Strength Training During Pregnancy
Can you do strength training during pregnancy?
Key Takeaways:
Under the right conditions it is possible to continue to perform strength training exercises while pregnant. Though there are some important considerations that must be followed to do so safely.
You must have already strength trained for several months and be very familiar with the major exercises, such as squats, deadlifts, presses and bench presses.
You must have medical approval from your doctor to exercise and be having an otherwise normal pregnancy with no advisories against certain physical activities.
It is highly recommended that during this time and following the return to exercise after the delivery, that you work with a professional coach who understands how and when to modify exercises at each point in the pregnancy.
If you are new to exercise or currently in a detrained condition, it is not advised to begin strength training if you become pregnant. You can however take up lighter forms of exercise if approved by your doctor.
Disclaimer:
DO NOT ATTEMPT this approach to training unless approved by your doctor. This post is for information purposes only and anyone wishing to try this kind of training during pregnancy should consult the appropriate coach and have medical clearance from your doctor and midwife.
about this case study
In this article I am going to document (with the permission of Olivia) some of the practical steps I took to coaching Olivia through her pregnancy. Most of my work with my clients involves tailored programming and exercise selection, and during her pregnancy I was sometimes making changes on a weekly basis as things developed.
Therefore if you are reading this article in mind of taking a cut and paste approach, then this would be ill advised.
Olivia circa 39 weeks.
What I hope to do for coaches and mums alike is to provide some handy to know about stepping points that you may encounter with training during pregnancy.
Everything I did was inline with her doctor’s and midwife’s approval, and she had regular check ins with them during the pregnancy.
In general I make sure to provide a high level of care and consideration to everyone I coach. In this case I allowed even more time for regular check ins and routine updates during all three trimesters.
background. Training Before Pregnancy.
I’d coached Olivia for almost 12 months before she became pregnant and she was well adapted to physical activity, she was experienced with the movement patterns of different lifts, had good form and she had become very strong.
“The first thing they tell you to do when you become pregnant is to not lift anything over 50lb. That day I had just pulled 202lb on my deadlift and felt great doing it. ”
We had previously been in a long phase of peaking to set some new 1RMs (1 rep maxes). And following this phase, we had decided to do a short cut (calorie deficit) and were approximately 2/3 weeks in when Olivia declared she was pregnant.
The first step I took, was to have her end the cut immediately.
I then remapped the considerations for future training sessions and advised Olivia what these kind of changes would look like.
One of the main things I found was that during the pregnancy communication needs to go up between coach and client.
Things can develop on a weekly basis and the coach needs to be on top of correspondence.
Exercise during pregnancy
Official sources[i] [ii] have indicated that exercise is advised during pregnancy.
[i] https://www.nhs.uk/conditions/pregnancy-and-baby/pregnancy-exercise/
[ii] https://www.health-ni.gov.uk/news/physical-activity-advice-expectant-mothers-chief-medical-officer
But exercise is a phrase wide open to interpretation. Olivia wanted to have the ongoing benefits that resistance training offers during her pregnancy and so my objective with her exercise recommendation had some practical goals.
The idea was to have her continue to exercise in the gym, but with a new focus on outcomes. Gone were the 1RM’s and days of cutting, now the top priority was for the wellbeing of her and the baby.
She wanted to have the best pregnancy possible, culminating in the smoothest possible delivery. In this respect resistance training with barbells has some very unique and useful applications, which I’ll be discussing later in the article.
Needless to say when all forms of exercise are on the table, resistance training with barbells offers some highly useful applications that other forms of exercise cannot match.
However, there are contraindications that must be considered as you would expect with any form of exercise during pregnancy.
Olivia. In this clip she’s in the third trimester of pregnancy, at 39 weeks and 5 days. She is pulling nearly 200 pounds in a Sumo style deadlift off the ground
The Benefits of strength training to pregnancy
Activity in general provides and makes for better energy levels.
However strength training does have an ace playing card up its sleeve. Strength training by its very design means that the lifter develops an increased ability to produce force, because they are fundamentally stronger than their former self prior to resistance training.
This means that all tasks which are sub maximal (light enough to be done many times) to their absolute strength become easier the stronger they get.
This matters during pregnancy because tasks that would otherwise be more fatiguing and place more of an energy drain to an untrained mother-to-be are easier and ultimately a lot less taxing to the fitter, stronger mum.
Olivia was able to stay in work right to the final phases of her pregnancy. She is self-employed (no company maternity leave) and her work is very physical as she's on her feet most of the day as a massage therapist and this is in addition to already being a mum of two boys and running busy household.
For Olivia, the benefits of strength training meant the ability to work later during her pregnancy, maintain good energy levels and still have a normal family life.
exercises for lower back pain during pregnancy
Resistance training exercises in particular with barbells and dumbbells are highly adaptable. This means that it is possible to continue this kind of exercise well into the later trimesters.
Later on in the article I will be giving some examples of how I modified the exercises to better suit Olivia as she grew in size with the baby.
One of the main things I was aware of from having friends that had been pregnant is the unwelcome appearance of persistent lower back pain.
In this instance the reason that strength training works well for pregnancy and back pain is for the same reason it works well when a person is not pregnant but is still managing back pain.
In short, having a strong back and being physically active has had a high success rate with people that have suffered chronic back pain in the past.
“The pregnancy hormone Relaxin, kept loosening my SI joint causing it to flare up. At times I was unable to walk without pain. Deadlifting made it feel so much better every time. ”
morning sickness & body weight during pregnancy
My research also indicated that those who had engaged in strength training reported a reduction in morning sickness. However, it is unclear whether any form of physical activity would do this or whether in particular strength training helped alleviate the symptoms of nausea.
Still, I comprehend what a blight it must be to suffer from persistent morning sickness, and what a welcome relief this would have been as Olivia reported that there were no bouts of morning sickness at all during this pregnancy, versus her previous two pregnancies where it did frequently occur in the first trimester.
Another ace playing card that strength training and resistance training has is that it is one of the primary tools with which to develop a healthy body composition.
As lean body mass improves, by default the body fat percentage of a person lowers.
Strength training accompanied by the right nutritional approach is the best tool I have to develop lean body mass in anybody.
Now, this is particularly useful during pregnancy because it gives the mother a chance at maintaining an appropriate healthy weight whilst allowing for expected and natural weight gain that will occur. Gestational diabetes is a diabetic condition that can occur during some pregnancies, and because of her age Olivia was at risk of this in the latter part of the pregnancy.
Ironically, it did not happen, but she did develop hypoglycaemia, where the blood sugar clears too quickly and can lead to feelings of sleepiness, blurred vision, shaking and weakness among others.
Below is what Olivia had to say about her hypoglycaemia:
“The thing about training and nutritional goals for the day is I never felt it [hypoglycaemia effects]. I rarely crashed because I was always eating to hit my goals for the day. If I did not have that practice in place I might have had some bad crashes.”
returning to pre-baby weight
So you can see above that after a year of strength training and running nutritional guidance side by side, that these habits carried over to be directly of use.
This may all be starting to sound too good to be true. But, there’s still more. Following the birth of her daughter and while she was resting up, Olivia wrote me to say:
“Only a week postpartum, I’m sitting in my pre-pregnancy jeans...
Being able to wear pre-pregnancy pants at this stage is totally new and unexpected! Usually it takes months to get here, but I’m 4lb away from pre-pregnancy weight.”
Olivia with daughter, born March 2019.
the day of delivery
Lastly, on the day of delivery Olivia reported having the smoothest possible delivery that can be expected. As her coach, this is truly one of the things I was hoping for the most for her.
“My entire labor was unmedicated start to finish, as was my second, the difference being that the second labor was so much more exhausting and mentally challenging to work through than this one. ”
Strength training affords the opportunity to practice calling muscles into contraction. It is also challenging and difficult as the weights get heavier.
My observation is that strength training benefits both the positive psychology of the mother in the run-up to the delivery date as well as her ability to call into contraction the relevant muscles when needed to facilitate a timely delivery.
I have heard stories from friends of deliveries in excess of 25 hours, this is extremely taxing and fatiguing on the mother. By contrast Olivia's labour time was 7 hours, and she described three hours of that as being hard labour.
my rules for strength training during pregnancy
Strength training during pregnancy has its own approach. During pregnancy the mother has a lot more input into session planning and performance and there were important guidelines I gave to Olivia.
If it is not feeling good don't do it. It's ok to stop an exercise during warm up or working weight sets at any point. You are NOT required to grind out reps and/or complete the set no matter what.
Form takes top priority. Focus on the quality of the movement and how that will complement your well-being outside of the gym.
Exercises can be modified as needed. With barbells you can switch to lower intensities and maintain comfortable (adjusted) form according to your size. You can also switch to dumbbells or bodyweight exercises at any point if needed on the day and as decided by you.
Keep core temperature <102°F/38°C. In other words beware of hyperthermia.
modifications to the barbell exercises during the trimesters
Now for the part you coaches an PT’s have been waiting for.
During the first trimester very few modifications to exercises were made, we did however implement the safety guidelines you see above.
I also began introducing some exercise variants early on, so that Olivia would have experience of them ahead of time.
Also, a lifter meeting a new lift for the first time may find it more challenging and therefore more taxing. This has the potential to affect recovery. It cannot be understated that a big part of coaching through pregnancy is managing both the outcomes of exercise sessions and recovery in between.
With that in mind I planned that there would be zero surprises in the weight room for Olivia.
using the rPE scale
By far the most important guideline I implemented was a safety limit on the level of intensity that Olivia would now be allowed to go to during exercise.
As she was well accustomed to the RPE (rate Of perceived exertion) method, I chose to use this to set safety limit on the intensity she would do for any exercise.
The RPE limit was set at RPE 7. Meaning I no longer prescribed an exact weight that she would go in and lift that day during her gym training.
This is because I could not account for how she would feel each and every day. It was more practical for her to select the working weight on the bar for each exercise that day and then regulate whether or not this needed to increase or decrease to not exceed the RPE ceiling but also not diminish the benefits of strength training.
form became the new pR
Additionally, I instructed that during the entirety of the pregnancy there would be no attempts at setting any new PRs (new personal records in terms of the amount of weight on the bar).
The way I phrased it was to say that achieving absolutely correct form was the new PR.
The main Strength lifts
modifying the barbell squat during pregnancy
Stance width will need to be increased in order for the mother to continue to be able to hit depth. I advised Olivia to autocorrect as needed to achieve depth as she went. The picture below highlights the stance width adjustment differences.
![Olivia, stance width before pregnancy [Left) and during pregnancy [Right] - around the third trimester.](https://images.squarespace-cdn.com/content/v1/5915c791be65944f1cfeb9eb/1561026304950-IMVI9GEXVKBX7YT9EG1P/Squat%2BWidth.jpg)
Olivia, stance width before pregnancy [Left) and during pregnancy [Right] - around the third trimester.
Using the belt. At some point her belly diameter is going to exceed the belt notches. I anticipated the removal of the belt occurring much earlier than it did, and Olivia found that by shuffling the belt a little higher up she was able to continue its use for quite some time.
Bracing effectiveness. Diastasis Recti is the the separation of the abdominal wall. In Olivia’s case I found this started to impinge upon bracing earlier than the anticipated belt issue.
The bracing contributes to a correct setting of the back in strength training and is useful in life in general whenever you have to lift something.
With this in mind, I am glad I removed top single sets and PRs from the programming and selected an RPE ceiling, as this negated an unwanted back tweak due to form breakdown.
As a coach, you may notice in the squat that the hips rise and the back angle is not held but instead becomes horizontal. This is a potential sign that bracing is beginning to become compromised.
I introduced beltless squats after the end of the first trimester. One of my approaches was to anticipate possible exercise modifications, and introduce them in smaller exposures, earlier on in the programme to build up practice and familiarity with them. Then, when they needed to come in full time they wouldn’t be in any way brand new exercises.
Centre of Mass. The baby weight has the potential to lower the CoM point and the squat may start to feel different in the proprioception of the mother.
The process seems to be relatively gradual and Olivia did not report any balance issues with this, but I still had her squat inside the rack with safeties on should she ever need to set the bar down.
Accessory lifts. During the pregnancy Olivia started to report some hip pain. We found that it presented after some squat sessions and it also flared up with some cardio sessions.
I used some accessory lifts to dial down the squat volume per week, which meant we managed to keep her squatting long term throughout the pregnancy. In place of the squat at times she used the hack squat machine or leg press.
modifying the barbell deadlift during pregnancy
I kept Olivia using the conventional deadlift for as long as possible, but in anticipation of the widening belly and stance issues to accommodate this I gradually introduced the sumo deadlift (latter weeks of Trimester 1).
I really wanted to keep the deadlift in the programme for Olivia, as I had heard many stories from mums of persistent low back pain, most likely owing to extra weight that is carried by the mother as the baby grows heavier.
It turns out that maintaining the strength of Olivia's back was the right thing to do because she never did report back pain to me at any point during pregnancy.
She reported that performing the deadlift helped her hip pain that had arisen to feel better.
shoulder pressing & bench pressing
shoulder pressing.
Olivia reported one or two brief instances of feeling lightheaded during exercise fairly early on in the pregnancy.
One concern I had was that if she experienced light headedness during the standing shoulder press with the barbell that this might lead to her losing balance and landing on the floor, with the barbell coming down and following her.
I took two courses of action to manage this situation.
The first was to introduce pin presses using the safety arms of the rack.
That way the barbell would come to rest on the safety arms and not be able to follow her if she did have to take a knee on the ground during a light headed episode.
The second, was to introduce seated dumbbell shoulder presses. In this case if there was any problem I simply instructed her to drop the dumbbells beside her.
The feelings of lightheadedness only occurred early on and as she adapted to the training they did not reappear and so I did not need to proceed in the long-term with the pin press, But I did in later stages of the program keeping the dumbbell shoulder press as her overall workouts were becoming more taxing towards the final phases of the pregnancy.
“I understand the risk of inferior vena cava syndrome – a late-term complication involving the compression of the vein by the baby when lying flat in a supine position”
bench pressing.
For practical reasons, pregnant women end up not being able to do much work supinated (think abs and crunches). However, I’d read about an additional concerning condition called inferior vena cava syndrome.
For this reason I began introducing the incline bench press as early as the first trimester.
For those reading this article that are less familiar with barbell lifts and the Starting Strength approach to bench pressing, there are some important safety considerations for this exercise in general. I’ve written about them in this article.
As an aside, I also halted the lying tricep extension very early on and switched this to standing tricep cable pulls downs.
exercise programming during pregnancy
The kind of coaching I am used to receiving and using in my coaching business is done bespoke to the lifter and is reactive in that sense.
I periodically programme on a weekly basis and was prepared to amend lifts during the week in this case. Because every pregnancy is different, at this time I do not believe a programme could be pre written and sold as a cut and paste template.
Every five weeks I programmed a mandatory low stress week, an example of which is pictured below.
This was to dissipate any total accumulated fatigue, which I was already managing weekly with the RPE ceiling that meant Olivia should not arrive at intensities as high as RPE 8 or beyond.
Weight on the bar could be increased on any lift, as long as it did not breach the RPE ceiling.
the first trimester
The first trimester looks a lot like the programming I had used before Olivia was pregnant.
We still had a functional 3 day routine.
I switched from prescribing exact weight on the bar over to prescribing an RPE.
On Tuesday I had included some light cardio and deliberately programmed in a well-being block.
Olivia runs a busy household of 2 young children and she is self-employed and usually very busy with her work. She is a highly motivated, hard working person and is of the temperament that potentially could lead to over working and not resting adequately, in favour of getting more done.
This is partly where I acted as a ‘brake’ to build in recovery.
I wanted this well-being block to be a time for her, when she was not at home or at her place of work. We later used it for physio, midwife appointments and at times just for her to have a rest and relax mid week.
workout A
workout b
the second trimester
Below you can see where I started to introduce the Pin Press (as discussed above for safety concerns), this was complimented on Fridays with the dumbbell variant of the press.
The sumo deadlift, although not technically needed yet, was introduced to give plenty of time to practice it.
I used beltless squats practice breathing and bracing and squat variations like the pin/tempo squat to keep the productivity of the lift in the programme but lower the intensity on the bar.
On weeks where Olivia would bench press two times, in one session she would incline bench press with the barbell, then on the end of week session she would incline dumbbell bench press.
The low stress week was included every 5 weeks in the programme.
the low stress week
the third trimester
By the third trimester shorter sessions worked much better for Olivia. I shortened most training days to just 2 strength lifts.
At the end of week session, letters A & B were to be completed and letters C & D were optional volume work she could add on.
resistance machines
Resistance machines were not my go to exercise during pregnancy, in part because Olivia is an experienced barbell lifter, but also because many machines cannot be fractionally loaded.
Instead they have much larger weight jumps, sometimes as much as 15kg and also their range of motion is much more restrictive.
Conclusion
There’s no such thing as a “normal” pregnancy. To say all systems normal, might make you, dear coach or personal trainer, think that you are going to get an easy ticket and it’s ok to drop your guard. But, that would be an error.
The term normal pregnancy applies from the medical standpoint, meaning there are no forecasted complications, indicative of an abnormal pregnancy that would contraindicate weight training, or in some cases any kind of training.
This decision comes from the doctor and midwife, with which there are regular check ins and update meetings. Once you have this early green light for exercise to continue, it’s best to get out of your mind the word normal. During 9 months there will inevitably be ups and downs.
During Olivia’s 3 trimesters we managed the following life events; stomach bugs, hip pain, various family trips and a surgical operation on one of her feet.
With this in mind, it becomes apparent that you are going to be managing not only training sessions but also planning for recovery to take place in between. Note, the programmed wellbeing slot wasn’t a joke, but designed to get Olivia out of the house/business and away from mum duties and boss duties and just recover from all of the above.
Keep in mind to have an open channel to the mother about weekly events that may inhibit recovery.
the importance of strength coaches contribution to training during pregnancy
Overall, there is now a growing body of evidence that expecting mothers who are strong, fit and healthy have better pregnancies, better deliveries and they get back to pre-pregnancy weight more quickly.
However despite all this, there is a lack of written content on the approaches that can be taken with proper strength training in mind.
Strength is a term the media loves to bat around, often with the best intentions in mind, but frequently lacking in the truest sense of force production, with the right exercise selection in a way that could actually be of benefit.
One quick example, here is a link and excerpt that Google returned on its first page results for “strength training during pregnancy”
This image from Babble.com features sports dietician Heather Neal getting ready to lock out a 2lb rubber dumbbell press.
Image credit,Heather Neal & Babble.com
By way of comparison, here is Olivia. In the week during which she would give birth. Locking out close to 70lbs.
I already know from reading the work of Starting Strength coaches that have had babies, the massive benefits that came along with proper strength training during pregnancy.
I hope this case study provides some useful support to the coaching profession as well as expectant mums who have wondered about how exercise can play a part in pregnancy.
You can find and follow Olivia on her onward journey through motherhood and being a strong mum at her Instagram account:
“Each pregnancy is different, and pregnancy affects every woman differently, but for me, this time, lifting was something that I continued to do 3-4x a week and I had a very smooth pregnancy, an amazing delivery and “got my body back” in record time”