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!

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!

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!

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.…

We discovered this 3rd body in working with women to gain the fitness necessary to have a healthy recovery and enjoy motherhood. What we found was that women were often becoming more fit than they had been before pregnancy, with less body fat and more muscle, yet their clothes did not fit the same.  Sometimes the flaring of the ribs and/or hip bones made for a larger waist – despite less fat!

Many clients also feel a new, deeper sense of their core developed. In fact, over time they realized they actually liked this body better in some ways! After all, they came into the world with the pre-pregnancy body, but this body they actually created out of the profound experience of the physical self that pregnancy and birth provide. It extended the empowerment of birth into motherhood.

Extending this metaphor even further, of course, leads to the 4th and 5th bodies, if you have another child. Eventually, there are more bodies as women go through perimenopause, menopause, post menopause, and what I like to call the phenomenal wisdom stage. Each body represents a new opportunity to become someone strong and profound.

I figure I am to body #8 now, and in each stage I have found something incredible that I could not have at other stages. Long ago I gave up looking for my past bodies. Each one has been brilliant in some way, but in the end it had to be left behind if I was to enjoy life’s path to the fullest.

Living in the moment does require knowing where you are in time, space and energy. So, discard your past bodies with delight and move on. Use your energy to create yourself in the present.

It’s a process and you won’t fully live in your next body until you own the toll of the last one. A postpartum mom may experience hair loss, bigger feet, a mal-aligned spine, constant thirst if she is breastfeeding, exhaustion and a jelly belly. But, all these things will pass with time, if you eat right and exercise regularly. Oh, and you can bring the baby, who will have a blast meeting other babies!!

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.