walking and swimming, would probably be best for you and beneficial for your baby, whereas starting a new competitive sport or vigorous exercise programme would not be ideal Your body is already undergoing huge changes with your heart, lungs, kidneys, and virtually every other major body organ beginning to work much harder. Also, the pregnancy hormones progesterone and relaxin are softening the muscles and ligaments, so soft tissue injuries, back injuries, and abdominal strain become more likely, especially if you haven’t exercised much before. Contact sports, vigorous team sports, and activities like diving and gymnastics carry the further risk of direct injury to your abdomen and uterus - especially as your uterus grows and rises out of your pelvis.
Is it safe to go jogging when you’re pregnant?
Exercise is recommended in pregnancy to improve your circulation and energy levels, boost the immune system, and increase your stamina for labour. Although low-impact activities, such as walking, swimming, and gentle toning and stretching, are ideal, if you are used to jogging and your pregnancy is straightforward, it is fine to continue in pregnancy. However, it is not advisable to take up jogging for the first time now, particularly as there is a risk of falling and hurting your abdomen, and you should avoid jogging if you have a high-risk or multiple pregnancy Other sports and exercises to avoid include gymnastics, horse riding, skiing, and squash.

When should I start doing pelvic floor exercises?
Pelvic floor exercises (see above) can be started at any stage of your pregnancy, but the earlier you start them the better These exercises strengthen the pelvic floor, which is the network of muscles that support the bladder, womb, and bowel. Strengthening these muscles helps to reduce the risk of leaking urine while coughing or sneezing, known as stress incontinence It is important that you know how to do these exercises and practise them regularly throughout your pregnancy
As well as practising the exercises shown above, another way to exercise your pelvic floor muscles is by inserting a finger into your vagina and tightening the muscles around it.

I’m very desk-bound in my job - is it dangerous to sit for long periods of time?
During pregnancy, your circulation slows down and if you sit for long periods of time with the lower leg vertical, it can make it hard for blood to travel upwards. Although this may increase the risk of a blood clot, known as deep vein thrombosis (DVT), sitting for long periods in itself is unlikely to cause a clot Your degree of risk also depends on your level of activity at other times. Exercise is the best way to minimize the risk of a blood clot and taking a brisk daily walk is ideal as it exercises your legs. There are also simple measures you can take while at work to reduce the risk of developing a clot. Try ankle movements every hour, get up and walk around every 3-4 hours, take the stairs rather than the lift, and walk over to see a colleague rather than email.
If you are especially concerned, talk to your midwife or doctor about wearing special stockings that are designed to improve circulation However, it is important that you get the right size, as stockings that are too tight can add to the problem.

I’ve been getting lower back pain - could it be due to bad posture? I’m eight months pregnant.
In a recent review of current research, more than two thirds of pregnant women reported back pain. This pain increased with advancing pregnancy interfering with work, daily activities, and sleep. Lower back pain is caused by the forward pull of the growing abdomen, so as your baby increases in size and gestation, the strain on your back is greater So although bad posture may not be the sole cause adopting a good posture is important to reduce the strain Gentle exercise also helps to reduce the pain, and water aerobics is particularly beneficial.
Some women use a Transcutaneous Electrical Nerve Stimulation (TENS) machine in late pregnancy (see p.175), which helps to block the pain nerve impulses to the brain and stimulates the release of natural painkillers called endorphins. Other tips for lower back pain include a warm hand massage using a base oil a warm deep bath, and using cushions to support you when relaxing and in bed
I’m seven months’ pregnant now and quite big. Should I adapt my swimming style?
You may find that as you get very large towards the end of pregnancy, you need to alternate your swimming style to find the one that is most comfortable for you. Apart from this, a low-impact activity like swimming is ideal as the water provides resistance, there is a low risk of injury and the mass of water relieves pressure on the abdomen and helps to ease lower back pain.
My midwife is running aquanatal classes at our local pool - are they safe?
Yes, low-impact activities such as aquanatal classes are fine in pregnancy. You are fortunate to have this facility as not all areas are able to provide classes. The trainer or midwife conducting the sessions
should be able to advise you about the range of movement recommended to minimize any risk.

We love going clubbing; will the loud music be OK for my baby?
There is evidence to suggest that babies can hear
in the womb from about 16-20 weeks. However, your baby is protected by the amniotic fluid surrounding him, so most noises do not affect him. The ears of a fetus are often full of a protective greasy coating produced by the skin, known as vernix, so external loud noises would be muffled by the time they reach your baby. Your baby is most likely to respond to your reaction to loud music rather than the music itself
There is a study that suggests that constant or regular exposure to noise can increase the risk of a small-for-dates baby, meaning your baby’s growth is smaller than expected for his gestation. However, it is more likely that it is the environment and its effect on the mother that contributes to the baby’s weight rather than the actual noise. Too much clubbing may mean you are getting too little rest and you may be drinking more alcohol than you should. You should
probably consider whether you are getting enough quality rest and ensure that you are reducing or stopping your alcohol intake, as this is more harmful to your baby than loud music.
We like walking, but should I cut down on the number of miles now that I’m pregnant?
Walking is ideal in pregnancy as it is low-impact exercise and can be maintained throughout your pregnancy If you plan to continue lengthy walks and like to walk briskly, try combining this with a slower, more leisurely pace. It’s important to control your body temperature so that you don’t overheat and feel uncomfortable To do this, drink plenty of water to avoid dehydration and wear layers that you can take on and off as required. As your tummy grows, you may find hill climbing causes physical instability, as may trekking over uneven terrain, so stick to more level paths. If you find yourself getting breathless, take frequent breaks.

Antenatal yoga
Practising yoga in pregnancy is hugely beneficial. As well as strengthening and toning muscles, which will help you in labour and birth, yoga aims to bring about a greater awareness of your breathing rhythms, providing a perfect relaxation tool in pregnancy and preparing you to breathe through the contractions. Find an accredited teacher experienced in teaching pregnant women or attend an antenatal class.

Exercise in late pregnancy
adapting your routine to suit your changing needs
Towards the end of pregnancy, you will inevitably slow down, but you may not want to stop altogether! There are sensible ways to modify your exercise regime to ensure you stay safe and fit. * In later pregnancy, avoid exercises that involve sudden movement, such as tennis, as your balance is less steady now. * Swimming is perfect in late pregnancy and aids relaxation.You may need to modify your stroke and enjoy more floating. * Reduce the intensity and length of your workout to avoid exhaustion.

Pelvic floor exercises Strengthening the muscles that support pelvic organs
Learning how to exercise your pelvic floor muscles is vital in pregnancy to help you avoid stress incontinence (leaking urine). This discreet exercise can be practised any time. Pelvic floor exercises involve squeezing your buttocks in and pulling in your tummy muscles, then holding for 5 seconds and releasing. Repeat this 5-6 times several times a day. You could imagine your pelvic floor going up like a lift, contracting your muscles a little more at each floor.

Safe exercise
Taking care in pregancy
Although exercise is highly recommended during pregnancy, this is a time when you may have to moderate your usual programme, especially as you get bigger, and avoid types of exercise or situations that may put you or your baby at risk.
What safety precautions should I take? If you are taking up exercise during pregnancy, be sensible about which type of exercise you choose. Avoid any type of exercise that is too strenuous and opt for low-impact activities, such as walking and swimming. Always do warm-up stretches before exercising and build up your stamina and fitness gradually. This is especially important as hormones in pregnancy relax joints and ligaments
in preparation for labour (see opposite), which means that you are more susceptible to injury. Avoid exercising in very hot conditions as this may be harmful to the baby; in hot months, exercise early in the morning or indoors Also, avoid exercising near traffic as you are more likely to be affected by pollution while exercising. Your centre of gravity changes in pregnancy, so avoid high-impact, fast-moving sports, such as tennis.
Should I stop exercising at any time?You should stop exercising straight away if you feel dizzy or short of breath; if you feel that you are overheating; if you are experiencing pain in your back or pelvis; or if you feel exhausted.