For most women with an uncomplicated pregnancy, yes. Once your obstetrician or doctor has cleared you to exercise, reformer and other equipment-based Pilates can continue through pregnancy, with the positions and load changing as the weeks go on. After giving birth, the return should be gradual and start only once you have been medically cleared, which depends on how you delivered and how your recovery is going.
Pilates is one part of being active in pregnancy, not all of it. The guidelines ask for aerobic activity as well as strength work, and a private session covers much of the strength side.
Is it safe to do Pilates while pregnant?
The guidelines agree that, without a medical reason to avoid it, exercise in pregnancy is safe and beneficial. The American College of Obstetricians and Gynecologists (ACOG) says physical activity in pregnancy carries minimal risk for most women, and that women who were already active can carry on, with some changes for the normal physical changes of pregnancy1. The 2019 Canadian guideline recommends at least 150 minutes of moderate activity a week, over at least three days, mixing aerobic and resistance training2. The World Health Organization’s 2020 guidelines say the same for pregnant and postpartum women3.
Clearance comes first
ACOG advises a thorough clinical evaluation before an exercise programme starts, to make sure there is no medical reason to hold back1. The Canadian guideline lists conditions where exercise should be avoided, such as ruptured membranes, vaginal bleeding, placenta previa or pre-eclampsia, and others, such as gestational hypertension or twins after 28 weeks, where it needs discussing with your doctor2. These are decisions for your obstetrician, not your Pilates instructor.
When to stop
Both guidelines list warning signs that mean stopping straight away and contacting your doctor. They include vaginal bleeding, fluid leaking, regular painful contractions, chest pain, persistent dizziness, headache, shortness of breath that comes before effort or does not settle, abdominal pain, muscle weakness that affects balance, and calf pain or swelling12.
How does a session change as the pregnancy progresses?
Lying flat on your back
Much of classical Pilates is done lying on the back, and the guidance is not a blanket ban. ACOG notes that after about 20 weeks, lying on the back can reduce blood return to the heart because the uterus presses on the large blood vessels, which can lower blood pressure1. The Canadian guideline is symptom-based: if you feel light-headed, nauseous or unwell exercising flat on your back, change position2. A systematic review carried out alongside that guideline found too little evidence to say whether supine exercise is safe or should be avoided4. In practice, that means keeping time flat on the back short from mid-pregnancy and using inclined, side-lying, seated, kneeling or standing positions.
Using the equipment
On the reformer, leg work can move from lying flat to side-lying, and the arm series can be done seated or kneeling, with the Pilates equipment springs set for control rather than effort. The stability chair allows seated footwork with an upright trunk, and supported step-ups and split squats with a hand on the frame, which matters as balance shifts. On the trapeze table (Cadillac), side-lying leg work against the Pilates equipment springs trains the hips without lying on the back, and the seated push-through works the upper back and arms. The spine corrector can support the back at an incline, and work lying on the front is replaced as the bump grows.
Pelvic floor and breathing
The Canadian guideline suggests pelvic floor muscle training may be done daily to reduce the risk of urinary incontinence2. Pilates already pays close attention to breathing, so sessions can teach both contracting and fully relaxing the pelvic floor, and link that to effort in each exercise. If you have leaking, heaviness or pelvic pain, a pelvic health physiotherapist should assess it.
When can I return to Pilates after giving birth?
ACOG advises that exercise can be resumed gradually after birth once it is medically safe, and that the timing depends on whether you had a vaginal or caesarean birth and on any complications1. Pelvic floor exercises can begin early. A sensible order is breathing, pelvic floor and gentle trunk work, then standing and single-leg control, then progressively heavier strength work for the physical demands of motherhood, such as lifting a growing baby from the floor or carrying a car seat on one side. After a caesarean, the scar and the abdominal wall set the pace, and your doctor’s clearance comes before any loaded trunk work.
Abdominal separation
Separation of the two sides of the abdominal muscles, diastasis recti, is common during and after pregnancy, and the evidence on exercise for it is mixed. Benjamin and colleagues reviewed eight studies of 336 women and found that exercise in pregnancy was linked to fewer cases, but the studies were of poor quality and the authors concluded exercise may or may not help5. A sensible approach is to build load gradually while watching how the abdominal wall responds, and to involve a physiotherapist where the separation is large or symptoms persist.
One client, four months postpartum and with scoliosis, wrote that “from the first session she prepared a workout completely tailored to my needs. She is very methodical and detail oriented and I feel very safe doing Pilates with her.”
What does the research show?
Well established. All three guidelines recommend regular activity in pregnancy. The WHO links it with lower risks of pre-eclampsia, gestational hypertension, gestational diabetes, excessive weight gain, delivery complications and postpartum depression, with no increase in risk of stillbirth or newborn complications3. A Cochrane review of 46 trials and 10,832 women found pelvic floor muscle training in pregnancy probably lowers the risk of urinary incontinence in late pregnancy for women who start out continent, and slightly lowers it three to six months after birth. Training started only after delivery had an uncertain effect6.
Uncertain. Whether exercise lying on the back is harmful is not settled: the supine review’s evidence, from seven studies of 1,759 women, was rated very low to low quality4. The evidence on diastasis recti is similarly weak5.
Preliminary, and specific to Pilates. Li and colleagues pooled 11 trials with 538 pregnant women and found Pilates was linked to shorter labour and less labour pain, with no clear effect on weight or mode of delivery. Nine of the trials used mat Pilates, and most had an unclear risk of bias7. Song and colleagues found Pilates reduced musculoskeletal pain in pregnancy compared with standard care, but results varied widely between trials8. These are small studies of varied programmes, and they do not compare equipment-based private sessions with other supervised exercise.
Practical application. The position changes and equipment choices above apply the guidelines and standard training principles. They are reasoned recommendations, not trial findings, adjusted for each woman after an assessment.
Does Pilates replace my doctor, physio or strength training?
No. Your obstetrician or doctor decides whether and when you exercise, and a pelvic health physiotherapist leads on any pelvic floor or abdominal problem. At Peak Performance the sessions are not purely Pilates: we combine Pilates principles with strength and conditioning principles, and mix in strength and conditioning work depending on your goal, with more focus on control of movement. We align with your physiotherapist and any trainer you work with.
Where to start
Get clearance from your doctor first, then start with an assessment rather than a class. The Pre & Post-Natal programme is adapted to pregnancy, recovery and building strength for the physical demands of motherhood. The 55-minute initial consultation looks at how you move and what you want to work towards, and the programme is then built, progressively loaded and reassessed as your pregnancy or recovery moves on, with exercises to take away between sessions.