A (semi) Comprehensive Guide to Perinatal Training

A (semi) Comprehensive Guide to Perinatal Training

Over the last decade, I’ve been fortunate to be able to help dozens of women through their pregnancies, which have concurrently been the most rewarding, stressful, demanding, and fulfilling experiences of my coaching career.

In that time, I’ve learned quite a bit about what to do and what not to do—but I’ve learned even more about the persistence and pervasiveness of public misconceptions around perinatal training.

Luckily, the science is catching up—recent research strongly corroborates my own anecdotal experience: that resistance training is not only safe during pregnancy but actually advantageous for both the mother and child.

A sound training plan seems to facilitate a more comfortable pregnancy, avert many complications, promote a healthier baby, and expedite the mother's postpartum recovery.

But it takes time for data to trickle out of the lab and replace longstanding beliefs and practices. And this delay is allowing misconceptions around training to continue to fester, infect, and entrench themselves in the public mindspace.

The process MUST be sped up—For the health of millions of mothers and their babies is dependent on it.

But it also has to be done right—For the margin for error is literally zero.

So I'm going to walk through some of the most effective strategies I've picked up over the years, through trial-and-error, tons of research, and hours of conversations with clients.

We’ll start conceptually at a high-level and then zoom in on some tangible examples and tactics to use when designing perinatal programs.

The goal here is to provide a semi-comprehensive guide on how expecting mothers can safely navigate pregnancy while retaining and maximizing fitness as much as possible. No matter if you’re the aforementioned expecting mother, her supportive significant other, or even a coach looking to help their clients through this exciting journey, this article should be a great place to start.


Let’s Take a Step Back

Prior to even thinking about conception, it's crucial to establish a solid fitness foundation. Obviously, this isn’t realistic advice for everyone (hey, accidents happen!) but in an ideal world, expecting mothers should go into their pregnancy with at least technical knowledge on how to train properly, and preferably a high baseline of fitness already in place.

Building muscle and strength and work capacity and stability and body awareness are all really hard to do even in the absence of a little human growing in your womb. Trying to play catch-up after the deed has been done isn’t necessarily a losing battle (something is always better than nothing provided it’s done right), but it’s definitely going to be an uphill battle within an already uphill battle.

Taking your fitness from 0 to 1 is hard under normal circumstances; and damn-near impossible by the time you realize you’re pregnant, weigh your options, and decide to actually get started on a plan. But the upshot here is that maintaining fitness levels are much easier than improving them! And the higher your starting point, the more breathing room opens up for the inevitable regressions that will happen by the time the due date rolls around.

We want this foundation to be as solid as possible to ensure not only your health throughout the pregnancy, but also your baby’s health. And then to enable a much faster, easier, and safer post-pregnancy recovery.

We all recognize the importance of exercise and training hard for general health. For women planning to conceive, this is even more vital. Procrastination has potentially severe consequences here.

The best time to start was yesterday. But the second best time is right now.


Is Training During Pregnancy Safe?

Now that you’ve gotten in the gym and built yourself an unbreakable foundation of muscle mass and strength, it’s all smooth sailing right?

It’s time to rest on those laurels and coast for the next 9 months right?

Because training hard and heavy with free weights is dangerous right?


(cracks knuckles)

Yes, pregnancy is an extremely vulnerable period.

Yes, there are numerous contraindications when exercising.

Yes, there are a lot of ways that bad things can happen.

And yes, it requires a bit more brain power to think about how to do this effectively.

But resistance training throughout this peripartum window can not only be done safely, but it MUST be done if you’re at all concerned with you, or your baby’s, health.

Granted, I’m just a guy on the internet talking about how women’s bodies work, so my number one recommendation is always to consult with and listen to your primary physician. It’s crucial to ask questions, do your own research, and get extensive tests done to ensure that resistance training is a safe option for you.

There are a number of potential barriers that can prevent (or limit) your ability to follow a traditional program; some of these are pre-existing and some may be emergent as a result of the pregnancy. Cardiovascular or respiratory disease, anemia, bleeding disorders, and joint issues are examples of conditions that may preclude you from training through pregnancy and may necessitate a more specialized approach. Pelvic floor dysfunction, diastasis recti, hypertension, pre-eclampsia, placenta previa, and fetal distress are complications that may arise as a result of pregnancy and will often require modification, or cessation, of a resistance training program until they are managed or resolved.

However and luckily, the majority of expecting moms won’t experience these issues in a severity that prevents training from being continued.

In other words, most women have the green-light to train during pregnancy!


How Should Training Change During Pregnancy?

Though there is a solid chance you don’t fall into one of the contraindicated buckets, training still must evolve drastically throughout the perinatal period. But evolve doesn’t necessarily imply debilitating restrictions either…There will be some things that will definitely be advised against (which we will get into shortly), but that list is much shorter than intuition would lead you to believe.

The key to effectively training through pregnancy is understanding why and how deviations from the norm should be applied.


Accounting for Anthropometric Variability:

Wtf is anthropometric variability?

That’s just a fancy way of saying your proportions will be changing rapidly, and these changes must be accounted for when designing a program.

It’s not hard to visualize a woman going through the physical progressions of pregnancy—and from this, intuit how these changes might impact exercise.

To start, the continuous and rapid growth of the infamous pregnancy belly is going to require some serious workarounds. Most women will begin to see visible distention by the second trimester, if not sooner. Obviously, the onset, speed, and severity of this process will vary from mother to mother, but the outcome inevitably leads to some degree of exercise modification.

Though overly simplistic, the “backwards backpack with a bowling bowl in it” analogy isn’t too far off from the perspective of program design—the mechanics and impact on the body are pretty similar to that of the third trimester. And we probably don’t have to follow through with this thought experiment in practice to understand that shifting the center-of-mass anterior and dramatically expanding the waist circumference will create many downstream effects that have to be managed. Due to the former, the pelvis will get pulled into anterior tilt; the posterior postural muscles will be asked to work overtime; and the hamstrings will lengthen, quads/hip flexors will shorten, and glutes will , in turn, be mechanically disadvantaged from producing force. Because of the latter (enlarged waist circumference), gait will be altered, movement patterns affected, range-of-motion limited, and certain exercises rendered impractical.

Though I’ve chosen to highlight these specific variables, that’s not to say that there won’t also be sweeping anthropometric and biomechanical changes happening elsewhere. But the anterior shift in center-of-mass and expanding baby bump are, by far, the most impactful when it comes to affecting how expecting mothers need to think about training.


There’s a Human Growing In There:

Because there’s a little person inside your belly, we should probably take care to not compress it too much or increase intra-abdominal pressure too violently. I would really hope that this one is pretty intuitive and doesn’t really require a whole section to hammer home the point, but let’s just cover our bases…

Babies are precious and delicate and vulnerable; and they should be treated as such. At every point throughout this process, the health of the mother and child should be the absolute priority. But one thing that’s easy to overlook is that the mom is much more resilient and robust than the baby. Whereas the mother can voice her aches and discomforts, the baby can’t. Whereas the mother can easily shake off a bruise or mild trauma, the baby can’t. Whereas the mother can respond and adapt to external demands, the baby can’t.

So it’s on us (i.e. the designers and/or implementers of the program) to make a priori assumptions about the baby’s fragility/condition/state and account for them ruthlessly. We have to operate within the supposition that any exercise that unnecessarily compressed the belly, or any technique of that excessively raises the intra-abdominal pressure, should be preemptively avoided.

Training through pregnancy isn’t about eliminating all risk—that’s just not possible under the circumstances. Instead, it’s about not doing the dumb shit that creates unnecessary risk.

And with that, it should go without saying that lying flat on your belly and/or wearing a lifting belt should be vehemently contraindicated once you begin to show.


What About Intensity?

Ah yes, my favorite topic! But this time, it’s intensity with a twist.

When I talk about intensity, it’s usually in the context of a proximity to failure. RPE and RIR tend to dominate the conversations as ways to modulate that proximity. And the quality of our volume is typically measured as a function of that proximity.

But with pregnancy (especially the last two trimesters), we shouldn’t care AT ALL about failure. It’s doesn’t even need to be in the discussion. As such, RPE and RIR can still be useful tools, but we need to think of them slightly differently. Rather than measuring the quantity of effective reps, the focus should be shifted to the quality and magnitude of effort and strain.

In theory, this is actually what RPE should be gauging (RPE=Rate of Perceived Exertion). In practice, the default use case has almost always been correlated with failure. However, with pregnant women, effort and strain must be our North Star, because the line between “not enough” and “too much” is the difference between “regression of fitness” and “unnecessary risk”—and that line is contracting by the day.

So what are we to do? We don’t want to just be going through the motions creating absolutely zero stimulus and wasting time. But we also have to be extremely cautious about drifting too close to the Sun.

Even someone who knows nothing about pregnancy or exercise can probably come to the logical conclusion that training intensity should taper down as the due date approaches. And they would obviously be correct in that assessment if we were still measuring intensity as we normally would; but in my opinion, that is still viewing a very complex topic through an overly-simplistic lens.

The definition of intensity, as we’re now using it, is something new—Shifting from reliance on the rigid and binary failure as the primary target to the intangible and fluid hardness allows us to cheat the system somewhat. We can make things challenging without making them traditionally intense, by absolute or relative standards.

The simplest way to do this is by shifting exercise selection to movements that reduce ancillary dependence and isolate only ONE quality or muscle group at a time. While Smith Squats are a phenomenal way to build the quads under normal circumstances, they can easily be replaced by Leg Extensions, thereby, reducing the ability of the glutes and erectors to contribute, as well as lowering the need for abdominal bracing. Similarly, a Standing Barbell OHP might be a great way to build upper body pressing strength but the stability prerequisites impose unnecessary demands for the pregnant athlete; whereas, moving to a Seated variation allows the same qualities to be trained without the potential risks.

Additionally, we can deliberately shift to more unilateral work, adjust tempos, implement more machine/cable movements in lieu of their barbell/dumbbell counterparts, and even get creative with techniques that can increase the intensity without increasing the intensity like isoholds, loaded stretching, 2 Up/1 Down, etc.

Granted, everything that is proposed here is meant to be a template rather than prescription. There are still more ways to fuck this up drastically than there are ways of actually doing it right. Much of how intensity during pregnancy should evolve will come down to subjective feedback and modification in the direction of best fit for the individual.

As a general rule, remember that intensity must be thought of differently during the last two trimesters and postpartum—from there, select the appropriate building blocks, plug-and-play, iterate, and refine the programming until the end result is practical, effective, and most of all, safe.


Y/N Exercises:

We’ve gone over a good amount of information up to this point, and I’m sure you’re sitting there screaming “JUST TELL ME WHAT TO DO FFS!”

First, take a breath.

Second, something about teach a man to fish yada yada nonsense.

Third, ok fine here we go…

Let’s walk through a very non-comprehensive list of movements that should generally be avoided during pregnancy, and how to modify them to their simplest and most similar corollary (i.e. still keeping within the same general patterns):

Conventional Deadlifts -> Trap Bar Deadlifts

Barbell Squats -> Wide Stance Landmine Goblet Squats

Leg Press -> Wide Stance Deadstop Leg Press

Standing Barbell OHP -> Seated Machine OHP

Seated DB OHP -> Tall Kneeling Single Arm Landmine Press

Chest Supported Rows -> Seated Low Cable Rows

Bent Over Barbell Rows -> Single Arm DB Rows

Barbell Bench Press -> Machine Chest Press (preferably sitting upright)

Weighted Crunches -> Deadbugs (though, supine positions need to be modulated by individual)

Barbell Hip Thrusts -> Feet Elevated Hip Thrusts (remove load across lap; hip thrusts/bridge movements can also be done unilaterally)

Barbell Hip Thrusts -> Single Leg Cable Glute Kickbacks (further regressed from above)

Lying Hamstring Curls -> Seated Hamstring Curls

Ab Wheel Rollouts -> Swiss Ball Planks

Ab Wheel Rollouts -> Push-Up Position Planks (further regressed from above)

Ab Wheel Rollouts -> Push-Up Position Planks Against Bar (further regressed from above x2)

Russian Twists -> Band Pallof Holds

Again, I want to emphasize that this is a very short list of the movements that will inevitably be affected by pregnancy, and the modifications are just meant to be examples of how specific exercises can be adjusted to account for the pregnancy-induced contraindications. Always get your programs created and tailored to your individual needs by a professional who knows what they’re doing.


What About Postpartum?


Now what?

Getting through pregnancy is tumultuous, but the journey isn’t over quite yet. After giving birth, nailing the postpartum phase is absolutely critical for ensuring a speedy recovery to prior fitness levels, as well as keeping you healthy.

Your body has been incubating and prioritizing your growing baby for the last nine months. With that, your proportions, biomechanics, and even neural patterns have changed drastically. Then suddenly, the baby is out and your body is now thrown into chaos. Though there is no longer an 8lb miniature human hanging onto your uterus, your brain and support structures can’t rewire themselves nearly as quickly as you can give birth. This leaves a gap of vulnerability in which your new (or old; depending on how you look at it) body is grasping to find an equilibrium while lacking the tools to get there. Many basic functions like pelvic floor control and even breathing will need to be effectively relearned.

Though every mother’s recovery will be vastly different, we can run through some general guidelines for how to make the most of this postpartum period to snap back quickly and safely. (Again, make sure to consult with your doctor above all else!)

For at least the first 2-3 weeks, the goal should be to minimize physical activity and avoid straining yourself, if at all possible. And this includes very basic things like bending over to pick something up off the floor, putting on shoes, reaching for a high cabinet, etc. Just focus exclusively on recovering, resting, and sleeping as much as possible (though, that’s obviously easier-said-than-done with a newborn). The hope here is that you will have some support to allow for this mandatory sedentation in the form of a significant other, family or friends who can step up and help.

After this period, when you’ve had a little bit of time to acclimate to your new (old) body, some very light activity can resume. And by light, I mean LIGHT—slow walking, mild static stretching, and extremely low-intensity resistance band work. For example, you might start with 2x20 min walks around your neighborhood, 5 min of stretching before bed, and 2 sessions of isolation band work (i.e. 2x20 band triceps extensions, 2x20 band seated leg curls, 2x20 seated band rows, etc). I like to evaluate and talk to my clients after each week in this stage to see how we need to progress. My default is always going to bias being overly conservative and prioritizing work-capacity/mobility/stability/proprioception before strength/hypertrophy. How long this phase will last depends heavily on the fitness levels that were carried throughout pregnancy and into labor, but 2-4 weeks should be expected. The fitter you are, the quicker you’ll be able to progress up the postpartum ladder of intensity, volume and complexity.

Once it’s mutually agreed that you’re ready to get back on a training program (by your doctor, coach, and you), start out with 2-3 full-body sessions per week. Focus the majority of work on single-joint movements that take your target muscles through the fullest ROM that you can safely accommodate. Prioritize machines as much as possible when performing this strength/hypertrophy work and fulfill the stability/rigidity/postural necessities directly (rather than cross-contaminating qualities). Keep volume low, tempo slow, and rest periods long enough to ensure full interset recovery and focus. Titrate intensity up very carefully as tolerance begins to build and return to pre-pregnancy baselines. This phase should last between 4-8 weeks under normal circumstances, but can be stretched out as long as is needed.

Beyond this, “normal” training can be reintegrated relatively rapidly by adding in training days, volume, intensity, and exercise complexity; though, it’s probably best to focus on one “additive” at a time. Don’t rush in guns blazin’ otherwise you might catch a stray.

Some lucky moms will be back to their normal self within 6 weeks as if they didn’t just synthesize the most complex life in the Universe from just a few cells. While others will have lasting effects and contraindications stemming from pregnancy that prevent them from every truly getting back to where they were before. It’s an unfortunate hand to be dealt and a very real risk that comes with the process. If you fall in this latter bucket, don’t worry—hope isn’t lost. There are plenty of ways to continue to not just exercise and stay fit, but to actually train hard. The window of efficacy is just a bit narrower. The best thing to do is find yourself an experienced and knowledgable coach who can act as your guide.

In other words, just reach out to me.


Let’s Put It Into Practice

Before we wrap this all up, I want to show some of the highlights of what we’ve talked about in a visually-pleasing way (since, understandably, not everyone wants to read my brain vomit). Again, for the 10th time, this is very high-level and isn’t meant to be nuanced…Focus the principles and trajectories intrinsic to each phase and extrapolate that to meet your individual needs:


Exercise Modifications & Focus




First Trimester

- Continue pre-pregnancy routine as long as there are no contraindications.

- Avoid high-intensity and high-impact plyometrics

- 4-5 sessions per week

- 1-3 sets

- 5-20 reps

- Normal rest

- Moderate-to-High

- Proximity to failure as gauge

Second Trimester

- Modify exercises for growing belly and changing center-of-mass.

- Reduce frequency and duration of prone and supine position. Avoid twisting or compressing the abdomen.

- Limit intensity of Valsava maneuver and intra-abdominal pressure (not eliminate…limit) 

- Shift focus to maintenance of fitness rather than gain of strength or muscle. 

- Increase stability and mobility work

- 3-4 weight training sessions per week

- Potentially add in a dedicated stability/mobility session (if able)

- 1-3 sets

- 8-20 reps

- Normal rest

- Moderate

- Effort/strain as gauge

Third Trimester

- Modify exercises to reduce joint, ligament, and axial stress

- Avoid heavy loads, high impact, and excessive range of motion.

- Focus on stable and controlled exercises with liberal use of machine and cables. 

Slow tempos, increase proportion of unilateral work, and emphasize postural/proprioceptive awareness as much as possible.

- 3-4 weight training sessions per week

- Potentially add in a dedicated stability/mobility session (if able)

- 1-3 sets

- 5-8 reps on compound movements (slow tempo down to reduce load requirements)

- 10-15 reps on isolation movements (use primarily machines, cables, and unilateral variations if possible)

- Extended rest

- Low-to-Moderate 

- Effort/strain as gauge

Postpartum Period

- Weeks 2-3: Minimal physical activity

- Weeks 4-8: Light walking, stretching, and band work

- Weeks 9-16: Ease back into resistance training by titrating up very slowly

- Focus on restoring pelvic floor, abdominal, and postural strength.

- Focus on improving mobility and proprioception

- Consult with doctor and coach regularly, and especially before phase transitions.

NA (refer to postpartum section for specifics)

NA (refer to postpartum section for specifics)




Wrapping Up

Exercise is universally good.

But exercise through pregnancy is conditionally good.

There are plenty of reasons to be wary and skeptical of training if you’re an expecting mother—bad advice or improper implementation can be catastrophic.

But there are more reason why expecting mothers should be exercising—as doing so the right way protects, strengthens, insulates, and reinforces not just your health, but also your baby’s.

So get started yesterday.

Learn how to train hard.

Strengthen your body.

Build a resilient foundation.

Become more fit; for the gym, for life, and for pregnancy.

You owe it to yourself, and your future family.

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