Fit To Deliver reviewed by: Robyn Churchill, CNM, MSN

Fit to Deliver by Karen Nordahl, Renee Jeffreys, and Carl Petersen is a complete guide to maintaining fitness throughoutpregnancy. Written by a Canadian physician, an exercisephysiologist, and a physical therapist, this book is atimely addition to the layperson’s literature on pregnancy.As our society faces increasing obesity rates and decreasingactivity levels among all ages, addressing questions abouthow to safely exercise is a public health mandate. Fit toDeliver can contribute both to establishing a healthierlifestyle as well as to decreasing obstetric complicationsdue to excessive weight gain and limited exercise inpregnancy.

Fit to Deliver was developed for use as an instructionalmanual in a prenatal exercise program. While it is not ascholarly text, the authors do reference ACOG’s 2002statement on the benefits of appropriate exercise duringpregnancy, and they include more than a page of selectedreferences for those women looking for academic supportfor their exercise program. The book begins by explainingthe role of proper exercise during pregnancy. The authorscite current studies in both obstetric and physiologic literatureon the benefits of exercise in pregnancy. They discussspecific effects of prenatal exercise on physiologic wellbeingin pregnancy, including alleviation of back pain,constipation, and leg cramps, a reduction in risks ofdeveloping PIH and gestational diabetes, and building morestamina to cope better in labor.

The first chapters of Fit to Deliver provide a background forunderstanding the fitness program. The authors explain thedivision of pregnancy into three trimesters and offer generalguidelines for safe exercise during each. For example, theyrecommend that in the third trimester, a woman should dono exercise requiring lying directly on her back for morethan 30 seconds. There is a good section on proper postureand lifting techniques. There is also discussion throughoutthe book about which exercises address which commondiscomforts of pregnancy.

The fitness program itself begins with a core workout,including pelvic floor and abdominal strengthening exercises.These are described and illustrated well, usingpregnant models who demonstrate the exercises bothlying on the ground and sitting on a chair. Other chaptersaddress aerobic training, strength training, and balance.There is a good explanation of how to build a comprehensive workout session using the various types ofexercise. Nearly all the exercises can be done at homewith little equipment. A physical therapy ball and elasticbands are used in some exercises, and a few require freeweights. The workouts are not overly intense and can bemodified for women who have not been working outprior to pregnancy. The authors appropriately recommendthat a pregnant woman discuss safe levels ofexercise with her obstetric provider before beginning anexercise program during pregnancy.

After the exercise chapters, the authors have included achapter on “Relaxation Techniques,” written by a contributingauthor and RN. This chapter presents breathing,aromatherapy, hydrotherapy, and visualization in fourpages. While the philosophy of relaxation in pregnancy andlabor are consistent with the fitness program, not enoughtime is devoted to it to do it justice. At the same time, toomuch space is given to it to suggest a woman should domore reading on the subject on her own. With a bit morework, this chapter could either become a much strongercomponent of the book and a more integrated element of apregnancy fitness program, or, conversely, it could bemoved to the appendix section, along with a reference list,with suggestions for relaxation or childbirth readings and/orclasses.

The final chapter on postpartum exercise is very well done.There are general guidelines about when to start each typeof exercise after a vaginal birth or after a cesarean delivery.Again, the authors emphasize the importance of discussingpersonal recommendations with a provider. They alsorecommend including baby in the postpartum exercises,and many are demonstrated by using a baby, which makesthese exercises both more fun and more realistic for newmothers.

There are two appendices, one on diet, including recommendationson nutrients and calories, foods to avoid, anddietary approaches to common discomforts, such as nausea,heartburn and constipation, and the other on preconceptualhealth, and fitness, nutrition, and smoking cessation. Infertilitydue to extreme behaviors such as strict dieting,excessive exercise, or obesity is touched on, as well as therole of stress on fertility. These appendices are succinct andclearly presented.

Overall, the book is excellent. The illustrative photos showthe exercises very clearly, although they depict only Caucasianwomen. The women vary in shape, and very fewhave highly athletic bodies, so a moderately active womanwould not be intimidated by them. The major weakness,from this reviewer’s perspective, is that midwives are never mentioned. However, there seems to be an assumption ofvaginal birth, and perhaps even an unmedicated birth,although that is not directly stated. The content of Fit toDeliver meshes well with the midwifery model of promotingwellness and normalizing and addressing commondiscomforts of pregnancy from a holistic perspective. It is awelcome addition to the lay literature on healthy pregnancy.

Originally published in "American Journal of Midwifery and Women's Health," February 2005