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

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!

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?

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.

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.

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.

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.

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):

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!!

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!

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.