Did you know that cesarean rates have been on the rise globally? According to the World Health Organization (WHO), the worldwide rate has climbed from about 7% in 1990 to a whopping 21% today. And it's not slowing down! In the United States, the cesarean birth rate has surged to 33% in the 21st century, compared to just 5.8% back in 1970. Shockingly, one in three babies in the US is now delivered via cesarean section, with even higher rates among Black communities, nearing 36%. The WHO suggests that a more ideal cesarean rate should hover between 10-15%, highlighting the urgent need to address this public health concern.

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Cesarean Rates: A Local Perspective

Thanks to the presence of academic medical centers with specialized maternity care teams, initiatives focused on promoting vaginal birth and reducing unnecessary interventions, and a strong network of midwives and doulas, hospitals in the Boston region generally have lower cesarean rates compared to the national average and align with the WHO's recommendation!

It is important to note that here in the Greater Boston area, we are surrounded by some of the greatest hospitals in the world and fully support any method of birth that keeps moms and babies safe and healthy. By no means are we implying that a C-section birth is inferior to a vaginal birth. At GCPT, we want moms to have the best birth experience possible and empower women throughout the perinatal period. We are proud to support Cesarean Awareness Month this April by sharing how Pilates can help to reduce preventable cesareans, as well as support those recovering from necessary or chosen cesareans. Whatever your goal or birth outcome is, we are here to support you every step of the way! 

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How Pilates Prepares Moms for Labor + Delivery

As the due date nears, professionally trained Pilates teachers prepare moms for birth by focusing on relaxation with deep breathing and gentle, flowing movements that open the pelvic inlet and bring balance to the pelvis. A balanced pelvis means that the baby has enough room to move into the ideal position for birth. Supervised Pilates programs have been proven to be an effective and achievable exercise method decreasing the incidence of cesarean delivery while enhancing the birth experience and recovery for moms.

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What Does The Evidence Say About Pilates During Pregnancy?

• A 2023 systematic review and meta-analysis of 13 studies that included a total of 719 pregnant women showed that women in the Pilates group were significantly more likely to deliver vaginally than the control group, who had significantly higher incidence of Cesarean delivery.¹
• A randomized controlled trial published in 2021 revealed that Pilates exercise during pregnancy improved the labor process and increased maternal satisfaction of childbirth process, without causing complications for the mother and baby. The results of the study showed that Pilates exercise during pregnancy significantly reduces the labor pain intensity, length of the active phase and second stage of labor and increases maternal satisfaction of the labor process.² 
• A 2021 retrospective case control study evaluated the effects of a supervised weekly Pilates program for eight weeks on the labor and newborn outcomes and found that the incidences of episiotomy, vacuum-assisted vaginal delivery, and cesarean section were significantly lower in pregnant women who participated compared to those who did not. It is important to note, that the babies thrived as well, as APGAR scores were significantly higher among those whose mothers were in the Pilates group.³

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How Prenatal Pilates Reformer Can Help Breech Positioning

C-sections are often scheduled If a baby is still in breech in the final weeks of pregnancy and has not flipped to head down. While we advise mothers to do lots of walking to help with getting the baby into a good laboring and birthing position, our Reformer classes also include some techniques that help bring balance to the pelvis and spin the baby into a more optimal position:

• Cueing for proper alignment with the ribcage stacked over the pelvis (e.g. not constantly tucking the tailbone under or flaring the ribcage upwards)
• Sitting on the Box to keep the hips higher than the knees
• Footwork (with a supportive pregnancy wedge) to mimic a variety of squatting movements
• Forward leaning inversions where the bum is higher than the shoulders, such as Elephant or Modified Control Balance Front
• Strength training both sides of the body at the same time and unilaterally

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Can Postnatal Pilates Help Moms Recover From Cesarean?

After the baby arrives, Pilates professionals adapt exercises for the postpartum body for six months to a year or more. The recovery differs from person to person.

In the first few weeks after delivery, prioritize rest. An easy rule of thumb to follow is the 5-5-5 rule: 5 days in the bed, 5 days on the bed, 5 days near the bed. During this time, consider the breathwork you practiced during prenatal Pilates your therapeutic exercise. This will activate your pelvic floor and transverse abdominal muscles and help support your body while lifting the baby and baby gear.

In the coming weeks, continue to do your breathwork, add in bridges, and increase your daily step count. Exercising too vigorously during this timeframe can increase bleeding and slow the healing process. Before you know it, it will be time to follow up with your medical provider about when it is right for you to return to the studio. In recent years, our clients have been approved to return between 3-6 weeks postpartum; this depends on what your body experienced during pregnancy and delivery.

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How To Safely Resume Pilates After Childbirth

At this point, we always recommend scheduling a complimentary pre/postnatal screening with our resident physical therapist and perinatal fitness specialist, Dr. Kristen Hardin. She will ask about your delivery experience, pelvic floor concerns, assess your posture, breathing mechanics, and diastasis gap. This will help her determine what modifications and exercises are best to help you regain strength and body control where and how you need it most!

At Gold Coast Pilates Therapy, our programming can help accelerate the healing process by boosting blood flow and oxygenation to muscles in need of TLC and correcting imbalances that develop as a result of pregnancy and delivery, by focusing on:

• Pelvic floor muscle training
• Oblique and transverse abdominis (aka lower abdominal muscle) activation
• Stabilization of the lower back and pelvis
• Gentle stretching of the piriformis (AKA dead center of the buttocks), hamstrings, hip and shoulder girdles
• Thoracic spine mobility

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Whether you're preparing for birth or on the road to recovery, Pilates offers a gentle, yet effective way to strengthen and support your body during pregnancy. As the only physical therapist owned Pilates studio on the North Shore, we are here to help you prevent an unnecessary Cesarean section and/or assist with a smooth recovery post-cesarean. Embrace the power of Pilates to nurture your body and mind on your journey to motherhood!

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¹ Zaman AY. Obstetric, maternal, and neonatal outcomes after Pilates exercise during pregnancy: A systematic review and meta-analysis. Medicine (Baltimore). 2023;102(21):e33688. doi:10.1097/MD.0000000000033688

² Ghandali, N. Y., Iravani, M., Habibi, A., & Cheraghian, B. (2021). The effectiveness of a Pilates exercise program during pregnancy on childbirth outcomes: a randomised controlled clinical trial. BMC pregnancy and childbirth, 21(1), 480. doi.org/10.1186/s12884-021-03922-2

³ Kırıcı P, Nacar MC, Karaçor T, Bülbül M, Baktıroğlu M, Mavral N, Kaya N. Pilates workouts can improve the labor and newborn outcomes: A case control study. J Surg Med [Internet]. 2021 Jun. 1 [cited 2024 Mar. 21];5(6):642-7. Available from: https://jsurgmed.com/article/view/951898