Activities
Ideally, a neutral spine should be maintained at all times when you are upright and active, to protect your back/spine. A few activity-specific tips are as follows.

• When brushing teeth, washing face, or working at the sink or counter, place one foot on a ledge or stool, bending the knee to keep the back straight.
• To place socks or slacks over feet, sit on a supportive chair and bend leg up while keeping the back straight.
• Avoid reaching and bending by keeping frequently used food items and dishes at a “user friendly” height. If space does not allow for this, make sure light, unbreakable products are placed at low and high levels, and consider using a step stool or a reacher as needed.
• Squat or kneel with tasks such as making the bed, loading/unloading dishwasher or dryer. Always avoid bending and twisting of the back.
• When lifting (a child), squat down and bring him/her close to you first, then stand up using your knees. Encourage older children to walk.

Sitting
Sitting puts a great deal of stress on the spine, so it pays to do it right. When sitting, choose a firmer chair with a straight back and arms for better support, and place a pillow or lumbar roll behind your low back, at waist level, to preserve its natural inward curve. Elevate legs if possible. Avoid sitting for longer than 20 minutes without changing position to avoid stasis in the legs and feet. For the same reason, never cross your legs – not only can it promote circulation problems, but it can alter the posture of the pelvis and spine, aggravating back pain.

Rest and Sleep
When resting or sleeping, it is recommended that beyond 20 weeks of pregnancy a woman avoid supine lying (lying on the back), as the weight of the developing baby can press against vessels and organs underlying the uterus, thus inhibiting good circulation and digestive functions. The position which least impedes mother’s system and enhances blood flow and nutrition to placenta/baby is left sidelying. In left sidelying, it is suggested that a pillow be placed between thighs and kenees to avoid strain with twisting to the lower back. Many women find it helpful to place a small wedge beneath the abdomen and a pillow (or husband) in the arms to “hug”, to support the middle and upper back, as well. When getting up from a lying position, first roll onto your side (always tightening belly beforehand), swing legs over the side of the bed and push up to a sitting position with your elbow.

Exercise
For reasons mentioned, constant postural awareness is a must for pregnant women. Efforts should be made to combat exaggerated spinal curves/postural imbalances resulting from altered weight distribution and gravity.

Specific areas which generally require stretching are the anterior chest, low back and hip flexors; while the upper back/interscapular region, abdominals, gluteals, and pelvic floor promote support and balance and may need to be strengthened.

Some helpful exercises include:

Doorway Stretch:

• Stand in front of a door frame with your palms at either side, elbows bent and pointing downward.
• Place one foot slightly forward of the other to avoid overarching the lower back.
• Tighten your belly and lean forward “with your chest leading”. You should feel a stretch in the front of your shoulders and chest.
• Hold the stretch, breathing deeply for 30 seconds.
• Repeat 3-5 times.