Prenatal Pilates is a topic that consistently stays popular. Pregnancy is a wonderful time in the life of a woman but it often raises a lot of questions and red flags for movement specialists.
- What exercises are safe?
- When should we stop doing Pilates?
- How late in the pregnancy can a woman start a new movement modality?
- How can we deal with pregnancy discomforts?
- And when can a woman safely return to her Pilates practice?
We have covered the topic of pre/postnatal Pilates before with Carolyne Anthony and Leah Stewart (PRO resources) and have explored the causes and recovery tips for Diastasis Recti with Diane Lee.
Today Leah Stewart is back to talk about Pilates programming for pre/postnatal clients. Leah first started teaching prenatal teacher training courses as a faculty member of BASI. In 2015 she made a decision to take her teaching courses online and she launched her first interactive online course Prenatal Pilates Doula Program.
In this interview we will talk about the building blocks of creating a well-balanced prenatal Pilates program and will address most common teacher concerns about teaching prenatal clients.
You will also notice an appearance of a special guest during the video. One of my younger girls decided to join us for the recording.
Complete interview and full transcript download are available for PRO members of PilatesBridge. Join here or log in.
Questions covered in the interview:
- Advice for the expecting mothers on how to stay calm.
- How Pilates teachers can provide support for their clients during pregnancy.
- Beneficial breathing patterns during different stages of pregnancy.
- How to create a well-balanced prenatal Pilates program for a client.
- When is it too late during pregnancy to start a Pilates program?
- What are the benefits of taking a prenatal teacher training course online?
Interview with Leah Stewart
PB: Leah, how did you get started with Pilates?
Leah Stewart: I started Pilates when I was a young dancer which is a common story for many of us teachers. Shortly after college I went to the BASI program with Rael Isakowitz, and I was able to work in his studio for several years. I trained with Rael to become a BASI faculty member and that was such a fantastic experience.
Then I had the honor and privilege of teaching the BASI courses for years all over the world in many different cultures and that was invaluable to me, not only as a Pilates professional, as a teacher, but also as an individual.
After I worked at the BASI headquarter studio I opened my own home studio, and then I eventually opened a small Pilates studio here in Southern California – LiveLife Pilates. I started teaching Pilates focusing on pre- and postnatal, but also able to do a lot of other classes for just the general population, not a specificity of pregnant women and new moms.
I was developing pre and postnatal courses and teaching them under BASI at first. Since then I went through two of my own pregnancies and was able to learn so much about the labor experiences. I was exploring the Pilates repertoire during my two pregnancies in really different ways and was able to bring this information into my courses.
In 2015 I made a very tough decision to close my studio and focus primarily on my education and workshop programs for pregnant women and new mothers. Even more, I have decided to take my whole business online by teaching online courses.
I have taught two courses so far, a Mommy and Me Pilates course and my Prenatal Pilates course online and both of them worked so well. I couldn’t be happier about this decision and the great experience of doing an online course. I was so happy to have a lot of support from my clients and family members during this year of transformation for me.
PB: Do you have any advice for the expecting mothers on how to stay calm and for their Pilates teachers on how to “guide” them during the pregnancy?
Leah Stewart: As Pilates teachers we have the opportunity to guide a woman through her pregnancy. First we need to look at what is already built into the Pilates practice that is designed to help keep that confidence, keep that empowerment, keep that calm, keep that joy, keep that zest and just the love of movement.
- Breath is such a powerful tool, not only physiologically to keep our muscles and joints healthy, keep the circulation, but also a powerful tool mentally and emotionally to calm us, to physiologically bring our heart beat down or to bring it up, or just get into a certain state of mind. The important of breath and then carrying on from that breath is going to be a major tool, that’s going to be used during labor and during birth.
- Flow/fluidity is the other tool. Being able to enjoy the feeling of movement and how we can really experience each exercise or each session in our body on that particular day. All of this becomes very important.
- Acceptance even though it’s not necessarily one of the tenets of Pilates, we can really integrate it into the practice. Each day a pregnant woman feels a little bit different. How she feels at six weeks is going to be obviously very different from how she may feel at 36 weeks or 16 weeks or 26 weeks.
Knowing that that body is going to adapt and being accepting of that is really powerful. Some days you feel more energetic, you can do a little bit more, have a little bit more challenge. On the days that you feel quite fatigued or nauseous, you can bring it down a notch, and you can just enjoy some deep breathing, you can enjoy some different type of exercising, a different vibe with your program.
That’s a really powerful thing for us as teachers to know and for us as pregnant women to know that the work will adapt to us, it will meet us at where we are.
- Focus and concentration together with body awareness. I was just in a workshop yesterday at Pilates Anytime with Brent Anderson, and he was speaking about the pelvic floor. We were talking about how for so many women pregnancy is really the first time that they develop an awareness in their pelvis, the pelvic floor because obviously that’s where things happen. It’s such a unique opportunity for women to learn about their bodies and sometimes for the first time, or sometimes in a whole different way and to become really acquainted or acquainted intimately with the majesty, the power of their body.
When we can appreciate the changes that are going on, not only that our body is helping this beautiful little baby grow inside, but also the way that our body naturally adapts anatomically, physiologically to meet the needs of that baby, it is a miracle. It is absolutely astounding, and so when we have that knowledge and we accept and we can love that about our bodies, I always find that women stay more calm, they stay more confident in their body.
PB: What types of breathing patterns do you recommend during different trimesters?
Leah Stewart: It’s a really-really great question, but the answer is complex because the body changes so much during the course of pregnancy. In the courses that I teach, I do teach several different breathing pattern options.
Lateral Breathing: I do still incorporate lateral breathing, but it’s not as we strictly know it in the Pilates system. The traditional way is to keep the abdominal wall as flat as possible, but that increases the intra-abdominal pressure. We want to have a healthy relationship between the diaphragm and the pelvic floor. When I talk about lateral breathing I teach to breath into the rib cage, breathe into those intercostal muscles, breath into the posterior ribcage. A lot of women have trouble breathing deep if the diaphragm is pushed up into the rib cage, and the uterus starts to grow up into the belly and all the way up to the bottom of the rib cage.
We can make a woman feel a little bit more comfortable, give her more freedom by mobilizing the thorax, spine and the rib cage, but we can also do a lot of breathing into the sides, into the posterior rib cage to bring a little bit more air and circulation into that area.
After that breathing many women come back and say, “Oh my gosh, it just made me feel lighter!”
Hypnobreathing: I use breathing techniques that I learned during HypnoBabies classes.
During these birthing classes wet talked a lot about breath and imagery as to find a way to keep a woman calm and present during her labor. I really fell in love with those techniques and adapted them a little bit to meet the needs during movement, during Pilates.
Calming Breath: I do a calming breath where we do four breaths in, hold it and then a long exhale out, so we get all the air in and allow all the air to come out. We stimulate the diaphragm on the inhale and then exhale with as much efficiency as we can get out of the pregnant body doing that.
Energizing breath is really fun. We inhale for a quick-quick 20 counts, and then you exhale for quick 20 counts. So it’s just a very long breath that stimulates and brings focus and energy. I always imagine waves in the ocean, or a tide pulling in and out.
Belly breathing. It’s not a bearing down, like a percussive in or out, it’s more of a full breath with directive imagery of filling up the belly or pelvis with air. And that feeling, that expansion of those bones so to speak, and that’s the imagery that we use.
I find that breathing really correlates great with postural changes. We have very common postural deviations during pregnancy that are supposed to happen but they don’t have to be excessive.
If we can keep this optimal alignment during pregnancy, then we can breathe more efficiently, we feel more comfortable in our body. We feel stronger, we feel more energized because we are able to breathe more efficiently, so that’s a big deal.
Breathing is such a great tool always, but especially during pregnancy. For example, that common breathe of four in and eight out can be a great one to do in between contractions, especially that kind of early labor where the contractions are further apart and that energizing focused breath is really great.
If a woman is in between contractions, and maybe she is having her partner rub her back or just give her some good relaxation techniques, she can practice some of that posterior rib cage breathing and that will allow a lot of breathing into her rib cage. If we can train women in their bodies then they can use these techniques during labor and even postpartum. We are setting up the body physiologically for a lot of health, a lot of healing, a lot of stimulation and that’s exactly what we want to do.
PB: Breathing is really the first kind of “exercise” that a woman can do after delivery. What types of breathing are most beneficial in the early postpartum stages?
Leah Stewart: Let me start by saying that there is not a lot of science out there, so we are making educated guesses or hypothesis based on the experience.
I think that breathing is great. Personally I would not even focus at first on a particular type of breathing – I would just breathe. Just breathe, you can lay there in your bed, in your hospital bed, wherever you are feeling comfortable, and just start that process of breathing and sending the oxygen through the body.
Now at the same time I have always found success in my own body, and I have reports of women that have taken my programs in their own bodies, postpartum especially those first few days to kind of use some of the imagery that we talk about in the pelvis, and in the abdominal wall, and just think about that imagery as they are breathing. With the eyes closed, they are feeling calm, they are feeling relaxed, they are feeling really heavy in their body.
Their body has been damaged depending on the type of birth that they had. There’s been a traumatic experience to that part of the body, so it’s just about physiologically stimulating the recovery process with some breathing and some imagery, that’s the first place to start.
Then from there I don’t even talk to women about muscular contractions initially, we talk more just about more imagery and just letting that imagery naturally move the bones of the body. Laying in bed let’s start with simple pelvic tilts, let the bones roll and stimulate muscle movement as a result of that.
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PB: What are your steps for creating a well-balanced prenatal Pilates program for a client?
Leah Stewart: As you know, there is no “one size fits all” program that we can apply to every client. At the same time when I teach prenatal sessions I talk about seven pillars of a meaningful prenatal Pilates practice. During some of my free training videos I spoke of four of those pillars: maintain, open, relax, strength, lengthen. I go in depth discussing those pillars during the program and I want to make sure that we integrate these pillars into our sessions. Depending on the trimester, and just how our client is feeling on a particular day we will focus on different pillars. For example, during third trimester we can focus more on the opening aspect and we will bring in the relaxation pillar. During the second trimester when women are usually feeling really good we are able to hone in a little bit more on the maintenance and strengthening aspects of our pillars.
So if we can make sure in our overall program that we incorporate all of these pillars the we are going to keep a woman healthy and balanced and strong and empowered during her pregnancy. And when we do that we can really make sure that our classes, our sessions, our individual sessions, are very well rounded, and they are meeting the needs of our clients.
I always say we do women major disservice by treating them when they are pregnant like they are fragile, and you are going to hurt them.
Yes, obviously we want to proceed with caution, we want to proceed with safety. We want to proceed with creativity, and wisdom. We want to proceed with compassion and empathy and sensitivity to their needs, clearly. I think when the pendulum swings too far to “We can’t do this, we can’t do this, we can’t do this, we can’t do this,” like all of a sudden a woman is like, “Okay, here I am.” And she’s like, “What’s wrong with my body? Like what …
PB: Yeah, they feel almost handicapped by their pregnancy.
Leah Stewart: Absolutely. The women that I worked with or that took my classes on PilatesAnytime have reported to me how empowered they felt in their body. Because the reality is that labor, no matter what it looks like, labor is a very powerful experience, hands down, for any woman.
I like the analogy between a pregnant woman and a marathon runner. If we don’t prepare the runner for the marathon, they can maybe get through it, it’s not going to be fun. It’s going to be really hard, but they are not going to have that empowerment going into, they are not going to have that joy of going into. It might be, “Well I just hope I get through it. We’ll see what happens.” Labor is something that we have to prepare for in every facet of our being. And physically we can certainly do that. And the physical obviously will help and achieve that mental and that emotional preparation as well.
PB: Leah, your online training program is called “Prenatal Pilates Doula Program.” What does “doula” stand for, why did you bring it into your program?
Leah Stewart: The idea of calling it doula has been sitting on my mind and my heart for really a long time. And I was afraid. I’m just going to be very transparent. I was really afraid to use it because I didn’t want people to take it the wrong way.
So I really looked into the history of doulas and the meaning of the word. “Doula” is a Greek word, and there are a couple of different definitions of it. Essentially what it means is a woman assistant or a guide who is there. It’s kind of open ended like exactly what that means.
We know historically during labor obviously children were born via midwives. And often women accompanying labors to help the mother stay calm, to help her feel empowered, to assist the midwife. There was very normal to have women surrounded with other women during labor all through our history. So “doula” kind of comes from that historical aspect.
So now we have labor doulas, we have postpartum doulas. And these are women that are there during labor or postpartum to help a woman with her experience, to be that support, to be that guide, to be there. So in my opinion, we have an honor as prenatal or as Pilates teachers when we are working with pregnant women. That woman is probably seeing her doctor during her appointments, or she’s having a baby with a midwife which is a slightly different experience. But besides those appointments, the pregnant woman is probably not speaking to any other professional about her pregnancy.
So she’s coming into our Pilates studio and we are guiding them through their movement experience of pregnancy. We are movement doulas. We are not birth specialists, we are not labor specialists, we are not falling into those category.
W teach them a lot about their body and about their alignment, a lot about the way their body moves. We teach them a lot about their pregnancy because we know the stages of pregnancy, and we’ve been trained in this work and we’ve studied it. So that’s a responsibility that we have. She may or may not be getting that information from other professionals, she maybe reading it on her own, but then really tying it in to the way that everything works with movements. So for me that gives us this great honor of being that guide, movement guide and being that prenatal Pilates doula.
So that’s why I called it that. Nothing other than just to really stress the importance of teaching with knowledge, wisdom, sensitivity, love, compassion, and creativity. And that’s really such a wonderful gift that we are given when a woman trusts us with her movement, and her body during this really meaningful experience that she’s going through.
PB: Is there a point in pregnancy when it is too late to take a woman as a client?
Leah Stewart: I tend to not give a lot of yes and no answers. But a lot of teachers who are new to teaching prenatal Pilates want to have a little bit more of a clear structure of “When can I take on a client? When can I not take a client? When I can I do this exercise? When can I not do this exercise?”
Sometimes it’s nice to be able to give those guidelines to teachers, to professionals. And then let them be comfortable with those guidelines and then let them as they gain more confidence in their teaching, they gain more experience in teaching their population, then they can kind of start to expand those guidelines while still staying in the safety parameters.
So to answer your question, the whole notion of a woman shouldn’t practice any new modality during pregnancy has been pushed to the side, especially modality like Pilates that can be very gentle and very advantageous. Because again we are denying a woman something that is going to help her during her pregnancy immensely, and help her during labor, and help her during her postpartum healing. Obviously there are going to be variations within that.
One thing is for sure, if a woman wants to practice Pilates, and because of a couple of different reasons she’s never had Pilates before, if she’s been sedentary before and she comes to you maybe early in her pregnancy, I believe personally that if she has been cleared by her physician or by her midwife, and her health is in the right state, and her pregnancy is not high risk, you can take her on because the movement can be extremely gentle and extremely wonderful. And it is a really fantastic time to bring that awareness into the body and start teaching those foundational elements of Pilates. Obviously it’s going to feel different for her.
Now, how late can it be? It really depends on the client. I just took a client. She’s had her baby not too long ago and moved here from Hawaii, and she was late into her pregnancy, but she had been practicing prenatal Pilates. I took her. Her drive to me was ridiculously long, and so I found a really great instructor for her where she lived to pass her along, and that instructor would not see her because she felt like she was too late into her pregnancy. So very different, you know this is an experienced teacher. A very good teacher and one that she knows she worked with me and she worked with another teacher prior to her pregnancy, and during the early stages of her pregnancy still wouldn’t see her, she didn’t feel comfortable taking her on as a client. And she didn’t really specify why, but it just wasn’t something she wanted to do.
If you as a professional feel, “I just, I can’t. It feels like it’s a little too high risk for me. I understand that she’s a good mover. I understand that the assessment looks good, but I just, don’t feel comfortable with it, the liability feels too risky for me.” You have to honor that feeling as a professional. So it’s hard for me to say yes or no.
The instance where I wouldn’t take a client is probably later into the pregnancy, a sedentary client that hasn’t done anything before. But then even within that, if I did an interview with that client, and she was like, “Listen here’s the thing. I really want to use Pilates. I know it’s late. I haven’t been physically fit, but I’m so clear I don’t have any preeclampsia. I really want to go for a natural birth, and I’ve heard that Pilates is a great way to train for that.” I’ll say, “You know what, you are 30 weeks, you still have 10 – 8 weeks to go. I don’t feel like I can teach you Pilates at this point. But if you want to learn some beautiful movements, some breathing techniques and imagery, and some light movements, that maybe you can incorporate into your labor, we can talk about that being an option.”
I would feel really confident exploring this scenario with a woman. I’m not going to slam the door in her face. I know in my mind as a Pilates teacher that I’m not going to teach her the practice, the discipline of Pilates right now, but I can certainly teach her some movements that she can do to help alleviate some of the lower backpain. I can take a look at her alignment and maybe we can work on some of those things.
As a Pilates teacher and a teacher of teachers I can take the work and make sure that we look at it from a bigger perspective, and we look at what’s behind the repertoire, meaning what’s the intent behind it? What are the risks, what are the benefits? Does one really outweigh the other? How would a program look like for this particular client?
Then we need to learn and teach and practice, rather than “this is what you do the first trimester. This is what you do in the second trimester; this is what you do in third trimester.” These guidelines are great and we need those. We also need to be able to peel those layers back and see what’s behind it, so we can make educated decisions.
PB: Yes, because a lot of times pregnancy is the time when women realize that they want movements of some sort, or want to change their routine, want to stop being sedentary, because they just feel uncomfortable in their pregnancy, and they want to do something about it. You don’t want to feel sick and in pain for nine months of your life.
Leah Stewart: I think also at the same time, a woman comes in and she’s like, “Oh my gosh! I’m gaining all this weight, I want to lose weight.” I think as all women we worry about our body during pregnancy and what it will look like after a baby. And that’s natural and healthy, and I don’t think it’s bad to not be at all to be concerned with that. Because we know, the better alignment you have, the better balance you have in your musculature, the better breathing patterns you can do. We know that not only is that better for your pregnancy and the growth of your baby, and the advantageous labor experiences, and setting yourself up for healthy postpartum healing.
At the same time it’s also going to help us not to gain excessive weight, or not experience a lot of discomfort or pain. The benefits of that go way beyond the way that we look, but we all are going to look good, and there is nothing wrong with that. But if we feel good, we have good posture, we feel strong, we feel like we can breathe, we feel healthy walking around, and we can manage those discomforts when have them, we are going to feel really good, and plus having that knowledge of our body. So yeah, so I think it’s really individual thing not only for the client but most importantly for the instructor. The instructor needs to feel that she has the resources and the confidence and the knowledge to take on any client, any situation. Or if he/she does not feel comfortable with a situation then maybe find a colleague to refer the client to.
Know the black and white but also know that a lot of times people are in that grey, and that’s really where life happens, that’s really where bodies move, and that’s really what’s going on. So I think it’s an element of empowering instructors more than it is of saying do this, don’t do that. These are the guidelines, these are the considerations, this is what we need to watch out for, this is what we need to look for, but then within that, within those guidelines being able to move within there.
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PB: Pregnancy can bring a lot of discomforts (sciatica, lower back pain, round ligament discomfort etc.) Do you address those during your training?
Leah Stewart: I break down the program into trimester and in each trimester I speak about hormonal changes, physiological changes, anatomical changes and within that postural changes. And we speak about somewhat the specific things like changes in the abdominals or the pelvis and going into more details about the pelvis and the pelvic floor and the ligaments of the pelvis and so on. But within those sub-categories, within each module I talk about contraindications, I talk about conditions and symptoms, and I talk about how those can affect movement. So it’s very broken down, so it’s speaking about things around ligament pain.
We talk about why those symptoms/conditions occur and what are some of the general things that we can do to help alleviate those conditions before we go into specific examples of exercises.
One of the conditions that gets brought up in my course a lot is heart burn, how heart burn and indigestion is such a common experience for clients. A client doesn’t feel comfortable laying down even before 20 weeks, or doesn’t feel comfortable in a quadruped position during exercise. How do we explore that as far as our movement options. Those are certainly a condition and symptom that we want to be able to work with. So we can come up with some modifications and some variations, and then if a woman is still experiencing something that seems more severe than that, and then at that point it’s out of our scope, and we’ll need to refer her to a different specialist.
PB: You have new online teacher training programs coming up in 2016. How long is the course? How does the online learning happen?
Leah Stewart: Before I started promoting my online courses, I sent out surveys and asked what are some of your concerns with taking online courses? And I got some really great feedback, and things that I already anticipated as well and some things that I hadn’t anticipated. The length of the courses is different, depending on the material.
The prenatal course is quite long because it’s a big course.
The “Mommy and Me” course is a bit shorter, because it’s an addition to a postnatal education course. But we are more specifically talking about how mommy can do Pilates with baby in tow. And it’s really fun, and we speak about baby’s development for the first year and mom’s postpartum healing for the first year. And then we look at the exercise options according to that.
So the courses I set up are lectures, so you sit down and you watch a video of me lecturing. And then there are videos of exercise demonstration, and the next videos are sample classes. And there is also interviews with a physical therapist, with a doctor and with a midwife. So again bringing those other professionals that we tend to work alongside.
The course is very organized. But the most wonderful thing that I really enjoy about the course is every week depending on how long the course is, I send out a little questionnaire or survey. And the students will fill that out with specific questions that I ask for their own concerns or things that need more clarification, or they want to go in deeper discussion about. And then we have a Q&A call once a week.
And I go in and look at all those questions and I organize them into categories, and then I address each one, so that the Q&A call is very organized. Those calls are recorded so that you can listen—our students can listen to them after if they’ve missed that Q&A call for whatever specific reasons. That part really adds the connection, and of course we have Facebook groups, there is always email.
So I am with you at every step, these courses aren’t what we would call “evergreen.” You can’t always come in and say, “Oh I’m going to take the prenatal course now.” It happens at a specific time, and I am there with you for the duration whether it’s two weeks or six weeks. So I’m there with you and releasing modules, lessons in a very systematic order.
I love teaching in studios over two days or three days, but it’s always like go-go-go-go, it’s just like a lot of information. And yes they can write great notes, yes the handouts and the manuals are really great and helpful. But the online experience really slows down that learning process so that the brain can really absorb things slowly. And the very best part is you have access to the course forever.
So let’s say you teach and then let’s say in six months to a year later you want to review a certain element on it, you can go back and watch it. And every time I teach the course I may update things, or I may add things or whatever, you can have access to that material as well no matter when you took the course.
Probably the biggest concern has been how are you going to be able to watch us cue a client. And guess that part of it would be great, but we don’t really even get into that in a studio, face to face version in anyways. And to be quite frank with you at this point I am not here to assess your teaching skills, that’s what advanced educational courses, particularly this one, are for. You already are a teacher; you already know how to teach. I want to know more about how you are processing the material, how you’re incorporating the material, and how you’ll design a program for your clients.
You know how to teach, you know how to do exercises, you know how to perform exercises. So that element I feel is very good right now, and I designed the evaluation and final exam to this way. You have a client, you tell me what you are going to do with this client, I want to see your thought process. And from there I can kind of see how you refer the material and how you are going to use that material. Because when we teach it’s not an element of blurting out all the fancy information we know. It’s how we can actually apply that in simple effective ways for our clients to understand.
Connect with Leah Stewart
- LiveLife Pilates Academy – registration is now open for the upcoming Prenatal Pilates Doula Program – click here to register.
- LiveLifePilates Youtube Channel