Continuing education for Certified Nurse Midwives (4 contact hours with ACNM). Covers evidence on benefits of exercise, strategies for the fitness interview, monitoring patients’ progress and outcomes. Plans are underway for a Spring or Summer date at Yale-New Haven Hospital.
March 21 at Yale-New Haven Hospital.
Aerobics is definitely the biggest bang for the buck! Cardiovascular fitness is the key to almost every benefit of pre/postnatal exercise that has been found through well-designed research. Our instructors develop their own individual style of aerobic dance or fitness activities as part of our training program, but follow best practice guidelines.
Instructors also learn how to incorporate effective mind/body skills such as breathing and relaxation, along with strength and flexibility exercises. As the contemporary world puts more and more demands on our time, getting the most from your pre/postnatal program is a smart approach.
The training program has both academic and practical components. A study guide and written test precede practical learning. Accommodations are made for those wishing to develop their own programs, as well as those wishing to teach under our auspices.
There is nothing so joyful as a group of moms-to-be, at various stages of pregnancy, moving freely and fully. Celebrating this special state of being by maintaining strength, endurance and range of motion promotes emotional well-being as well as health during this major life transition.
By selecting activities that promote fitness, health and well-being for their programs, our teachers insure that moms-to-be receive the maximum benefit from the time they spend in class.
Just to let readers know where we are on the pregnancy pathway, here is the large graphic. We have just finished Pregnancy and are getting ready for Birth. Labor is beginning…are you timing those contractions?!! If you have want to review any of the content prior to Birth, you can scroll down and find an entry for each bubble. Or, use the Search Topics tool on the right side bar for a faster find.
So far, the blog has covered through Pregnancy; next Birth (purple)
A detour: We received a question about nutrition and exercise for multiples. So, here is some information for those with twins and triplets. Add a comment if you have a question or experience to share on this topic! Next comes birth, we promise!!
If one is a girl and one is a boy, they’re fraternal!
Nutrition for Multiples:
The primary thing we tell people with twins or more is that the protein needs rise about 30 grams/baby/day above the 70 — 90 grams/day needed for a singleton. Water intake also needs to rise. Avoid thirst and as much as possible, drink until urine runs clear rather than yellow (as best as you can).
Multiples is considered a risk factor, and for each risk factor (multiples, underweight, teenage mom, inter-pregnancy period less than a year) an additional 200 calories is often recommended, with 400 extra calories the upper limit.
Exercise with Multiples:
A critical factor in successful implantation and growth of the placenta appears to be aerobic fitness in the six months prior to and the first half of pregnancy. Once biomechanics become difficult in mid-pregnancy, women with multiples can continue activity safely as long as monitoring show the babies are growing appropriately. A belly support can be extremely helpful when exercising.
Contraindications for exercise include the discovery that one fetus is growing at a significantly slower rate than the other(s), that both/all are too small, that the placenta(s) is/are malfunctioning, or some other condition occurs, such as an incompetent cervix or placenta previa, that would be a factor in any case.
Absolute size difference does not necessarily mean that one baby is growing more slowly, as some fetuses may be a couple weeks younger than their uterus-mate(s) if the mother ovulated twice in the fertility cycle. Or, s/he might be smaller if genetically destined to be a smaller infant at birth. Thus, growth rate is the measurable factor that helps determine if a fetus is at risk of not receiving adequate energy. This can happen when there are two placentas and one placenta is working more poorly than the other, or for some reason there is a flaw in the umbilical cord of an identical. The competition for energy places a slower growing baby at risk.
Protecting Mom and Baby:
The placenta is designed to nourish the baby and will do so at a cost to the mother first if there is inadequate nutrition. Thus, activity to the level the mother can tolerate and following nutritional guidelines above — in the absence of medical complications — produces healthy offspring. Multiples will garner all the same benefits a singleton does.
Note about images: we strive to use images we own or that are advertised as free on the internet. We want to thank google, bing and yahoo for making free images available.
Sometimes it seems like pregnancy is a time of restrictions. Avoiding risks can be one thing that makes it seem that way. But, bear with us here in an interesting trip through danger and finding you find ways of enhancing your pregnancy!
Risk Factor #1:
Lack of prenatal care. More than anything else, be sure you have care. Having someone monitor your health and that of your baby during pregnancy is vital to a good outcome.
Exercise! Avoiding it is a risk factor for diabetes and preeclampsia.
Risk Factor #2:
Not exercising. Sedentary behavior increases the risk for metabolic, cardiovascular and immune disorders.
I know, I know, you don’t have time to exercise. Well, pay now or pay later, as they say. Make time to go to a class (make sure it includes 20 –30 minutes of aerobics) a couple times a week. A class will also provide social support, another factor that enhances your pregnancy. Take a walk at lunch time. Practice relaxation techniques.
Risk Factor #3:
Breathing dangerous fumes. Yes, this includes smoking and second-hand smoke. But, it also means avoiding environments where there is a lot smog (near highways), living with mold or dust, and fancy cleansers that may have dangerous chemicals in them. Stick with vinegar, ammonia or bleach as cleansers.
Smog can endanger your fetus!
We are learning that combustion exhaust from cars and trucks can negatively affect birth weight and prematurity. If you live or work near a highway or in an area where smog is prevalent, what are your options? Can you transfer or move? Can you wear a mask? Talk to your care provider and figure out the best protection for you and your fetus.
Risk Factor #4:
Poor Nutrition. Yup, just go back one entry and find out how food affects pregnancy. If you don’t eat enough protein and drink enough water, you don’t make sufficient blood volume to nourish your placenta and thus your fetus.
Read labels!
Eat whole foods and learn to read labels when you buy processed foods. What is a “processed” food? Anything with more than one ingredient!
Some processing (ex: homemade soup) takes little nutrition away, but some processing (ex: potato chips) takes everything good away and replaces it with unsafe substances. Look for low sodium, low sugar, high vitamin and mineral content items with no saturated or trans fats.
Read the ingredients; if you don’t know what the words mean, maybe you want to pass it up.
Risk Factor #5:
Alcohol and Drugs. Common items can be as dangerous as street drugs, which
There is plenty of time in life for a glass of wine…later.
No. No. No. Only meds from your prenatal care provider are okay.
Caffeine? Only one cup & only if you must.
can severely compromise you baby’s future. If you have a drug or alcohol habit, get help.
Risk Factor #6:
Genetics. You can have genetic predispositions for many pregnancy issues. However, that does not necessarily mean you will develop a given disorder. For example, nutrition and exercise greatly reduce the risk and severity of metabolic issues. Some genetic issues are unavoidable however, and your care provider will alert you to these, if they are relevant.
Risk Factor #7:
Social issues — isolation, lack of support, abuse, poverty. All of these factors can have negative effects.
If isolation is a simple matter of needing to meet other moms-to-be, join an exercise program. That way, you get both support and exercise; just be sure it includes aerobics, along with centering, relaxation and appropriate strength.
If your situation is more dire, seek the help of a care provider or social worker at your local hospital or clinic. Safety and support are critical for you at this time. Get the help you need. There are people who care. And, if you know of someone who needs help, help them.
If you have other risk factors to offer, please post them in the comments. Thanks!
What’s next? BIRTH!!
Fresh fruit = vitamins & minerals!!
Question:
How many extra calories do you need in each trimester to offset the metabolic cost of pregnancy?
Answer:
First trimester — 0; Second trimester — 300; Third trimester — 500 (source: Institute of Medicine).
Keep in mind that you may also need calories for any fitness program you are doing. If you are continuing a program, the only change is due to the pregnancy.
If you begin or increase your activity, you need to take that into account. One yoga class = 100 — 150 calories. One aerobics class = 200–400 calories. Walk one mile = 100 calories.
1 slice whole grain bread = 50–100 calories
Be sure you read food labels so that you can balance your food intake and your calorie output. A small woman (under 5’3″ & 130 lbs.) probably needs about 1200 calories per day as a base. A medium sized woman needs about 1400, and a large woman (over 5’9″ & 160 lbs.) probably needs 1600 to 1800 calories. Add your activity and pregnancy needs to your base amount.
Question:
What foods are necessary for a healthy pregnancy?
Answer, part A:
PROTEIN. Lean proteins like turkey and those with omega 3 fats like ocean fish and eggs.…yes! EGGS!
Turkey is a good protein
Ocean fish 1 or 2 times/wk = good protein & omega 3 fat
Eggs are a perfect pregnancy food!
70–90 grams of protein are necessary each day, along with adequate water. These are needed to make an extra 40% blood volume required to support the placenta.
Answer, part B:
WATER. Two (2) quarts of water…more if you are very active…are needed to make extra blood and to prevent dehydration.
Question: What else?
Fresh vegetables also provide fiber
Answer: CARBS. Fresh, colorful fruits & veggies provide necessary vitamins and minerals, as well as fiber. Eat 5 servings a day from all the colors: yellow, orange, red, purple and green, and you will get live vitamins all day long that help your baby develop properly! Fruits, vegetables and whole grains are low glycemic index carbohydrates — the good ones!
Dairy provides calcium
Question:
Do I need dairy products and red meat? Can I get the needed minerals in other ways?
Answer:
Calcium is needed in adequate amounts for bones and teeth. It is most easily obtained by drinking milk or eating cheese, yogurt or cottage cheese. Soy, dark green leafy vegetables and calcium fortified juice are alternatives.
Iron is necessary for red blood cells to take up oxygen. It is found in high amounts in beef, and lesser amounts in raisins, spinach, and prune juice. Prenatal vitamins are your insurance against deficiencies of these essential minerals.
Question:
Anything else that’s essential?
Answer:
Yes! Healthy FAT!!
Avocado is an excellent source of omega 6 fat
In addition to omega 3 fats found in fish, walnuts and flax seeds, you need also need omega 6 fats, which are found in avocados, olive oil and other vegetable oils. Healthy fats help balance cardiovascular constriction and dilation, reducing the risk for hypertension.
Last Question:
What is a healthy weight gain?
Answer:
In 2009, the National Academy of Sciences revised its recommendations. It now bases desirable weight gain on pre-pregnancy BMI (Body Mass Index…google this!).
BMI less than 18.5 (low) — 28 to 40 lbs.; BMI between 18.5–24.9 (normal) — 25 to 35 lbs.; BMI 25.0 to 29.9 (high) — 15 to 25 lbs.; obese women (BMI over 30.0) — 11 to 20 lbs.
Coming Next: Avoiding Risks.
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
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!
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
Two updates on the ACNM website of interest:
• the value of exercise in pregnancy
• health care reform
Check out the ACNM site!!
Hot topic for today: Toxins and infections in pregnancy.
Pregnancy Exposure to Toxins and Infections
A mother-to-be needs to be aware of items that can have adverse effects on the health and development of her fetus, as well as her own health. Two of these factors are toxins and infections.
1. Toxins can be food, environmental factors, and medications, alcohol or drugs. Let’s start with food. Interestingly, many plants have slight toxins in them that can have a small negative impact during early fetal development. One theory of nausea and vomiting in early pregnancy is that this helps the mother’s body prevent these toxins from interfering with normal development. Pica — especially eating dirt that is largely clay — may be another manifestation of how the body strives to counter plant toxins, as clay can counteract some of the effects of these toxins. So, plant toxins can be one food source in early pregnancy.
Another source is food additives (things you cannot pronounce, so read the ingredients!). We have no idea how many chemicals and hormones added to foods affect fetal development.
NIH illustration of reading food label
Risk-aversion involves avoiding items that are risky. If you are not sure, don’t eat it. For up to date information, look at the FDA site on food safety or the NIH site on reading food labels.
Environmental factors that may affect fetal development can include air pollution, household cleansers, mold and other items encountered anywhere one goes. Things we breathe can be particularly dangerous, so be sure to keep cleanser use to simple items such as vinegar, ammonia or chlorine bleach. Wearing a mask while cleaning is also a good idea.
Medications, drugs or alcohol that might normally be considered safe for a non-pregnant person — something as simple as aspirin — can be dangerous as they affect blood clotting factors and threaten the placenta. Or, because they cross the placental barrier but cannot be metabolized by the immature fetal liver, they are toxic and induce damage to the fetus.
2. Infections are of concern, as well. It is possible that an active infection at the time of fertilization and implantation can contribute to dysfunction in pregnancy because it interferes with the normal immune responses of early pregnancy. Hypertension in pregnancy may be related to infection in the early days of pregnancy. Some infections — particulary sexually transmitted infections — are known to have detrimental effects on the baby’s health. Preterm premature rupture of membranes (P-PROM) almost always reflects active infection.
Taking Precautions: First, be sure to let your health care provider know about any illness or infection. Second, take care of yourself. Follow recommendations for frequent handwashing and carry sterile hand gel in your purse or backpack. Avoid places where hygiene might be compromised. Practice safe sex.