Learning How to Train Pregnant Clients Takes More Than Just Searching on Google

Women are not just a niche market; they are 50% of the population. And almost every woman is in one of the three stages of motherhood: preconception, pregnancy and postpartum.

Here is how you can open opportunities, make more money, and change the lives of women in Prenatal and Postnatal Fitness.

It Isn’t Enough to Just Google “Tips for Training Pregnant Women”

When a pregnant client approaches a fitness expert, she assumes every exercise and all workouts with this trainer will be safe during her pregnancy. She also assumes that the exercises she’s being given will provide her the birth-related results that she is looking for. But many fitness professionals lack education in pre- and postnatal training, and some don’t know that entire courses exist that are dedicated to this topic.

Instead of referring an expecting client to a prenatal fitness expert, fitness professionals sometimes put their trust into the first few pages of Google search results.

Relying on unsubstantiated “education” isn’t just risky for the client’s health and function; it can also potentially damage your reputation as a fitness professional and undermine your client’s trust in her healthcare providers. Here’s how….

You Are a Member of Your Client’s Prenatal Wellness Team!

A certified fitness professional is a part of the allied healthcare continuum, which includes other health professionals “who are credentialed through certifications, registrations, and/or licensure and provide services to identify, prevent, and treat diseases and disorders.”1

This means that a fitness professional is responsible for ensuring a client’s optimal health and function while working alongside the client’s other healthcare providers, including any doctors, nurses, dietitians, mental health professionals, or licensed medical specialists.

For a pre- or postnatal client, these healthcare professionals may include an obstetrician/gynecologist, a women’s health physiotherapist, a certified nurse-midwife, or a doula.

Each professional fulfills a specific function according to his or her scope of practice.

A quick refresher: scope of practice is the legal range of services that can be provided within certain guidelines and set parameters according to the “specific education, experience, and demonstrated competency of their credential.”2

A pregnant client wouldn’t arrange for an internal pelvic exam at your gym, and likewise, she wouldn’t ask her nurse-midwife which exercises she could safely perform with a diastasis recti. She goes to the correct, accredited healthcare provider for each specific service she requires.

A personal trainer’s job is to provide the specific services “within the boundaries of his or her education, certification, and legal scope of practice.”3

Would you want a dermatologist to treat you for a cardiac condition after searching for a solution on Google? What’s to be said for fitness professionals and other wellness professionals who Google search for tips to train pregnant women?  

While we can learn valuable information through the internet and books, getting the right credentials may be more important than you think. By doing so, we can uphold our place in the allied healthcare continuum as we best serve our clients.

Once we have the education, experience and demonstrated competency that comes with a credential, we can then powerfully work within the scope of practice to better our client’s pregnancy or postpartum period.

There Can Be Consequences From Working Outside Scope of Practice

Working within your scope of practice is important to avoid unintended consequences, which can include hurting your clients or even being sued for malpractice.

A common example of a fitness professional working outside his or her scope of practice is when he or she agrees to train a pregnant client without understanding the physical changes of pregnancy that necessitate corrective exercise.  

Without this knowledge, a fitness professional may not identify dysfunction or may even unknowingly incorporate harmful exercises into the pregnant client’s workouts.

Imagine a woman nearing the end of her second trimester meeting with a personal trainer because her regular workouts were suddenly causing discomfort in her pelvis. Her routine included three days of running and three days of weightlifting, which she had been performing the duration of her pregnancy.

She noticed that her pain was specifically worse on “leg day,” especially during walking lunges, which she performed with 8 lb dumbbells. She also said that she felt worse after a long day of work as a preschool teacher, where she supervised students’ art projects at their tables.

Sometimes even just getting into and out of bed would send a slight radiating pain through her pelvis and/or glutes.

After evaluating her workout routine, this fitness professional suggests dropping the dumbbells and performing stationary lunges to continue increasing strength while aiding with stability in a less plyometric manner.

Noticing that the client has tight hips, the professional then decides to add a stretching sequence that uses lateral lunges to incorporate her adductors. And at the end of the session, among other stretches, the professional leads his or her client through a gentle butterfly stretch with the intention to relieve the hip tightness.

The next day, this client still feels discomfort in her pelvis, and now wonders whether or not to return to her training sessions.

The exercises chosen by this fitness professional were a start, but they were also setting this client up for much bigger problems. The professional didn’t realize that several of these seemingly valid ideas could actually be aggravating one of several pregnancy-related pelvic pain syndromes.

If training continues, this professional may eventually have to avoid any exercise that makes the pain flare up, likely to include lunges, squats, step ups — basically the entire lower body. This is far from the potential of guiding this client through exercises that correct the appropriate muscles and could help heal this syndrome mid-pregnancy.  

The solution attempted here was to manage the pain with exercise regression and stretching, which are both legitimate ideas. What’s missing, in this case, is the knowledge of which positions specifically improve function and which do not. Certain stretches, including the butterfly stretch, could literally cause the pain. “In the worst case scenarios sufferers are incapacitated and have to use crutches or wheelchairs.”4

While any fitness professional can provide workouts for pregnant and postpartum clients, not every professional is capable of correcting or preventing common pregnancy and postpartum related challenges. Working outside the scope of practice can be detrimental to a client’s health and in the most unfortunate cases, lead to liability in a fitness professional’s career.  

Knowing what changes will affect the pre- and postnatal body, a fitness professional can implement the best exercises to adequately and safely prepare a mother-to-be’s body for labor, delivery, and postpartum.

Training Prenatal and Postnatal Women Properly

Understanding how to assess and program prenatal and postnatal fitness routines correctly can prevent or aid in the recovery of certain pregnancy-related dysfunctions or pains, including lower back pain or pelvic girdle pain.

The client from the above example appeared to have pubis symphysis pain, which would have been more evident to a prenatal corrective exercise specialist who has studied how pregnancy and related alignment, as well as birth-related and hormonal changes, affect a woman’s body.

When educated, a prenatal fitness professional would recognize that the pain was associated with movements that split her legs, as well as the various related over-activated and under-activated muscles.   

Though the fitness professional may have even been accurate about the client having tight adductors, he or she didn’t recognize that the tightness was a compensation for her weakened core inner unit musculature. Instead of focusing on stretching the adductors, the proper education would have revealed a different set of exercises to fast-track fixing — rather than avoiding — this common prenatal scenario.  

There are core activations that pregnant women can perform but aren’t often taught to do in fitness, like Fit For Birth’s Core Breathing Belly Pump™ technique.

The Pre & Post Natal Corrective Exercise Specialist is able to recommend alternatives that go far beyond simply avoiding split-leg exercises so the client can continue to exercise and actually improve her function during pregnancy.

A fitness professional specifically educated in prenatal and postnatal fitness has a more thorough knowledge of specific pregnancy-related issues that may occur and how to effectively address them.

Rather than just avoiding certain exercises, a pre- and postnatal fitness professional would be able to identify the problem and present a solution for the client.

An Abundance of Prenatal Fitness Information, But A Lack of Value and Education

Internet articles can explain symptoms to look for or give advice about how to alleviate pregnancy-related issues, but with so many results and sometimes conflicting information, a personal trainer needs more guidance when programming exercises for pregnant clients.

One widely used fitness guideline is that pregnant women avoid supine exercises because the pressure from her uterus and baby could press on her vena cava, which would reduce her blood flow.

This guideline is incomplete on several levels:

  • The American College of Obstetricians and Gynecologists (ACOG) doesn’t specify a time frame when women should avoid supine exercises, unlike other countries, such as Australia, which gives 28 weeks as the cut-off.
  • ACOG doesn’t explicitly state that whether or not an exercising supine position must be avoided only that: “Motionless postures, such as certain yoga positions and the supine position may result in decreased venous return and hypotension.”
  • ACOG shows this result happens in only “10-20% of all pregnant women.”5
  • ACOG also does not account for the widespread dysfunction in diaphragmatic breathing, which may one day turn out to be a research-proven remedy for this age-old limiter of prenatal comfort.

This reveals that fitness professionals could use more guidance that includes an accurate understanding of the incredible changes that occur in a pregnant woman’s body and life before, during, and after birth.

When would your client need to avoid supine exercises? Should they avoid them completely or would it be best to modify the training program to incorporate them for short periods? When might it be wise to use corrective exercise to prevent the problem altogether?

Fitness professionals need to know how to properly apply that information to a training program to avoid dysfunction and optimize the woman’s fitness.

With a prenatal education, a fitness professional could know how to handle the previous example by truly observing a client’s function, while encouraging her to listen to her body.

Another example of conflicting information occurs when typing “Pelvic Floor Exercises for Pregnancy” into Google.  

Kegels seem to be the exercise of choice when it comes to pelvic floor prenatal training, and plenty of results will populate this search.

One reveals pelvic floor advice like: “Always squeeze and hold your pelvic floor muscles before you sneeze, cough or lift.”6 Another reference recommends: “Kegel exercises strengthen the pelvic-floor muscles, helping to prevent the urinary incontinence that’s common after childbirth. To do Kegels, squeeze the muscles around the vagina as if you are stopping the flow of urine; hold for 10 seconds, breathing normally, then slowly release. Do 20 reps five times a day.”7  

What you haven’t been told in these articles is that research shows half of the women who are taught to do Kegels are activating the muscles incorrectly.

In the corrective exercise realm, this fact means that the instruction of many fitness professionals is actually worsening that client’s function.

With worse function, comes worse performance and an increased risk of diastasis recti and other pelvic girdle syndromes, as well as complications in labor and delivery. This client may be left wondering if her personal training was a good investment.

Reliance on Google and lack of valuable education can cost your client her function and performance, and it can cost you your reputation.

But your story doesn’t have to be this way.

That’s where Prenatal and Postnatal Fitness courses can make an impact.

1. See: ACE Personal Trainer Manual, Chapter 1: Role and Scope of Practice for the Personal Trainer, Page 5 (https://www.acefitness.org/academy/AcademyElitePDFs/ACE_PT4th_Manual_Ch1.pdf)
2. See: ACE Personal Trainer Manual, Chapter 1: Role and Scope of Practice for the Personal Trainer, Page 5
3. (https://www.acefitness.org/academy/AcademyElitePDFs/ACE_PT4th_Manual_Ch1.pdf)
4. http://babycarejournals.com/spd/
5. https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Physical-Activity-and-Exercise-During-Pregnancy-and-the-Postpartum-Period
6. https://www.pregnancybirthbaby.org.au/pelvic-floor-exercises
7. https://www.fitpregnancy.com/exercise/prenatal-workouts/ready-set-push

______________________________

Kimiko Wadriski, PPCES
Fit For Birth Contributor
Kimiko is a fitness professional who passionately believes that fitness and education can empower, inspire, and create community for women during pregnancy, postpartum, and motherhood.  She delivered her first child in Thailand, and dealt with issues that she would like other women to avoid. Kimiko’s desire is to pass on information; to encourage women to take care of themselves and their bodies so they can take care of their babies. Her drive to understand and then pass on that understanding is so that she can make even one mother’s transition easier.

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