Pilates in Pregnancy and After Childbirth: What the Research Says and Why the Instructor’s Education Matters

Movement in pregnancy is no longer a question of “whether” but of “how”. Professional bodies consider it a normal part of a healthy pregnancy, and Pilates is one of the forms of movement that help pregnant women in practice – with back and pelvic pain, with body awareness, with preparation for birth and with the return to movement afterwards. Safety, however, comes first: a pregnant client needs an instructor who knows exactly what they are doing.

This article is written for Pilates instructors, physiotherapists and other movement professionals who work, or plan to work, with pregnant and postpartum women. It summarises the recommendations of professional bodies, the benefits of Pilates supported by both practice and research, the principles of safe exercise, and the reasons why it makes sense to train in this area under the guidance of an experienced practitioner – a physiotherapist.

What do the guidelines recommend?

Experts agree that a pregnant woman without contraindications (medical reasons why she must not exercise) should stay physically active throughout pregnancy, aiming for at least 150 minutes of moderate-intensity activity per week.

American College of Obstetricians and Gynecologists (ACOG), 2020

Committee Opinion No. 804 describes exercise in pregnancy as safe and desirable in the absence of medical complications. Observational studies link exercise with lower rates of gestational diabetes, caesarean and instrumental deliveries, and with faster recovery after birth. Medical clearance before starting is advisable. [5]

Canadian Guideline for Physical Activity throughout Pregnancy, 2019

Recommends at least 150 minutes per week spread over a minimum of three days, a combination of aerobic and resistance activity, and daily pelvic floor muscle training to reduce the risk of urinary leakage. It describes physical activity as a front-line therapy for reducing the risk of pregnancy complications. [6]

Recommendations for the postpartum period are covered below in a separate section: After childbirth: returning to movement.

Two things follow for the instructor. First, Pilates does not appear in these guidelines as a category of its own – it belongs among strength, flexibility and stability activities, and on its own does not replace aerobic exercise (walking, swimming, cycling). Second, the guidelines assume that exercise is adapted as pregnancy progresses – and that is precisely the skill an instructor must master.

How Pilates helps during pregnancy

Research and many years of practical experience show that regular, professionally guided exercise applying Pilates principles brings pregnant women a range of health benefits.

1. Less low back and pelvic pain

Most women experience low back pain during pregnancy. The most comprehensive review of studies to date (2026) showed that a structured Pilates programme – typically two to three sessions a week for 8 to 12 weeks – noticeably reduced pain and made everyday activities easier. [1]

2. Psychological well-being

Women who practised Pilates reported less anxiety and better psychological well-being – in a period of so much change, this matters as much as the physical benefit. [1]

3. Preparation for birth

Pooled studies suggest that women who practised Pilates during pregnancy had shorter and less painful labours. [2, 3]

4. Breathing and the pelvic floor

Pilates teaches conscious breathing and awareness of the deep stabilising system. The pelvic floor, however, also needs targeted training – which is exactly why the instructor needs to know how to include it in a session correctly and safely. [2, 6]

Practice is ahead of research

Research on Pilates in pregnancy is young and the studies are still relatively small. That does not mean Pilates does not help – only that science has not yet examined everything instructors and physiotherapists have long observed in practice. Studies also differ in what they call “Pilates”; often it is exercise applying Pilates principles rather than the classical Pilates repertoire.

For the client, the conclusion is simple: what matters is not only whether she does Pilates, but who guides her. Both the benefit and the safety of a session rest on an instructor who understands how the body changes in pregnancy, can adapt the session and recognises when the client should be referred to a doctor. Exercise in pregnancy is safe – it is not associated with a higher risk of miscarriage or preterm birth. [6]

Pilates is a suitable, well-tolerated choice for pregnant women – ideally combined with aerobic activity such as walking or swimming, and always under the guidance of a properly trained Pilates instructor.

After childbirth: returning to movement

Movement (once the puerperium is over) is as important in the postpartum period as it is in pregnancy. Pilates helps restore core strength, posture and balance, and confidence in one’s own body – provided the return to movement is gradual and safe.

Canadian Guideline for the First Year Postpartum, 2025

The first stand-alone guideline on movement and sleep in the first year after childbirth [7] recommends:

at least 120 minutes per week of moderate-to-vigorous activity, such as brisk walking and strength training,
daily pelvic floor muscle training,
light activity soon after birth, which supports healing.

Regular postpartum activity is also associated with a lower risk of depression and better sleep quality.

How Pilates helps after childbirth

Studies show that postpartum Pilates reduces fatigue and improves sleep quality – two of the most common complaints of new mothers. [8, 9] The foundation of a safe return to movement is pelvic floor training, on which Pilates naturally builds. [11, 12]

Diastasis – Pilates can be a valuable part of abdominal wall work when the rectus abdominis muscles have separated. [10] Exercise selection and modification must, however, be individual – a poorly chosen exercise can make things worse. That is why this work belongs in the hands of an instructor with specialised training, ideally in collaboration with a physiotherapist.

What to watch for after childbirth

An individual approach – the return to movement depends on the course of the birth (vaginal birth, caesarean section, perineal injury) and on the doctor’s advice.
Breathing, the pelvic floor and the deep stabilising system first, higher loads later; impact activities (running, jumping) only after the pelvic floor and abdominal wall have been assessed, ideally by a physiotherapist.
Warning signs that call for referral to a doctor or physiotherapist: urinary or faecal leakage, a feeling of pressure or heaviness in the vagina, pain in the pelvis, back or scar, doming of the abdominal wall along the midline during exercise.

Safety: what an instructor must know

The basics are simple: exercise in pregnancy begins only with the approval of the client’s gynaecologist, and the instructor works as part of her care team.

Situations in which exercise is not appropriate (selected from the Canadian guideline and ACOG recommendations – the final decision always rests with the doctor):

ruptured membranes or preterm labour,
unexplained or persistent vaginal bleeding,
placenta praevia (placenta covering the cervix) after 28 weeks,
pre-eclampsia (a pregnancy complication with high blood pressure),
cervical insufficiency (the cervix shortens or opens prematurely without contractions, increasing the risk of preterm birth),
foetal growth restriction,
high-order multiple pregnancy (e.g. triplets),
uncontrolled type 1 diabetes, high blood pressure, thyroid disease or other serious heart or lung conditions.

Warning signs – stop exercising immediately and advise the client to contact her doctor: persistent marked shortness of breath that does not settle with rest; chest pain; regular painful contractions; vaginal bleeding or fluid leakage; persistent dizziness or feeling faint.

Practical session adjustments:

Intensity – moderate, checked with the “talk test”: the client should be able to speak in full sentences while exercising.
Lying on the back – in later pregnancy, prolonged supine positions can make some women dizzy (pressure of the uterus on the large vein – aortocaval compression syndrome). If this happens, move the exercise to side-lying, sitting or all fours.
Abdominal wall – as the bump grows, exercises with pronounced trunk flexion against resistance need to be modified, and doming of the abdominal wall along the midline should be watched for (a sign of diastasis – separation of the rectus abdominis muscles).
Balance and environment – avoid exercises with a risk of falling, overheating and inadequate hydration.
Breathing and the pelvic floor – breath guidance and pelvic floor awareness are taught individually and with precise cues; a blanket “pull your centre in” is not right for every client.

Why specialised training and collaboration with a physiotherapist

The studies that showed a benefit used structured programmes led by professionally trained teachers – several explicitly supervised by certified instructors or physiotherapists. The result therefore depends not only on the exercises, but also on who leads them.

Pregnancy changes the body from week to week: the centre of gravity shifts, breathing changes, hormonal changes affect joint stability and the load on the pelvic floor increases. An instructor with basic training knows that a pregnant client needs a “careful” approach. An instructor with specialised training knows exactly what to adjust and why.

What training led by a physiotherapist and certified Pilates instructor specialising in women’s health adds:

Understanding the changes in each trimester – and the resulting choice and progression of exercises.
Working with breath and the pelvic floor in line with current physiotherapy knowledge, not generic phrases.
Recognising diastasis and pelvic girdle pain and adapting the session so it does not aggravate them.
A clear scope of practice – when to refer the client back to a doctor or physiotherapist, and how to talk about it without alarming her.
A shared language with healthcare professionals – the instructor can understand a gynaecologist’s or physiotherapist’s recommendation and build on it.

Specialised training does not turn an instructor into a healthcare professional. It makes them a reliable partner to healthcare professionals – someone who keeps regular, safe movement going between medical check-ups. For a pregnant client and a woman after childbirth, such an instructor is the safest choice.

In conclusion

Pilates can give pregnant and postpartum women a great deal – but only when it is led by an instructor who knows what they are doing. Continuing education is the way to become an even better and safer instructor for your clients.

Glossary

ACOG	American College of Obstetricians and Gynecologists
Contraindication	A medical reason why exercise is not recommended
Diastasis recti	Separation of the left and right rectus abdominis muscles along the midline of the abdomen
Incontinence	Involuntary leakage of urine or stool
Meta-analysis	Statistical pooling of the results of several studies into a single overall estimate
NPCP	National Pilates Certification Program – an international certification programme for Pilates instructors
Pelvic girdle	The bony ring of the pelvis – sacrum, hip bones and pubic symphysis
Pre-eclampsia	A pregnancy complication with high blood pressure and other symptoms
Puerperium	Roughly the first six weeks after birth, while the body recovers
Randomised controlled trial	A study in which participants are randomly assigned to an exercise group or a control group
Systematic review	A summary of all available studies on a question, searched and appraised according to predefined rules
Urogynaecology	The field focused on the pelvic floor and on women’s urinary and gynaecological problems

Sources

Numbers in square brackets refer to the following list of studies and guidelines.

Pilates for musculoskeletal pain and other discomforts during pregnancy: a systematic review and meta-analysis. BMJ Open, 2026;16(5):e112441. Link
Li Y, Lu H, Zhang L et al. Pilates exercise in pregnancy: a systematic review and meta-analysis. BMC Sports Science, Medicine and Rehabilitation, 2025;17:20. Link
Haseli A, Eghdampour F et al. Optimizing labor duration with Pilates: evidence from a systematic review and meta-analysis of randomized controlled trials. BMC Pregnancy and Childbirth, 2024;24:573. Link
The effect of Pilates on pain during pregnancy and labor: a systematic review and meta-analysis, 2023. Link
ACOG Committee Opinion No. 804: Physical Activity and Exercise During Pregnancy and the Postpartum Period. Obstetrics & Gynecology, 2020. Link
Mottola MF et al. 2019 Canadian guideline for physical activity throughout pregnancy. British Journal of Sports Medicine, 2018;52(21):1339–1346. Link
Davenport MH et al. Consensus statement: 2025 Canadian guideline for physical activity, sedentary behaviour, and sleep throughout the first year postpartum. British Journal of Sports Medicine, 2025. Link
Ashrafinia F et al. Effect of Pilates exercises on postpartum maternal fatigue. Singapore Medical Journal, 2015;56(3):169–173. Link
Effects of the Pilates method on the quality of sleep, fatigue and urinary incontinence in puerperal women: systematic review and meta-analysis. RIPS UNISC. Link
Effects of Pilates-Based Exercise on Diastasis Recti Abdominis, Pelvic Floor Function, and Musculoskeletal Pain Across the Perinatal Period: A Narrative Review. Quality in Sport. Link
Cochrane: Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Link
Mørkved S, Bø K. Effect of pelvic floor muscle training during pregnancy and after childbirth on prevention and treatment of urinary incontinence: a systematic review. Link

This article is for information only and does not replace medical advice. Consult your gynaecologist before starting or changing physical activity during pregnancy or after childbirth.

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