 Operative vaginal delivery with forceps or vacuums is frequently performed secondary to maternal exhaustion, which leads to an inability to push effectively; 40 of operative vaginal deliveries at Prentice are for maternal exhaustion. The risk of severe birth trauma is increased three to four fold with operative delivery. This randomized, controlled trial will compare rates of operative vaginal delivery and severe birth trauma in two groups of women: 1 an intervention group who will participate in the antepartum Total Control fitness and education program modified for pregnancy; and 2 a control group. Women will be recruited and followed from the second trimester until 6 weeks postpartum; all will complete validated questionnaires regarding their 1 level of worry and knowledge about their birthing experience 2 pelvic floor symptoms and quality of life 3 sexual function 4 satisfaction with their birthing experience and 5 level of depressive symptoms at various time points during and after their pregnancy. Obstetrical data will also be collected. 