Pregnancy Pathway — Exercise cont’d

MORE?!! You didn’t think that was it? Only a few com­ments on evi­dence as to WHY mov­ing around, burn­ing calo­ries, being strong and learn­ing to relax while preg­nant is ben­e­fi­cial? No, of course not. You know there is more to it, like WHAT move­ment is safe and effec­tive dur­ing pregnancy?

So, what is safe? Well, first, unless you have a very few con­di­tions that your health care provider con­sid­ers unsafe, every woman — fit, cur­rently seden­tary, young or a lit­tle older — can exer­cise safely in preg­nancy. How much of what kind depends on your fit­ness level and exer­cise his­tory. Get med­ical screen­ing first.

If you are fit, you can do vigorous exercise

If you are fit, you can do vig­or­ous exercise

If you are fit, you just need to learn how to mod­ify some move­ments to accom­mo­date your bio­me­chan­ics. As your body changes, stress on the joints and tis­sues means a lit­tle less jump­ing or bal­lis­tic motion will be more com­fort­able and safer. If you are fit, you can con­tinue with vig­or­ous exer­cise and it will be of ben­e­fit to you and your baby.

If you are not so fit or are seden­tary, find a cer­ti­fied pre/postnatal instruc­tor and join a group where you will have fun, get some guid­ance and be mon­i­tored for safety. How do you find such a per­son? Try our Find A Class or Trainer page.

What is effec­tive? Don’t spend your time on things that may be nice to do but don’t help you focus and pre­pare for birth, relieve dis­com­forts or have the sta­mina for birth and par­ent­ing. There is sub­stan­tial sci­en­tific evi­dence and infor­ma­tion from large sur­veys that these things are helpful.

Car­dio­vas­cu­lar or aer­o­bic activ­ity is the most impor­tant activ­ity you can do. Already fit? Keep work­ing out; join a class if you want sup­port or new friends. If you are seden­tary or some­what active, you can improve your fit­ness by doing at least 20 — 30 min­utes of aer­o­bic activ­ity 3 times a week. Work at a mod­er­ate pace — some­what hard to hard — so that you can talk, but not sing an aria! If you are more than 26 weeks and have not been doing car­dio, you can walk at a com­fort­able pace. Aer­o­bics is key because it gives you endurance to tol­er­ate labor and pro­motes recov­ery.

Strength and flex­i­bil­ity exer­cises that do not hurt and are done cor­rectly are also safe. There are some spe­cial preg­nancy exer­cises that actu­ally help you pre­pare for birth. Essen­tial exer­cises that aid your com­fort, align­ment and birth prepa­ra­tion include:

Kegels (squeez­ing and relax­ing pelvic floor mus­cles) — squeez­ing strength­ens them and thus sup­ports the con­tents of the abdomen, and learn­ing to release these mus­cles is nec­es­sary for push­ing and birth.

Abdom­i­nal hiss/compress and C-Curve® - con­tract­ing the trans­verse abdom­i­nal mus­cles reduces low back dis­com­fort and strength­ens the mus­cle used to push and later to recover abdom­i­nal integrity after birth.

Squatting

Squat­ting

Squat­ting — get­ting into this posi­tion strength­ens the entire leg in a deeply flexed posi­tion; start seated and use arms for sup­port, sta­bil­ity and safety. Leg strength improves mobil­ity and com­fort in preg­nancy and post­par­tum; plus, deep flex­ion is a com­po­nent of push­ing in almost all positions.

Strength­en­ing for bio­me­chan­i­cal safety — strength­en­ing some parts of the body helps pre­vent injury to bone sur­faces, nerves and blood ves­sels within joints re-aligned in preg­nancy. This can be done using resis­tance rep­e­ti­tions (weights, bands, cal­is­then­tics or pilates) or iso­met­rics (yoga or bal­let). A respon­si­ble class will focus on upper back (row­ing), push-ups, abdom­i­nals, gluteals, ham­strings, and mus­cles of the lower leg.

Stretch­ing of areas that tend to get tight — reliev­ing some dis­com­forts through flex­i­bil­ity helps you main­tain a full range of motion. Sta­tic stretches, used in com­bi­na­tion with strength exer­cises or fol­low­ing aer­o­bics, is most effec­tive. Stretch­ing prior to exer­cise tends to pro­duce more injuries than not stretch­ing. Areas need­ing stretch­ing include the chest, low back, ham­strings and hip flex­ors (psoas).

Mind/Body skills are very impor­tant. There are two activ­i­ties that exer­cis­ers con­stantly tell us are a big help in preg­nancy, birth and parenting.

• Cen­ter­ing employs a bal­anced or neu­tral pos­ture, deep breath­ing and mind­ful­ness to help you work in a relaxed way. Ath­letes and dancers call this “the zone.” Start­ing your work­out in asso­ci­a­tion with your body estab­lishes econ­omy of motion, some­thing very use­ful in birth and par­ent­ing, and reduces risk of injury.

• Relax­ation is another key activ­ity; it relieves stress, pro­motes labor in the early stages and helps you enter the zone!

Remem­ber: Birth is a Motor Skill™

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Pregnancy Pathway — Exercise

How lucky is this? Just a few days ago, yet another study was released and has been cir­cu­lat­ing on Med­scape and other med­ical sites that indi­cates exer­cise is ben­e­fi­cial in preg­nancy, whether the mother is a pre­vi­ous exer­ciser or not. Just in time for this entry!

Behavior Affects Pregnancy Outcome

Behav­ior Affects Preg­nancy Outcome

Phys­i­cal exer­tion (we call it “exer­cise” nowa­days) is a nor­mal state for healthy humans. Only in the last cen­tury has the desire to rest or the need to store extra calo­ries as fat become more pos­si­ble to achieve than our need to move about to survive.

Preg­nancy is a state in which both of these fac­tors (rest­ing and stor­ing calo­ries) are enhanced through organic changes in body chem­istry, adap­ta­tions that favor fetal sur­vival. The cur­rent seden­tary lifestyle exag­ger­ates these meta­bolic changes and results in syn­dromes that increase the risk for a num­ber of meta­bolic, car­dio­vas­cu­lar and immuno­log­i­cal dis­or­ders of pregnancy.

When con­fronted by the idea that it is coun­ter­in­tu­itive to think exer­cise in preg­nancy might be safe (let alone ben­e­fi­cial) I am dumb­founded. To me, it is coun­ter­in­tu­itive to think that a seden­tary lifestyle in preg­nancy might be safe!

Burning Calories in Pregnancy Improves Outcomes!

Burn­ing Calo­ries in Preg­nancy Improves Outcomes!

What is the evi­dence that exer­cise in preg­nancy is ben­e­fi­cial? Keep in mind that some stud­ies have been exe­cuted more expertly than oth­ers. But, what is com­pelling is that numer­ous well-respected researchers have sought to test the hypoth­e­sis that exer­cise is not safe, but come away with results that indi­cate the opposite!

Here are some of the major findings:

• The pla­centa is larger and has more trans­port sur­face in exer­cis­ers than seden­tary women

• The fetuses of (aer­o­bic) exer­cis­ing moth­ers make ben­e­fi­cial car­dio­vas­cu­lar adaptations

• Women who do aer­o­bic exer­cise are less likely to develop severe preeclamp­sia or ges­ta­tional dia­betes, and the long term health prob­lems that accom­pany these disorders

• Women who are aer­o­bi­cally fit recover from birth 10 times faster than seden­tary women (as mea­sured by time needed to metab­o­lize free rad­i­cals pro­duced in labor)

• Women who exer­cise in preg­nancy are more likely to be phys­i­cally fit in midlife

• Babies of aer­o­bi­cally fit women are at reduced risk for pre­ma­tu­rity and low birth weight
DTP_mover2
So, we have arrived at the take-home mes­sage: MOVE!! Preg­nancy works best when you move and burn calo­ries in a mod­er­ate to vig­or­ous fash­ion. But, alter­nate this activ­ity with rest and good nutri­tion, and be sure to stay well hydrated.
If you want more specifics and resources on this topic, try these:
“Women and Exer­cise” in Varney’s Mid­wifery.
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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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Back Pain — prevention in pregnancy and postpartum.

Check out this video, DTP con­tributed con­tent. Back care in preg­nancy and postpartum.

Yale Preg­nancy and Post­par­tum Back Care Video.

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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 Pathway, Pregnancy

Time for an entre: Preg­nancy!!

Up for discussion…

Health Influences in Pregnancy

Health Influ­ences in Pregnancy

Let’s start at the begin­ning…in the first trimester you feel sick and tired, right? Three things:

1) your immune sys­tem is pro-inflammatory (caus­ing nau­sea and fatigue), 2) your body is pro­tect­ing your fetus from some tox­ins (if you eat some­thing not so great for the fetus, you throw up), and 3) you have extreme swings in blood sugar lev­els so that after you eat, the level soars and you feel sick.

Num­ber 3 can be fixed with behav­ior, but you may have to wait out 1 & 2. To fix num­ber 3 eat very small meals fre­quently (6 or 8 times a day) and be sure to eat pro­tein, that is, eggs, meat, fish, fowl, cheese, nuts, rice & beans, soy, etc. with each small meal. This sta­bi­lizes blood sugar and pre­vents dra­matic ele­va­tions that can cause nausea.

In most healthy preg­nan­cies, the immune sys­tem will rebound in the sec­ond trimester so that you feel good; it is pro­tect­ing you again!  But, those wicked tox­ins and infec­tions are still out there in the envi­ron­ment, so the mes­sage is beware bad air (smog, smok­ing, indus­trial air pol­lu­tion), highly processed foods (lunch­meats, things with names you can’t pro­nounce), any drugs or meds not pre­scribed or okayed by your ob or mid­wife, alco­hol, and dan­ger­ous bac­te­ria, viruses and other microbes!

Exer­cise wisely…no sky-diving or scuba div­ing! Eat healthy food and get enough sleep. De-stress through relax­ation and med­i­ta­tive tech­niques. Don’t take risks with your health, but do stay active and start to pre­pare for birth and bring­ing home a baby (or two?).

Third trimester & the immune sys­tem goes on the fritz again — can’t keep this baby in here for­ever; must expel! You may feel sick and tired again. BUT, keep your pre­na­tal care appoint­ments, keep mov­ing, get good nutri­tion, rest and stay focused. Before you know it the real work begins, not to men­tion the 18 years of sleep deprivation.

Get­ting from here…

Being Fully Present in Your Pregnancy...

Being Fully Present in Your Pregnancy…

…to here..

Being Fully Present as Mom

Being Fully Present as Mom.

…is a jour­ney like no other. The adap­ta­tions of your body to the demands of preg­nancy are amaz­ing. If you pay atten­tion, you will learn more about the mean­ing of exis­tence from this than from any­thing else.

BE HERE NOW!!

Sign up for this Blog (top tool­bar, click blog info and sub­scribe)!! Learn from our more than 30 years of help­ing make healthy moms & healthy babies.

Visit our web­site:  www.dancingthrupregnancy.com

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Pregnancy Pathway, Conception — Review & Small Rant!

REVIEW: Evi­dence is clear - pre-pregnancy mater­nal health sta­tus, includ­ing phys­i­cal fit­ness, healthy nutri­tion and an uncom­pro­mised immune sys­tem affect the health and well-being of both mother and off­spring, in both short and long term.

This is the mes­sage sum­mary from our first two areas of dis­cus­sion:  Pre­con­di­tions and Con­cep­tion — the green and sand col­ored sec­tions on the chart below.

pregnancy_pathway

COMING ATTRACTIONS: We are about to move on to the blue sec­tion — Preg­nancy!!  So, book­mark this Blog for future reference!

Also, you can sub­scribe to this Blog by click­ing on Blog Info in the upper right cor­ner and then click­ing on Sub­scribe in the drop down menu.

But, yes, you guessed it, first we have a small rant!

SMALL RANT: When we note that fit­ness, nutri­tion and a healthy immune sys­tem play sig­nif­i­cant roles in the out­come of preg­nancy and the future health of mother and child, we are appeal­ing to young peo­ple of child­bear­ing age to be care­ful about your bod­ies. The alliance of egg and sperm shapes the world. With 6.5 Bil­lion egg/sperm com­bi­na­tions (yes, peo­ple) presently liv­ing on earth, our resources are stretched. With time, either we get more picky about doing this, or the 3rd rock from the sun (remem­ber that show?) is cooked.

Humor­ous incur­sion: In case you need fur­ther enlight­en­ment on this whole area, there is a great web­site that will help you out. Be pre­pared to be amused and amazed!

The Truth about Eggs and Sperm

Hope­fully, this gets you in the right mood and keeps you smil­ing. After all, once you actu­ally are preg­nant, we have more seri­ous mat­ters to discuss.

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Pregnancy Pathway, Conception — Prior Sperm Exposure

Today:  Sperm!!!

For com­plete graphic, see Feb. 5 or 23 post.

The mother's prior sperm exposure can affect her pregnancy.

The mother’s prior sperm expo­sure can affect her pregnancy.

Not every sperm is your friend! Sperm expo­sure — like so many expo­sures — affects our immune sys­tem. Women who have babies with more than one father may be at risk for dis­or­ders of preg­nancy because the chal­lenges to their immune sys­tem have been exten­sive. And, very young women who become preg­nant are at increased risk of some dis­or­ders because they have had very lit­tle expo­sure to sperm.

In addi­tion, women who have pri­mar­ily and exten­sively used bar­rier meth­ods of con­tra­cep­tion may be at risk for dis­or­ders for rea­sons sim­i­lar to young women with lit­tle expo­sure. Unlike women whose immune sys­tem has had too much chal­lenge due to preg­nan­cies by sev­eral men, women with lit­tle expo­sure may not have a strong defense against for­eign DNA. Please do not take this as a rea­son to not use a con­dom — one of the bar­rier meth­ods along with a diaphragm and cer­vi­cal cap. Rather, if you use a bar­rier method of con­tra­cep­tion, keep in mind that your body’s adjust­ment to preg­nancy may take time.

For more infor­ma­tion on bar­rier meth­ods, to go the Amer­i­can Col­lege of Obste­tri­cians and Gyne­col­o­gists’ online pam­phlet: ACOG Pam­phlet on Bar­rier Con­tracetp­tion.

Another way sperm can affect the preg­nancy is that the com­bi­na­tion of the mother’s and father’s nat­ural immune responses may be strong against the tro­phoblast implan­ta­tion. This is not some­thing  you can know ahead of time. Also, women are eight times more likely than men to develop autoim­mune dis­or­ders. One rea­son may be the pre­na­tal expo­sure to for­eign DNA encoun­tered in pregnancy.

Keep in mind that by get­ting good pre­na­tal care, exer­cise, suf­fi­cient rest, stress man­ag­ment and healthy nutri­tion, you do all within your power to have a healthy preg­nancy. Your health care provider will deter­mine your risk fac­tors that may affect preg­nancy out­come and treat you in an appro­pri­ate manner.

Moms and babies enjoy exercise together!

Moms and babies enjoy exer­cise together!

Once your baby comes, there will be time to max­i­mize health for both of you. Exer­cis­ing together is great fun!

Get­ting there may require some patience, but the reward is well worth it.

When you are look­ing around for sperm, use your head. The same behav­ior that pro­tects you from infec­tions you never want to get, pro­tects you from sperm you don’t really want to meet. When the time comes to adopt some sperm, find out about it’s credentials!

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Pregnancy Pathway, Conception — Health Status

Today: How the mother’s health sta­tus at the time of con­cep­tion affects the pregnancy.

For com­plete graphic, see Feb. 5 or 23 post.

The Impact of Health Status at the time of conception.

The Impact of Health Sta­tus at the time of conception.

When a woman becomes preg­nant, her health can be a major fac­tor how her preg­nancy will pro­ceed. If she has been exposed to a vir­u­lent infec­tion, it may have an impact on how well the implan­ta­tion goes. If she has meta­bolic syn­drome, she is at risk for com­pli­ca­tions such as ges­ta­tional diabetes.

On the other hand, if she has taken care of her­self, is phys­i­cally fit and well nour­ished, is well rested and has not been exposed to ill­nesses that induce dra­matic changes in her immune sys­tem, she has done her best to cre­ate a sit­u­a­tion in which her body is best pre­pared for the rig­ors of pregnancy.

There are still genetic and envi­ron­men­tal fac­tors that can affect the course of the preg­nancy, but behav­ior is the one fac­tor that women have con­trol over. At Danc­ing Thru Preg­nancy we are fond of the notion that if you know a cer­tain behav­ior is the best for a sit­u­a­tion, it is smart to chose that behav­ior; if you do not, you are sab­o­tag­ing yourself.

So, if preg­nancy is in your head­lights, eat right, exer­cise, and be cau­tious about expo­sure to ill­ness and infec­tion. Wash your hands, use one of the hand cleansers, prac­tice safe sex (okay, so if you are try­ing to get pg, this may change, but in the meantime!).

We wel­come com­ments on what you are doing to be healthy for pregnancy!

Curl-up! Strong abs are part of physical fitness!

Curl-up! Strong abs are part of phys­i­cal fitness!

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Pregnancy Pathway, Preconditions — Behavior

Please refer to Feb­ru­ary 5 entry for entire graphic. Today:  Behav­ioral Pre­con­di­tions to Preg­nancy.
bubblus_preconditions-behavior

Why do you sup­pose the Amer­i­can Col­lege of Nurse Mid­wives and the Amer­i­can Col­lege of Obste­tri­cians and Gyne­col­o­gists rec­om­mend the min­i­mum time between preg­nan­cies to be two years? Why is it crit­i­cal to eat foods high in B vit­a­mins (includ­ing folic acid) and cal­cium dur­ing the child­bear­ing years? How does your exer­cise reg­i­men in the six months prior to con­cep­tion affect your risk for some dis­or­ders of preg­nancy, such as preeclampsia?

Answer:  Your pre­con­cep­tion or inter­con­cep­tion behav­ior affects the course and out­come of your preg­nancy. As it turns out, it takes about two years for a mother’s body to replen­ish her stores between preg­nan­cies. Prior to a first preg­nancy, behav­ior in the six months lead­ing up to con­cep­tion has been shown to affect outcome.

Dur­ing preg­nancy, nutri­tional and func­tional resources must sup­port two beings in one body, one of whom is grow­ing at a very fast speed by bio­log­i­cal stan­dards (think cell time NOT com­puter time). Essen­tial vit­a­mins and min­er­als (such as B vit­a­mins and cal­cium) are taken from the mother’s body — already in meta­bolic stress due to demands on the kid­neys and liver to clear tox­ins and fil­ter meta­bolic waste from the fetus as well as the mother.

Insur­ing that mater­nal stores of valu­able nutri­ents are ade­quate to pro­vide for both fetus and mother is a job that only the poten­tial mother can do. By eat­ing a bal­anced and col­or­ful diet of pro­teins, fruits and veg­eta­bles, whole grains and essen­tial fatty acids (omega 3’s and 6’s — fish, wal­nuts, olive oil, ava­cado, eggs), as well as ade­quate aer­o­bic exer­cise lead­ing up to and dur­ing preg­nancy, a woman improves her odds for a healthy infant. Smart behav­ior reduces her risk for con­di­tions that cause immune sys­tem and car­dio­vas­cu­lar dis­or­ders that dis­turb implan­ta­tion, blood pres­sure and blood flow to essen­tial organs.

Fur­ther, avoid­ing risky behav­iors that may lead to sys­temic infec­tions, meta­bolic syn­dromes or mal­nu­tri­tion lead­ing up to con­cep­tion is an aspect of behav­ior known as “risk-aversion” -  the abil­ity to avoid behav­iors that have neg­a­tive con­se­quences. Infec­tion at the time of con­cep­tion (to be dis­cussed in a future post), an extreme lifestyle (either seden­tary or anorexic), toxic food choices, drugs, tobacco and alco­hol are all behav­iors that incur risk for poor preg­nancy out­comes, includ­ing pre­ma­tu­rity and low birth weight — out­comes  on the rise in the U.S.

dtp_mover22As dis­cussed in the pre­vi­ous two posts, behav­ior is inter­twined with genet­ics and envi­ron­men­tal influ­ences. Hav­ing a cer­tain gene muta­tion or an envi­ron­men­tal risk may pre­dis­pose a woman to pos­si­ble prob­lems in preg­nancy or the devel­op­ment of cer­tain can­cers, but some behav­iors — espe­cially exer­cise — may mit­i­gate this poten­tial or reduce the sever­ity or course of dis­ease. Behav­ior is the area in which we have the great­est con­trol. Exer­cise, healthy nutri­tion and risk aver­sion are the three areas in which women can exert con­trol over their des­tiny as moms-to-be. It’s a dif­fi­cult set-up. We live in a time of instant grat­i­fi­ca­tion of per­sonal acts. But, moth­er­hood is a long-term com­mit­ment to the bio­log­i­cal and psy­chic well­be­ing of a new human who is — and is not — us.

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