Pilates guide
For most women with an uncomplicated pregnancy, Pilates is a safe way to stay strong and mobile: the American College of Obstetricians and Gynecologists (ACOG) lists modified Pilates among the safest exercises in pregnancy, and the NHS says to tell your instructor you're pregnant and stop if you feel uncomfortable, too hot or unwell.
The main change is position. From the end of the first trimester, keep moves on your back short or swap them, and do face-down moves on all fours instead. Pilates trials in pregnancy are small, so this guide says plainly what they can and can't show.
It covers what the guidelines say, the moves to swap in each trimester, the warning signs to stop, the tummy gap (diastasis recti), and when to start again after a vaginal birth or a caesarean, with a 20-minute pregnancy Pilates workout to follow.
For most women with an uncomplicated pregnancy, ACOG lists modified Pilates among the safest exercises, and the NHS says exercise is safe for you and your baby. Tell your instructor you're pregnant, and skip hot Pilates.
From the end of the first trimester, keep moves on your back short, prop your upper body up, or switch to side-lying, all-fours, seated or standing versions. Guidelines differ on the exact week, but the practical rule is the same.
Lying on your front can get uncomfortable early in pregnancy, so do those moves on your hands and knees instead.
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In a 2026 review of small trials, Pilates eased aches and pains in pregnancy by about 2.6 points out of 10. Claims that it shortens labour come from small, inconsistent trials, and a large review of exercise in pregnancy found no link with labour length.
Daily pelvic floor exercises, started in pregnancy, cut the chance of leaking in late pregnancy and in the months after birth. Pilates doesn't replace them.
Walking, breathing and pelvic floor exercises can start in the first days, and gentle Pilates from about 4 weeks if you have no bleeding, wound or pelvic floor problems. After a caesarean, exercise may not feel comfortable for 6 weeks or so. Build up to harder exercise over at least 3 months after your 6 to 8 week check.
ACOG notes that prenatal Pilates classes are designed for pregnant women and often teach modified moves for your changing balance. In trials, Pilates in pregnancy was mostly done twice a week for 4 to 16 weeks, led by Pilates instructors or physiotherapists.
Teaching varies: in a survey of 192 Pilates practitioners, views differed on moves on the back, bending forward and balancing on one leg, and few followed exercise guidelines closely. Tell your teacher how many weeks pregnant you are.
As the bump grows, its weight can press on the main vein returning blood to your heart, which can lower your blood pressure and make you feel dizzy.
Pregnancy hormones relax the ligaments that support your joints, so ACOG advises avoiding jerky, bouncy or high-impact movements. The bump also shifts your balance, which makes falls more likely.
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Pelvic girdle pain affects up to 1 in 5 pregnant women. It is felt over the pubic bone, across the lower back or between the vagina and anus, and is often worse when walking, on stairs, standing on one leg or turning over in bed. It isn't harmful to your baby, and a physiotherapist can help.
The World Health Organization (WHO), the NHS, the UK Chief Medical Officers and Canada's guideline all recommend at least 150 minutes of moderate activity a week in an uncomplicated pregnancy, including muscle-strengthening activity. "There is no evidence of harm", the UK guidance says.
ACOG lists "modified yoga and modified Pilates" among the exercises experts agree are safest. It advises against hot yoga or hot Pilates, which can overheat you, and against poses that keep you still or on your back for long periods.
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You can start in pregnancy. The NHS suggests starting slowly, with something like 10 minutes a day, and not taking up a new vigorous activity such as running. The UK pelvic health physiotherapists' booklet suggests 15 minutes 3 times a week, building to 30 minutes at least 4 times a week.
Our exercise in pregnancy guide compares all the guidelines.
From the end of the first trimester, keep moves on your back short, prop your upper body up, or switch to side-lying, all-fours, seated or standing versions. If you feel dizzy, sick or unwell lying down, roll onto your side.
Guidelines differ on timing, but the practical rule is the same. The grade is for the guidance: the evidence of harm from short bouts is thin.
A review of 7 studies found no link between exercise programmes that included moves on the back and low birth weight. During single bouts of exercise on the back, blood flow to the womb fell by 13%, and 20 of 65 babies showed unusual heart-rate patterns. The authors concluded there isn't enough evidence to say whether exercising on your back is safe or should be avoided, so the guidelines play safe.
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The POGP Pilates booklet notes that lying on your front can be uncomfortable even quite early in pregnancy, and suggests doing those exercises on all fours.
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Pilates trials in pregnancy are small, and several reviews pool the same trials.
A 2026 review of 13 studies found Pilates eased aches and pains in pregnancy by about 2.6 points on a 0 to 10 scale (moderate certainty) and reduced pregnancy-related disability (low certainty), but the trials disagreed a lot with each other. An earlier review of 4 studies found no effect on pain during pregnancy. Two small trials, of 34 and 40 women, found twice-weekly Pilates eased back and pelvic pain more than usual antenatal care.
Across 32 studies, exercise in pregnancy didn't stop back and pelvic pain starting, but made it less severe. A Cochrane review found low-quality evidence that exercise on land reduced pregnancy back pain, and a 2026 review of 31 trials found exercise helped pain more than standard care after 6 to 12 weeks.
NICE (the National Institute for Health and Care Excellence) advises considering referral to physiotherapy for exercise advice or a support belt. The POGP Pilates booklet suggests seeing a physiotherapist if you have pelvic girdle pain, and notes that lying on your side may be the most comfortable position for exercise.
In women without leaking, pelvic floor training in pregnancy cut leaking in late pregnancy by 62% and 3 to 6 months after birth by 29%. Canada's guideline says it can be done daily, ideally after being taught the technique, and NICE recommends encouraging it during and after pregnancy.
In a trial of 50 first-time mothers, Pilates with pelvic floor squeezes didn't raise pelvic floor strength more than standard exercise. In another trial, of 126 women, pregnancy Pilates reduced how severe leaking was, and a study looking back at 142 women found milder stress leaking after pregnancy Pilates.
The 2026 review found no clear effect on sleep, at very low certainty. A comparison of 120 pregnant women found better sleep in those who did Pilates, but it can't show cause and effect. After birth, 80 first-time mothers who did home Pilates slept better than those who didn't.
Reviews of Pilates trials report shorter labours (by about an hour and a half in one) and more vaginal births, but the trials are small, the reviews overlap, and the results are inconsistent: one review found no clear difference in how women gave birth, and a 21-woman trial found no significant difference in labour length. A review of 113 studies of exercise in pregnancy found no link with labour length or caesarean birth.
Do Pilates for comfort and strength, not to change your birth.
Across 113 studies of 52,858 women, exercise in pregnancy wasn't linked with harm to mothers, injuries or a tummy gap, and it cut the odds of a forceps or ventouse delivery by about a quarter (moderate-quality evidence).
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The guideline rules are in the notes; applying them to each Pilates move is our editorial advice.
Most beginner mat work is fine if you feel well, including moves on your back: in the early weeks, any comfortable position is safe, UK pelvic health physiotherapists say. If you're new to exercise, start with about 10 minutes a day. Avoid getting overheated, especially in the first trimester, and anything with a risk of falling or a blow to your tummy.
Keep moves on your back short or propped up on pillows or a wedge, or swap them. Swap face-down moves for all fours. Keep twists gentle and open, and if the middle of your tummy bulges into a ridge, choose an easier version.
The same swaps, with smaller movements and more rest: "it is natural to slow down". Hold a wall or chair for standing balance moves, because the bump shifts your balance.
Our suggested swaps after the first trimester:
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Side-lying positions are often the most comfortable. Keep your knees closer together, avoid standing on one leg or crossing your legs, and skip anything that hurts. Sit-to-stands are a good swap for step-ups (our suggestion).
Seated, standing, all-fours and side-lying moves; for side-lying work, use pillows under your head and bump and between your knees, and in child's pose take your knees wide. The cat is the NHS's back exercise for pregnancy, done slowly 10 times with your back returning to flat. Other doses are on each move's page.
3D demoLateral breathing (Pilates breathing)Beginner · No equipment
3D demoBreath reachBeginner · No equipment
3D demoMermaid (Pilates seated side bend)Beginner · No equipment
3D demoStanding pelvic tiltBeginner · No equipment
3D demoWall angelBeginner · A wall
3D demoWall push-upBeginner · A wall
3D demoSit to stand from a chairBeginner · A bench or box
3D demoCat-cowBeginner · No equipment
3D demoBird dog, one limb at a timeBeginner · No equipment
3D demoBird dogBeginner · No equipment
3D demoSide-lying tummy draw-inBeginner · No equipment
3D demoClamshellBeginner · No equipment
3D demoSide-lying leg raiseBeginner · No equipment
3D demoSide-lying Open Book RotationBeginner · No equipment
3D demoSide-lying leg circles (Pilates side kick series)Beginner · No equipment
3D demoChild's Pose (Balasana)Beginner · No equipmentFine in the first trimester. After that, do them propped up on pillows or a wedge and keep them short, or use the swaps above.
3D demoSupine heel slideBeginner · No equipment
3D demoKnee foldBeginner · No equipment
3D demoBent-knee fall-outBeginner · No equipment
3D demoPelvic tilt into bridgeBeginner · No equipment
3D demoDead bug heel tapsBeginner · No equipment
3D demoChest lift (Pilates curl-up)Beginner · No equipment
3D demoHundred (Pilates)Intermediate · No equipmentA gap between the two long muscles down the middle of your tummy is common. In 300 first-time mothers, it was found in 33% at 21 weeks of pregnancy, 60% at 6 weeks after birth, 45% at 6 months and 33% at a year. The NHS says it will usually go back to normal by the time your baby is 8 weeks old.
Across 113 studies, exercise in pregnancy wasn't linked with a tummy gap.
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In 16 trials, tummy exercises narrowed the gap by about 0.4 cm compared with usual care (moderate certainty), too little to matter. Other reviews found very low to low quality evidence for any specific programme. Exercise still builds strength, and pelvic floor training after birth cut the odds of leaking.
In 35 first-time mothers, 4 weeks of Pilates narrowed the gap and the waist, and a network meta-analysis ranked Pilates best for the gap at the belly button, with other treatments best above and below it. Small and indirect: Pilates is one reasonable option, not a proven fix.
In a trial of 70 women 6 to 12 months after birth with a gap, 12 weeks of head lifts and curl-ups, 5 days a week, didn't widen the gap and built strength. The NHS suggests avoiding sit-ups, planks and high-impact exercise to start with, so build up to them.
The POGP Pilates booklet says your tummy "should not bulge upwards or dome", and if it does, to draw your lower tummy in and wide. In a study of 26 women with a gap, an ordinary curl-up narrowed the gap but distorted the tissue between the muscles more, and the authors said their measure needs more testing. No trial shows doming harms recovery: treat it as a sign to make the move easier.
Contact your GP if the gap is still obvious 8 weeks after the birth; they can refer you to a physiotherapist. See a specialist pelvic health physiotherapist if you've been diagnosed with a gap, or notice bulging of your tummy muscles.
The timings are expert advice: go by how you feel.
Breathing and pelvic floor exercises can start within the first few hours after birth, or once your catheter is out after a caesarean. After a straightforward birth, gentle exercise such as walking, gentle stretches and pelvic floor exercises can start as soon as you feel up to it; ACOG says it's usually safe a few days after the birth, or as soon as you feel ready.
Build up gradually. The UK pelvic health physiotherapists suggest low-level Pilates such as stretches, and simple tummy exercises (a pelvic tilt held for 3 seconds, knee rolls, heel slides and a head lift), building up to 10 repetitions 3 times a day. Then knee bends, knee fall-outs and bridges: 2 sets of 5 to 10, every other day.
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The POGP Pilates booklet says gentle Pilates is safe from 4 weeks if you have no concerns about bleeding, wound healing or pelvic floor problems, such as leaking or signs of prolapse. A full beginner class or workout suits from about 6 to 8 weeks, once the early moves feel easy with no doming, leaking or heaviness. Ask at your 6 to 8 week check before high-impact exercise such as running.
A caesarean is major surgery. Walk every day, and start exercise, driving and lifting again when you feel able and it isn't uncomfortable: the NHS says "This may not be for 6 weeks or so". Lift nothing heavier than your baby for at least 6 weeks, and ask your midwife, GP or obstetrician when exercise is safe for you.
The UK guidelines say harder exercise can gradually resume after the check, building from moderate to vigorous over at least 3 months; if you weren't active before pregnancy, the NHS doesn't recommend vigorous activity. Canada's 2025 guideline suggests working up to at least 120 minutes a week of moderate to vigorous activity, over 4 or more days, once wounds or tears have healed and bleeding doesn't increase with exercise.
UK pelvic health physiotherapists suggest a specialist assessment around your 6 to 8 week check if you can get one. NICE suggests a supervised 3-month pelvic floor programme after a forceps or ventouse birth, a birth with your baby facing up, or a tear involving the anal sphincter. Roughly 1 in 3 women have urinary leaking 3 months after pregnancy, the UK government says, so it is common and treatable.
The pregnancy Pilates workout has no lying on your back or front, so it suits any trimester. The postnatal routine covers the first weeks after birth. The beginner Pilates workout suits the first trimester, or after birth from about 6 to 8 weeks; later in pregnancy, use the swaps above.
A 20-minute Pilates workout for any trimester: seated, standing, all-fours and side-lying moves, with no lying on your back or front and no jumping.
20 minBeginner15 movesA wall, A bench or boxA gentle 25-minute routine for the first weeks after birth: pelvic floor, breathing, tummy and hip exercises on the floor, sit-to-stands and a walk.
25 minBeginner12 movesA bench or box, Cardio machineA 5-minute daily pelvic floor workout for women and men: slow holds and quick squeezes, three times a day, with how to find the right muscles.
5 minBeginner2 movesNo equipmentA steady 30 to 45 minute cardio session at talk-but-not-sing pace: walk, cycle, row or cross-train, counting toward weekly activity guidelines.
40 minBeginner3 movesCardio machine, A wallA 20-minute mat Pilates workout for complete beginners. It covers breathing, spine position and the foundation moves, each with an easier option.
20 minBeginner13 movesNo equipmentFrom about 8 weeks after the birth, once the beginner workout feels comfortable (our suggestion, as in our guide to exercise after birth).
Stop exercising and get advice (in the US, call your obstetrician) if you have:
Before 12 weeks, contact your GP surgery or early pregnancy unit; from 12 to 19 weeks, your midwife or early pregnancy unit; from 20 weeks, your midwife or maternity unit. Always call 999 (911 in the US) if you think it's a life-threatening emergency. The NHS lists these among the symptoms to get help for:
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Contact your GP or midwife urgently if you have back pain in your second or third trimester, as it could be a sign of early labour, or back pain with a fever, bleeding from your vagina, pain when you pee, or pain under your ribs on one or both sides. Call 999 or go to A&E if you lose feeling in one or both legs, your bottom or your genitals.
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Call your midwife or GP if it's hard to move around, it hurts to get out of a car or turn over in bed, or going up or down stairs is painful.
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Canada's guideline advises against strenuous exercise with conditions such as broken waters, premature labour, unexplained ongoing vaginal bleeding, a low-lying placenta after 28 weeks (after 26 weeks in the UK pelvic health physiotherapists' Pilates booklet), pre-eclampsia, a weak cervix, a baby who isn't growing well, triplets or more, or uncontrolled type 1 diabetes, high blood pressure or thyroid disease. Ask your midwife or doctor first if you have one of these, or another medical condition.
Contact your midwife or GP straight away if you have:
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Pelvic girdle pain, leaking from your bladder or bowel, wind you can't control, sudden vaginal discomfort, backache, or bulging of your tummy muscles. Stop pelvic floor exercises and get help if you notice a bulge or downward movement at the vagina when you squeeze.
In the early weeks, any comfortable position is safe, and short periods of exercise on your back are fine, UK pelvic health physiotherapists say. Guidelines limit time on your back from the end of the first trimester or later, and the evidence of harm is thin.
Curl-ups didn't widen the tummy gap in a trial, and they built strength, and exercise in pregnancy isn't linked with a gap. The NHS advice is to avoid sit-ups and planks to start with, then build up.
Exercise narrows the gap only a little, about 0.4 cm, and the Pilates studies are small.
It's a cue to make the move easier. No trial shows it harms recovery.
Small Pilates trials report it, but a review of 113 exercise studies found no link with labour length or caesarean birth.
The NHS says you can start exercise slowly in pregnancy, and ACOG lists modified Pilates among the safest choices. Avoid starting a new vigorous activity such as running.
After a straightforward birth, you can start gentle exercise as soon as you feel up to it; the check is about high-impact exercise. After a caesarean, recovery takes longer.
Yes, for most women with an uncomplicated pregnancy: ACOG lists modified Pilates among the safest exercises in pregnancy. Tell your instructor you're pregnant, avoid hot Pilates, and stop if you feel uncomfortable, too hot or unwell.
Yes, gently. The NHS suggests starting slowly, for example 10 minutes a day, and not taking up a new vigorous activity. A pregnancy class, or a beginner session with pregnancy swaps, is a good place to start.
Guidelines differ on timing, from the end of the first trimester to later in pregnancy, but the practical rule is the same: from the end of the first trimester, keep time on your back short, prop yourself up, or switch to side-lying, all-fours, seated or standing versions. Roll onto your side if you feel dizzy, sick or unwell.
After the first trimester, swap long spells on your back and face-down moves for seated, standing, side-lying or all-fours versions. Leave out hot Pilates, upside-down moves such as the roll-over, and anything with a risk of falling. With pelvic girdle pain, avoid standing on one leg and wide positions.
The guidelines don't single out the reformer, so the same rules apply: limit time lying on your back after the first trimester, avoid moves where you could fall, and tell your instructor. Our reformer guide explains the equipment.
Probably a little: in a 2026 review, Pilates eased pain by about 2.6 points out of 10, but the trials were small and inconsistent. Exercise in general makes pregnancy back and pelvic pain less severe. For pelvic girdle pain, ask your midwife about physiotherapy.
Small Pilates trials report shorter labours, but they are small, overlapping and inconsistent, and a review of 113 exercise studies found no link with labour length or caesarean birth. Exercise in pregnancy did make a forceps or ventouse delivery slightly less likely.
No: exercise in pregnancy isn't linked with a tummy gap, and a gap is common anyway, found in a third of first-time mothers at 21 weeks. After birth, exercise narrows it only slightly.
Treat it as a cue to make the move easier: UK pelvic health physiotherapists say your tummy shouldn't bulge upwards or dome, and suggest drawing the lower tummy in and wide. There's no evidence that doming harms recovery.
Breathing, pelvic floor exercises and walks can start in the first days, and gentle Pilates from about 4 weeks if you have no bleeding, wound or pelvic floor problems. A full beginner class suits from about 6 to 8 weeks. Ask at your 6 to 8 week check before high-impact exercise, and build up to harder exercise over at least 3 months.
Start breathing and pelvic floor exercises once your catheter is out, and walk gently every day. Return to exercise classes when it feels comfortable, which may not be for 6 weeks or so, and lift nothing heavier than your baby for at least 6 weeks.
Not straight away: the NHS advises avoiding sit-ups and planks to start with. Later, curl-ups are fine: in a trial they built strength without widening the tummy gap.
Exercise education, not a personal prescription, and clinical review of these guides is pending. If you are pregnant, have a health condition or have had recent surgery, check with a doctor, midwife or physiotherapist before starting, and stop for sharp or increasing pain. Health disclaimer.
