Fetal Programming

What is fetal pro­gram­ming? Every per­son liv­ing on earth was first exposed to a uter­ine envi­ron­ment that helped deter­mine their life­time health and devel­op­ment. The term for this phe­nom­e­non is fetal pro­gram­ming. It is a hot topic and deserves attention.

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.

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Mom-Baby Fitness in Spanish on YouTube!

El Show de Analeh — on Uni­vi­sion — a seg­ment on Healthy Moms, Healthy Babies, fea­tures DTP’s Mom-Baby Fit­ness and par­tic­i­pant Car­olina Baffi. Now avail­able on YouTube!  Check it out!!

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The 51% Factor: Pregnancy, Power & Health

In the U.S. and most of the devel­oped world, approx­i­mately 51% of the pop­u­la­tion is female. Most females give birth at some point in their lives, although, in any year, only about 2% of the pop­u­la­tion gives birth.

No one liv­ing on earth got here any other way than ges­ta­tion, so there ought to be some power attached to being part of that 51%. His­tor­i­cally, it might be said that the power has been merely for survival…the good breed­ers sur­vived long enough to pro­duce heirs and those who lived on knew where the roots and fruit grew.

Only women can make more peo­ple with their bodies.

Here are some things to consider:

  • Women make people
  • Women’s health and fit­ness before preg­nancy affects whether the preg­nancy is healthy
  • Women’s health and fit­ness dur­ing preg­nancy affects her life­time health and that of her offspring
  • Mater­nal sur­vival is impor­tant to off­spring well-being
  • Mater­nal health and fit­ness affects mater­nal adap­ta­tion and thereby off­spring well-being

Thus, is it not a san­guine notion that the health and sur­vival of women is crit­i­cal to the health of every­one? After all, the health of nations is asso­ci­ated with this slight major­ity of females, and the wealth of nations is asso­ci­ated with its health.

The good news is that peo­ple work­ing from this under­stand­ing are mak­ing some head­way around the globe. Recently, the World Health Orga­ni­za­tion noted that mater­nal death among preg­nant and birthing women world-wide has been dra­mat­i­cally reduced from the 1980’s to recently. This is very good news!

Here is the inter­est­ing foot­note:  Mater­nal death in the U.S. has risen 42% in the same period. While the absolute num­bers remain small, this is a dis­turb­ing pic­ture. What could be caus­ing this?

Time will tell if we can fig­ure it out and fix it. I ven­ture to sug­gest some direc­tions for consideration:

  • The ele­vated cesarean birth rate with its sequel­lae of car­dio­vas­cu­lar and immune sys­tem disorders
  • Obe­sity
  • Meta­bolic syndromes
  • Dia­betes
  • Heart dis­ease

Why am I hope­ful, then? I see among our cur­rent edu­cated gen­er­a­tion of new moms and moms-to-be a will­ing­ness to exert their influ­ence – as breed­ers – over the health care scene. They want less tech­no­log­i­cal birth. They want sup­port. They want more infor­ma­tion. They want to be healthy. These are won­der­ful things. I salute these young women…they also make my job eas­ier in the process.

In addi­tion, I see among young health care prac­ti­tion­ers an under­stand­ing of the value of these things. Among prac­ti­tion­ers work­ing in pub­lic health clin­ics there is a sense of des­per­a­tion on the one hand that the poor and indi­gent have no capac­ity or will to take care of them­selves. On the other hand, the first step is always edu­ca­tion and there are a lot of peo­ple work­ing on this issue.

Which brings me to the clos­ing point:  How do we bring more resources and intel­li­gence to help­ing women be healthy, pre­pare for preg­nancy, have healthy babies, reduce preg­nancy com­pli­ca­tions, and improve infant and mater­nal death rates? I, for one, will keep blog­ging on this issue. You, I hope, will vote for peo­ple who under­stand this issue. The polit­i­cal power and will is in our hands.

51% of us are women…some day 51% of us can set priorities

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Value of Postpartum Fitness

Here are two impor­tant facts regard­ing phys­i­cal activ­ity fol­low­ing birth:

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.

You have to teach your abdomen to be flat.
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.

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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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