DTP Offspring – Renee Crichlow: REAC Fitness

By anncowlin | Published May 19, 2013

In Part 4 of our con­tin­u­ing series on DTP’s off­spring, meet Renee Crichlow, ACSM Cer­ti­fied Per­sonal Trainer from Bar­ba­dos, whose REAC Fit­ness busi­ness includes Mum-me 2 B Fit­ness Series (pre­na­tal), After Baby Fit­ness Series (post­na­tal) and 6 week Jump­start Body Trans­for­ma­tion Pro­gram (gen­eral female population).

See pho­tos and read more about Renee’s busi­ness on the DTP Blog here. The adven­tures of one of her stu­dents is fea­tured in a recent series of arti­cles in Bar­ba­dos Today.

Renee is a women’s fit­ness spe­cial­ist, tar­get­ing all stages of a woman’s life cycle from ado­les­cent, child bear­ing years, pre­na­tal, post­na­tal to menopause. I design var­i­ous exer­cise pro­grammes to help women get into shape. As a trainer, friend and coach, I am com­mit­ted to guid­ing, moti­vat­ing and edu­cat­ing women to exceed their fit­ness goals and to per­ma­nently adopt healthy lifestyles. She started study­ing with DTP in March 2012 and com­pleted the practicum in May 2012.

I most enjoy the good feel­ing asso­ci­ated with know­ing that I am help­ing women to pos­i­tively change their lives through exer­cise. I have learned that we are con­nected and not sep­a­rate from each other. Shar­ing our chal­lenges and tri­umphs enable each of us to grow and have a sense of belong­ing like a sis­ter­hood. The baby and preg­nancy sto­ries always amaze me and I learn a lot con­sid­er­ing I don’t have chil­dren of my own.  I am also fas­ci­nated by the fact that as the preg­nant mum­mies bel­lies grow, they are still mov­ing with lots of energy and I feed off of that energy.  I just love work­ing with preg­nant ladies and mothers.

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Pregnancy Exercise — The Evolutionary Imperative for Vigorous Activity

By anncowlin | Published June 18, 2012

This arti­cle is from my blog, Danc­ingTh­ruPreg­nancy on Word­press.

I have long wanted to write this post. Recently two arti­cles appeared in the NY Times prompt­ing me to move for­ward. One arti­cle dealt with how it is that ongo­ing vig­or­ous exer­cise pro­duces brain enhance­ments. The sec­ond arti­cle dealt with how run­ning cre­ates its “high” and explained why the result­ing addic­tion is an evo­lu­tion­ary ben­e­fit for human survival.

Every day in Africa a gazelle wakes up.

It knows it must run faster than the fastest lion or it will be killed.

Every morn­ing a lion wakes up.

It knows that it must out­run the slow­est gazelle or it will starve to death.

It doesn’t mat­ter whether you are a lion or a gazelle.

When the sun comes up, you bet­ter be running.

Abe Gubegna
Ethiopia, circa 1974

The preg­nant mom who exer­cises vig­or­ously and reg­u­larly — the one who runs or swims or does aer­o­bic danc­ing — is not the one at risk, or whose infant is at risk, of a lack of tol­er­ance for the rig­ors of labor or for lifestyle health prob­lems. It is the seden­tary or low activ­ity mother and her off­spring who are at risk. I have writ­ten at length on this real­ity in my chap­ter on Women and Exer­cise in Varney’s Mid­wifery.

This real­iza­tion has plagued me for ages, and the two arti­cles in the Times con­vinced me to make this state­ment, explain why it is true and exhort women of child­bear­ing age to become aer­o­bic animals.

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 health care providers hear that women are afraid to exer­cise, and child­birth edu­ca­tors hear that preg­nant moms 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. It increases endurance, strength and range of motion. It improves breath­ing capac­ity (you get more oxy­gen + less fatigue). It reduces your need to tap your car­diac reserve (your body works hard in labor but not to the degree it must if you are not fit). Plus, reg­u­lar par­tic­i­pa­tion in a good car­dio or aer­o­bic work­out gives you the men­tal tough­ness and con­fi­dence you need to know that your body is capa­ble of the work and the recov­ery — what we call body trust. Fit Preg­nancy has dis­cussed the myths sur­round­ing how hard a preg­nant woman can work out.

Learn­ing use­ful posi­tions and move­ments is extremely help­ful. Be sure that your work­out also includes strength and coor­di­na­tion move­ments — such things as squat­ting, core move­ments for pelvis and spine, and other motions that aid your progress in labor. Being upright and mov­ing are keys to a healthy labor. These require strength and coordination.

Men­tal focus and being present teach you to work with your body. Activ­i­ties such as relax­ation train­ing, yoga, pilates for preg­nancy and dance help you develop the men­tal skills (mind­ful­ness and deep breath­ing) that accom­pany your move­ment. Learn to rec­og­nize your body’s sig­nals so you know when it’s time to push.

A truly effec­tive use of your time is a one hour class a cou­ple times a week that com­bines all these ele­ments. We have known this for decades. The evi­dence is clear that it works. Keep moving…right into labor and birth!

Find a safe and effec­tive class or trainer.

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Active Pregnancy — the rationale

By anncowlin | Published November 26, 2010
Mov­ing into Motherhood

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.

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High Birth Weight: The New Adverse Outcome

By anncowlin | Published October 6, 2010

While pub­lic aware­ness of low birth weight and pre­ma­ture infants is becom­ing — at long last — inter­est­ing to the main­stream cul­ture and media, another phe­nom­e­non is begin­ning to shake the pro­fes­sional birthing world:  high birth weight. Because it is occur­ring in a more afflu­ent ele­ment of soci­ety, it is alarm­ing. This tells us that you can­not buy your way out of preg­nancy risks that are cre­ated by a seden­tary, toxic food life-style.

Here is the dilemma:

Nor­mal weight and some over­weight women who eat too much in preg­nancy tend to have babies who are, basi­cally, already obese at birth. There­fore, these infants already have meta­bolic and car­dio­vas­cu­lar dys­func­tion. Babies born over 8 lbs. 14 oz. are at increased risk for Type 2 Dia­betes and heart disease.

Inter­est­ingly, the Insti­tute of Med­i­cine  recently issued new guide­lines on preg­nancy weight gain. After nearly 20 years of adher­ing to the “nor­mal” weight gain being 25 to 35 pounds, the Insti­tute rec­og­nized that pre­na­tal BMI plays a role in how much weight gain is nec­es­sary for a healthy pregnancy.

The evi­dence that under­lies this change demon­strates that gains greater than 22 pounds — for all clas­si­fi­ca­tions of pre­na­tal BMI — is the demarka­tion point for increased health prob­lems.  More infor­ma­tion on this is avail­able at:  New IOM Guide­lines.

We have known for a while now that obe­sity in preg­nancy puts mother and infant at risk for a num­ber of prob­lems from car­dio­vas­cu­lar, meta­bolic and immune dis­or­ders to pre­ma­tu­rity, low birth weight, increased need for cesarean birth and slow recov­ery. Add another one:  Obese new­borns with increased risk for heart and metab­o­lism problems.

Ref­er­ence on weight gain and high birth weight:

Lud­wig DS, Cur­rie J. The asso­ci­a­tion between preg­nancy weight gain and birth­weight: a within-family com­par­i­son. Lancet. 2010 Sep 18;376(9745):984–90. Epub 2010 Aug 4.

A good ref­er­ence for issues sur­round­ing obese pregnancy:

Leddy MA et al. The Impact of Mater­nal Obe­sity on Mater­nal and Fetal Health. Rev Obstet Gynecol 2008;1(4):170–178.

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Fitness Starts Early!

By anncowlin | Published September 20, 2010

Preg­nancy fit­ness is not only impor­tant for moms, but for the fetus as well. Evi­dence is clear that aer­o­bic fit­ness improves brain, heart, immune and meta­bolic function…at all ages, includ­ing in utero. If con­tin­ued early in life, healthy phys­i­cal adap­ta­tions that occur in the uterus become rein­forced behav­ior, prepar­ing a good foun­da­tion for a healthy lifestyle. Babies are acute observers of move­ment and activ­ity, and learn from each other. A key com­po­nent of a good mom-baby pro­gram is the inter­ac­tion of the babies them­selves. A good teacher will facil­i­tate healthy activ­ity among our small­est class members!

There is grow­ing evi­dence that at all ages, aer­o­bic fit­ness pro­duces the great­est num­ber of ben­e­fits. Recently, researchers deter­mined that aer­o­bic fit­ness in 9 and 10 year olds pro­duced ben­e­fits in the devel­op­ment of two impor­tant brain regions — the basal gan­glia and the hip­pocam­pus — that are sig­nif­i­cant fac­tors in problem-solving intel­li­gence. This is just one of the lat­est reports that tells us the capac­ity to absorb and use oxy­gen (which improves with aer­o­bic fit­ness) is a key to health, qual­ity and length of life…beginning in the womb!

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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.

Posted in 1, Pregnancy Pathway, birth, conception, exercise, pre-pregnacy, pregnancy, trophoblast | Tagged , , , , , , , , , | 2 Comments