Active Pregnancy — the rationale

Mov­ing into Motherhood

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.

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American College of Nurse Midwives updates

Two updates on the ACNM web­site of interest:

• the value of exer­cise in pregnancy

• health care reform

Check out the ACNM site!!

Posted in 1, baby, birth, exercise, health care, pregnancy, worthy global human endeavors | Tagged , , , , , , , , | Leave a comment

Rant: Health Care Reform/Pregnancy

Since Health Care Reform is a hot topic, let’s look at it from the per­spec­tive of preg­nancy and birth.

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?

3. Change the busi­ness model for health care. When we make finan­cial incen­tives for care providers, base them on best prac­tice, not on enrich­ing the mid­dle man. Cur­rently the pay­ers (insur­ance com­pa­nies) are mid­dle men, mak­ing money (i.e., con­duct­ing busi­ness) by charg­ing fees. They ration pay­ments for ser­vices in order to pay their own salaries and over­head. They do not actu­ally do any­thing pro­duc­tive. This is why sin­gle payer, gov­ern­ment, and health care coop options have been pro­posed. They elim­i­nate most of the cum­ber­some mid­dle layer.

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.

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