In the contemporary world, we are not as active as previous generations. Few women exercise to the extent required to develop the capacity to withstand the rigors of birth. It is little wonder that so often what childbirth educators hear from pregnant moms is that they are afraid of birth and don’t have confidence in their ability to do it. There are solutions for these issues…

The biggest bang for the buck is aerobics. This gets almost everything that helps you in labor:  increased endurance, strength and range of motion; improved breathing capacity (you get more oxygen + less fatigue) and reduced need to tap your cardiac reserve (your body works hard but not to the degree it must if you are not fit); and mental toughness that gets you the confidence you need that your body is capable.

Learning useful positions is extremely helpful. If you are active be sure that your workout includes such things as squatting and other movements that aid your progress in labor. Being upright and moving are keys to a healthy labor.

Mental focus and being present teach you to work with your body. Activities such as yoga, pilates for pregnancy and dance help you develop the mental skills that accompany your movement. Learn to recognize your body’s signals to you when it’s time to push.

Keep moving…right into labor and birth!

There are three sections to this post: 1) moms-to-be, 2) pregnancy fitness teachers and personal trainers and 3) some specific contraindicated and adapted exercises. All information presented is based on peer-review research and evidence collected over a 30 year period of working with this population. More information on safety can be found on this site on the page Benefits, Safety & Guidelines.

1) Safety & Exercise Guidelines for Moms-To-Be

First and foremost, be safe. Trust your body. Make sure your teacher or trainer is certified by an established organization that specializes in pre/postnatal exercise, has worked under master teachers during her preparation, and can answer or get answers to your questions.

These are the safety principles that we suggest to our participants:

• get proper screen­ing from your health care provider
• pro­tect yourself
• do not over­reach your abilities
• you are respon­si­ble for your body (and its contents)

Squatting is an example of a standard pregnancy exercise used for childbirth preparation that must be adapted by each individual based on body proportions, flexibility, strength and comfort.

Don’t assume that because your teacher and some participants can do a certain movement or position that you should be able to do it just like they do. If your teacher is well trained, she will be able to help you select variations that are appropriate for your body.

When you are exercising, make sure you are getting the most from your activity. Keep these findings in mind when choosing your workout routine:

• Aerobics and strength training provide the greatest health benefits, reduce the risk for some interventions in labor, help shorten labor, and reduce recovery time
• Cen­ter­ing helps to prevent injury; relaxation and deep breathing reduce stress; and mild stretching can relieve some discomforts
• Avoid fatigue and over-training; do reg­u­lar exer­cise 3 — 5 times a week
• Eat small meals many times a day (200–300 calo­ries every 2–3 hours
• Drink at least 8 cups of water every day
• Avoid hot, humid places
• Wear good shoes dur­ing aer­o­bic activities
• BE CAREFUL! LISTEN TO YOUR BODY!

If you experience any of the following symptoms, stop exercising and call your health care provider:

• Sudden pelvic or vaginal pain
• Excessive fatigue
• Dizziness or shortness of breath
• Leaking fluid or bleeding from the vagina
• Regular contractions, 4 or more per hour
• Increased heartbeat while resting
• Sudden abnormal decrease in fetal movement (note: it is completely normal for baby’s movements to decrease slightly during exercise)

2) Safety & Exercise Guidelines for Teachers & Trainers

A principle of practice that increases in importance for fitness professionals working with pregnant women is having the knowledge and skills to articulate the rationale and safety guidelines for every movement she asks clients to perform.

This goal requires adherence to safety as the number one priority. Here is how we delineate safety and the procedures we require of our instructors for achieving safety in practice:

First priority: safety [First, do no harm]

• sometimes medical conditions preclude exercise
• find an appropriate starting point for each individual
• individual tolerances affect modification
• general safety guidelines are physical
• pregnant women also need psychological safety

Mind-Body Safety Procedures

• Centering enhances movement efficiency and safety.
• Always begin with centering.

Strength Training Cautions

• avoid Valsalva maneuver
• avoid free weights after mid pregnancy (open chain; control issue)
• avoid supine after 1st trimester
• avoid semi-recumbent 3rd trimester
• keep in mind the common joint displacements, and nerve and blood vessel entrapment when designing specific exercises

Aerobics or Cardiovascular Conditioning Procedures

• Monitor for safety
• Instructional style needs to be appropriate.
• Walking steps with natural gestures can be done throughout pregnancy
• Vigorous steps with large gestures are more intense, appropriate as fitness increases
• The ability to create movement that will be safe and work for various levels of fitness and at different points in pregnancy is one of the most critical skills for pregnancy fitness instructors.

Venue Safety

• Setting should provide physical and emotional safety
  Equipment must be well-maintained

3) Contraindicated and adapted exercises

Exercises for which case studies and research have shown that there are serious medical issues include the “down dog” position, resting on the back after the 4th month, and abdominal crunches and oblique exercises. Here is more information and adaptation suggestions:

Contraindicated: “Down Dog” requires that the pelvic floor and vaginal area are quite stretched, bringing porous blood vessels at the surface of the vagina close to air. There are records of air entering the vaginal blood vessels in this position and moving to the heart as a fatal air embolism.

Adaptation: Use the child’s pose, with the seat down resting on the heels and the elbows on the ground, hands one on top of the other, and forehead resting on the hands. Keep the heart above the pelvis.

_________

Contraindicated: Resting on the back during relaxation.

Adaptation: Rest in the side-lying position. About 75% prefer the left side, 25% prefer the right side.

_________

Contraindicated: Abdominal crunches and oblique exercises can contribute to diastasis recti in some women. The transverse abdominal muscle is not always able to maintain vertical integrity at the linea alba, and thus there is tearing and/or plasticity of that central connective tissue.

Adaptation: Splinting with curl-downs, see positions below. By pressing the sides of the abdomen toward the center, women can continue to strengthen the transverse abdominals without the shearing forces that place lateral pressure on the linea alba.

Curl-downs are generally the safest and most effective abdominal strenthening exercise.

Splint by crossing arms and pulling toward center (L)

Or, splint by placing hands at sides and pressing toward center ®

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.

Pregnancy fitness is not only important for moms, but for the fetus as well. Evidence is clear that aerobic fitness improves brain, heart, immune and metabolic function…at all ages, including in utero. If continued early in life, healthy physical adaptations that occur in the uterus become reinforced behavior, preparing a good foundation for a healthy lifestyle. Babies are acute observers of movement and activity, and learn from each other. A key component of a good mom-baby program is the interaction of the babies themselves. A good teacher will facilitate healthy activity among our smallest class members!

There is growing evidence that at all ages, aerobic fitness produces the greatest number of benefits. Recently, researchers determined that aerobic fitness in 9 and 10 year olds produced benefits in the development of two important brain regions — the basal ganglia and the hippocampus — that are significant factors in problem-solving intelligence. This is just one of the latest reports that tells us the capacity to absorb and use oxygen (which improves with aerobic fitness) is a key to health, quality and length of life…beginning in the womb!

Recent CDC Guidelines on Exercise for the general population include pregnant and postpartum women. Specific information for pregnant women is included at this URL:

http://www.cdc.gov/physicalactivity/everyone/guidelines/pregnancy.html

James Pivarnik, PhD, president of the American College of Sports Medicine has released a Medscape video for health care providers encouraging them to be aware of the fact that the CDC considers a minimum of 150 minutes per week of moderate activity (or 75 minutes of vigorous activity for athletic women, or a combination of intensity for fit women) to be important for pregnant women, along with the general population.

DTP’s Total Pregnancy Fitness instructors learn how to combine activities so that women receive an adequate amount of exercise each week during their pregnancy. To find out about becoming a teacher, click on Become a Teacher above.

Filed under: Aerobics, Yoga, birth, exercise, labor | Tagged: aerobics, birth, breathing, exercise, moms-to-be, mother, yoga | Leave a Comment »

Accepting the importance of fetal programming places responsibility on the mother-to-be to do all she can to insure her body provides nutrients and oxygen to her growing infant while avoiding possible risks and toxins. At the same time, genetic and environmental factors contribute greatly to the potential for some disorders and problems that arise. Thus, we must be careful in assigning guidelines for acceptable behavior or blame for poor outcomes to pregnant women.

On the one hand, we can all see the negative consequences of something like fetal alcohol syndrome…clearly the result of maternal behavior. Is a pregnant woman whose baby has been damaged in this way guilty of abuse?

But, what if a mother is obese, eats poorly and ends up with an infant with a disturbed metabolism. Is this abuse? What if the mother has an infection that results in cerebral palsy? Or what if she lives near a highway and involuntarily inhales fumes that negatively affect the placenta?

How do you get a healthy baby? Of course, there are no guarantees. There remain many unknown factors that can affect the course and outcome of a pregnancy. Some factors we are aware of, such as avoiding certain fumes or chemicals.  There are some behaviors we know can maximize the potential for a good outcome, such as eating adequate protein, aerobic conditioning and strength training. [Note for new readers…lots of these factors have been covered in our previous posts.]

But, what about all the things we don’t know about?

If these goats eat the wrong grass, will they go into labor?

Here is a cautionary tale:  There is a species of goat that, if they eat a certain type of skunk grass on day 14 (and only day 14) of pregnancy, will not go into labor. Why? Plant toxins in this grass interfere with the development of a small portion of fetal brain, the paraventricular nucleus. This nucleus is involved in the signaling cycle of labor. Without it, the mother will not go into labor!

What are the take-home messages here?

• Probably no one is ever a perfect fetus…too many possible threats.
• There are some threats we can avoid…being lazy, over-eating, smoking.
• There are some threats we cannot avoid, so we do the best we can.

Do the best you can by your baby…aerobic fitness, good nourishment, sleep, good hygiene and de-stressing your life.