When You’re Exercising While Pregnant, ‘Listening to Your Body’ Isn’t Always Enough
- Christine Sterling, M.D., FACOG, a board-certified OB/GYN, founder of Sterling Parents, and Oura medical advisory board member
But in my own pregnancy, I’ve found that “listening to my body” when I'm working out doesn't always leave me feeling my best. Sometimes when I let my body guide my exercise, I still end up feeling overtired or under-challenged, gassed in totally novel ways, and even in pain or lightly injured. Those times have have left me feeling alienated from myself, frustrated, hurt, and upset—but they've also required that I show myself more compassion than I’ve ever had to before.
Listening to your body during pregnancy: The recommended approach to exercise
The American College of Gynecology and Obstetrics (ACOG) recommends that pregnant women get 150 minutes of moderate physical activity per week, which is the same recommendation that the Centers for Disease Control and Prevention (CDC) gives all Americans. According to ACOG, exercise is associated with multiple positive pregnancy health outcomes, such as reduced risk of blood pressure issues, better mental health, higher rates of vaginal birth, and more.
Personally, in addition to these benefits, I wanted to keep exercising during my pregnancy because walking and hiking, lifting weights, running, and doing yoga are frankly just a big part of my life. Movement helps me get to sleep and reduces my sleep anxiety, clears my head, makes me feel accomplished and positive and energized. With so much changing in my body and in my life, it's felt important to keep that part of me.
Doctors support this approach to fitness during pregnancy. “[For] somebody who is engaged in a regular exercise program, we see that it's safe for them to continue that exercise program,” says Christine Sterling, MD, an OB/GYN and member of Oura’s medical advisory board. “If you feel comfortable and you feel that you're not exerting yourself too much and you're not experiencing pain, we're not going to tell you, 'Oh, you can't do that kind of exercise.'” As a result of this guidance, fitness offerings for pregnant people have proliferated.
"In pregnancy, our relationship with our body has to change, and this is really difficult." —Christine Sterling, MD
My fluctuating energy levels have meant that I’m definitely doing more walking than running these days; I still want to exercise, but not as much or as intensely as I did pre-pregnancy. It's been an adjustment, but not a huge one, to modify my effort and my goals.
“A lot of exercise is like, okay, I'm going to get to that other side of the runner's high, I'm going to get through this difficulty,” Dr. Sterling says. “But we really want people listening to their bodies in pregnancy and not pushing past pain. Your blood volume is increased, your heart rate—the actual stroke volume—is increased, your heart is actually doing more work, your cardiovascular system is already stressed and [in] your respiratory system, you don't have the same respiratory reserve. It's already kind of working at its maximum. So we don't want somebody to exert themselves to the point where they're impacting their body's ability to function.”
Easy enough advice to follow, right? If something hurts or is difficult, stop. If you’re getting out of breath, pause. (Dr. Sterling recommends using the talk test: You should still be able to have a conversation during the exercise you’re doing.)
Where the train has come off the tracks for me is when I’ve thought I was following advice about listening to your body during pregnancy, and my body still reacted in unpredictable ways.
When listening to my body wasn't enough
Take a recent Saturday afternoon doubles pickleball match I played during the end of my second trimester. It’s not something I do regularly, but doubles pickleball (a beloved pastime of senior citizens) is not the most strenuous of sports. I also instituted pregnancy rules: I was allowed to hit off of a double bounce, no one was allowed to serve too hard to me (or the point was mine), if I hit near the line, my ball was in. It felt great to slice, compete, talk trash, and spend an afternoon outside being active. When I was starting to feel tired, I told the group it was my last game. Way to set limits and listen to my body, right?
One hour later I was on the couch, depleted and horizontal. I was brain dead and exhausted from head to toe. Most troublingly, my hip joints felt like jelly. I could barely hoist myself off the couch let alone stand upright because I felt I couldn’t put pressure on the joints, like they were about to collapse underneath me. Recovery took days.
Pregnancy, of course, played a role. Dr. Sterling explains that lactic acid takes longer to clear during pregnancy, so your muscles might feel sore for a longer amount of time. Higher amounts of the hormones progesterone and relaxin make your joints and ligaments looser, so “they're going to ache more because there's more movement in them.” Running around for an hour until I got tired felt fine—fun!—in the moment, but it turned out to be more than my muscles, joints, and cardiovascular system could handle after the fact.
Pickleball wasn't the only time I’ve felt let down by my limits: In month six of my pregnancy, I set out for a walk-run, which I had done multiple times. At around the 30-minute mark, pain exploded on my right side, and I had to stay off my feet for a week. Apparently, my stomach had gotten big enough that one of the ligaments around my uterus was simply not up to the task of supporting the bouncing load for half an hour anymore. Once I was recovered a few weeks later, I tried again, intending to stop well before the point where my side had started hurting. The pain came after just 10 minutes that time, and I had to limp my way home.
Then there's the way I sometimes have to choose between having the energy to get exercise or get my work done, the pain in my feet that blooms when I’m wearing what are normally my most comfortable pair of walking shoes, the energy crash that happens at the farthest point of my favorite walking route despite feeling totally up for a walk of that length at the outset. In these instances, “listening to my body” has simply not been enough guidance.
My body and I have had over 30 years to develop our vernacular. I’ve learned how to tune in to the signals and feedback that tell me what kind of movement I’m in the mood for and for how long, whether I want to push through fatigue or give myself a rest, when I’ve had enough of an activity or when I’ve got another mile, another game, another set in me. But now, my body doesn’t always have the language to express what it needs. How is it supposed to say, “Hey, my joints are loose, my muscles take longer to recover,” when my joints and muscles haven't behaved that way for the last 30 years?
Ideally, we’d be able to work with our doctors to keep us informed and feeling tip-top day in and day out, but Dr. Sterling says the fact that most OBs have just 10 minutes to see patients each appointment means “one size fits all” advice about what to do or not do is the most common type dispensed.
“We're in an imperfect situation of how to really guide people,” Dr. Sterling says. “We have a paucity of data because back in the very paternalistic white male days of OB/GYN, the advice was, 'Oh no, pregnant women, don't exert yourselves.' We were overly protective, I think. And so there were many, many years where no studies were done looking at this issue.”
Which leaves us with little more advice than listening to your body during pregnancy.
How to be a better 'listener'
I’ve been surprised at how emotional I become in the moments where listening to my body hasn't been enough. It feels like my body has betrayed me by giving out, or that I'm losing touch with my sturdy and spirited identity, my capability and my strength. It also feels like a personal failing, like I have been negligent in taking good enough care of myself and my growing baby in pursuit of, what, a temporary endorphin rush? How could I be so irresponsible?
"In pregnancy, our relationship with our body has to change, and this is really difficult," Dr. Sterling says.
Though this period is temporary, how do we bridge the gap? I don’t have the ultimate answer, but I’ve instituted a few things in recent weeks that are helping me to stay active without beating myself up.
1. Be prepared for changes
The first thing I've learned is to roll with the punches and internalize the idea that pregnancy is an individual experience where the rules of the game are under a constant renegotiation. When I walked home at the end of that second failed walk-run, I felt dejected. But I also felt more resigned than the first time I got hurt, because it was simply time to face the fact that my belly was now too big to run with. Sure, Charlotte York could keep running in the Sex and the City movie when she was pregnant. But it no longer worked for me and my ligaments. Change: noted.
2. Notice how your body reacts, and reassess
I've learned to take stock of my body's reactions. For instance, I stopped playing pickleball soon after I got tired. That’s the time frame I’d always used pre-pregnancy to know when to end a workout: When you feel tired, go a little bit more, then you’re done. Now, I know that formula is too much for me. I have to stop before the point where I get tired, and not wait until I’m waning. Taking lessons when things don’t go 100 percent to plan can help guide me for next time.
3. Get curious
Learning more about what's happening "under the hood" has helped me have more compassion for my limits. I'm not just a delicate baby-making vessel who can't do what I used to. I'm pumping more blood at a higher stroke rate in order to send nutrients to the placenta (which is a a whole new organ I grew, by the way), my joints are loosening to prepare me for the task of labor, my three centimeter–long cervix is having to withstand pounds and pounds of pressure it's never had to support before. Increasing my knowledge about why my body might react differently than it used to is helping me become a more understanding and proactive listener.
4. Know you'll be okay
Lastly, I've started to have faith in my resilience. When I strained my ligament, turned my hip joints to jelly, or found myself on the couch, I eventually got better. It’s never the goal to end up wrecked and in pain. But if you're already making an effort to listen to your body, it’s not usually the end of the world, either. I’m lucky to be strong and healthy, and in this time where the ground is shifting under my feet, I’m not always going to feel great. But I’ll be okay.
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