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.

In the past few decades, the average age for a first pregnancy in the U.S. has moved from the mid twenties into the mid thirties. In the same time period, the facts of conception — sperm enters egg released in mid cycle, then zygote implants in the uterus, along with how sex allows this to happen and how to prevent it — seems to have disappeared from middle and high school health classes. If that weren’t enough, as women have become more and more essential in the work force, the cost of having children as well as starting later, have driven down the birth rate. Similar conditions exist in most developed nations, although teen pregnancy rates are lower everywhere else.

The birthing population has bifurcated — we see older women (over 35) and teens as the major groups having children. On the one hand we have been working to reduce teen pregnancy while helping older and older women become first time moms. To a certain extent, they need the same information; its just that with teens we use this information to prevent pregnancy and with older women we use information to help them increase their odds of getting pregnant.

Understanding the menstrual cycle, ovulation, charting temperature — all the basic techniques of using the “natural” method of birth control — have become the first steps of the how-to-get-pregnant coaches. Beyond this, a number of sites have their own essential lists to help women be healthy and ready. Sites such as gettingpregnant.com, pregnancy.org/getting-pregnant, and storknet.com/cubbies/preconception/ provide additional information. Many suggestions — things to avoid eating, what proteins are needed for ovulation, how to reduce stress, what to do if there are sperm problems, how to find IVF clinics, donors and surrogates — are addressed.

How effective are these suggestions? Well, research tells us they are somewhat effective. None of the sites I contacted answered my query about how they measure or assess consumer outcomes when following their suggestions.

An interesting article in the NY Times 9/1/2011, entitled Are You as Fertile as You Look? openened with this sentence: “FORTY may be the new 30, but try telling that to your ovaries.” The reality is that being under 35 is still the best predictor of how difficult it may be for you to become pregnant. As the article makes clear, looking 30 and being 30 are not the same thing. Even healthy living does not prevent the loss of good eggs.

So, what conclusions can we draw? First, even if you come from a “fertile family,” it may behoove you to have your children in your late 20s or early 30s. Second, if you are putting off having children beyond that time, ask yourself what extremes you are willing to go to to have your own biological offspring. And, third, consider adoption. Frankly, it would be wonderful if adoption were easier, but in the drive to conceive at later and later ages we see the hand of biology and understand why adoption is not easy:  Our own offspring — our own DNA out there in the world — is a heady motivation.

If you are on the pathway of becoming pregnant, being under 35 is the best ally you have. If not, maybe some of the suggestions on the web will work for you. Whatever you decide, all the best.

One parting comment:  Regular moderate exercise — while it helps you stay young and healthy — will not prevent your eggs from being popped out every month. It will help you have a healthy pregnancy if you conceive, so stay with it!

Mom & Baby Beauties!

Special thanks to Bonica and Julia from one of our Mom & Baby Fitness groups for this delightful photo! It just goes to show…there is no end to the fun things you can do if you use your imagination. Do think “Safety First,” but other than that, the sky’s the limit!

Mother’s Day is an important day!  It is set aside because – let’s face it – without our mothers, none of us would be here. Not only do moms carry us inside their own bodies for those critical nine months, but once we are here our mom, or someone who can sub for our mom, is essential to our early survival.

Many presents celebrate motherhood. We can also give gifts that save mother’s lives, help them nurture their children, and improve the lives of families in our own countries and the developing world.

Here are a few groups to which you might want to consider giving this year. By donating to these organizations you can help improve the lives of mothers and children. Most will send a card or email message to the mom in whose honor you give the gift.

UNICEF Inspired Gifts.  You can choose gifts that improve education, water, health, nutrition, emergency care and other factors that affect the well-being of women and children.

White Ribbon Alliance for Safe Motherhood. You can advocate for every mother and every child in 152 nations when you give to this organization.

International Confederation of Midwives. This group exists to raise awareness of the global role of midwives in reducing maternal and newborn child mortality.

The Fistula Foundation. This group exists to raise awareness of and funding for fistula treatment, prevention and educational programs worldwide. Fistula is the devastating injury cause by untreated obstructed labor.

The Preeclampsia Foundation. This organization supports research to prevent and treat one of the most dangerous disorders of pregnancy, one that accounts for a large percentage of premature births and low birth weight infants. Having preeclampsia is also a risk factor for later heart disease for the mother.

March of Dimes. The “mother” of all charities for helping prevent and treat disorders and diseases that affect children.

Happy Mother’s Day to you and – hopefully – to all mothers everywhere!

Here is the dilemma:

Normal weight and some overweight women who eat too much in pregnancy tend to have babies who are, basically, already obese at birth. Therefore, these infants already have metabolic and cardiovascular dysfunction. Babies born over 8 lbs. 14 oz. are at increased risk for Type 2 Diabetes and heart disease.

Interestingly, the Institute of Medicine  recently issued new guidelines on pregnancy weight gain. After nearly 20 years of adhering to the “normal” weight gain being 25 to 35 pounds, the Institute recognized that prenatal BMI plays a role in how much weight gain is necessary for a healthy pregnancy.

The evidence that underlies this change demonstrates that gains greater than 22 pounds — for all classifications of prenatal BMI — is the demarkation point for increased health problems.  More information on this is available at:  New IOM Guidelines.

We have known for a while now that obesity in pregnancy puts mother and infant at risk for a number of problems from cardiovascular, metabolic and immune disorders to prematurity, low birth weight, increased need for cesarean birth and slow recovery. Add another one:  Obese newborns with increased risk for heart and metabolism problems.

Reference on weight gain and high birth weight:

Ludwig DS, Currie J. The association between pregnancy weight gain and birthweight: a within-family comparison. Lancet. 2010 Sep 18;376(9745):984–90. Epub 2010 Aug 4.

A good reference for issues surrounding obese pregnancy:

Leddy MA et al. The Impact of Maternal Obesity on Maternal and Fetal Health. Rev Obstet Gynecol 2008;1(4):170–178.

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!

“We arrived at the hos­pi­tal at 8pm on Fri­day and I was 6 cm dilated…I deliv­ered by 1 am with­out pain meds.  It was an amaz­ing expe­ri­ence. You really do focus inward.  I found sit­ting in the shower hold­ing the sprayer to be help­ful.  Def­i­nitely try dif­fer­ent posi­tions.  I used the bar for when it can time to push.  Just know that there is an end in sight and just hold­ing your baby at the end is the most won­der­ful, amaz­ing feel­ing in the world!”  — P.E.

Recent research at UC Davis has shown that a strain of the bifido bacteria — acquired from the mother — thrives on complex sugars (largely lactose) that were previously thought to be indigestible. The bacterium coats the lining of the immature digestive tract and protects it from noxious bacteria.

This combination of interactions affects the composition of bacteria in the infant gut as it matures. Another example of how evolution has “invented” the perfect nutrition for infants, this research contributes to the notion that evolution has selected for many genes that serve normal birth and breastfeeding by protecting the newborn. Intervening with the normal progression of birth and breastfeeding — while occasionally necessary — interrupts these beneficial adaptations and contributes to allergies and autoimmune disorders.

Periodically, arguments arise in the birthing field over who controls the way we give birth. Often this happens at times when birthing women change their behavior trends, putting financial pressure on professionals working in this field. The major players in this argument are medical doctors (obstetricians), certified nurse midwives and professional home birth midwives.

Currently we are seeing women leave the traditional hospital setting for birth in larger and larger numbers…and taking their dollars with them in the process. While the question of home birth safety arises every time this control argument comes around, the question of whether it is safe to intervene in a labor that is progressing normally is a new component of the discussion. This time the argument is: The safety of home birth vs. the safety of using hospital technology to intervene in normal birth.

How Money Affects this Issue

As with all commercial ventures, controlling access to safe birth requires controlling the information in the market place. This information needs to address the perceived wants of the target audience. For a long time the main message has been: Safe birth is only available in a hospital.

The financial pressure of giving women (consumers) what they want — a normal experience of birth in a safe setting where medical help can be quickly available — has powered the birth-center industry. Free-standing and in-hospital birth centers have grown in numbers, and are largely enabled by certified nurse-midwives. Meanwhile, professional home birth midwives have increased both their credentials and practice standards, as well as their visibility.

Both of these options, birth centers and home birth, threaten the livelihood of traditional obstetrical practices. Low risk births (about 70% of births) have the potential to be normal births, requiring little or no intervention. But, giving birth in the hospital means participating in measurement procedures that intervene in the labor process.

So, to convince women they need to be in a hospital to be safe, medicine has maintained the argument that home birth or out of hospital birth is not safe. However, research does not indicate this is true. The nature of this ongoing argument is discussed in a 2002 article from Midwifery Today.

What’s New? The Counter Argument.

The physiology of normal labor is dominated by parasympathetic, meditative, gonadal energy systems. Measurement is a sympathetic, rational, adrenal energy dynamic. Only when it is time to expel the baby does the underlying energy system make a transition (transition, get it?) to an adrenal impetus for the strength activity of pushing. Immediately following normal birth, maternal physiology is again dominated by gonad-driven energy along with a rush of endorphins.

“Intervene enough and things will go awry. You can easily end up being cut and/or separated from your baby at birth.” These ideas have gone viral. With the arrival of the internet, women have found a very quick way to do what we have always done: Share information.

Thus, in my exercise program and in my childbirth preparation classes, I have more and more frequently been fielding the following question from women who want a normal birth and want to be safe: “How can I avoid interventions while I am in the hospital?”

So, I ask them what leads them to ask this question. And, they say: “I read on the internet and/or heard from my friends that interventions make birth less normal and less safe. I want to protect myself.”

Women themselves are entering the argument in a much more conscious way than in the past. Some professionals would like to keep women out of the argument. But, like with many things in our 21st century world, we have already past the point of no return. As they say, the horse has already left the barn!

Word has gotten around. More and more, as a prenatal fitness expert who strives to listen to my clients, my job has become educating and physically training women to cope with a strenuous and primitive process in a technological world.

Hopefully, we can all keep our eye on the ball here. Preventing trauma should be one key goal. Just as we have learned to hold our newborns skin to skin so they can smell and taste us, listen to our heart beat and voice, and maintain their core temperature, let us learn to comfort and nurture our new mothers, while we steel them for the rigors of birth.