She's on the list. You've got about four minutes. And somewhere in the back of your head is a list of things you half remember about pregnancy from uni, most of which were about what not to do.
If your first instinct is to panic and give her the easiest version of everything, you're not alone. That's what most of us were taught, by accident.
I want to give you something better than a protocol.
Start here: she's pregnant, not unwell
Pregnancy is a healthy part of being a human. It isn't a condition you're treating.
Pregnant women are not fragile and I'm honestly a bit sick of people treating them like they are. Handing her a watered down class because you're nervous isn't safe. It's just unhelpful, and she'll feel it.
So the first question isn't what can't she do. It's what does she actually want.
Ask what she's here for
You'd be amazed how often nobody asks. The answer changes everything you program:
- Is she here for glute strength?
- Is she here to settle pelvic girdle pain?
- Is she here to get fit and strong?
- Is she preparing for birth?
Those are four different sessions. Once you know which one you're in, you can be really potent about what you prescribe and why.
Then run the same framework you always run
This is the bit I want you to take away. You don't need a pregnancy protocol. You need the framework you already use, applied to a pregnant body.
Same steps, every time:
- Red flags. Screen them properly, same as anyone
- Range
- Control and proprioception
- Strength
- Function, and how it all integrates
- Pain drivers, with a bit of extra thought about hormone sensitivity
That's it. That's the same list you'd run on a bloke with a sore shoulder. The framework doesn't change, the answers do.
Where you do need to be careful
A few things genuinely shift the picture, and they're mostly about loading:
- Placenta placement and cervix closure. Both change how careful you need to be with load. If you don't know, ask
- Anything vigorous or high intensity, especially if she's high risk
- Unilateral standing work, depending on how her pelvis is tolerating things
If she's high risk, get clearance from her obstetrician or care team before you push into the harder stuff. Not a note in your file saying you asked. Actual clearance.
Working alongside her care team isn't a hassle. It's the thing that lets you push her properly, because you know where the edges are.
The lying on your back thing
Here's one worth talking about honestly, because most of us repeat it without checking.
The rule you were taught is that after roughly sixteen to twenty weeks she can't lie on her back, because the uterus presses on the inferior vena cava, drops venous return, and that's bad for her and the baby.
The mechanism is real. The blanket rule is stronger than the evidence supports.
What the research actually shows:
- Symptomatic supine hypotension affects a minority of pregnant women, not all of them
- Brief supine exercise hasn't been shown to cause harm to the baby
- The frightening stillbirth data everyone half remembers is about going to sleep on your back in the third trimester. Hours of it, motionless. Not a set of bridges
So the sensible version is: avoid long, still, flat-on-her-back positions. Watch for symptoms, dizziness, nausea, feeling short of breath. If they show up, change position. And ask her, because she almost certainly already knows what feels off.
Please go and read the current guidelines yourself rather than taking my word for it. I'd rather you checked than trusted me.
I'm making a point of this one because it's a good example of the thing I keep banging on about. A rule gets repeated until it becomes gospel, and we stop reasoning. Then we tell a healthy woman she's fragile, and she believes us.
So what can you actually put her in
Heaps, honestly. Across the reformer, Cadillac, Wunda chair and mat you've got:
- Side lying
- All fours
- Prone over a box, with modifications
- Standing work
- Supported over a bolster in the right spot
None of that is a compromise. It's a full session.
The point
You could learn a pregnancy protocol. It'd cover you for the common cases and leave you stuck the moment someone turned up who didn't fit it.
Or you could learn the framework properly, which gets you about eighty percent of the way there for any client who walks in, pregnant or not. Then you're only reasoning about the handful of things that are genuinely specific.
That's the whole idea. Learn how to think once, apply it to everyone.
It's not your fault you weren't taught this. Uni taught you how not to hurt someone, and nobody taught you the next step, which is how to actually help her get strong while she's pregnant.
Have a crack at it this week with whoever's in front of you. And if you've got questions about how we teach this, just yell out, genuinely happy to have a chat.
The Clinical Collective is free to join too if you want to have a look at how we work before deciding anything.
Let me know how you go with it.