Can I ride a horse while pregnant?

The verdict

It depends whose guidance you are reading, and the split is real rather than a matter of wording.

The NHS names horse riding first in its list of exercises that "have a risk of falling" and says these "should only be done with caution", because "falls carry a risk of damage to your baby". The company it keeps in that sentence is downhill skiing, ice hockey, gymnastics and cycling.

ACOG places horseback riding in a different category altogether. Its patient guidance lists activities that may result in a fall as things to avoid while pregnant, and horseback riding is named alongside downhill snow skiing, water skiing, surfing, off-road cycling and gymnastics.

Tommy's uses the NHS framing with the reasoning attached: any exercise or activity where there is a risk of falling, such as skiing, climbing or horse riding, can be risky, because your growing bump alters your centre of gravity, which can make it harder to keep your balance.

What the guidance is actually reasoning from

There is no trial of riding in pregnancy, no registry, and no published figure for the risk of a fall from a horse at any stage of gestation. What every one of these bodies is doing is applying a general principle about balance and joints to a specific activity.

ACOG sets out the principle in two parts. First, the hormones made during pregnancy cause the ligaments that support your joints to become relaxed, which makes the joints more mobile and at risk of injury, so jerky, bouncy or high-impact motions should be avoided. Second, the extra weight in the front of your body shifts your centre of gravity, placing stress on joints and muscles especially in the pelvis and lower back, and because you are less stable and more likely to lose your balance you are at greater risk of falling.

Riding is unusual in that it engages both of those at once. The sitting trot and canter are, in ACOG's terms, repetitive bouncy motion transmitted through a pelvis whose ligaments are more lax than they were. And the fall, if it comes, is from height at speed with an animal nearby.

The parts nobody addresses

Riders will notice immediately that the guidance does not distinguish between activities that are not remotely alike. Leading a horse in hand, hacking at walk on a familiar animal, schooling, jumping and hunting are one word in a guideline and five different risk profiles in a yard.

No health body has published anything on those distinctions, and it is more useful to say so than to invent a scale. The same applies to body protectors and air jackets: they are standard equipment in eventing and there is no published assessment of what they do or do not do for a pregnancy.

Pelvic girdle pain is the other thing riders ask about and here the RCOG does have something to say, although not about horses. It reports that pelvic girdle pain affects one in five pregnant women, is usually caused by the pelvic joints moving unevenly, and is more likely if you have had a back problem, have injured your pelvis in the past or have hypermobility syndrome. Sitting astride is a hip-abducted position, which is exactly the movement the RCOG's own advice tells women with pelvic girdle pain to limit.

If you are staying in the saddle

Many riders do continue, particularly in the first half of pregnancy, and the guidance does not make that irrational so much as a decision you are taking with your eyes open. The things within your control are the ones that change the actual hazard.

• Which horse. A settled, familiar animal and an unfamiliar or green one are not the same activity.
• What you do on it. The bouncing that ACOG describes is a function of pace and of jumping, not of being mounted.
• Where. An enclosed school and open country differ in what a fall lands on and how quickly help arrives.
• Whether you are alone. This is the point riders most often overlook and the one that determines what happens after an incident rather than whether one occurs.

The general NHS advice applies here as anywhere: do not exhaust yourself, avoid strenuous exercise in hot weather, drink plenty of water, and use the conversation test, because if you become breathless as you talk you are probably exercising too strenuously.

Yard work is a separate question

Riding is only part of what most horse owners do, and the ground work carries its own considerations that the exercise guidance does not cover. The Health and Safety Executive, writing about pregnant workers, lists lifting or carrying heavy loads and the risk of physical injury among the common risks that need controlling, and notes that the consequences of physical injury for pregnant workers can be more serious.

Mucking out, carrying water, moving feed sacks and handling horses on the ground all sit in that category. So does being in a confined space with an animal that weighs half a tonne.

What being active does buy you

It is worth keeping the frame right. The RCOG hosts the UK Chief Medical Officers' physical activity guidance for pregnancy, and the whole thrust of it is that activity is good for you. ACOG's Committee Opinion 804 states that physical activity and exercise in pregnancy are associated with minimal risks and benefit most women, and that women who habitually engaged in vigorous-intensity activity before pregnancy can continue.

The horse riding advice is not an argument for doing less. It is an argument about one specific hazard, and if you step away from riding, stepping into walking, swimming or a stationary bike keeps the benefit that the guidance actually cares about.

The short version

The NHS says take care, ACOG says do not, and neither is holding evidence you have not seen. Decide which framing you are using, be honest with your midwife about it, and pay attention to the ground work as well as the riding.