It’s time to hit the main theme again:  Aerobically fit women are at reduced risk for things that go wrong in pregnancy, improve their tolerance for labor and birth, and recover more rapidly in the postpartum period.

Moving into Motherhood

The arrival of the holidays provides a good reason to bring this up, yet again! Pregnancy is a gateway time in women’s lives…we become more aware of our bodies, our sensations, our feelings, our needs, and how versatile and amazing our bodies are. We can make people with our bodies! During pregnancy, we often take precautions…we eat more carefully, avoid toxins, try to avoid stress. When the holidays arrive, we see indulgent behavior in a different light.

Yet, even with all this focus on behavior, we sometimes miss the biggest aid to a healthy pregnancy:  physical fitness. Research clearly demonstrates that fit women do better, are healthier and happier. More and more in the U.S. we see disorders of normal organ function that accompany sedentary pregnancy.

Let’s look at this a little closer (yes, I am going to repeat myself some more, but it is an important concept to spread). We live in a body model that rewards an active lifestyle.

Being sedentary causes things to go wrong

Not moving creates biochemical imbalances because the cardiovascular system atrophies and molecules created in the brain or brought in through the digestion may not get where they need to go for a healthy metabolism.

Your cardiovasculature is the highway that brings usable substances to the place they are used. You have to help it grow and develop, use it to pump things around and give it a chance to be healthy. Aerobic fitness does all these things.

Advice for young women of childbearing age

If you are thinking of pregnancy, have recently become pregnant, or work with women of childbearing age, we encourage you to open avenues of activity for yourself or others in this population. You can learn more from our blog dancingthrupregnancy.wordpress.com. You can seek out local pre/postnatal fitness experts on this site. Yoga is nice…we use some of it in our work, along other specific exercises for which there is a direct health benefit. But, we also see yoga converts who come into our program in mid pregnancy unable to breathe after walking up a flight of stairs. How will they do in labor? Not as well as those who have been doing aerobic dance or an elliptical machine 2 or 3 times a week.

The AHA/ACSM guidelines for the amount of aerobic exercise needed to improve cardiovascular status hold true for pregnant women just as they do for the rest of the population – a minimum of 150 minutes of moderate, or 75 minutes of vigorous, or a combination of these levels of intensity, per week. If you are not getting this level of activity, you are putting your health – and that of your offspring – at risk.

1. Women who return to vigorous (vigorous, as in jogging or aerobic dance) prior to six weeks postpartum…

• have less weight to lose
• experience a more joyful state of mind
• do better on the Lederman Maternal Adaptation scales (how well they adapt to motherhood)

…than women who are sedentary during this period (Sampselle, 1999…this is not new information)

2. Postpartum obesity is a dangerous short and long term health risk (Leddy, 2008).

Who should exercise and when, following birth?

Day 1: If you have a vaginal birth, begin your “body scan” the first chance you get. Within the first day, the first chance you get to focus on yourself, take a mental trip through your body. See if you can squeeze the kegel muscles. Try exhaling and sucking in your deep abdominal muscles. Note if your shoulders need to relax. Take some deep breathes and begin to help your body recover.

If you had a cesarean: Wait a few days to 2 weeks at most to work on this.

After that: As soon as you can, get up and walk around. Start walking in 5 or 10 minute strolls several times a day (ask someone to hold or watch baby so you can allow your body to recover a non-pregnant upright). If you had a cesarean, hold a pillow to your abdomen until you have control of your abdominal muscles and stand tall.

How can you get more information on this?

Go to our website:

http://dancingthrupregnancy.com/take-a-class/postpartum-exercise/

Find a class. If you had a typical birth and your baby has been slowly and safely exposed to new people, by four to six weeks you and baby should be ready for a structured activity session that includes baby. It will also provide focus and adult interaction during the week.

How do you know if you did too much?

Your lochia, or the bleeding/discharge from the placental site, will increase if you have been too vigorous. If you are healthy and have no anemia issues, your lochia will likely cease by three to four weeks, six at most.

What are safety issues?

Don’t exercise if you have a fever, a warm red spot on your leg that may be painful (or not), or sore nipples that need attention. Call your care provider. If you or your baby are sick, it is best not to go into a group setting. If your baby is not well or just doesn’t seem right, call your pediatrician.

The most important reason to join a mom-baby fitness program may be that it will help keep you sane.

The Second Stage of Birth is different from the First Stage. The actual expulsion of the baby requires a change in energy axis. During dilation (first stage), oxytocin is most easily released from the pituitary gland during relaxation (see previous post), but during transition, a change occurs so that the ergotropic response takes over and adrenaline is key in helping oxytocin to spike.

What does this mean as far as preparation is concerned? While it is important to learn to relax or maintain positions such as one does in yoga, the ability to sprint, or turn on an aggressive action at the end, is critical. You need  good aerobic conditioning. Begin exercise with easy breathing and movement, then practice aerobic endurance and power moves at the end of your workout! Finish up with cool down and stretching.

The contractions themselves change. They remain intense for a longer stretch, but the time between them increases. Pushing involves not only the uterus contracting, but the pressure exerted by the transverse abdominal (TrA) muscle. Similar to squeezing a tube of toothpaste, TrA pressure helps press the baby toward the exit — yes, that is the vaginal opening. If the laboring mother is not able to apply adequate pressure, labor assistants sometimes apply pressure manually to the top of the uterus or — if need be — forceps or a vacuum extraction may be necessary.

How can a mom best prepare so that the TrA can provide the needed pressure? Strength training the TrA! Like any other motion requiring power strength, this muscle can be strengthened to do its job! Here’s how:

picture 1:  sit upright, inhale

picture 2:  exhale, compress abdomen and curl down

Return to upright and repeat 8 times. Rest. Repeat 8 more times.

What if something goes awry? Cesarean, or surgical birth is an alternative. Major complications before labor include a placenta previa, infection or undeliverable breech position. During labor, the most common problem is dystocia — stalled progress through dilation (first stage) or pushing (second stage). In the pushing stage, head to large for pelvis is the most common difficulty.

What happens next? If the birth is natural, you will feel a tremendous euphoria. Bring the baby right up onto your chest for skin-to-skin contact. If you have had medications, your response may be slightly blunted, but you will definitely be overwhelmed by the emotions of birth.

Third Stage is expulsion of the placenta, which can no long remain connected to the shrinking uterus. When it detaches, the nurses or midwives will ask you to push and !plop! out it comes. It can be interesting to see what has nourished your baby for so long!

CONGRATULATIONS!  YOU’RE A MOM!

Labor is generally a long, slow process…there is no “enter” button for dilation!

Before the baby can leave the mother’s body, s/he must leave the uterus. The opening of the cervix to let the baby out of the uterus generally takes up the most time. For a first time mom it can be 10 or 12 hours…or, yes, a couple of days. Of course, for some moms, this time is difficult and for others it only becomes difficult in the last few hours.

But, you know all this, right? What you want to know is:  Why do I have to go through this? And, if I must, how can I make it the least painful?

Why labor is important. Let’s go to another question:  How important would your offspring be if it was no big deal to drop one out? If you were walking along the sidewalk and you could simply drop a newborn on the pavement, would you even stop to pick it up if you could do it again in a few days, when, of course, it will be much more convenient?

Frankly, pregnancy and labor remind us to pay attention. A newborn cannot survive on its own for at least two years. If we don’t pay attention, it will die.

Okay, now that labor has your attention, what else does it do that is beneficial? It stimulates the baby’s stress response and teaches the newborn to be alert during situations of duress. Each contraction is pulling the cervix, helping it slowly open. If you are upright, each contraction is also alerting the baby to the influence of gravity.

Why is labor painful? So, you need to go through this because it is the bridge from pregnancy to parenthood. Why does it have to be painful?

The first thing to keep in mind about pain is that pain is a combination of sensations and emotion, mainly fear. Fear makes you tense; tension reduces blood flow. Reduced blood flow to the uterus makes the contractions less effective. In addition, cortisol is released, making sensations stronger and evoking greater fear.

Fear is the emotion of fight or flight. Interestingly, the opposite response, the relaxation response, is very effective in promoting labor. So, relax. Breathe deeply and slowly, focus, move through the center of your experience. You don’t have to be in fear if you know what is happening and if you are physically fit and prepared. Both childbirth education and physical fitness teach your body to work with discomfort. By including them in your preparation, you give yourself a tremendous advantage.

Does this mean you will never feel like you want to stop in the middle of labor? No, but it does mean you can do it. It is finite. The notion that the baby will not do well is also tied to your physical fitness…babies of fit mothers less often experience fetal distress. Your care providers will let you know if there is some factor beyond your control that requires medical intervention.

Birth is an empowering event. But, before the baby can be born, it must escape the uterus. It is a classic conflict and the mother’s body is the venue. Give yourself over; go with it. Only women can do this.

So, what is safe? Well, first, unless you have a very few conditions that your health care provider considers unsafe, every woman — fit, currently sedentary, young or a little older — can exercise safely in pregnancy. How much of what kind depends on your fitness level and exercise history. Get medical screening first.

If you are fit, you can do vigorous exercise

If you are fit, you just need to learn how to modify some movements to accommodate your biomechanics. As your body changes, stress on the joints and tissues means a little less jumping or ballistic motion will be more comfortable and safer. If you are fit, you can continue with vigorous exercise and it will be of benefit to you and your baby.

If you are not so fit or are sedentary, find a certified pre/postnatal instructor and join a group where you will have fun, get some guidance and be monitored for safety. How do you find such a person? Try our Find A Class or Trainer page.

What is effective? Don’t spend your time on things that may be nice to do but don’t help you focus and prepare for birth, relieve discomforts or have the stamina for birth and parenting. There is substantial scientific evidence and information from large surveys that these things are helpful.

Cardiovascular or aerobic activity is the most important activity you can do. Already fit? Keep working out; join a class if you want support or new friends. If you are sedentary or somewhat active, you can improve your fitness by doing at least 20 — 30 minutes of aerobic activity 3 times a week. Work at a moderate pace — somewhat hard to hard — so that you can talk, but not sing an aria! If you are more than 26 weeks and have not been doing cardio, you can walk at a comfortable pace. Aerobics is key because it gives you endurance to tolerate labor and promotes recovery.

Strength and flexibility exercises that do not hurt and are done correctly are also safe. There are some special pregnancy exercises that actually help you prepare for birth. Essential exercises that aid your comfort, alignment and birth preparation include:

• Kegels (squeezing and relaxing pelvic floor muscles) — squeezing strengthens them and thus supports the contents of the abdomen, and learning to release these muscles is necessary for pushing and birth.

• Abdominal hiss/compress and C-Curve® - contracting the transverse abdominal muscles reduces low back discomfort and strengthens the muscle used to push and later to recover abdominal integrity after birth.

Squatting

• Squatting — getting into this position strengthens the entire leg in a deeply flexed position; start seated and use arms for support, stability and safety. Leg strength improves mobility and comfort in pregnancy and postpartum; plus, deep flexion is a component of pushing in almost all positions.

• Strengthening for biomechanical safety — strengthening some parts of the body helps prevent injury to bone surfaces, nerves and blood vessels within joints re-aligned in pregnancy. This can be done using resistance repetitions (weights, bands, calisthentics or pilates) or isometrics (yoga or ballet). A responsible class will focus on upper back (rowing), push-ups, abdominals, gluteals, hamstrings, and muscles of the lower leg.

• Stretching of areas that tend to get tight — relieving some discomforts through flexibility helps you maintain a full range of motion. Static stretches, used in combination with strength exercises or following aerobics, is most effective. Stretching prior to exercise tends to produce more injuries than not stretching. Areas needing stretching include the chest, low back, hamstrings and hip flexors (psoas).

Mind/Body skills are very important. There are two activities that exercisers constantly tell us are a big help in pregnancy, birth and parenting.

• Centering employs a balanced or neutral posture, deep breathing and mindfulness to help you work in a relaxed way. Athletes and dancers call this “the zone.” Starting your workout in association with your body establishes economy of motion, something very useful in birth and parenting, and reduces risk of injury.

• Relaxation is another key activity; it relieves stress, promotes labor in the early stages and helps you enter the zone!

Remember: Birth is a Motor Skill™

Behavior Affects Pregnancy Outcome

Physical exertion (we call it “exercise” nowadays) is a normal state for healthy humans. Only in the last century has the desire to rest or the need to store extra calories as fat become more possible to achieve than our need to move about to survive.

Pregnancy is a state in which both of these factors (resting and storing calories) are enhanced through organic changes in body chemistry, adaptations that favor fetal survival. The current sedentary lifestyle exaggerates these metabolic changes and results in syndromes that increase the risk for a number of metabolic, cardiovascular and immunological disorders of pregnancy.

When confronted by the idea that it is counterintuitive to think exercise in pregnancy might be safe (let alone beneficial) I am dumbfounded. To me, it is counterintuitive to think that a sedentary lifestyle in pregnancy might be safe!

Burning Calories in Pregnancy Improves Outcomes!

What is the evidence that exercise in pregnancy is beneficial? Keep in mind that some studies have been executed more expertly than others. But, what is compelling is that numerous well-respected researchers have sought to test the hypothesis that exercise is not safe, but come away with results that indicate the opposite!

Here are some of the major findings:

• The placenta is larger and has more transport surface in exercisers than sedentary women

• The fetuses of (aerobic) exercising mothers make beneficial cardiovascular adaptations

• Women who do aerobic exercise are less likely to develop severe preeclampsia or gestational diabetes, and the long term health problems that accompany these disorders

• Women who are aerobically fit recover from birth 10 times faster than sedentary women (as measured by time needed to metabolize free radicals produced in labor)

• Women who exercise in pregnancy are more likely to be physically fit in midlife

• the value of exercise in pregnancy

• health care reform

Check out the ACNM site!!

What revisions would most benefit pregnant women, their offspring, families and communities?

1. Reward healthy behaviors. A system that provides reduced premiums for health care for women who exercise, eat well, do not smoke and are in a normal weight range is evidence-based.

Yes! We could provide financial incentives for being healthy during pregnancy. Why? Healthy moms have healthy babies; healthy babies cost the payer less money.

2. Review best practices. Is a 40 or 50% cesarean rate the best practice?  Accompanying the rise in cesarean births is growing information that babies born by cesarean are at increased risk for a number of immune disorders. But the business model of medicine rewards cesarean because it both pays the provider more and is defensive medical practice.

Fetal monitoring to determine if a cesarean may be necessary, is wrong 3/4 of the time. In an effort to change this, guidelines are changing for the use of monitors during labor. What is the evidence that this change of practice is beneficial? Will it lead to more or less monitoring, which may itself be an intervention that can disrupt normal labor?

Why does insurance pay for cesareans? Well, they will do it once. After all, the care providers have to practice defensive medicine. But, once you have a cesarean, you become a risk for the insurance company (they know what the research says about cesareans and offspring health problems) and may be denied insurance. They can no longer afford you.

Because care providers are paid fee for service and must practice defensive medicine, pregnancy and birth have become increasingly burdened with intervening procedures that do not necessarily promote a healthy pregnancy or birth process. How is this playing out? Increasingly, we see women giving birth in what they perceive as a more supportive and health-inducing setting:  their own homes. Think of it this way:  many women now believe that it is safer to stay home than go to a hospital to give birth.

Unless health care becomes about best practices and healthy outcomes — not price, size, and getting paid for passing money back and forth — the U.S. will continue to have some of the worst maternal/infant outcomes in the developed world.

Up for discussion…

Health Influences in Pregnancy

Let’s start at the beginning…in the first trimester you feel sick and tired, right? Three things:

1) your immune system is pro-inflammatory (causing nausea and fatigue), 2) your body is protecting your fetus from some toxins (if you eat something not so great for the fetus, you throw up), and 3) you have extreme swings in blood sugar levels so that after you eat, the level soars and you feel sick.

Number 3 can be fixed with behavior, but you may have to wait out 1 & 2. To fix number 3 eat very small meals frequently (6 or 8 times a day) and be sure to eat protein, that is, eggs, meat, fish, fowl, cheese, nuts, rice & beans, soy, etc. with each small meal. This stabilizes blood sugar and prevents dramatic elevations that can cause nausea.

In most healthy pregnancies, the immune system will rebound in the second trimester so that you feel good; it is protecting you again!  But, those wicked toxins and infections are still out there in the environment, so the message is beware bad air (smog, smoking, industrial air pollution), highly processed foods (lunchmeats, things with names you can’t pronounce), any drugs or meds not prescribed or okayed by your ob or midwife, alcohol, and dangerous bacteria, viruses and other microbes!

Exercise wisely…no sky-diving or scuba diving! Eat healthy food and get enough sleep. De-stress through relaxation and meditative techniques. Don’t take risks with your health, but do stay active and start to prepare for birth and bringing home a baby (or two?).

Third trimester & the immune system goes on the fritz again — can’t keep this baby in here forever; must expel! You may feel sick and tired again. BUT, keep your prenatal care appointments, keep moving, get good nutrition, rest and stay focused. Before you know it the real work begins, not to mention the 18 years of sleep deprivation.

Getting from here…

Being Fully Present in Your Pregnancy…

…to here..

Being Fully Present as Mom.

…is a journey like no other. The adaptations of your body to the demands of pregnancy are amazing. If you pay attention, you will learn more about the meaning of existence from this than from anything else.

BE HERE NOW!!

Sign up for this Blog (top toolbar, click blog info and subscribe)!! Learn from our more than 30 years of helping make healthy moms & healthy babies.

Visit our website:  www.dancingthrupregnancy.com

This is the message summary from our first two areas of discussion:  Preconditions and Conception — the green and sand colored sections on the chart below.

COMING ATTRACTIONS: We are about to move on to the blue section — Pregnancy!!  So, bookmark this Blog for future reference!

Also, you can subscribe to this Blog by clicking on Blog Info in the upper right corner and then clicking on Subscribe in the drop down menu.

But, yes, you guessed it, first we have a small rant!

SMALL RANT: When we note that fitness, nutrition and a healthy immune system play significant roles in the outcome of pregnancy and the future health of mother and child, we are appealing to young people of childbearing age to be careful about your bodies. The alliance of egg and sperm shapes the world. With 6.5 Billion egg/sperm combinations (yes, people) presently living on earth, our resources are stretched. With time, either we get more picky about doing this, or the 3rd rock from the sun (remember that show?) is cooked.

Humorous incursion: In case you need further enlightenment on this whole area, there is a great website that will help you out. Be prepared to be amused and amazed!

The Truth about Eggs and Sperm

Hopefully, this gets you in the right mood and keeps you smiling. After all, once you actually are pregnant, we have more serious matters to discuss.