The 51% Factor: Pregnancy, Power & Health

By anncowlin | Published April 17, 2010

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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Babies Enjoy Being with Mom During Exercise.

By anncowlin | Published November 18, 2009

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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Rant: Health Care Reform/Pregnancy

By dancingthrupregnancy | Published July 13, 2009

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…Important Notes from Wonderrobyn

By dancingthrupregnancy | Published May 2, 2009

The fol­low­ing are notes from co-author Robyn Bran­cato, CNM (cer­ti­fied nurse mid­wife) who prac­tices in New York City, or, as she is know here: Won­der­robyn! You can read about both authors in the About tab above. Here they are on the beach in San Diego, when they gave a talk at con­fer­ence there a cou­ple years ago. Robyn on the left, Ann on the right.

Robyn and Ann, Pathway authors

Robyn and Ann, Path­way authors

1. Addi­tion to Small Rant: “Resist the temp­ta­tion to watch A Baby Story on TLC! It does not por­tray birth accu­rately, as they con­dense 15 hours of labor into 30 min­utes and play up the drama so that you will be on the edge of your seat! In the major­ity of women, birth is not that dangerous.”

2. Regard­ing: When does con­cep­tion occur? “This is a really inter­est­ing post… I love the dis­cus­sion about at what point con­cep­tion occurs! Per­son­ally, I like the Bib­li­cal notion of quick­en­ing. Even though this varies from woman to woman and can range any­where from 16 to 22 weeks ges­ta­tion, it seems like the most nat­ural theory.”

Dear Reader:  What do YOU think? Did you read the con­cep­tion post on March 23, ’09?

3. About sperm & preeclamp­sia. “Is the con­nec­tion between bar­rier meth­ods and preeclamp­sia actu­ally estab­lished? I have read stud­ies stat­ing the con­trary — that bar­rier meth­ods have no effect on preeclamp­sia rates.”

HURRAY! THIS REQUIRES FURTHER CONSIDERATION.

More infor­ma­tion: The immune mal­adap­ta­tion the­ory sug­gests that tol­er­ance to pater­nal anti­gens, result­ing from pro­longed expo­sure to sperm, pro­tects against the devel­op­ment of preeclamp­sia. Thus, bar­rier meth­ods and being young may pre­dis­pose women to this major dis­or­der of pregnancy.

Evi­dence exists on both sides of this the­ory. Here are two recent stud­ies (one of each) that read­ers may find help­ful in under­stand­ing this idea. Keep in mind that other fac­tors than just sperm expo­sure may be affect­ing research find­ings. But, it does seem that under some con­di­tions, bar­rier meth­ods and amount of expo­sure to sperm can affect the preg­nancy itself.

Ness RB,  Markovic N, Harger G, Day R. Bar­rier meth­ods, length of pre­con­cep­tion inter­course and preeclamp­sia, Jour­nal: Hyper­ten­sion in Preg­nancy 23(3):227–235. 2005.  Results did not sup­port the immune mal­adap­tion theory.

Yousefi Z, Jafarnezhad F, Nas­rol­lai S, Esmaeeli H. Assess­ment of cor­re­la­tion between unpro­tected coitus and preeclamp­sia, Jour­nal of Research in Med­ical Sci­ences 11(6):370–374. 2006. In a matched con­trols study, women with <4 months cohab­i­ta­tion or who used bar­rier meth­ods had higher risks of devel­op­ing preeclamp­sia than those with >4 months cohab­i­ta­tion. Oral con­tra­cep­tion users had a lower preeclamp­sia rate than those who used no oral contraception.

In a com­men­tary arti­cle in OB/GYN News ‚  July 1, 2002, the fol­low­ing note was made by Dr. Jon Einars­son: With insuf­fi­cient expo­sure, preg­nancy may induce an immune response and preeclamp­sia in some women with pre­dis­pos­ing fac­tors such as an endothe­lium that already is sen­si­tive to injury due to age, insulin resis­tance, or pre­ex­ist­ing hypertension.

Is there a plain and sim­ple truth about sperm expo­sure and preg­nancy risks? Alas, no. But, know your cir­cum­stances. If you are young, pro­tect your­self. Wear a con­dom. When you are ready to be a mom, you will be ready to fig­ure out your risks. So, this, too fol­lows the axiom:

Events in life are rarely plain and never simple.

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Pregnancy Pathway, Conception — Review & Small Rant!

By dancingthrupregnancy | Published May 1, 2009

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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Small Rant, Review, References & Coming Attractions

By dancingthrupregnancy | Published February 23, 2009

Small Rant — Women, their preg­nan­cies, births and moth­er­ing styles are all unique. The big issue in child­bear­ing these days is con­trol. Fear of los­ing con­trol, who con­trols birth (do YOU give birth or are you deliv­ered by oth­ers?), hav­ing the self con­fi­dence and skills to know when to let go of con­trol yet be okay. It’s inter­est­ing to hear what hap­pened to some­one else, but (here’s the rant part) this can often be fright­en­ing because — let’s face it — cat­a­stro­phe gets our atten­tion. What­ever you’ve heard, you still have to do it your­self. Preg­nancy, birth and par­ent­ing cre­ate a steep learn­ing curve.

Review — Our job at the DTP Blog is to help with the learn­ing curve through evidence-based infor­ma­tion. We are mov­ing along a path­way. Here it is, in a small ver­sion (see Feb. 5 for full ver­sion):
pregnancy_pathway

So far, we have dealt with Pre­con­di­tions (the Green items). If you under­stand what you can and can­not con­trol along your Preg­nancy Path­way it can help pre­vent you from spin­ning your wheels or wast­ing money. Some things are worth doing (self care, good food, exer­cise) and some are not (self-indulgence, tox­ins, stress). Pre­con­di­tions to preg­nancy — genet­ics, envi­ron­ment and behav­ior — are worth pay­ing atten­tion to if you are of child­bear­ing age and think or know you are mov­ing along this pathway.

Ref­er­ences - We have used hun­dreds so far and will use many, many more, but only some of you will find the sci­ence some­thing you want to pur­sue, so please go to our DTP web­site (use the Blogroll) for more infor­ma­tion on research in this field. Here are some texts that explain much more: “Women and Exer­cise” in Varney’s Mid­wifery (edi­tions 3, 4 & 5), Jones & Bartlett Pub.; Women’s Fit­ness Pro­gram Devel­op­ment by Ann Cowlin, Human Kinet­ics Pub.; and Immunol­ogy of Preg­nancy by Gil Mor, Springer Pub.

Com­ing Attrac­tions — next, we talk about con­cep­tion. Yes, this is an excit­ing part, though not per­haps why you think (!). It turns out con­cep­tion is fraught with many twists and turns.

Humor­ous incur­sion:
Q: Why does it take a mil­lion sperm to fer­til­ize just one egg?
A: Because none of them will stop and ask direc­tions.
[Sorry, couldn’t resist.]

After that we will likely rant and review again, have more humor­ous incur­sions, pro­ceed on to the preg­nancy and birth expe­ri­ences, then dis­cuss health out­comes for mom and baby in the short and long term.

Why do we spend our time on this? From a bio­log­i­cal per­spec­tive, humans can do noth­ing more impor­tant than cre­ate healthy off­spring. Wars may be fought, the banks fail or cars become a thing of the past; we might even become post-racial; but, hav­ing babies doesn’t really change. It remains a pri­mal expe­ri­ence. It’s nes­tled in a high tech world, but its still pri­mal. Women have always had guides; we take this role seriously.

Stay tuned!!

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Pregnancy Pathway, Preconditions — Genetics

By dancingthrupregnancy | Published February 18, 2009

Please refer to Feb­ru­ary 5 entry for com­plete graphic. The Pre­con­di­tion we will dis­cuss today is Genetics.

bubblus_preconditions_-_genetics

There are genetic fac­tors totally out­side your con­trol that deter­mine things as sim­ple as your offspring’s hair or eye color, how the ear­lobe attaches to the side of the head and whether or not s/he can roll the tongue. More com­plex things, such as a pre­dis­po­si­tion to types of can­cers, bleed­ing dis­or­ders or var­i­ous other dis­eases, also have a genetic basis.

Because the male con­tributes the sex of the off­spring, once con­cep­tion hap­pens, the sex off the fetus is deter­mined — at least genet­i­cally. But, it turns out not every­thing genetic is set in stone. In utero, hor­mone expo­sures may affect how male and female char­ac­ter­is­tics develop, so that some girls will be very girlie, some will be tomboys, and some may be gay. A sim­i­lar effect will influ­ence how boys develop.

Genetic, envi­ron­men­tal and behav­ioral pre­con­di­tions can be  inter­twined. Envi­ron­men­tal fac­tors can alter genes, caus­ing them to express pro­teins that would oth­er­wise be dor­mant. Like­wise, our behav­ior affects some of our genes. If we have a fam­ily propen­sity for heart dis­ease, but we eat a healthy diet, exer­cise and avoid risky behav­iors, we alter the impact of our genetic code.

Keep in mind that some things will be com­pletely deter­mined by genes. It is not rea­son­able to hope, for exam­ple, that our off­spring will be 6’5″ if both par­ents are short (or vice versa). If the mother has “thrifty genes” — that is, genes that make it easy for her to gain weight — she may well do so dur­ing preg­nancy, even if she fol­lows a rea­son­ably healthy lifestyle. If the immune sys­tems of both par­ents have some sim­i­lar­i­ties, it may affect the mater­nal immune response to the implant­ing tro­phoblast cells, thus affect­ing the pla­centa and, indeed, the entire pregnancy.

So, how do we advise peo­ple who are think­ing of preg­nancy to pre­pare them­selves for a healthy preg­nancy genet­i­cally? Surely, to deter­mine all the poten­tial genetic pos­si­bil­i­ties is not fea­si­ble or afford­able at this point. Maybe in another cen­tury! But, we can know some fac­tors:  Is there sickle cell ane­mia in both fam­i­lies? Is there a Mediter­ranean type of sickle cell dis­or­der? What about clot­ting fac­tors or dif­fer­ences in Rh? What about dis­eases or dis­or­ders that are not com­mon, like ALS? These are things that poten­tial par­ents may want to discuss.

Like so much of life, we can’t know every­thing. There are no guar­an­tees. There is a lot to be learned still about human genes and how they work.

This blog has at its heart the notion that phys­i­cal activ­ity has tremen­dous ben­e­fits for mother and offspring…and for part­ners, too. How does the genetic com­po­nent affect this? First, pre­con­cep­tion fit­ness low­ers some risk fac­tors for moth­ers and babies. Sec­ond, each mother’s genes will make it eas­ier or more dif­fi­cult for her to enjoy or ben­e­fit from the activ­ity of exer­cise. We appre­ci­ate this and encour­age young moms-to-be to find some­thing enjoy­able that you like doing and find peo­ple or sit­u­a­tions that sup­port you in being active now before you become pregnant.

If you need assis­tance or advice, please go to www.dancingthrupregnancy.com (use the BlogRoll)

Find Ask the Expert under the Con­sumer menu. Let us know how we can help!

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Pregnancy Pathway, introduction

By dancingthrupregnancy | Published February 7, 2009

Please refer to the Preg­nancy Path­way chart in the Feb­ru­ary 5, 2009 entry. Dur­ing preg­nancy, there are some fac­tors within our con­trol and some that are not. The Preg­nancy Path­way, designed by Danc­ing Thru Preg­nancy® founder and Yale Uni­ver­sity Move­ment Spe­cial­ist Ann Cowlin, and Cer­ti­fied Nurse Mid­wife Robyn Bran­cato, is intended to describe the flow of fac­tors that influ­ence preg­nancy and its outcome.

In the weeks to come, we will focus on indi­vid­ual areas. Our goal is to help women under­stand how they can opti­mize their preg­nancy by focus­ing on what they can con­trol that results in ben­e­fi­cial outcomes.

Ann and Robyn are also found­ing mem­bers of the Women’s Health Fit­ness Insti­tute, a non-profit orga­ni­za­tion whose mis­sion is research and pub­lic edu­ca­tion out­reach in women’s health fit­ness. Our com­ments for this blog are based on sci­en­tific evi­dence and 30 years of track­ing indi­vid­ual preg­nancy out­comes from women through­out the world. Some entries will include ref­er­ences to the rel­e­vant studies.

By help­ing women under­stand what endeav­ors are effec­tive in pro­duc­ing ben­e­fits for moth­ers and their off­spring, we hope to aid moms-to-be and those con­sid­er­ing preg­nancy to be fully present and active in the empow­er­ing process of becom­ing a mother.

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