Birth preparation is important for you as parents-to-be to prepare yourselves physically and emotionally as a couple and as individuals for the birth of your child. This can take place as part of group courses or individual sessions .

Anneke, CEO of Physio Restart, would like to share her own experience of how she prepared for the birth of her first child, partly together with her husband but also with other people. She would like to point out that this was her personal experience, which depended on her current mental and physical condition. Anneke was very fortunate to be physically free of major ailments, perhaps also as a result of her knowledge, regular exercise and healthy diet. We recommend that you consider which content is relevant for you and possible at the time .

Anneke:

For birth preparation, you may want to seek help from your gynaecologist, midwife, doula, specialized physiotherapist, osteopath or other specialist disciplines. It is important to know at all times how you and your baby or babies are feeling in the womb so that you can implement or omit the following measures accordingly.

Preparation already begins when you are trying to conceive. In this article, however, I am mainly referring to the 3rd trimester of pregnancy.

What can you do (together with the people around you) so that you (you) are stronger going into the birth and the time afterwards?

Where can I obtain prenatal care?

1. a birth preparation course: A great idea to get information about the birth process, birthplace (infrastructure, staff and mission statement), breathing and relaxation techniques and to meet other parents-to-be. Zurich offers a variety of options, from purely informative lectures to practical events in your chosen place of birth, as well as fitness classes on land and in the water.

2. in therapeutic sessions: Your treating doctor may give you a prescription for physiotherapy, osteopathy or chiropractic. Often due to complaints that you may have mentioned. The costs are fully covered by basic insurance from the 13th week of pregnancy. At Physio Restart you can book both, i.e. you can book appointments without a prescription and get the costs reimbursed by your supplementary insurance if necessary.

3. on social media, books, forums, podcasts: there are certainly great offers that you can consume easily and conveniently from home and on the go, but I recommend taking a close look at the information you are getting involved with. It’s certainly not a good idea to google and take the opinions and advice of other mothers online as a reliable source. Even your own mother or mother-in-law may often give you precocious advice. But books like Baby Years, The complete Australian Guide to Pregnancy and Birth, Midwife’s Consultation or podcasts like Keleya, From the Beginning or The Peaceful Birth are some that I have found valuable. In the end, however, the most reliable source remains your doctor, therapist and midwife. By the way, I have written an article in the Mama Guide from Let’s Family and am planning another one for the Baby Guide. You can get these books in doctors’ surgeries and hospitals, they are usually included in the mommy and baby box that they give out for free. But take a look at my story and publications here.

What content is important for birth preparation?

I divide them into theoretical and practical:

Theoretical birth preparation

1. What happens in and to my body in the last few weeks of pregnancy? How is the baby developing? Which physical and mental changes are normal for me and which are less so?
2. How do I prepare my home and my environment for the arrival of the new addition to the family?
3. How do you decide which type of birth is possible? When is an abdominal birth (caesarean section) considered?
4. Where and how can I recognize that the birth is about to start? When do I contact my midwife and/or the place where I am giving birth?
5. What is the normal birth process and what other scenarios are possible?
6. What role does my birth companion play? Do I even want my partner or someone from my family or circle of friends with me? What is important to me?

Practical birth preparation

By the 3rd trimester at the latest, you should know the pelvic floor in all its forms. Where it is located, what function it has when and where and how you can relax it at the end of pregnancy and during childbirth and tighten it at other times.

Practice various breathing techniques that will accompany you towards the end of your pregnancy and can then support you during the birth and postpartum period.

You can do wonderful mobilizing exercises with your partner to open your pelvis and familiarize yourself with birth positions.

Muscle-strengthening and endurance training can also often take place up to the birth and give you enough energy and strength to keep going. There are now some studies that report that the birth time is shortened and the recovery for you and your baby is faster afterwards. I am also still active (currently in week 39+0) 5-6 per week in my practice and in the fitness center.

By massaging and stretching around your perineum, vagina and anus, you can familiarize yourself with this area of your body, which unfortunately has often been taboo until then. You can also do the massage (from week 32-34+0) and stretching with a balloon (from week 36+0) in pairs, always in consultation with your doctor.

Your diet should be balanced and predominantly healthy and tasty throughout your pregnancy. A few weeks before the birth, you could follow a Louwen diet. This is not a diet per se, but rather an avoidance of foods high in sugar and carbohydrates so that you can regulate your blood sugar levels and thus release the receptors that are important for the natural onset of labor.

Ultimately, it’s about preparing yourself mentally and physically for the birth and strengthening your confidence in your abilities as an expectant mother. Your pregnancy is unique and an absolute miracle. Listen to your needs, take sufficient rest breaks and don’t let yourself be influenced by other opinions or supposed role models. Don’t put yourself under pressure if the day doesn’t go as planned. Pregnancy, birth and the time afterwards should be a journey with pleasure and not a ticking off of to-do lists! In the end, you certainly did your best.

If you are looking for physiotherapeutic support during your pregnancy and would like to have the above questions answered, you can contact us at any time with your concerns. Book your appointment here: tBooking – Online-Buchung für Ihre Termine
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The female menstrual cycle is a natural process in the body that usually lasts around 28 days, but can also vary (24-35). It comprises four main phases: Menstruation, follicular maturation, ovulation and the luteal phase.

Menstruation occurs at the beginning of the cycle (day 1 of bleeding is day 1 of the cycle), followed by the maturation of an egg in a follicle. Ovulation is the time when the egg is released and the luteal phase prepares the body for a possible pregnancy. If fertilization does not occur, the cycle begins again. The menstrual cycle is regulated by hormones such as oestrogen and progesterone.

Phase 1 Follicular phase

The follicular phase is the first phase of the female menstrual cycle. It begins on the first day of menstruation and usually lasts around 14 days, but can vary from woman to woman.
Important:
Day 1 is described as only the real bleeding, and not the brownish discharge or so-called spotting, which can occur a few days before. During the first phase, small structures called follicles develop in the ovaries, each containing an egg. Under the influence of hormones such as FSH (follicle stimulating hormone), a follicle matures and usually one of the eggs is selected for ovulation. The follicular phase ends with ovulation, when the selected follicle releases the mature egg.

Ovulation

Ovulation is the time in the female menstrual cycle when a mature egg is released from a follicle in the ovary . This normally occurs in the middle of the menstrual cycle, about 14 days before the start of the next menstruation. Ovulation is triggered by the rise in luteinizing hormone (LH), which causes the follicle to rupture and allows the egg to be released. The egg can then be absorbed by the fallopian tubes and is ready for fertilization by sperm. Ovulation is a crucial step in the reproductive cycle and a key factor in conception.

Luteal phase

The luteal phase is the phase of the female menstrual cycle that follows ovulation. It normally lasts around 14 days, regardless of the total length of the cycle. During this phase, the empty follicle from which the egg was released transforms into a temporary gland called the corpus luteum. The corpus luteum produces progesterone, a hormone that prepares the lining of the uterus for a possible pregnancy.

If fertilization has not taken place, the corpus luteum recedes, progesterone production decreases and the uterine lining is shed, leading to menstruation. However, if fertilization has taken place, the progesterone supports the implantation of the fertilized egg and helps to maintain the pregnancy until the placenta is sufficiently developed to take over this function.

Training

Cycle-controlled training refers to adapting the training plan to a woman’s menstrual cycle. Some research suggests that women respond differently to exercise during certain phases of their cycle and their performance may vary .

Follicular phase

In the first phase, women are often more powerful, especially in terms of strength/muscle building. Studies describe a 40-45% higher strength potential at this time. This is supported by the higher increase in the hormone oestrogen. It is recommended that training is organized so that intensive strength training takes place every two days or eight sessions in the first phase of the cycle. Of course, it is important to remember that the first few days of your period can also bring symptoms and the sessions may need to be adjusted accordingly.

Ovulation

Women are much more sociable in the days around ovulation, as nature can guarantee a possible pregnancy. Preventive training should include components such as stability and coordination, as the ligaments, muscles and tissue are somewhat more unstable and softer than usual at this time.

Luteal phase

In the second phase of the cycle, recovery sessions and moderate exercise are more likely to be tolerated. Strength training should not be the focus of training, but can still be carried out once a week or with a total of two sessions during this time. With the increased progesterone, the body temperature rises by approx. 2°C and metabolic activity increases.

Cycle-driven exercise takes into account hormonal changes in the menstrual cycle to optimize exercise and better support a woman’s individual needs and goals. However, it is important to note that the effects of the menstrual cycle on exercise can vary from woman to woman, and there is not (yet) enough consistent scientific evidence to provide clear recommendations for all women. It is advisable to listen to your own body and make training adjustments according to your personal needs, preferably with a specialized professional and all parties involved (trainer, therapist, family).

Nutrition

Cycle-controlled nutrition refers to the adaptation of nutrition to a woman’s menstrual cycle. During the cycle, energy requirements, hormone levels and nutritional needs can change. Some women report different preferences, appetite changes and metabolic variations during the different phases of their cycle.

In the follicular phase, which begins with menstruation, there may be a greater need for iron and protein to support blood loss and muscle recovery.

During the luteal phase, which follows ovulation, an emphasis on a nutrient-rich diet, particularly complex carbohydrates, may be useful to cope with the possible increased energy requirements and emotional changes.

It is important to note that needs vary from woman to woman, and there is limited scientific evidence to support specific recommendations for cycle-managed nutrition. Individual preferences and needs should be considered, and it may be helpful to work with a dietitian or health professional to develop an appropriate dietary strategy.

Do you have any questions on this topic? Do you need more information about your cycle, the associated training and/or do you have any problems? Book your appointmet here: tBooking – Online-Buchung für Ihre Termine
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References:

1.Swiss Olympic. Women and elite sport. https://www.swissolympic.ch/athleten-trainer/frau-spitzensport

Own participation in Webinar by SART Impact of the menstrual cycle on prevention and rehabilitation. 25.11.2023

2.Kiesner J, Eisenlohr-Moul T, Mendle J. Evolution, the Menstrual Cycle, and Theoretical Overreach. Perspect Psychol Sci. 2020 Jul;15(4):1113-1130. doi: 10.1177/1745691620906440. Epub 2020 Jun 15. PMID: 32539582; PMCID: PMC7334061.

3.Carmichael MA, Thomson RL, Moran LJ, Wycherley TP. The Impact of Menstrual Cycle Phase on Athletes’ Performance: A Narrative Review. Int J Environ Res Public Health. 2021 Feb 9;18(4):1667. doi: 10.3390/ijerph18041667. PMID: 33572406; PMCID: PMC7916245.

4.Rogan MM, Black KE. Dietary energy intake across the menstrual cycle: a narrative review. Nutr Rev. 2023 Jun 9;81(7):869-886. doi: 10.1093/nutrit/nuac094. PMID: 36367830; PMCID: PMC10251302.

5. https://www.nhs.uk/conditions/periods/fertility-in-the-menstrual-cycle/

6. https://my.clevelandclinic.org/health/articles/10132-menstrual-cycle

During pregnancy

When a woman is pregnant, it is usually safe and beneficial to continue exercising and staying active during this time. However, it is important that she follows some basic guidelines and seeks advice from a professional to ensure that she is not taking any risks to herself or her unborn child.

Question: “Won’t I harm my unborn child with sport? They say you shouldn’t go jogging anymore? Besides, I don’t want to increase the risk of a premature birth.”

It’s understandable that you’re asking yourself these questions and it’s good that you’re looking into the issue to be on the safe side. However, we can answer all your questions with a NO. Sport and exercise per se are not harmful, even during pregnancy. Provided that there are no medical reasons against it. It is therefore important that you talk to your gynecologist about your exercise plan and, ideally, review it with a pelvic floor physiotherapist (e.g. Anneke) and adjust it week by week.

Exercise during pregnancy is important for your health and that of your child, to prevent possible pregnancy risks, to prepare you optimally for the birth process and the time afterwards and to maintain your mental strength. To date, there is no evidence that moderate exercise provokes premature birth or causes side effects for the unborn child.

The World Health Organization (WHO, 2020) updated the exercise recommendations during pregnancy. It even advises against inactivity and recommends staying as active as possible during a normal pregnancy.

2.5 hours of moderate* endurance training per week, strength training 2 days a week and daily pelvic floor training are recommended for every expectant mother with an uncomplicated pregnancy. Those who were already exercising before pregnancy may continue their vigorous** training.

*Moderateheart rates are 125 – 146 beats per minute (under 29 years) and 121 – 141 (over 30 years). **Vigorousheart rates are 147 – 169 (under 29) and 142 – 162 (over 30).

But which exercises are safe? What should you avoid? And where should you focus?

Sports such as swimming, cycling, pregnancy fitness, Pilates, yoga, fast walking or hiking and jogging are also permitted. You should only be careful with contact and high-risk sports where there is a risk of falling (horse riding), being hit in the stomach (boxing) or colliding, or where too high intensities can be achieved (maximum strength training). However, the latter can be done during pregnancy if you control your training well and are used to it!

The pelvic floor is certainly a very important area during pregnancy that you should pay extra attention to. In addition to strengthening it, it is important that you also train relaxation, especially towards the end of your pregnancy. The table below gives you two examples of different types of training (there are other important ones too!). Try it out now!

Activate your pelvic floor by closing both orifices as if you wanted to hold back urine and stool or pull a turnip out of the ground. It is important that you do not pull in your stomach, hold your breath or contract your buttocks. Place your hands calmly on your stomach and buttocks to control these errors. When relaxing, it is important that you do it slowly and consciously and don’t just let everything fall away. However, this alone is not pelvic floor training. It is much more varied and involves so much more.

1. maximum strength with relaxation:

Tense as hard as possible without compensating and consciously release. Repeat this 10 times with a pause of approx. 5 seconds.

2. relaxation:

Divide the contraction and relaxation into two phases of equal strength. To do this, first apply 50% of your strength, then another 50%, first relax only half again, and then completely. Repeat this 5 times.

Pregnant women should watch out for warning signs, such as dizziness, nausea or pain, and stop the activity immediately if these occur. It is also important that you drink enough fluids. Plan rest periods and take regular breaks, especially if you are still working and have other children at home, to minimize fatigue and maintain your energy levels.

Further information

The following video gives you another very clear overview:

Active Pregnancy Foundation – Pregnancy CMO Guidelines – YouTube

After the birth

No, you don’t have to wait 6-8 weeks after the birth before you can resume light activities. However, a certain amount of recovery immediately after the birth (early postnatal period 2 weeks) is important, use the first few days after the birth to recover, gather strength for the time ahead, get to know your baby or babies, cuddle and enjoy it. Avoid any household activities, shopping and schedule your visits well.

If you have a pelvic floor physiotherapist accompanying you during the late postpartum period (from 3 weeks onwards), he/she will discuss with you which movements are suitable. This depends on your (health) condition, your birth, your current daily routine and sleep, your available time and mood, symptoms. The training recommendations are always reassessed based on the examinations during the therapy sessions. The most important thing now is that you do the correct exercises for the abdomen and pelvic floor, which can be different for every woman, so don’t try unsorted YouTube videos or start something too early. We also offer postnatal recovery classes for later.

Is there anything to consider after the birth?

Yes, pay attention to the following symptoms, among others: loss of urine or bowel movements, increased urination, pulling in the lower abdomen, back pain, pressure in the pelvic floor area, pain (e.g. during urination or sexual intercourse). Don’t worry and don’t be ashamed, because many women describe these symptoms, but they should definitely be treated as early as possible and ideally prevented.

Click here for the video for after the birth (in English):

Active Pregnancy Foundation – Postnatal CMO Guidelines – YouTube

Overall, it is important that you continue to stay active during pregnancy and start again soon after giving birth, but also take care of your body and your limits. A customized training plan and regular consultations with Anneke can help ensure a safe and healthy workout. We can do a lot during pregnancy, so get good advice.

Book your appointment here: tBooking – Online-Buchung für Ihre Termine

References:

1 CMO guidelines UK Chief Medical Officers’ report.

2 Bø, K. et al. (2019) “Comment and questions to Mottola et al. (2018): 2018 Canadian guideline for physical activity throughout pregnancy,” Journal of Obstetrics and Gynaecology Canada, 41(10), pp. 1404-1405.

3 Davenport MH, Kathol AJ, Mottola MF, et al. Prenatal exercise is not associated with fetal mortality: a systematic review and meta-analysis. Br J Sports Med 2018.

4 Evenson KR, Barakat R, Brown WJ, et al. Guidelines for Physical Activity during Pregnancy: Comparisons From Around the World. Am J Lifestyle Med 2014;8:102-21

5 Bo K, Artal R, Barakat R, et al. Exercise and pregnancy in recreational and elite athletes: 2016/17 evidence summary from the IOC expert group meeting, Lausanne. Part 4-Recommendations for future research. Br J Sports Med 2017;51:1724-6

6 Bo K, Artal R, Barakat R, et al. Exercise and pregnancy in recreational and elite athletes: 2016/17 evidence summary from the IOC Expert Group Meeting, Lausanne. Part 3-exercise in the postpartum period. Br J Sports Med 2017;51:1516-25.

7 Bo K, Artal R, Barakat R, et al. Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 2-the effect of exercise on the fetus, labor and birth. Br J Sports Med 2016;50:1297-305.