'I ran the City2Surf 4-months pregnant. People's reactions made me doubt my decision.'

When I took part in the 14km City2Surf, one week shy of being four months pregnant, there were certainly a few eye-rolls. Among the positive comments from fellow runners – like “Your baby is going to be born fit!” and “I won’t be able to live down the fact I was beaten by a pregnant woman” – there was the not-too-veiled judgement from others. 

Some people wondered why I would even want to push myself in this way. Others wanted to know what I had to gain from doing such a strenuous event. 

I get it. We aren’t used to seeing pregnant women train at a certain level of intensity. But as an elite athlete (I played for the NSW Swifts Netball team), who had spent years building my fitness and strength, what might have felt like an incredible athletic achievement to some, felt like just another day for me.

The Mamamia team discuss pregnancy myths. Post continues below.  

I felt incredibly proud of my body and myself while running the City2Surf. But later that day, I had a lot of pain around my pelvis and lower abdominals, and it was during this time that I really let those few naysayers' voices creep into my head. Even though these people had no medical qualifications, and no experience with training pregnant women, it was their voices who I kept coming back to whenever I doubted myself. 

It’s not just me who has experienced this. Elite athletes who continue to train at a high level during pregnancy are often plagued with criticism and admonishment. 

The blame (in part) is the fact that for a long time, we were sold the message that all pregnant women are fragile and in need of protection. Pregnant women were given a long list of exercises to avoid, often based on expert opinion, rather than empirical evidence.

What I wasn’t aware of at the time – even though recent research emerging out of Canada and Australia challenges these misconceptions and provides new insights into the upper limits of exercise during pregnancy – is that I needed to take any warning signs, such as pain and leaking seriously. I would learn that running while pregnant places a different load on the body, and my lower abdominal muscles and pelvic floor had to work incredibly hard to support my growing bump. 

While women should be encouraged to continue to do the type of exercise they love, some modifications will be necessary to ensure that this exercise remains safe for the mother and her baby. If I had my time again, I would have worked more closely with a pelvic floor physiotherapist during my first pregnancy to ensure that my pelvic floor was able to keep up with the rest of my body and prevent a lifetime of incontinence issues. For me, the City2Surf was a sign to reduce my running distance and wear specialised support garments to provide more support to my belly while exercising. 

Since that experience, I've become a pregnancy and postnatal exercise specialist and mum of three. So whether you’re an elite athlete, or just someone who loves to run, I hope the following information and research gives you the confidence to continue to enjoy the exercise you love... with a few pregnancy-safe modifications, of course!

Changing the pregnancy status quo. 

In Australia, up until early 2021, the Royal Australian College of Obstetricians and Gynaecologists (RANZCOG) recommended that pregnant women, experiencing a low-risk normal pregnancy, should aim for 150 to 300 minutes of moderate-intensity exercise (moderate intensity being a level where they are able to maintain a conversion), including two strength-based sessions per week. 

For some women, this represented a significant regression (read: downgrade) from their pre-pregnancy routine. It meant that women who would continue to do high-intensity exercise during pregnancy would often feel anxiety or stress over whether the exercise they were doing was safe for their baby, University of Alberta researcher Margie Davenport pointed out.

In early 2021, the RANZCOG guidelines were updated to include 150-300 minutes of moderate-intensity exercise OR 75 to 150 minutes of vigorous exercise, or some combination of the two. (Vigorous exercise is at a level where you need to pause for breath during a conversation).

This change represents the growing trend of acknowledging that some women will come into pregnancy with years of training behind them. But it also recognises that a woman’s exercise routine is often part of her mental, social and emotional wellbeing care. 

The benefits of exercise in pregnancy are numerous. Research, headed by Davenport, shows that just nine minutes of exercise a day can result in a 25 per cent reduced risk of pre-eclampsia. Or just 19 minutes of exercise a day can result in a 25 per cent reduced risk of gestational diabetes. 

As Lyz Evans, APA Titled Pelvic Health Physiotherapist, any my co-founder from the Empowered Motherhood Program, points out: “Only around 30 per cent of all Australian pregnant women are meeting the recommendations for physical activity in pregnancy, and with the health benefits so widely documented, it's time to shift the dial. 

“It’s such a shame when a woman loses the fitness levels she has spent a lifetime building out of fear. Provided that a woman is supported by qualified healthcare professionals who are experienced in working with prenatal women (such as women’s health physios, exercise physiologists or certain PTs), and she’s willing to listen to her body, the research is showing us that she should feel confident to keep going with the exercise she loves.”

What are the upper limits of ‘safe’ exercise in pregnancy? 

Most research into exercise during pregnancy has been in the moderate-intensity range. According to Davenport, it could be one reason the RANZCOG Exercise during Pregnancy Guidelines state that due to “limited research regarding exercise at higher intensities, there is no evidence-based safe upper limit for the intensity of exercise”.

However, Davenport and her team have recently found that brief bouts of near-maximal exercise (10 × 1-min intervals ≥ 90% maximum heart rate) are well tolerated by both mother and foetus. It’s reassuring safety data for those who wish to continue this type of exercise during pregnancy, and who aren’t experiencing any contraindications (ie, medical reasons why physical activity might not be recommended during pregnancy). 

This is HUGE for pregnant female athletes and women who are used to such levels of high-intensity training, who are also being supported by a team of medical professionals. 

However, pregnancy definitely isn’t the time to start high-intensity interval training. Davenport notes that the above findings may not be applicable to those who have not done HIIT previously. 

Evans says, "Signs that you may need to reduce the volume or intensity of the exercise you’re doing include pain, excessive fatigue, leaking, bleeding, and abdominal contractions.”

Evans also notes that if you’re doing high intensity training, it’s super important to make sure that you’re focussing on adequate hydration to avoid overheating.

Listen to this Hello, Bump episode on self care. Post continues below.

Should you be lifting that?

As more money is invested into female sports, we’re going to see more and more women who want to continue to exercise and compete at the highest level during their pregnancy, with the view to returning to elite sport as soon as possible. 

Professional athletes will often have a team of healthcare professionals around them ensuring that they are exercising at a level that’s optimal for their longevity as an athlete and for the health of their baby. 

However, for everyday athletes who want to continue to train at a high level, is it safer just to drop the barbell and stick with ‘pregnancy-safe’ movements? 

Not according to Christina Prevett and the team of researchers who recently published a paper on the ‘Impact of Heavy Resistance Training on Pregnancy and Postpartum Health Outcomes' in the International Urogynecol Journal (2022). 

Prevett and her team surveyed 675 women and found that “those with experience in heavy lifting prior to pregnancy were not found to have adverse pregnancy, delivery, and pelvic floor outcomes if they continued heavy weightlifting, holding their breath during lifting skills, or performing exercises on their back during pregnancy.” 

Co-author Lori Forner shares that this research “found that women who continued to lift throughout their pregnancy had better health outcomes than those who stopped lifting when they became pregnant. 

“One extremely important finding in our study was the beneficial impact of heavy weightlifting in pregnancy on perinatal depression. We observed much lower rates of postpartum/postnatal depression and anxiety in women continuing to lift in pregnancy compared to the general population.”

However, Forner also cautions that “pregnancy is not the time to start Olympic or high-intensity weightlifting.” She also notes that “more research is needed to look deeper into mother-baby responses to heavy weightlifting during pregnancy.”

It’s important to note that while there were no adverse outcomes, approximately 57 per cent of the women surveyed experienced urinary incontinence following pregnancy. This is above the usual rate of postnatal incontinence that is commonly reported (33 per cent) and may be of significance for some women.  (Thom et al 2010). 

It definitely was for me. Like I mentioned earlier, if I had my time again, I would have worked more closely with a pelvic floor physiotherapist during my first pregnancy to ensure that my pelvic floor was able to keep up with the rest of my body and prevent a lifetime of incontinence issues. 

If you’re unsure where to start with your pregnancy exercise, this personalised where-to-start quiz from the Empowered Motherhood Program can help. Likewise, Davenport and her team have developed a Get Active Questionnaire for Pregnancy which helps women work out if they need to speak to their healthcare provider before continuing or beginning exercise during pregnancy.

I believe that it is really important that women are supported to exercise in a way that is safe for their pregnant body and which takes into account their exercise history, their fitness levels, the physiological changes that are occurring (including changes to connective tissue, structural changes, hormonal changes and changes to weight distribution) and their long term exercise goals. 

I am incredibly grateful that research teams are now investing so much time and effort into prenatal exercise in this way. While these studies provide encouraging insights, it's important to acknowledge that every woman is different. If you wish to continue to participate in Olympic weightlifting, CrossFit, elite sport or HIIT, it’s important to seek guidance from healthcare professionals, including pelvic health physiotherapists. So, invest in your pelvic floor health and your future self will thank you. 

Kimberley Smith is a pregnancy and postnatal exercise specialist, former professional athlete, mother of three, and the co-founder of the award-winning Empowered Motherhood Program. The program combines physio-led exercise and expert education for every stage of pregnancy, birth and postnatal in a easy to use week by week program and includes specialised programs for prolapse, c-section and abdominal separation.

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