Babies Enjoy Being with Mom During Exercise.

08 4

Hav­ing baby present while you are work­ing out is a lot of fun. Like most of new mom’s lives, the abil­ity to be together with baby and be pro­duc­tive at the same time is a fit­ness chal­lenge. A cer­ti­fied post­na­tal fit­ness instruc­tor can guide new moms in fig­ur­ing out how to do this. Being in a group also enables new moms to learn from each other.

Strollers are a per­fect aid to start your engine for aer­o­bic fit­ness. Mat work with baby is a great fol­low up. Multi-tasking can mean strength­en­ing mom’s shoul­der mus­cles while babies learn to social­ize. There are many ways to be fit and an inter­ac­tive mom at the same time!

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Pregnancy Pathway, Birth

There is no birth of con­scious­ness with­out pain.

Birth is a process with two major components

Birth is a life process with two major components

Okay, be here now:  This is about a really major experience…bringing human con­scious­ness into the world…opening a door to a room of love in your heart that you can only know by giv­ing birth to this person…changing your iden­tity forever.

Get­ting your mind around the image: If you have not taken the time yet to get your mind around this, take a moment. Breathe in deeply. Gen­tly blow the air out. Repeat. Repeat. Let go of any resis­tance. Slow your heart. Slow your mind. Con­sider:  Your body has the power to cre­ate a per­son. Your body has the power to expel this per­son when the rent is up.

Your brain, glands and organs are hav­ing a con­ver­sa­tion with the baby’s brains, glands and organs. At some point, this dis­cus­sion reaches a place where it is time to end this arrange­ment of two peo­ple shar­ing one body. It is true that occa­sion­ally the pas­sen­ger doesn’t want to leave, but that is rare. And, we have a rem­edy for that. Let’s just focus now on the what hap­pens when it’s time to go.

Labor starts how? Well, it depends. Some­times con­trac­tions start in fits and spurts and take a while to get orga­nized. Some­times they start strongly from the get go, and for oth­ers the process of get­ting rolling can take a few days. Some­times it starts early, and some­times has to be helped to start. Once in a while, the water breaks and labor starts…or not. So, the first les­son of hav­ing a child come to live with you is that you need to be flex­i­ble in your expectations.

In the next two posts, we’ll cover Labor and then the Birth Mode. Each of these processes is unique. They involve dif­fer­ent energy sys­tems. They require dif­fer­ent mind-sets from the mother and her sup­port team. The out­comes are dif­fer­ent. Going through the cen­ter of these processes helps you deal with them, helps you recover from their stren­u­ous nature and helps you move on to being a parent.

Remem­ber: Breathe in deeply. Gen­tly blow the air out. Repeat. Repeat. Let go of any resis­tance. Slow your heart. Slow your mind. Con­sider:  Your body has the power to cre­ate a per­son. Your body has the power to expel this per­son when the rent is up.

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Twins & Triplets — Exercise & Nutrition Tips

A detour: We received a ques­tion about nutri­tion and exer­cise for mul­ti­ples. So, here is some infor­ma­tion for those with twins and triplets. Add a com­ment if you have a ques­tion or expe­ri­ence to share on this topic! Next comes birth, we promise!!

If one is a girl and one is a boy, they're fraternal!

If one is a girl and one is a boy, they’re fraternal!

Nutri­tion for Multiples:

The pri­mary thing we tell peo­ple with twins or more is that the pro­tein needs rise about 30 grams/baby/day above the 70 — 90 grams/day needed for a sin­gle­ton. Water intake also needs to rise. Avoid thirst and as much as pos­si­ble, drink until urine runs clear rather than yel­low (as best as you can).

Mul­ti­ples is con­sid­ered a risk fac­tor, and for each risk fac­tor (mul­ti­ples, under­weight, teenage mom, inter-pregnancy period less than a year) an addi­tional 200 calo­ries is often rec­om­mended, with 400 extra calo­ries the upper limit.

Exer­cise with Multiples:

A crit­i­cal fac­tor in suc­cess­ful implan­ta­tion and growth of the pla­centa appears to be aer­o­bic fit­ness in the six months prior to and the first half of preg­nancy. Once bio­me­chan­ics become dif­fi­cult in mid-pregnancy, women with mul­ti­ples can con­tinue activ­ity safely as long as mon­i­tor­ing show the babies are grow­ing appro­pri­ately. A belly sup­port can be extremely help­ful when exercising.

Con­traindi­ca­tions for exer­cise include the dis­cov­ery that one fetus is grow­ing at a sig­nif­i­cantly slower rate than the other(s), that both/all are too small, that the placenta(s) is/are mal­func­tion­ing, or some other con­di­tion occurs, such as an incom­pe­tent cervix or pla­centa pre­via, that would be a fac­tor in any case.

Absolute size dif­fer­ence does not nec­es­sar­ily mean that one baby is grow­ing more slowly, as some fetuses may be a cou­ple weeks younger than their uterus-mate(s) if the mother ovu­lated twice in the fer­til­ity cycle. Or, s/he might be smaller if genet­i­cally des­tined to be a smaller infant at birth. Thus, growth rate is the mea­sur­able fac­tor that helps deter­mine if a fetus is at risk of not receiv­ing ade­quate energy. This can hap­pen when there are two pla­cen­tas and one pla­centa is work­ing more poorly than the other, or for some rea­son there is a flaw in the umbil­i­cal cord of an iden­ti­cal. The com­pe­ti­tion for energy places a slower grow­ing baby at risk.

Pro­tect­ing Mom and Baby:

The pla­centa is designed to nour­ish the baby and will do so at a cost to the mother first if there is inad­e­quate nutri­tion. Thus, activ­ity to the level the mother can tol­er­ate and fol­low­ing nutri­tional guide­lines above — in the absence of med­ical com­pli­ca­tions — pro­duces healthy off­spring. Mul­ti­ples will gar­ner all the same ben­e­fits a sin­gle­ton does.

Note about images:  we strive to use images we own or that are adver­tised as free on the inter­net. We want to thank google, bing and yahoo for mak­ing free images available.

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Pregnancy Pathway, Pregnancy — Nutrition

Fresh fruit = vitamins & minerals!!

Fresh fruit = vit­a­mins & minerals!!

Ques­tion:

How many extra calo­ries do you need in each trimester to off­set the meta­bolic cost of pregnancy?

Answer:

First trimester — 0; Sec­ond trimester — 300; Third trimester — 500 (source: Insti­tute of Medicine).

Keep in mind that you may also need calo­ries for any fit­ness pro­gram you are doing. If you are con­tin­u­ing a pro­gram, the only change is due to the pregnancy.

If you begin or increase your activ­ity, you need to take that into account. One yoga class = 100 — 150 calo­ries. One aer­o­bics class = 200–400 calo­ries. Walk one mile = 100 calories.

1 slice whole grain bread = 50-100 calories

1 slice whole grain bread = 50–100 calories

Be sure you read food labels so that you can bal­ance your food intake and your calo­rie out­put. A small woman (under 5’3″ & 130 lbs.) prob­a­bly needs about 1200 calo­ries per day as a base. A medium sized woman needs about 1400, and a large woman (over 5’9″ & 160 lbs.) prob­a­bly needs 1600 to 1800 calo­ries. Add your activ­ity and preg­nancy needs to your base amount.

Ques­tion:

What foods are nec­es­sary for a healthy pregnancy?

Answer, part A:

PROTEIN. Lean pro­teins like turkey and those with omega 3 fats like ocean fish and eggs.…yes! EGGS!

Turkey is a good protein

Turkey is a good protein

Ocean fish 1 or 2 times/wk = good protein & omega 3 fat

Ocean fish 1 or 2 times/wk = good pro­tein & omega 3 fat

Eggs are a perfect pregnancy food!

Eggs are a per­fect preg­nancy food!

70–90 grams of pro­tein are nec­es­sary each day, along with  ade­quate water.  These are needed to make an extra 40% blood vol­ume required to sup­port the placenta.

Answer, part B:

WATER. Two (2) quarts of water…more if you are very active…are needed to make extra blood and to pre­vent dehydration.

Ques­tion: What else?

Fresh vegetables also provide fiber

Fresh veg­eta­bles also pro­vide fiber

Answer: CARBS. Fresh, col­or­ful fruits & veg­gies pro­vide nec­es­sary vit­a­mins and min­er­als, as well as fiber. Eat 5 serv­ings a day from all the col­ors:  yel­low, orange, red, pur­ple and green, and you will get live vit­a­mins all day long that help your baby develop prop­erly! Fruits, veg­eta­bles and whole grains are low glycemic index car­bo­hy­drates — the good ones!

Dairy provides calcium

Dairy pro­vides calcium

Ques­tion:

Do I need dairy prod­ucts and red meat? Can I get the needed min­er­als in other ways?

Answer:

Cal­cium is needed in ade­quate amounts for bones and teeth. It is most eas­ily obtained by drink­ing milk or eat­ing cheese, yogurt or cot­tage cheese. Soy, dark green leafy veg­eta­bles and cal­cium for­ti­fied juice are alternatives.

Iron is nec­es­sary for red blood cells to take up oxy­gen. It is found in high amounts in beef,  and lesser amounts in raisins, spinach, and prune juice. Pre­na­tal vit­a­mins are your insur­ance against defi­cien­cies of these essen­tial minerals.

Ques­tion:

Any­thing else that’s essential?

Answer:

Yes! Healthy FAT!!

Avocado is an excellent source of omega 6 fat

Avo­cado is an excel­lent source of omega 6 fat

In addi­tion to omega 3 fats found in fish, wal­nuts and flax seeds, you need also need omega 6 fats, which are found in avo­ca­dos, olive oil and other veg­etable oils. Healthy fats help bal­ance car­dio­vas­cu­lar con­stric­tion and dila­tion, reduc­ing the risk for hypertension.

Last Ques­tion:

What is a healthy weight gain?

Answer:

In 2009, the National Acad­emy of Sci­ences revised its rec­om­men­da­tions. It now bases desir­able weight gain on pre-pregnancy BMI (Body Mass Index…google this!).

BMI less than 18.5 (low) — 28 to 40 lbs.; BMI between 18.5–24.9 (nor­mal) — 25 to 35 lbs.; BMI 25.0 to 29.9 (high) — 15 to 25 lbs.; obese women (BMI over 30.0) — 11 to 20 lbs.

Com­ing Next: Avoid­ing Risks.

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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!!

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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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Pregnancy — 50% planned; 50% unplanned

So…are you plan­ning to become preg­nant? For the last decade, preg­nancy has been in a 50/50 sit­u­a­tion. That is, about half the preg­nan­cies occur­ring in the U.S. are planned. The rest? Well, not nec­es­sar­ily unwel­come, but def­i­nitely unplanned.

Will this change in the cur­rent reces­sion (or as a friend said today, Let us just call it a depres­sion and move on)? So far, it is clear that preg­nancy rates are not drop­ping, despite an unwill­ing­ness to spend money on many other things. What does this say?

Once again, despite liv­ing in a high tech world, hav­ing babies is a pri­mal expe­ri­ence. It does not dimin­ish when resources are scarce.

So, plan to or not, if you have a baby dur­ing this depres­sion, do not waste your money. Fig­ure out how to have a healthy pregnancy.

Next on the Preg­nancy Path­way: the act of conception.

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Small Rant, Review, References & Coming Attractions

Small Rant — Women, their preg­nan­cies, births and moth­er­ing styles are all unique. The big issue in child­bear­ing these days is con­trol. Fear of los­ing con­trol, who con­trols birth (do YOU give birth or are you deliv­ered by oth­ers?), hav­ing the self con­fi­dence and skills to know when to let go of con­trol yet be okay. It’s inter­est­ing to hear what hap­pened to some­one else, but (here’s the rant part) this can often be fright­en­ing because — let’s face it — cat­a­stro­phe gets our atten­tion. What­ever you’ve heard, you still have to do it your­self. Preg­nancy, birth and par­ent­ing cre­ate a steep learn­ing curve.

Review — Our job at the DTP Blog is to help with the learn­ing curve through evidence-based infor­ma­tion. We are mov­ing along a path­way. Here it is, in a small ver­sion (see Feb. 5 for full ver­sion):
pregnancy_pathway

So far, we have dealt with Pre­con­di­tions (the Green items). If you under­stand what you can and can­not con­trol along your Preg­nancy Path­way it can help pre­vent you from spin­ning your wheels or wast­ing money. Some things are worth doing (self care, good food, exer­cise) and some are not (self-indulgence, tox­ins, stress). Pre­con­di­tions to preg­nancy — genet­ics, envi­ron­ment and behav­ior — are worth pay­ing atten­tion to if you are of child­bear­ing age and think or know you are mov­ing along this pathway.

Ref­er­ences - We have used hun­dreds so far and will use many, many more, but only some of you will find the sci­ence some­thing you want to pur­sue, so please go to our DTP web­site (use the Blogroll) for more infor­ma­tion on research in this field. Here are some texts that explain much more: “Women and Exer­cise” in Varney’s Mid­wifery (edi­tions 3, 4 & 5), Jones & Bartlett Pub.; Women’s Fit­ness Pro­gram Devel­op­ment by Ann Cowlin, Human Kinet­ics Pub.; and Immunol­ogy of Preg­nancy by Gil Mor, Springer Pub.

Com­ing Attrac­tions — next, we talk about con­cep­tion. Yes, this is an excit­ing part, though not per­haps why you think (!). It turns out con­cep­tion is fraught with many twists and turns.

Humor­ous incur­sion:
Q: Why does it take a mil­lion sperm to fer­til­ize just one egg?
A: Because none of them will stop and ask direc­tions.
[Sorry, couldn’t resist.]

After that we will likely rant and review again, have more humor­ous incur­sions, pro­ceed on to the preg­nancy and birth expe­ri­ences, then dis­cuss health out­comes for mom and baby in the short and long term.

Why do we spend our time on this? From a bio­log­i­cal per­spec­tive, humans can do noth­ing more impor­tant than cre­ate healthy off­spring. Wars may be fought, the banks fail or cars become a thing of the past; we might even become post-racial; but, hav­ing babies doesn’t really change. It remains a pri­mal expe­ri­ence. It’s nes­tled in a high tech world, but its still pri­mal. Women have always had guides; we take this role seriously.

Stay tuned!!

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Pregnancy Pathway, Preconditions — Genetics

Please refer to Feb­ru­ary 5 entry for com­plete graphic. The Pre­con­di­tion we will dis­cuss today is Genetics.

bubblus_preconditions_-_genetics

There are genetic fac­tors totally out­side your con­trol that deter­mine things as sim­ple as your offspring’s hair or eye color, how the ear­lobe attaches to the side of the head and whether or not s/he can roll the tongue. More com­plex things, such as a pre­dis­po­si­tion to types of can­cers, bleed­ing dis­or­ders or var­i­ous other dis­eases, also have a genetic basis.

Because the male con­tributes the sex of the off­spring, once con­cep­tion hap­pens, the sex off the fetus is deter­mined — at least genet­i­cally. But, it turns out not every­thing genetic is set in stone. In utero, hor­mone expo­sures may affect how male and female char­ac­ter­is­tics develop, so that some girls will be very girlie, some will be tomboys, and some may be gay. A sim­i­lar effect will influ­ence how boys develop.

Genetic, envi­ron­men­tal and behav­ioral pre­con­di­tions can be  inter­twined. Envi­ron­men­tal fac­tors can alter genes, caus­ing them to express pro­teins that would oth­er­wise be dor­mant. Like­wise, our behav­ior affects some of our genes. If we have a fam­ily propen­sity for heart dis­ease, but we eat a healthy diet, exer­cise and avoid risky behav­iors, we alter the impact of our genetic code.

Keep in mind that some things will be com­pletely deter­mined by genes. It is not rea­son­able to hope, for exam­ple, that our off­spring will be 6’5″ if both par­ents are short (or vice versa). If the mother has “thrifty genes” — that is, genes that make it easy for her to gain weight — she may well do so dur­ing preg­nancy, even if she fol­lows a rea­son­ably healthy lifestyle. If the immune sys­tems of both par­ents have some sim­i­lar­i­ties, it may affect the mater­nal immune response to the implant­ing tro­phoblast cells, thus affect­ing the pla­centa and, indeed, the entire pregnancy.

So, how do we advise peo­ple who are think­ing of preg­nancy to pre­pare them­selves for a healthy preg­nancy genet­i­cally? Surely, to deter­mine all the poten­tial genetic pos­si­bil­i­ties is not fea­si­ble or afford­able at this point. Maybe in another cen­tury! But, we can know some fac­tors:  Is there sickle cell ane­mia in both fam­i­lies? Is there a Mediter­ranean type of sickle cell dis­or­der? What about clot­ting fac­tors or dif­fer­ences in Rh? What about dis­eases or dis­or­ders that are not com­mon, like ALS? These are things that poten­tial par­ents may want to discuss.

Like so much of life, we can’t know every­thing. There are no guar­an­tees. There is a lot to be learned still about human genes and how they work.

This blog has at its heart the notion that phys­i­cal activ­ity has tremen­dous ben­e­fits for mother and offspring…and for part­ners, too. How does the genetic com­po­nent affect this? First, pre­con­cep­tion fit­ness low­ers some risk fac­tors for moth­ers and babies. Sec­ond, each mother’s genes will make it eas­ier or more dif­fi­cult for her to enjoy or ben­e­fit from the activ­ity of exer­cise. We appre­ci­ate this and encour­age young moms-to-be to find some­thing enjoy­able that you like doing and find peo­ple or sit­u­a­tions that sup­port you in being active now before you become pregnant.

If you need assis­tance or advice, please go to www.dancingthrupregnancy.com (use the BlogRoll)

Find Ask the Expert under the Con­sumer menu. Let us know how we can help!

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