DAY ONE
What You Need to Know
About Strength Training
During Pregnancy
YOUR BONUS RESOURCE PACKET
INCLUDES:
• Girls Gone Strong Prenatal Physical Activity
Readiness Questionnaire
Click here to download standalone version
PAGE 1
• Stop, Caution, Go: Your Guide to Safely
Navigating Exercise During Pregnancy
PAGE 11
• 3 Activities to Avoid During Pregnancy
PAGE 21
• The GGS Perceived Effort Scale
PAGE 24
• Prenatal Referral Communications Kit
PAGE 26
STRENGTH TRAINING DURING PREGNANCY: HOW TO STAY SAFE,
HEALTHY, AND STRONG
Girls Gone Strong Prenatal Physical Activity
Readiness Questionnaire
This questionnaire is designed to help me learn what I need to know to help you stay safe and healthy during
pregnancy while reaching your goals. Please take your time and fill out this questionnaire as honestly as possible.
About You
Name:
Email:
Address:
Date of birth:
Phone Number:
Gender pronouns:
What’s the best way to contact you?
Phone call
Text message
Email
Other (please specify):
Emergency Contact Name:
Relationship:
Emergency Contact Phone Number:
Your Health
Primary Care Provider (PCP) Name:
PCP Phone Number/Email Address:
Permission to Contact PCP if Needed:
Yes
No
Please answer the questions below by checking YES or NO.
YES
NO
1. Has your doctor ever said that you have a heart condition and that you should only perform
physical activity recommended by a doctor?
2. Do you feel pain in your chest when you perform physical activity?
3. In the past month, have you had chest pain when you were not performing any physical activity?
4. Do you lose your balance because of dizziness or do you ever lose consciousness?
5. Do you have a bone or joint problem that could be made worse by a change in your physical activity?
6. Is your doctor currently prescribing any medication for your blood pressure or for a heart condition?
7. Do you know of any other reason why you should not engage in physical activity?
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Girls Gone Strong Prenatal Physical Activity Readiness Questionnaire
Please check the box that applies to you below:
1. I answered NO to all questions above, and I have been cleared for exercise while
pregnant by my healthcare provider.
2. I answered NO to all questions above, and I have NOT been cleared for exercise
while pregnant by my healthcare provider.
3. I answered YES to one or more questions above, my healthcare provider is aware of
these health conditions, and they have cleared me for exercise while pregnant.
4. I answered YES to one or more questions above, and I have NOT been cleared for
exercise while pregnant by my healthcare provider.
If you checked box 1 or 3, please sign the release below.
If you checked box 2 or 4, please get cleared for exercise with your healthcare provider before
starting an exercise program. Ask them to fill out the PARmed-X for Pregnancy form. Then,
return the completed form to me, along with this form.
Disclaimer and Release
 I, the undersigned, have read, understood to my full satisfaction, and completed this
questionnaire.
 I understand that if my health changes, I must inform my coach and check with my PCP that
I’m still cleared for exercise.
 I recognize that it is my responsibility to work directly with my PCP before, during, and after
seeking fitness and/or nutrition consultation.
 I understand that any information provided is not to be followed without prior approval of
my PCP. If I choose to use this information without such approval, I agree to accept full responsibility for my decision.
 I acknowledge that my coach may retain a copy of this form for their records. In these
instances, they will maintain the confidentiality of the same, complying with applicable law.
Signature:
Date:
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Girls Gone Strong Prenatal Physical Activity Readiness Questionnaire
Setting Boundaries
Throughout our coaching partnership, there may be things that come up that you are or are
not comfortable talking about. Topics such as your pelvic floor health, nutrition, sleep, and
stress may all have an impact on your training and your results to varying degrees.
Please indicate which topics you are comfortable talking about with me as your coach by
checking the box (or check the first box if you are comfortable talking about all of them). If you
are not comfortable talking about these issues with me, leave the box blank. (Please note, you
may change your decision at any time.)
As you go through the rest of this form, feel free to leave any questions you don’t feel
comfortable answering blank.
I am comfortable talking about all of the topics listed below.
I am only comfortable talking about these specific topics:
Birth preparation
Pregnancy symptoms
Miscarriage
Fertility concerns or treatments
Infant loss
Menstrual cycle
Pelvic floor health
Diastasis recti
Incontinence
Pelvic organ prolapse
Breastfeeding
Sleep
Stress
Emotional issues (e.g., depression, anxiety)
Body image
Nutrition
Weight
Other:
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Girls Gone Strong Prenatal Physical Activity Readiness Questionnaire
Your Pregnancy
Which trimester are you currently in? (please check one)
Trimester 1 (0–13 weeks)
Trimester 2 (14–27 weeks)
Estimated Due Date:
Trimester 3 (28–40)
Number of pregnancies:
Has your PCP recommended any limitations for your exercise during pregnancy? If so,
what are they?
How are you feeling so far during this pregnancy? Are you experiencing any symptoms
you think might impact your training?
Have you met with any of the following health care professionals in the 12 months before
or during this pregnancy?
Physiotherapists
Acupuncturists
Chiropractors
Other (please specify):
Please describe reasons for your visit(s):
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Girls Gone Strong Prenatal Physical Activity Readiness Questionnaire
Have you experienced any of the following before or during this pregnancy? If so, please
check the boxes and provide relevant details in the space provided below.
MUSCULOSKELETAL
Pain in the central pubic area
Lower back pain or sciatica – location:
Neck pain
Coccyx (tailbone) damage or pain
Knee pain
Any other joint pain (e.g., wrist) – please
specify:
Abdominal bulging or doming during
exercise
Other (please specify):
OTHER
Hemorrhoids
Varicose veins
Constipation
Gestational diabetes
Preeclampsia
High blood pressure
Low blood pressure
Other (please specify):
PELVIC HEALTH
Heaviness, dragging, or
bulging in the pelvic area
Diagnosis of pelvic organ
prolapse
Leaking urine when you
cough/sneeze/exercise
Strong and sudden urge to
urinate
Leaking of urine at rest
Difficulty or discomfort with
passing urine
Uncontrollable gas
Leaking of feces
Straining during bowel
movements (constipation)
Pain in the perineum during
sexual intercourse (or any
other time)
Unexplained bleeding during
or after exercise
Use this space for details on any boxes checked above. Please include when symptoms
started/diagnosis happened, any treatment(s), and current status.
Is there anything else you’d like me to know about this pregnancy, or any past pregnancies,
as your coach?
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Girls Gone Strong Prenatal Physical Activity Readiness Questionnaire
Your Past Birth Experience(s)
Please fill out this section if you’ve experienced birth in the past. If you haven’t, skip down to
“Your Training.”
Date(s) of birth:
Birth type (vaginal/assisted/C-section):
Tearing (including degree, if known):
Postnatal bleeding status:
Other complications, if any:
Breastfeeding status:
Is there anything else you want me to know about your past birth experience(s)?
Your Health Details
Have you been diagnosed (currently or in the past) with any significant medical
conditions and/or injuries that you haven’t mentioned yet? Please check all that apply.
Heart condition
Asthma
Cancer
Type 1 diabetes
Type 2 diabetes
Autoimmune condition
Thyroid disease
Seizures
Fibromyalgia
Arthritis
Blood disorder
Osteoporosis
Knee pain or injury
Neck pain or injury
Back pain or injury
Other (please list)
Use the space below to provide details on any boxes checked above.
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Girls Gone Strong Prenatal Physical Activity Readiness Questionnaire
Are you taking any medications, either over-the-counter or prescription? If so, list them
all below.
Have you ever had surgery or experienced any other major medical event you want me to
know about? If so, use the space below to share what happened, and when.
Your Training
In general, what are your goals for training during pregnancy? Check all that apply.
Maintain or improve strength
Maintain or improve aerobic fitness
Reduce or prevent aches and pains
Improve core and pelvic floor
connection
Reduce likelihood of a Cesarean birth
Feel less stressed or anxious
Improve or manage my mental health
Feel more in control
Have fun
Improve overall health
Attenuate weight gain
Other:
Out of the goals you checked, which ones feel most important? Rank your top 3.
1.
2.
3.
How many times per week did you exercise before becoming pregnant? And what types of
exercise did you do?
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Girls Gone Strong Prenatal Physical Activity Readiness Questionnaire
What’s your exercise routine now that you’re pregnant? How many workouts are you
doing per week, and what types of workouts do you do?
How’s your exercise routine working for you right now? What, if anything, do you want
to change?
Your Lifestyle
The purpose of the following questions is to help me, as your coach, get a better understanding of your lifestyle. Sleep, nutrition, hydration, and stress all affect your training and recovery.
When I have a better understanding of these factors, I can modify your workouts accordingly to
ensure you can recover. It also helps us work together to make sure your program leaves you
feeling strong and energized.
STRESS AND RECOVERY
How much sleep do you get in a 24-hour period?:
Rate your general stress level on a scale of 1–10 (1=little, 10=extreme):
Do you feel depressed or anxious?:
Do you suffer from mood swings?:
Have you ever been diagnosed with depression or anxiety?:
Your Nutrition
How much water do you drink in a 24-hour period?
Who does most of the grocery shopping & cooking in your household?
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Girls Gone Strong Prenatal Physical Activity Readiness Questionnaire
What does your nutrition look like on a “typical” day? Please list meals, snacks,
and beverages.
What, if any, nutrition challenges have you run into during pregnancy so far?
(For instance, are food aversions a problem? Are you nauseous? Having a hard time eating
a certain type of food that you’d like to be eating?)
What, if any, changes would you like to make to how you’re eating, and why?
Your Environment
Who do you live with? (e.g., spouse/partner, parents, roommates, pets, children)
Right now, on a scale of 1–10 (1=little, 10=extreme), how supported do you feel in your
efforts to have a healthy pregnancy by those around you and your home environment?
What, if any, major obstacles are you encountering at home or with loved ones when it
comes to your efforts to train, eat, and recover during pregnancy?
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Girls Gone Strong Prenatal Physical Activity Readiness Questionnaire
Your Coaching
What drove you to seek out coaching during pregnancy?
What do you hope to get out of our coaching experience?
What do you expect from me as your coach?
Is there anything else you want to share that you haven’t been asked yet?
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STRENGTH TRAINING DURING PREGNANCY: HOW TO STAY SAFE,
HEALTHY, AND STRONG
Stop, Caution, Go: Your Guide to Safely
Navigating Exercise During Pregnancy
When you’re exercising during pregnancy (or helping a woman who is
pregnant exercise), you should be aware of certain signs, symptoms, and
contraindications of exercise. After all, keeping mom and baby safe is the
top priority!
That’s why we created this resource.
Here’s how it works.
When you’re pregnant, there are certain signs and symptoms to look out
for that mean you need to stop exercising. Think of this as a red light.
There are also some signs and symptoms that mean you should exercise
caution. Treat these more like a yellow light.
And lastly, there are some boxes to tick that mean you’re good to go. Green
light!
First, let’s talk about the fun stuff.
When Are You Good to Go?
You’ve got the green light to train when you’re:
o Cleared by your doctor for exercise.
o Doing exercise and movement you enjoy.
o Engaging in activities that feel good and nourishing to your body.
o Not exhibiting any signs or symptoms of pain, pelvic floor
dysfunction, dizziness, nausea, vaginal bleeding, or any other
warning signs that your body is not tolerating the exercise well.
To learn more about training pregnant and postpartum women: girlsgonestrong.com/cppc
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Stop, Caution, Go: Your Guide to Safely Navigating Exercise During...
o Avoiding exercises that are contraindicated in pregnancy. (You can
read more about those in the 3 Activities to Avoid During Pregnancy
section.)
When Should You Proceed with Caution?
When we talk about exercising caution, we mean keeping a close eye
on symptoms, modifying the exercises you’re performing as necessary,
and sometimes making the choice to move on to the next activity or stop
exercising altogether.
This “caution” category is a bit trickier than the other two. It’s much easier
to define “yes” or “no” than it is to define what “maybe” entails!
We’re going to talk about five common indicators that you should proceed
with caution, but be aware: These aren’t the only instances where you need
to tread carefully.
Always listen to your gut. It’s always better to err on the side of caution.
And if you’re a coach or trainer, this is why maintaining good, open
communication with your client is important: So you can check with her
about how she feels, and she can feel comfortable telling you.
1. SOMETHING SEEMS “OFF” DURING YOUR WORKOUT
Proceed with caution (or pause to modify your exercise) if you feel any of
the following during a workout:
o Excessive fatigue
o Feeling very out of breath during exercise
o Aches and pains (e.g., wrist, knee, shoulder) beyond the normal mild
musculoskeletal pain that may come with exertion
To learn more about training pregnant and postpartum women: girlsgonestrong.com/cppc
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Stop, Caution, Go: Your Guide to Safely Navigating Exercise During...
o Pain in the front or back of the pelvis that can feel achy, sharp,
radiating, or like a burning sensation.
Mild symptoms like these are often normal signs of pregnancy, but they’re
worth keeping a close eye on to make sure they don’t develop or escalate
into something more serious.
2. YOU’VE BEEN DIAGNOSED WITH (OR THINK YOU MIGHT HAVE) PELVIC ORGAN
PROLAPSE
Pelvic organ prolapse (POP) is a condition in which the pelvic organs
descend toward or through the opening of the vagina. POP needs to be
diagnosed by your doctor or physiotherapist.
Symptoms to watch out for are:
o A feeling of excessive downward pressure in your pelvic floor,
heaviness in your perineum, or feeling like something is bulging,
dragging, or “falling out”
o Low back or pelvic pain
o Incontinence
If you start noticing any of these symptoms, try modifying the exercise by
reducing the load, intensity, or range of motion. If a modification doesn’t
help, or if your symptoms get worse, it’s probably prudent to stop that
exercise altogether.
3. YOU EXPERIENCE URINARY INCONTINENCE
Involuntary leaking of urine is pretty common during pregnancy, but it
can be a symptom of pelvic floor dysfunction or a sign you’re not handling
To learn more about training pregnant and postpartum women: girlsgonestrong.com/cppc
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Stop, Caution, Go: Your Guide to Safely Navigating Exercise During...
intra-abdominal pressure well. Leaking typically occurs during moments of
strain or excessive pressure, like when you’re:
•
Performing strenuous activity
•
Sneezing
•
Laughing
If you leak urine during a workout, you don’t have to stop exercising if
you don’t want to (it’s ultimately your choice how much it bothers you).
However, we do recommend speaking to a pelvic health physiotherapist
and considering making a modification to your workout. See our tips for
adapting an exercise to reduce symptoms for ideas later in this resource.
(Note: These modifications may also help you reduce symptoms of pelvic
organ prolapse.)
4. YOU OBSERVE ABDOMINAL WALL “DOMING” OR BULGING, OR YOU HAVE
CONCERNS ABOUT DIASTASIS RECTI
Diastasis recti (DR) is the widening of the linea alba — the connective tissue
that links the two sides of the rectus abdominis muscles (your “abs”).
DR is normal and expected during pregnancy, especially during the later
stages. But severe cases may make postpartum recovery more difficult.
While there is no definitive evidence that certain exercises make DR worse,
we think it’s prudent to be cautious with exercises that:
•
Cause doming or bulging of the linea alba.
•
Feel like “too much” for your core to handle.
Any woman experiencing symptoms of prolapse, incontinence, or problems
with DR should be under the care of a specialist, such as their OB/GYN or a
pelvic health physiotherapist (ideally, both!).
To learn more about training pregnant and postpartum women: girlsgonestrong.com/cppc
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Stop, Caution, Go: Your Guide to Safely Navigating Exercise During...
If you’re a trainer and have a client dealing with any of these problems,
check out the Prenatal Referral Network Communications Kit, also in today’s
bonus resources.
5. YOU’VE BEEN DIAGNOSED WITH A RELATIVE CONTRAINDICATION TO EXERCISE
If you have relative contraindications, then exercise during pregnancy may
be safe — as long as you have approval from your medical team and know
about any necessary modifications.
Relative contraindications to strength training during pregnancy include:1
o Mild respiratory disorders (e.g., well-controlled asthma)
o Mild congenital or acquired heart disease
o Well-controlled Type 1 diabetes
o Mild preeclampsia
o Preterm premature rupture of membranes (PPROMs)
o Placenta previa after 28 weeks
o Untreated thyroid disease
o Symptomatic, severe eating disorders
o Multiple nutrient deficiencies and/or chronic undernutrition
o Moderate to heavy smoking (>20 cigarettes per day) in the presence
of comorbidity, such as a respiratory disorder
If any of the above apply to you, it doesn’t automatically mean you can’t exercise. Instead, it means you and your doctor or healthcare provider should
discuss whether strength training is safe for you in your specific situation.
If you’re given clearance to exercise by your doctor, then chances are the
benefits outweigh the risk. But as with all of the above considerations,
there’s not an exact roadmap. It’s important to be cautious and listen to
what your body is telling you.
To learn more about training pregnant and postpartum women: girlsgonestrong.com/cppc
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Stop, Caution, Go: Your Guide to Safely Navigating Exercise During...
How to Adapt an Exercise to Reduce Symptoms
If you (or your client) are doing an exercise and start experiencing
symptoms like incontinence, heaviness or dragging in the perineum,
or doming or bulging of the linea alba, here are eight ways to modify
the movement to (hopefully) reduce any discomfort.
(Note that if these modifications don’t help, you may be better off
working on a different exercise entirely.)
11. Decrease the weight. You may be able to better manage the
intra-abdominal pressure using a lighter load.
22. Experiment with different sets and rep ranges. You may
find that simply by reducing the number of sets you’re doing,
or decreasing the number of reps per set, you’re less fatigued
and have fewer symptoms.
33. Try a different breathing strategy. There are many
breathing strategies that may work for you depending on the
exercise, load, position, and even the day. You can try exhaling
on exertion, inhaling on exertion, or try to breathe normally
without thinking about it too much and see what happens.
Experiment to find what works best for you in the moment.
44. Decrease the range of motion. Working in a smaller range
of motion (e.g., a 3/4 or 1/2 squat) may help you have better
control over the movement and your body.
55. Do what you can to feel safer. You can remove some potential
balance issues by squatting to a box, for example. Even the
feeling of safety can reduce symptoms for some women.
To learn more about training pregnant and postpartum women: girlsgonestrong.com/cppc
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Stop, Caution, Go: Your Guide to Safely Navigating Exercise During...
66. Change the position of the load. If you’re holding a kettlebell,
for example, try holding it lower toward the floor, or closer or
further away from your chest, or in an offset position (holding
on one side) or holding two, smaller kettlebells.
77. Make sure you aren’t creating excessive intra-abdominal
pressure. Make sure you aren’t “gripping” too much with
your upper abs, or bearing down on your pelvic floor during
the movement. For instance, you should be able to breathe
relatively normally and even have a conversation while
strength training. You may not be able to if you’re gripping
with your abs.
You may also notice a sensation of pressure moving down
toward your pelvic floor, especially if you have prolapse.
Thinking about “drawing up” through the pelvic floor may
help redistribute some of that pressure.
(If you’re a coach or trainer, you may need to ask your client
what she feels in her abdominal wall and pelvic floor, since
this can be difficult to visualize.)
88. Try different exercise techniques. You can try different
squat techniques including but not limited to:
o A narrower or wider foot position, toes turned out or more
forward, one foot turned out slightly more, an offset stance
with one foot slightly behind the other.
o A more upright or forward-leaning torso and more or less
ankle dorsiflexion (i.e., sitting straight down and driving
your knees forward in your squat or pushing your hips back
and sitting back into your squat with a more vertical shin).
To learn more about training pregnant and postpartum women: girlsgonestrong.com/cppc
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Stop, Caution, Go: Your Guide to Safely Navigating Exercise During...
When Should You Stop Altogether?
Similar to caution signs, red light signs to stop exercising can be broken
down into signs you might notice yourself, and ones your doctor or
healthcare provider will need to evaluate.
Let’s look at both.
STOP IF YOU EXPERIENCE ANY OF THE FOLLOWING RED LIGHT SYMPTOMS
If you experience any of the following symptoms — whether during a
workout or any other time — they need to be investigated with your doctor
or midwife before continuing with exercise.2
o Vaginal bleeding
o Feeling dizzy or faint
o Shortness of breath before starting exercise
o Chest pain
o Headache
o Muscle weakness
o Calf pain or swelling
o Regular, painful contractions of the uterus
o Fluid gushing or leaking from the vagina
o Significant pain of any kind
STOP IF YOUR DOCTOR HAS DIAGNOSED YOU WITH ONE OR MORE ABSOLUTE
CONTRAINDICATIONS
There are also absolute contraindications to exercise during pregnancy.
Absolute contraindications need to be diagnosed by your doctor, and they
mean strength training is definitely not safe.
To learn more about training pregnant and postpartum women: girlsgonestrong.com/cppc
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Stop, Caution, Go: Your Guide to Safely Navigating Exercise During...
These include:1
o Severe respiratory diseases (e.g., chronic obstructive pulmonary
disease, restrictive lung disease, and cystic fibrosis)
o Severe acquired or congenital heart disease with exercise
intolerance
o Uncontrolled or severe arrhythmia
o Placental abruption
o Vasa previa
o Uncontrolled Type 1 diabetes
o Intrauterine growth restriction (IUGR)
o Active preterm labor
o Severe pre-eclampsia
o Cervical insufficiency (also known as “incompetent cervix”)
Absolute contraindications are one of the reasons it’s so important to
get checked over by your doctor before you start an exercise program.
We recommend having your doctor fill out a PARmed-X for Pregnancy
that notes any absolute or relative contraindications and what those
contraindications mean for your training program. This form will also
confirm if you’re medically cleared to exercise.
(If you’re a coach, we recommend getting a signed copy of this form from
your client before beginning any prenatal training program.)
Also, some of these contraindications may develop over the course of a
pregnancy rather than be present right from the beginning. So attending
all your prenatal appointments and reaching out to your doctor or midwife
when something doesn’t feel right is crucial.
To learn more about training pregnant and postpartum women: girlsgonestrong.com/cppc
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Stop, Caution, Go: Your Guide to Safely Navigating Exercise During...
If You’re a Coach: Whose Decision Is It?
If you work with pregnant women, remember that your client has full
autonomy over her body and her decisions. Sometimes, a client may have
symptoms of pelvic floor dysfunction (such as urinary incontinence) and
is OK with that. While you can warn her that continuing what she’s doing
could make her condition worse, she’s the one in charge of deciding. Your
role is to educate her.
That said, if your client is experiencing any symptoms that could be
dangerous to her health (such as showing symptoms indicative of a heart
attack), you should insist she stop exercising immediately and contact a
member of her healthcare team.
Make sure to always document that you have made an explicit
recommendation, whether your client follows your recommendation or not.
REFERENCES
1.
Meah VL, Davies GA, Davenport MH. Why can’t I exercise during pregnancy? Time to revisit
medical ‘absolute’ and ‘relative’ contraindications: systematic review of evidence of harm and a
call to action. British Journal of Sports Medicine 2020;54:1395-1404.
2.
Exercise during pregnancy: Frequently asked questions. The American College of Obstetricians and
Gynecologists. July 2019. <https://www.acog.org/womens-health/faqs/exercise-during-pregnancy>
To learn more about training pregnant and postpartum women: girlsgonestrong.com/cppc
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STRENGTH TRAINING DURING PREGNANCY: HOW TO STAY SAFE,
HEALTHY, AND STRONG
3 Activities to Avoid During Pregnancy
There are hundreds of exercises that are appropriate during pregnancy, so
you don’t need to feel like your options are limited.
But that said, there are a handful of activities and exercises pregnant
women should be prepared to modify or avoid completely to keep both
mom and baby safe.
Here’s what you need to know.
#1. Avoid High-Risk Activities
Some activities and training choices that may place mother or baby (or
both) at high risk include:
o Contact sports that might put the fetus at risk of trauma (e.g., hockey,
boxing, soccer, rugby, football, basketball)
o Activities with a high risk of falling (e.g., downhill and water skiing,
surfing, off-road cycling, gymnastics, horseback riding)
o Scuba diving
o Activities done in high temperatures (like hot yoga and hot Pilates)
o Olympic lifts (the snatch and the clean and jerk, in which the bar
could collide with the belly)
o Exercising at altitudes greater than 8200 feet (2500 meters) if you
don’t live at that altitude
To learn more about training pregnant and postpartum women: girlsgonestrong.com/cppc
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3 Activities to Avoid During Pregnancy
#2. Modify or Avoid Exercises that Cause or Exacerbate
Symptoms
Certain activities, though not totally off-limits, may come with a higher risk
than reward during pregnancy. These include:
o Exercises that cause you to leak urine or give the sensation of
heaviness or dragging in your perineum. This varies from woman
to woman, but some find that jumping exercises or heavy lifting can
cause these symptoms. On the other hand, some don’t have issues
with these activities, so let your own experiences be your guide.
o Exercises that cause or aggravate existing pain, aside from mild
musculoskeletal pain that may be expected from certain exercises.
o Exercises that cause your abdominal wall to bulge, especially along
the midline. There’s a wide range of exercises that may cause
bulging, and what causes it for one woman may not be an issue at all
for another. A common culprit is front-loaded core exercises, such as
planks and push-ups.
o Prolonged exercise on your back in the later stages of pregnancy,
particularly if it makes you feel lightheaded, nauseous, or tingly.
o Exercises performed at such a high intensity that you can’t speak
comfortably.
The good news is there are lots of tweaks you can make that may alleviate
symptoms like these (see the Stop, Caution, Go section of this resource), but
note that if a modification does not reduce your symptoms, it’s probably
safest to switch to a different movement.
To learn more about training pregnant and postpartum women: girlsgonestrong.com/cppc
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3 Activities to Avoid During Pregnancy
#3. Avoid Valsalva Maneuver
The Valsalva maneuver is a breathing technique commonly used when
lifting heavy weights in which the lifter closes their airway while attempting to forcefully exhale (think of when you hold your nose and blow to pop
your ears on an airplane). Prior to closing their airway, most lifters also
take a large breath of air.
It can also be an unintentional breathing pattern during straining or lifting.
You’ll find conflicting advice on whether it’s OK to use during pregnancy,
but based on the research so far, we recommend avoiding it.
For one, we simply don’t have the evidence to advocate for its safety.
But on top of that, we also know that the Valsalva maneuver can place
extra pressure on the abdominal wall and pelvic floor muscles — two areas
that are already strained during pregnancy.
Plus, there isn’t generally a benefit of or need for it during pregnancy. This
technique is typically used when a person is lifting close to their one-rep
max, which we don’t recommend in pregnancy anyway.
To learn more about training pregnant and postpartum women: girlsgonestrong.com/cppc
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STRENGTH TRAINING DURING PREGNANCY: HOW TO STAY SAFE,
HEALTHY, AND STRONG
The GGS Perceived Effort Scale
What Is It?
A way to measure how hard you’re working based on how you feel.
Why Use It?
We want to be cognizant of intensity when training during pregnancy. That
includes both intensity of load (how heavy you’re lifting) and intensity of
effort (how hard you’re working).
It’s not that you’re fragile during pregnancy, but there are risks of
overdoing it, like putting too much pressure on your core and your pelvic
floor, which is the group of muscles and connective tissue that sits inside
your pelvis. You also don’t want to get your heart rate up too high, and
while, admittedly, heart rate doesn’t correlate well with exertion during
pregnancy, keeping an eye on your effort using this scale is still a great way
to easily make sure you’re staying within a safe range.
How It Works
To help you manage intensity during strength and aerobic training, we
suggest using an effort scale that ranges from 1 to 10.
Using this scale, the highest your effort should ever be during
pregnancy is an 8.5 out of 10.
Note that this rules out HIIT — or high-intensity interval training. Even if
you’re used to this kind of training (like “bootcamp” style workouts), put
them on hold during pregnancy, as they’re designed to take your intensity
to a 9 or higher.
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The GGS Perceived Effort Scale
1
2
3
4
5
6
7
8
9
10
Little or No Activity:
Anything other than sleeping, such as watching TV, reading, or riding in
a car.
Light Activity:
Easy and could be sustained for hours. It’s easy to carry on a
conversation.
Moderate Activity:
Feels like you could sustain it for hours, but your breathing is heavy, and
it’s more difficult to hold a conversation.
Vigorous Activity:
On the verge of becoming uncomfortable. You can only speak a sentence
or a few words at a time and can’t sustain the activity for long periods.
Very Hard Activity:
Very difficult to sustain. It feels like you can hardly breathe, and you can
barely speak a word.
Maximal Activity:
Almost impossible to keep going. You can hardly breathe, and you can’t
speak at all.
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STRENGTH TRAINING DURING PREGNANCY: HOW TO STAY SAFE,
HEALTHY, AND STRONG
Prenatal Referral Communications Kit
Welcome to your Prenatal Referral Communications Kit!
If you’re a coach working with pregnant women, having a solid referral
network is extremely valuable. It can:
o Help you support your clients’ health.
o Ensure you stay within your scope of practice.
o Increase the value you offer your clients (you can match them with
the right healthcare providers for their specific needs!).
o Encourage other providers to refer clients back to you.
(If you’re pregnant yourself and using this kit to see what other providers
you might want to add to your healthcare team during pregnancy, check
out the next page for info that’s especially relevant to you!)
Inside this kit, you’ll find:
o When to Consult a Specialist: A handy table to help you match
common pregnancy symptoms with the proper healthcare
professionals.
o How to Connect with Other Prenatal Healthcare Providers: Tips
for networking with like-minded practitioners and making initial
contact with your clients’ existing providers.
o Referral Letter Templates: Easy-to-customize introductory letter
templates to help make a first good first impression.
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Prenatal Referral Communications Kit
When to Consult a Specialist
The table below outlines common pregnancy symptoms and conditions,
and the professionals who can typically offer treatment for them.
Importantly, it’s not an exhaustive list of symptoms, diagnoses, or
respective healthcare providers — but it’ll give you a good idea of where to
start if you or a client are dealing with any of these issues.
What Type of Specialist Can Help?
Symptom /
Diagnosis
What can a coach
help with?
Who should you
refer to?
Who can make the referral?
PELVIC GIRDLE PAIN
DURING EXERCISE
Provide
modifications,
variations, or
substitutions for
that exercise; if
there is no relief,
refer out.
Pelvic health
physiotherapist or
musculoskeletal
physiotherapist
experienced with
pregnancy-related
issues
In many areas, a coach can refer to a
physiotherapist, or a woman can selfrefer. However, services may or may
not be covered by insurance without a
doctor’s referral.
LEAKING URINE DURING
EXERCISE
Provide
modifications,
variations, or
substitutions for
that exercise; refer
out.
Pelvic health
physiotherapist
In most cases, the coach can refer her
to a pelvic health physiotherapist, and
women may also be able to self-refer.
However, their services may or may
not be covered by insurance without a
doctor’s referral.
MUSCLE TENSION
Teach selfadministered soft
tissue work. If this
doesn’t relieve
tension, refer out.
Massage therapist
or musculoskeletal
physiotherapist
Women can self-refer, or a coach can
refer. Some massage therapists accept
insurance (which may or may not
require referral from a doctor). Services
with a musculoskeletal physio may
or may not be covered by insurance
without a doctor’s referral.
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Prenatal Referral Communications Kit
What Type of Specialist Can Help?
Symptom /
Diagnosis
DEPRESSION OR MOOD
SWINGS
PELVIC ORGAN PROLAPSE
What can a coach
help with?
Who should you
refer to?
Encouragement
and support in
seeking help from a
professional.
Mental health
professional
Provide variations
or modifications
to help reduce
symptoms; refer
out.
Urogynecologist
and pelvic health
physiotherapist
(Also mention
these symptoms to
her primary care
physician and/or
OB-GYN.)
Who can make the referral?
In most cases, the coach can refer
directly to a mental health professional,
or a woman can self-refer. If not, a
doctor’s referral may be needed.
Unless the coach or woman has a
great relationship with a mental health
professional who specializes in issues
related to pregnancy and postpartum,
it’s probably best to obtain a referral
from an OB-GYN, who can screen for
mental health concerns and refer to an
appropriately trained mental health
professional.
In many cases, referral to a
urogynecologist for POP staging will
need to come from a primary care
doctor or OB-GYN. The coach can refer
her to her PCP or OB-GYN for a consult
and specialist referral. In some cases,
she may be able to self-refer, but
services may or may not be covered by
insurance.
In most cases, the coach can refer her
to a pelvic health physiotherapist, and
women may also be able to self-refer.
However, their services may or may
not be covered by insurance without a
doctor’s referral.
MUSCULOSKELETAL
INJURIES:
• Neck pain and
headaches
• Upper back or rib pain
• Carpal tunnel
syndrome
• Low-back pain or
pelvic girdle pain
(SI joints or pubic
symphysis dysfunction)
• Hip pain
Modify
programming as
needed. If there is
no relief, or there is
concern about an
injury or condition
beyond mild
aches and pains of
pregnancy, refer
out.
Musculoskeletal
physiotherapist
experienced
with pregnancyrelated issues,
or pelvic health
physiotherapist
In many areas, a coach can refer to a
physiotherapist, or a woman can selfrefer. However, services may or may
not be covered by insurance without a
doctor’s referral.
If you’d like to learn more about becoming a Certified Pre- and Postnatal Coach, please visit:
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Prenatal Referral Communications Kit
Tips for Connecting with Other Prenatal Healthcare
Professionals
If you’re coaching a pregnant woman, you’re a member of her healthcare
team! Because of that, it’s smart to have a relationship with her medical
practitioners so you can exchange information as needed. It’s also a good
idea to have an established referral network of your own, so you can
recommend other providers should your client need them during her
pregnancy.
Follow these tips to approach other prenatal healthcare practitioners with
professionalism and confidence.
TIP #1: RESEARCH HEALTHCARE PROVIDERS IN YOUR AREA WHO ALIGN WITH
YOUR MISSION AND VALUES.
By working with people who have similar values, you’ll set yourself up
for a successful, mutually beneficial relationship. For example, if you’re a
coach who does a lot of strength training with your clients, you’ll be searching for an OB-GYN or pelvic health physiotherapist who also values the
benefits of strength training.
Search association directories online (e.g., the American College of
Obstetricians and Gynecologists, the Academy of Pelvic Health Physical
Therapy, etc.) to find practitioners in your region or nationally. Once you’ve
narrowed it down to a few names, visit their websites to get an idea of their
practice’s philosophies and values. Check out their social media platforms
as well for insight into the type of work they do.
From there, make a list of professionals you’d like to work with in the future.
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Prenatal Referral Communications Kit
TIP #2: REACH OUT LIKE A PRO.
If you’re reaching out to develop your referral network:
Once you’ve found healthcare providers who align with your mission and
values, reach out to them via email, a short handwritten note, or a phone
call introducing yourself. Briefly explain what you do. (Don’t worry —
we’ve made template letters to help you with the wording!)
Let them know you work with prenatal women, and you’re interested in
connecting with providers to whom you could refer your clients should
any issues come up. If you feel comfortable, offer to bring coffee or lunch
to their office sometime and have a brief chat to learn more about their
services and the best way to refer clients to them.
Whichever method you choose to communicate, keep the interaction brief
and low pressure. Respect their time and focus on how you can help them
and their clients and patients, rather than how they can help you.
If you’re reaching out to a member of a client’s current healthcare team:
After getting permission from your client in writing, contact the provider
by letter or email. Be clear about what you’re looking for. For instance, you
might want more information about your client’s exercise restrictions. Or
you might want to simply let them know you’d like to be looped into any
important changes in your client’s health. (Hint: Use the letter template
found in this referral kit!)
In your letter, introduce yourself and be concise about the situation at
hand. Also, make it easy for them to respond. At the end of the letter,
include your contact information and the best way to get in touch with you.
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Prenatal Referral Communications Kit
That way, they can keep you updated about any potential contraindications
as they arise throughout your client’s pregnancy.
TIP #3: KNOW THAT IT MAY NOT ALWAYS BE EASY TO CONNECT WITH HEALTHCARE PROVIDERS.
The ease of getting in touch will often depend on the provider’s schedule
(they’re often super busy!), their perception of the coach’s role in a patient’s
healthcare team, and their previous experiences with other coaches. For
example, a provider with a very heavy caseload may not have time for long
consultations with you.
If you have a pregnant client who’s experiencing a new symptom or
condition and is seeking care from a new health professional, she can ask
them about their willingness to work with you and other members of her
wellness team.
TIP #4: CONNECT ON SOCIAL MEDIA.
Like, follow, and share other health care professionals’ content if it’s a
good fit for your platform. Supporting them and showing an interest in
what they’re doing is a great way to develop a relationship. (Of course,
remember to maintain confidentiality and don’t publicly mention that your
client is working with this provider without the client’s explicit consent.)
TIP #5: STRENGTHEN YOUR RELATIONSHIPS WITH PROVIDERS AND DO WHAT’S
BEST FOR YOUR CLIENTS BY REFERRING OUT.
Once you feel that you know and trust a particular provider, begin
referring your clients to them when appropriate. Sending someone more
clients and patients is a surefire way to strengthen your relationship.
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Prenatal Referral Communications Kit
When recommending that your client see a specialist for assessment and
treatment, it may be helpful to send some information to the provider,
such as:
o The reason you’re referring your client.
o Information on your client’s current training program.
o Your thoughts about the progression and planning of your client’s
training.
All of this information not only helps the provider plan their assessment and
treatment, but also indicates that you’re knowledgeable, caring, and collaborative. This may even help you obtain more direct referrals in the future.
Letter Templates
We’ve created the following letter templates to help you establish
professional relationships and cultivate a robust referral network.
You’ll find…
1. A letter to introduce yourself to your client’s existing healthcare
provider.
2. A letter to introduce yourself to healthcare practitioners with whom
you don’t currently have mutual clients or patients.
3. A thank-you note for a healthcare provider who sends you a referral.
Use these letters as a guide if you’re writing your own from scratch, or you
can copy and paste the template to use as a starting point and edit to suit
your needs.
Make sure your client has given you written consent to identify them
by name in any correspondence you exchange with anyone.
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Prenatal Referral Communications Kit
Letter #1 — Introduction to a Client’s Healthcare Provider
Use professional letterhead that includes your name (and business name if
applicable), full address, phone number, email address, and website URL.
Date
Provider Name
Clinic
Address
City, State, Zip
Dear [Provider],
With consent from your patient and my client, [Client], I’m writing to introduce
myself and extend an invitation to work together from our respective areas of
expertise with the shared goal of offering [Client] the highest standard of care.
[Client] is interested in returning to an exercise program now that she is [length
of time] postpartum, and her eventual goal is to return to [specific activity]. I
would like to make sure that she is cleared to begin a training program, and if
so, it would be helpful to know if there are any limitations or concerns I should
be aware of so I can adjust her program to accommodate. She has mentioned,
for example, that [if your client has mentioned any particular concerns (e.g.,
incontinence), you can insert them here.] I have already made modifications to
her programming (outlined below) to prevent exacerbation of these symptoms,
but I would appreciate [include a request for clarification about any aspect of
your intended program that you feel needs further guidance from the medical or
allied health professional.]
My initial plan for her first [insert specific timeframe] includes [outline the
intended training program in brief (up to 3-4 bullet points), including strength
training and cardio selections.]
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Prenatal Referral Communications Kit
As I want to ensure that she receives only the services that will help her as she
returns to exercise post pregnancy, please let me know if there is anything you
object to within this programming or would like me to add. I hope that we can
collaborate to provide the best possible care for [Client]. I will update you with a
new plan when we progress into the next phase of her training.
Please let me know exactly what information you want from me so I can
provide just the right amount of detail rather than bog you down with too much
information.
I know that you are busy, and I want to be mindful of your time. Please contact me
anytime at [phone number] or via email at [email]. You can also learn more about
me on my website [personal website URL].
I look forward to working with you to support [Client].
Sincerely,
[Signature]
[Type your name]
Client Consent
I give [Coach Name/Business Name] permission to communicate
with the referring provider and/or my GP regarding my health
status and my progress relating to my exercise program.
Client Name
Client Signature
Date
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Prenatal Referral Communications Kit
Letter #2 — Introduction to a Healthcare Provider to
Establish New Relationship
Use professional letterhead that includes your name (and business name if
applicable), full address, phone number, email address, and website URL.
Date
Provider Name
Clinic
Address
City, State, Zip
Dear [Provider],
[Start with an opening sentence that lets the provider know you hold them in
high regard. For example, I’ve followed you on social media and always learn
something from the information you share. OR I’ve heard great things about you
from colleagues and friends.] I occasionally have clients who would benefit from
specialized treatment that is outside of my scope of practice, so I’d love to learn a
little more about what you do.
Here’s a little about me: As a [personal trainer/strength and conditioning coach/
movement coach/etc.] specializing in [briefly touch on the key population groups/
settings/type of activities you work with or deliver], it is very important to me that
my clients receive services that will promote a healthy lifestyle. In the cases in
which I believe a client is struggling with a problem that is outside of my scope of
practice, such as pelvic floor dysfunction, I want to be able to refer her to a quality
service provider who I trust. I am also committed to communicating clearly with
care providers throughout my client’s treatment and seeking guidance on how
their treatment will impact our training sessions.
I consider relationships with trusted healthcare providers like you to be essential
to my mission to deliver the highest standard of care to my clients. I know you run
a busy practice, so I’d love to bring coffee or lunch by your office at a time that is
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Prenatal Referral Communications Kit
convenient for you. In the meantime, you can learn more about me on my website
[website URL]. You are also welcome to contact me anytime at [phone number] or
via email at [email].
Thank you for your consideration — and for the important work you do!
Sincerely,
[Signature]
[Type name]
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Prenatal Referral Communications Kit
Letter #3: Thank-You Letter to Healthcare Provider Who
Sends Referral to Coach
Use professional letterhead that includes your name (and business name if
applicable), full address, phone number, email address, and website URL.
Date
Provider Name
Clinic
Address
City, State, Zip
Dear [Provider],
Thank you for referring [Client] for assessment and management of her exercise
program.
Based on [Client’s] goals and your recommendations, and taking into consideration
her history of [specific issue], I intend to have her start an exercise program
consisting of the following:
[Outline the intended program focus in brief (up to 3-4 bullet points). e.g., strength
/ cardio based program; group vs 1:1]
[Include a request for clarification about any aspect of your intended program
that you feel needs further guidance from the medical or allied health
professional.]
With [Client’s] consent, I will keep you informed of her progress and any major
changes in her condition.
As always, I thank you for your time and willingness to collaborate with fitness
professionals like me to ensure the people in our care receive the most wellrounded support possible. Knowing I can turn to you throughout my time working
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Prenatal Referral Communications Kit
with [Client] is not only reassuring, but essential to my commitment to her safety
and well-being.
Please feel free to contact me. I welcome your guidance with regard to her training
program and look forward to working together.
Yours sincerely,
[Signature]
[Type name]
Client Consent
I give [Coach Name/Business Name] permission to communicate
with the referring provider and/or my GP regarding my health
status and my progress relating to my exercise program.
Client Name
Client Signature
Date
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