For pregnant women, exercise offers numerous benefits with little risk. The American College of Obstetricians and Gynecologists (ACOG) endorses aerobic exercise for all pregnant women without medical or obstetric complications. Nonetheless, only a small percentage of pregnant women meet exercise guidelines. We investigated the extent to which obstetricians (Obs) in private or small group practice in the USA actively recommend exercise to their pregnant patients. Surveys were sent to 300 Obs in 33 American cities, of which 83 were returned. 52% of respondents reported discussing exercise with 81-100% of their patients. Using a 7- point Likert scale (1 = never, 7 = always), Obs reported recommending aerobic exercise more often than resistance exercise (5.6 ± 1.5 versus 3.8 ± 1.6, p < 0.001). Obs do not routinely advise sedentary women to initiate exercise during pregnancy (mean 4.4 ± 1.8). Of the 67% of Obs who specify a target exercise duration, 95% recommend ≥ 16 min, consistent with ACOG guidelines. However, 62% of Obs reported that they regularly specify a maximum heart rate, even though ACOG guidelines do not. Half of respondents indicated that they advise a reduction in exercise load during the third trimester, even for uncomplicated pregnancies. Respondents’ opinions were mixed regarding the extent to which exercise reduces gestational diabetes or preeclampsia risk and they believe more research on exercise during pregnancy is needed. Half of Obs do not routinely discuss exercise. The majority is hesitant to advise sedentary gravidae to start exercise and is conservative with respect to exercise intensity. Action may be needed to convince more Obs to routinely recommend exercise to all healthy patients.