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!

Here is the link to the story and the subtitle:

http://branford.patch.com/articles/ann-cowlin-a-prenatal-fitness-pioneer-celebrates-30-years-of-work

What started as a “fledgling experiment” has become one Branford woman’s life work.

Thank you for taking a look!

Still looking for new ways to develop core strength & coordination for new moms…start with the posture on the left (inhale) and move to the one on the right (exhale). Keep the transverse abdominal sucked in. Repeat.…

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 ®

The biology of birth is a complex series of cause-effect processes…baby’s brain releases chemical signals to the mother and the placenta begins to manifest the maternal immune system’s rejection of the fetus.

To help the ball get rolling, relaxation (the trophotropic response) helps promote the release of oxytocin. With the help of gravity, the head presses on the cervix, amplifying the uterine contractions. After an ultra-distance aerobic endurance test, the cervix opens enough to let the baby move into the vagina and the mother’s discomfort moves from sharp cramping into the bony structure as she transitions to the strength test of pushing. She transitions. Relaxation modulates into an ergotropic — adrenal — response to gather her power.

Pushing is an interesting term…more masculine, I think, than the one I prefer:  Releasing. Releasing or letting go of the baby. It’s a catharsis. In this portion of the labor another set of important processes help the baby clear its lungs of amniotic fluid, stimulate its adrenal system and challenge its immune system, as the contractions drive the baby downward. The mother’s deep transverse abdominal muscles — if strong enough — squeeze the uterus like a tube of tooth paste, to aid this expulsion. In the meantime, the labor is helping set up the mother to fall in love and produce milk. When the baby emerges and moves onto the mother’s chest, s/he smells and tastes the mother, recognizing her mother’s flavor and setting up the potential for bonding.

Any way you slice it, there are two parts to safe motherhood. One is a safe pregnancy…healthy nutrition, physical fitness, safe water, infection prevention, support and a safe environment. The other is a safe labor. In a safe labor, there is both an environment that promotes the natural process of labor and the means necessary for medical assistance when needed. Women die at an alarming rate from pregnancy or birth-related problems. Despite some progress made in recent years, women continue to die every minute as a result of being pregnant or giving birth.

What keeps us from having a better record on motherhood is often lack of care in the developing world and too much intervention in the U.S.. They are two sides of a coin. Mothers’ experience and health needs are not on equal footing with other cultural values. In places where basic prenatal care or family planning are low priorities, at-risk women are vulnerable to the physical stresses of pregnancy and birth. In the U.S., machine-measured data is paramount, even if it produces high rates of false positives, unnecessary interventions or counterproductive procedures. We are learning that obesity and sedentary lifestyles have detrimental effects, but fewer pregnant women than their non-pregnant counterparts exercise.

Despite the money spent to support the technological model of pregnancy and birth in the U.S., there are parts of the world with lower rates of maternal deaths — especially Scandinavia, Northern Europe and parts of the Mediterranean and Middle East (Greece, the United Arab Emirates, Israel, Italy and Croatia). In fact, in the U.S., maternal deaths are on the rise.

It’s a tricky business. Clearly Western medicine has a lot to offer the developing world when there are medical concerns. On the other hand, importing the U.S. model could create more problems than it solves. Instead, the micro-solutions now being developed in many locations will be observed and evidence collected by organizations such as the White Ribbon Alliance and UNICEF.

There is an effective international midwives model adopted by JHPIEGO, the Johns Hopkins NGO working toward improved birthing outcomes. It assesses the local power structure, social connections, potential for trained birth assistants, and location of available transportation to create a network so that locals will know when a labor is in trouble and who can get the woman to the nearest hospital.

In the U.S., there are in-hospital birth centers that allow low-risk mothers the opportunity to labor and birth in a setting designed to encourage the innate processes. Women are beginning to vote with their feet…staying home for birth. Women are going abroad to give birth. At the same time, women are coming to this country to give birth, believing it is safer than where they are. There are several ways these scenes could play out.

But, I’ll wager, improving outcomes will involve compromise:  Watchfulness and support in most births, plus better ways to assess danger and provide technology. No matter where you live in the world, the solution may be essentially the same.

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.

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.

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!

There is nothing so joyful as a group of moms-to-be, at various stages of pregnancy, moving freely and fully. Celebrating this special state of being by maintaining strength, endurance and range of motion promotes emotional well-being as well as health during this major life transition.

By selecting activities that promote fitness, health and well-being for their programs, our teachers insure that moms-to-be receive the maximum benefit from the time they spend in class.

Here are some birth stories from our clients (edited for privacy):

• We’re happy to report that [our baby boy] was born on Saturday at 12:31 am…our exercise classes were ESSENTIAL in the later part of labor — the doctor and nurse described me as a “natural” at pushing, but I had to admit to them that I’d been practicing my c-curves twice a week for a few months already! — G.S.

• 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.

• We arrived at the hospital at 6am and I was already 4cm dilated…[at] 5cm dilated, I requested an epidural. The anesthesiologist did a great job, and I was still able to move my legs with the epidural. I found movement during labor to be very helpful, and in particular, circular movements of my pelvis (i.e. belli dancing). Post partum recovery has been quick. No doubt that [your] guidance and preparation was crucial to this end. I would like to thank all of you for your support…  — K.L.

• On Sunday…after more than 26 hours of labor, [my wife] gave birth to [our baby boy]. Through the help of her birth support team she was able to deliver without pain medicine. She did a tremendous job, and we used many of the skills learned in class to focus, draw her out of her body, breath and relax.  — M.&L.S.

• I just wanted to share with you the very good news that [our baby boy] was born at 8:38 pm last night. He weighed 8 lbs 11 ozs and measures 21.5 inches long. He finally enabled me to put my c curves and such to direct use by arriving a mere 8 days late (instead of the 11 days late that would have led to my second c-section).  We are having a very nice time right now…and look forward to making our joint return to the gym in a few weeks!  — F.A.

• Our beautiful baby boy was born Tuesday night at 9:09 p.m. The delivery went well (drug free!) and I received many compliments on my 50 minutes of pushing. Thanks for everything and I hope to see you in 4 weeks or so!  — A.E.

It’s You Babe creates awesome support garments for pregnancy, including the Prenatal Cradle!

Find a Prenatal Dance Video here.

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DTP is the original provider of pregnancy exercise, postpartum exercise, teacher training and program development. We use evidence-based best practices to help ensure our moms have a healthy pregnancy, are strong in labor and birth, and recovery quickly. Sign up for the DTP E-news here.