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Exercise in Late Pregnancy and Pelvic Floor Hiatus Opening

Exercise in pregnancy is a loaded topic. We commonly see images of women doing vigorous exercise in late pregnancy accompanied by judgmental statements about the safety of such activity not only for the woman, but also for the baby. Many myths persist about exercise in pregnancy, and it’s our role as health care specialists to educate women about what is known about exercising. Holly Herman, co-founder of the Herman & Wallace Pelvic Rehabilitation Institute, has been educating providers about this topic for most of her career. Anyone lucky enough to take a course on pregnancy and postpartum issues from Holly Herman knows that her style of teaching is effective and her passion is contagious. From Holly’s use of patient stories to wonderful humor, you can really “get it” when it comes to clinical concepts and strategies. One of Holly’s clinical pearls that really stuck with me after learning about exercise and pregnancy is the research completed by James Clapp in his book “Exercise in Pregnancy”. In short, the book dispels the myth that women shouldn’t exercise in pregnancy and in fact reports on the benefits of exercise to both Mom and baby for labor, delivery, and beyond. In signature style, Holly held this book up in front of the class and to great laughter said, “And this is the book you should buy for your mother-in-law.”

Another myth that has been perpetuated in relation to pregnancy, labor and delivery is the notion that exercising can make the pelvic floor muscles short, tight, and more narrow, making delivery more difficult. In an article we reported on previously about women being “too tight to give birth” the authors concluded that strong pelvic floor muscles do not lead to challenges with birthing. (Bo et al., 2013) In a more recent article that addressed this issue, Kari Bo and colleagues studied 274 women for levator hiatus (LH) width to see if exercising in late pregnancy did in fact narrow this space. At week 37 of gestation, the exercisers were measured to have a significantly larger LH than the non-exercisers. (Exercisers were defined as women who exercised 30 minutes or more 3 times per week versus the non-exercisers.) The authors conclude that there were not any significant differences in labor outcomes or in delivery outcomes between the groups. (Bo et al., 2015)

Without a doubt, the patient’s obstetrician gives primary direction to the patient when any high-risk issues are present. Most women however, are basing their exercise choices on experience, on misinformation, myths, or popular opinion. It is our responsibility to engage women in conversations about her health, wellness, and fitness, and to appropriately counsel on exercise during pregnancy and the postpartum period. Most of us lacked proper education about this important population in our primary graduate training, and therefore must seek out information to fill in the gaps. If you are interested in filling in any gaps, join us at one of our peripartum courses around the country. Your next opportunities to take these courses are:

Care of the Postpartum Patient - Seattle, WA
Mar 12, 2016 - Mar 13, 2016

Care of the Pregnant Patient - Somerset, NJ
Apr 30, 2016 - May 1, 2016

Care of the Pregnant Patient - Akron, OH
Sep 10, 2016 - Sep 11, 2016


Bø, K., Hilde, G., Jensen, J. S., Siafarikas, F., & Engh, M. E. (2013). Too tight to give birth? Assessment of pelvic floor muscle function in 277 nulliparous pregnant women. International urogynecology journal, 24(12), 2065-2070.


Bø, K., Hilde, G., Stær-Jensen, J., Siafarikas, F., Tennfjord, M. K., & Engh, M. E. (2015). Does general exercise training before and during pregnancy influence the pelvic floor “opening” and delivery outcome? A 3D/4D ultrasound study following nulliparous pregnant women from mid-pregnancy to childbirth. British journal of sports medicine, 49(3), 196-199.


Clapp, J. F., Cram, C. (2012) Exercising Through Your Pregnancy. Addicts Books

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Upcoming Continuing Education Courses

Oncology of the Pelvic Floor Level 1 - Remote Course

Sep 12, 2020 - Sep 20, 2020
Location: Replacement Remote Course

Boundaries, Self-Care, and Meditation - Remote Course

Sep 12, 2020 - Oct 11, 2020
Location: Replacement Remote Course

Male Pelvic Floor - Arlington, VA (Postponed)

Sep 18, 2020 - Sep 20, 2020
Location: Virginia Hospital Center

Mobilization of Visceral Fascia: The Urinary System - Self-Hosted

Sep 18, 2020 - Sep 20, 2020
Location: Self-Hosted Course

Mobilization of Visceral Fascia: The Urinary System - Atlanta GA Satellite Location

Sep 18, 2020 - Sep 20, 2020
Location: JMM Health Solutions LLC

Mobilization of Visceral Fascia: The Urinary System - Crown Point, IN (Postponed)

Sep 18, 2020 - Sep 20, 2020
Location: Franciscan Health System

Mobilization of Visceral Fascia: The Urinary System - Kokomo, IN Satellite Location

Sep 18, 2020 - Sep 20, 2020
Location: You're In Control

Mobilization of Visceral Fascia: The Urinary System - Medford, OR Satellite Location

Sep 18, 2020 - Sep 20, 2020
Location: Asante Rogue Valley Medical Center

Athletes & Pelvic Rehabilitation - Minneapolis, MN (Postponed)

Sep 19, 2020 - Sep 20, 2020
Location: Viverant

Bowel Pathology and Function - Ann Arbor, MI (Postponed)

Sep 19, 2020 - Sep 20, 2020
Location: St. Joseph Mercy Ann Arbor

Pelvic Floor Level 1- Minneapolis, MN (SOLD OUT)

Sep 19, 2020 - Sep 20, 2020
Location: Allina Hospitals and Clinics

Osteoporosis Management - Remote Course

Sep 19, 2020 - Sep 20, 2020
Location: Replacement Remote Course

Pelvic Floor Level 2A - Boston, MA (Postponed)

Sep 19, 2020 - Sep 20, 2020
Location: Marathon Physical Therapy

Pregnancy Rehabilitation - Remote Course (SOLD OUT)

Sep 19, 2020 - Sep 20, 2020
Location: Replacement Remote Course

Athletes & Pelvic Rehabilitation - Remote Course (Sold Out)

Sep 19, 2020 - Sep 20, 2020
Location: Replacement Remote Course

Bowel Pathology and Function - Remote Course

Sep 19, 2020 - Sep 20, 2020
Location: Replacement Remote Course

Pelvic Floor Level 1 - Self-Hosted (SOLD OUT)

Sep 19, 2020 - Sep 20, 2020
Location: Self-Hosted Course

Pudendal Neuralgia and Nerve Entrapment - Remote Course

Sep 19, 2020 - Sep 20, 2020
Location: Replacement Remote Course

Pelvic Floor Level 1 - Coon Rapids, MN Satellite Course (SOLD OUT)

Sep 19, 2020 - Sep 20, 2020
Location: Mercy Hospital

Pelvic Floor Level 1 - East Norriton, PA Satellite Course

Sep 19, 2020 - Sep 20, 2020
Location: Core 3 Physical Therapy

Pelvic Floor Level 1 - Little Rock, AR (SOLD OUT)

Sep 19, 2020 - Sep 20, 2020
Location: University of Arkansas for Medical Sciences

Pregnancy Rehabilitation - Garden City, NY (Postponed)

Sep 19, 2020 - Sep 20, 2020
Location: Metro Physical & Aquatic Therapy

Pelvic Floor Level 1 - Satellite Lab Course

Sep 19, 2020 - Sep 20, 2020

Pelvic Floor Level 1 - Fairlawn, NJ Satellite Location

Sep 19, 2020 - Sep 20, 2020
Location: Bella Physical Therapy

Pelvic Floor Level 2A - Atlanta, GA (Postponed)

Sep 25, 2020 - Sep 27, 2020
Location: Emory Healthcare

Nutrition Perspectives for the Pelvic Rehab Therapist - Winfield, IL (Postponed)

Sep 25, 2020 - Sep 27, 2020
Location: Northwestern Medicine

Low Pressure Fitness for Pelvic Floor Care - Houston, TX (Postponed)

Sep 25, 2020 - Sep 27, 2020
Location: Texas Children’s Hospital

Sacral Nerve Manual Assessment and Treatment - Vancouver, WA (Postponed)

Sep 25, 2020 - Sep 27, 2020
Location: PeaceHealth Southwest Medical Center

Pelvic Floor Level 1 - Mequon, WI Satellite Location

Sep 26, 2020 - Sep 27, 2020
Location: Health In Balance Physical Therapy