Periodically, arguments arise in the birthing field over who controls the way we give birth. Often this happens at times when birthing women change their behavior trends, putting financial pressure on professionals working in this field. The major players in this argument are medical doctors (obstetricians), certified nurse midwives and professional home birth midwives.

Currently we are seeing women leave the traditional hospital setting for birth in larger and larger numbers…and taking their dollars with them in the process. While the question of home birth safety arises every time this control argument comes around, the question of whether it is safe to intervene in a labor that is progressing normally is a new component of the discussion. This time the argument is: The safety of home birth vs. the safety of using hospital technology to intervene in normal birth.

How Money Affects this Issue

As with all commercial ventures, controlling access to safe birth requires controlling the information in the market place. This information needs to address the perceived wants of the target audience. For a long time the main message has been: Safe birth is only available in a hospital.

The financial pressure of giving women (consumers) what they want — a normal experience of birth in a safe setting where medical help can be quickly available — has powered the birth-center industry. Free-standing and in-hospital birth centers have grown in numbers, and are largely enabled by certified nurse-midwives. Meanwhile, professional home birth midwives have increased both their credentials and practice standards, as well as their visibility.

Both of these options, birth centers and home birth, threaten the livelihood of traditional obstetrical practices. Low risk births (about 70% of births) have the potential to be normal births, requiring little or no intervention. But, giving birth in the hospital means participating in measurement procedures that intervene in the labor process.

So, to convince women they need to be in a hospital to be safe, medicine has maintained the argument that home birth or out of hospital birth is not safe. However, research does not indicate this is true. The nature of this ongoing argument is discussed in a 2002 article from Midwifery Today.

What’s New? The Counter Argument.

The physiology of normal labor is dominated by parasympathetic, meditative, gonadal energy systems. Measurement is a sympathetic, rational, adrenal energy dynamic. Only when it is time to expel the baby does the underlying energy system make a transition (transition, get it?) to an adrenal impetus for the strength activity of pushing. Immediately following normal birth, maternal physiology is again dominated by gonad-driven energy along with a rush of endorphins.

“Intervene enough and things will go awry. You can easily end up being cut and/or separated from your baby at birth.” These ideas have gone viral. With the arrival of the internet, women have found a very quick way to do what we have always done: Share information.

Thus, in my exercise program and in my childbirth preparation classes, I have more and more frequently been fielding the following question from women who want a normal birth and want to be safe: “How can I avoid interventions while I am in the hospital?”

So, I ask them what leads them to ask this question. And, they say: “I read on the internet and/or heard from my friends that interventions make birth less normal and less safe. I want to protect myself.”

Women themselves are entering the argument in a much more conscious way than in the past. Some professionals would like to keep women out of the argument. But, like with many things in our 21st century world, we have already past the point of no return. As they say, the horse has already left the barn!

Word has gotten around. More and more, as a prenatal fitness expert who strives to listen to my clients, my job has become educating and physically training women to cope with a strenuous and primitive process in a technological world.

Hopefully, we can all keep our eye on the ball here. Preventing trauma should be one key goal. Just as we have learned to hold our newborns skin to skin so they can smell and taste us, listen to our heart beat and voice, and maintain their core temperature, let us learn to comfort and nurture our new mothers, while we steel them for the rigors of birth.

Filed under: Aerobics, Yoga, birth, exercise, labor | Tagged: aerobics, birth, breathing, exercise, moms-to-be, mother, yoga | Leave a Comment »

Accepting the importance of fetal programming places responsibility on the mother-to-be to do all she can to insure her body provides nutrients and oxygen to her growing infant while avoiding possible risks and toxins. At the same time, genetic and environmental factors contribute greatly to the potential for some disorders and problems that arise. Thus, we must be careful in assigning guidelines for acceptable behavior or blame for poor outcomes to pregnant women.

On the one hand, we can all see the negative consequences of something like fetal alcohol syndrome…clearly the result of maternal behavior. Is a pregnant woman whose baby has been damaged in this way guilty of abuse?

But, what if a mother is obese, eats poorly and ends up with an infant with a disturbed metabolism. Is this abuse? What if the mother has an infection that results in cerebral palsy? Or what if she lives near a highway and involuntarily inhales fumes that negatively affect the placenta?

How do you get a healthy baby? Of course, there are no guarantees. There remain many unknown factors that can affect the course and outcome of a pregnancy. Some factors we are aware of, such as avoiding certain fumes or chemicals.  There are some behaviors we know can maximize the potential for a good outcome, such as eating adequate protein, aerobic conditioning and strength training. [Note for new readers…lots of these factors have been covered in our previous posts.]

But, what about all the things we don’t know about?

If these goats eat the wrong grass, will they go into labor?

Here is a cautionary tale:  There is a species of goat that, if they eat a certain type of skunk grass on day 14 (and only day 14) of pregnancy, will not go into labor. Why? Plant toxins in this grass interfere with the development of a small portion of fetal brain, the paraventricular nucleus. This nucleus is involved in the signaling cycle of labor. Without it, the mother will not go into labor!

What are the take-home messages here?

• Probably no one is ever a perfect fetus…too many possible threats.
• There are some threats we can avoid…being lazy, over-eating, smoking.
• There are some threats we cannot avoid, so we do the best we can.

Do the best you can by your baby…aerobic fitness, good nourishment, sleep, good hygiene and de-stressing your life.

With the recent emphasis on the importance of movement in the fight against childhood obesity, there is recognition that beneficial fetal programming through maternal exercise can make a big contribution to this effort. A combination of proper maternal nutrition and maternal fitness may well prove to be most efficient and potentially effective way to help children develop an appetite for motion!

One factor in this is the finding that regular, moderate-intensity exercise helps prevent obesity in the newborn: http://www.nlm.nih.gov/medlineplus/news/fullstory_97212.htmlt. This, may in turn, help prevent childhood obesity.

Recess for everyone!!!

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

December 5 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.

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.