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 what childbirth educators hear from pregnant moms is that they 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:  increased endurance, strength and range of motion; improved breathing capacity (you get more oxygen + less fatigue) and reduced need to tap your cardiac reserve (your body works hard but not to the degree it must if you are not fit); and mental toughness that gets you the confidence you need that your body is capable.

Learning useful positions is extremely helpful. If you are active be sure that your workout includes such things as squatting and other movements that aid your progress in labor. Being upright and moving are keys to a healthy labor.

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

Keep moving…right into labor and birth!

The biology of birth is a complex series of cause-effect processes…baby’s brain releases chemical signals to the mother and the placenta begins to manifest the maternal immune system’s rejection of the fetus.

To help the ball get rolling, relaxation (the trophotropic response) helps promote the release of oxytocin. With the help of gravity, the head presses on the cervix, amplifying the uterine contractions. After an ultra-distance aerobic endurance test, the cervix opens enough to let the baby move into the vagina and the mother’s discomfort moves from sharp cramping into the bony structure as she transitions to the strength test of pushing. She transitions. Relaxation modulates into an ergotropic — adrenal — response to gather her power.

Pushing is an interesting term…more masculine, I think, than the one I prefer:  Releasing. Releasing or letting go of the baby. It’s a catharsis. In this portion of the labor another set of important processes help the baby clear its lungs of amniotic fluid, stimulate its adrenal system and challenge its immune system, as the contractions drive the baby downward. The mother’s deep transverse abdominal muscles — if strong enough — squeeze the uterus like a tube of tooth paste, to aid this expulsion. In the meantime, the labor is helping set up the mother to fall in love and produce milk. When the baby emerges and moves onto the mother’s chest, s/he smells and tastes the mother, recognizing her mother’s flavor and setting up the potential for bonding.

Any way you slice it, there are two parts to safe motherhood. One is a safe pregnancy…healthy nutrition, physical fitness, safe water, infection prevention, support and a safe environment. The other is a safe labor. In a safe labor, there is both an environment that promotes the natural process of labor and the means necessary for medical assistance when needed. Women die at an alarming rate from pregnancy or birth-related problems. Despite some progress made in recent years, women continue to die every minute as a result of being pregnant or giving birth.

What keeps us from having a better record on motherhood is often lack of care in the developing world and too much intervention in the U.S.. They are two sides of a coin. Mothers’ experience and health needs are not on equal footing with other cultural values. In places where basic prenatal care or family planning are low priorities, at-risk women are vulnerable to the physical stresses of pregnancy and birth. In the U.S., machine-measured data is paramount, even if it produces high rates of false positives, unnecessary interventions or counterproductive procedures. We are learning that obesity and sedentary lifestyles have detrimental effects, but fewer pregnant women than their non-pregnant counterparts exercise.

Despite the money spent to support the technological model of pregnancy and birth in the U.S., there are parts of the world with lower rates of maternal deaths — especially Scandinavia, Northern Europe and parts of the Mediterranean and Middle East (Greece, the United Arab Emirates, Israel, Italy and Croatia). In fact, in the U.S., maternal deaths are on the rise.

It’s a tricky business. Clearly Western medicine has a lot to offer the developing world when there are medical concerns. On the other hand, importing the U.S. model could create more problems than it solves. Instead, the micro-solutions now being developed in many locations will be observed and evidence collected by organizations such as the White Ribbon Alliance and UNICEF.

There is an effective international midwives model adopted by JHPIEGO, the Johns Hopkins NGO working toward improved birthing outcomes. It assesses the local power structure, social connections, potential for trained birth assistants, and location of available transportation to create a network so that locals will know when a labor is in trouble and who can get the woman to the nearest hospital.

In the U.S., there are in-hospital birth centers that allow low-risk mothers the opportunity to labor and birth in a setting designed to encourage the innate processes. Women are beginning to vote with their feet…staying home for birth. Women are going abroad to give birth. At the same time, women are coming to this country to give birth, believing it is safer than where they are. There are several ways these scenes could play out.

But, I’ll wager, improving outcomes will involve compromise:  Watchfulness and support in most births, plus better ways to assess danger and provide technology. No matter where you live in the world, the solution may be essentially the same.

The Second Stage of Birth is different from the First Stage. The actual expulsion of the baby requires a change in energy axis. During dilation (first stage), oxytocin is most easily released from the pituitary gland during relaxation (see previous post), but during transition, a change occurs so that the ergotropic response takes over and adrenaline is key in helping oxytocin to spike.

What does this mean as far as preparation is concerned? While it is important to learn to relax or maintain positions such as one does in yoga, the ability to sprint, or turn on an aggressive action at the end, is critical. You need  good aerobic conditioning. Begin exercise with easy breathing and movement, then practice aerobic endurance and power moves at the end of your workout! Finish up with cool down and stretching.

The contractions themselves change. They remain intense for a longer stretch, but the time between them increases. Pushing involves not only the uterus contracting, but the pressure exerted by the transverse abdominal (TrA) muscle. Similar to squeezing a tube of toothpaste, TrA pressure helps press the baby toward the exit — yes, that is the vaginal opening. If the laboring mother is not able to apply adequate pressure, labor assistants sometimes apply pressure manually to the top of the uterus or — if need be — forceps or a vacuum extraction may be necessary.

How can a mom best prepare so that the TrA can provide the needed pressure? Strength training the TrA! Like any other motion requiring power strength, this muscle can be strengthened to do its job! Here’s how:

picture 1:  sit upright, inhale

picture 2:  exhale, compress abdomen and curl down

Return to upright and repeat 8 times. Rest. Repeat 8 more times.

What if something goes awry? Cesarean, or surgical birth is an alternative. Major complications before labor include a placenta previa, infection or undeliverable breech position. During labor, the most common problem is dystocia — stalled progress through dilation (first stage) or pushing (second stage). In the pushing stage, head to large for pelvis is the most common difficulty.

What happens next? If the birth is natural, you will feel a tremendous euphoria. Bring the baby right up onto your chest for skin-to-skin contact. If you have had medications, your response may be slightly blunted, but you will definitely be overwhelmed by the emotions of birth.

Third Stage is expulsion of the placenta, which can no long remain connected to the shrinking uterus. When it detaches, the nurses or midwives will ask you to push and !plop! out it comes. It can be interesting to see what has nourished your baby for so long!

CONGRATULATIONS!  YOU’RE A MOM!

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.

Here are some birth stories from our clients (edited for privacy):

• We’re happy to report that [our baby boy] was born on Saturday at 12:31 am…our exercise classes were ESSENTIAL in the later part of labor — the doctor and nurse described me as a “natural” at pushing, but I had to admit to them that I’d been practicing my c-curves twice a week for a few months already! — G.S.

• We arrived at the hospital at 8pm on Friday and I was 6 cm dilated…I delivered by 1 am without pain meds.  It was an amazing experience. You really do focus inward.  I found sitting in the shower holding the sprayer to be helpful.  Definitely try different positions.  I used the bar for when it can time to push.  Just know that there is an end in sight and just holding your baby at the end is the most wonderful, amazing feeling in the world!  — P.E.

• We arrived at the hospital at 6am and I was already 4cm dilated…[at] 5cm dilated, I requested an epidural. The anesthesiologist did a great job, and I was still able to move my legs with the epidural. I found movement during labor to be very helpful, and in particular, circular movements of my pelvis (i.e. belli dancing). Post partum recovery has been quick. No doubt that [your] guidance and preparation was crucial to this end. I would like to thank all of you for your support…  — K.L.

• On Sunday…after more than 26 hours of labor, [my wife] gave birth to [our baby boy]. Through the help of her birth support team she was able to deliver without pain medicine. She did a tremendous job, and we used many of the skills learned in class to focus, draw her out of her body, breath and relax.  — M.&L.S.

• I just wanted to share with you the very good news that [our baby boy] was born at 8:38 pm last night. He weighed 8 lbs 11 ozs and measures 21.5 inches long. He finally enabled me to put my c curves and such to direct use by arriving a mere 8 days late (instead of the 11 days late that would have led to my second c-section).  We are having a very nice time right now…and look forward to making our joint return to the gym in a few weeks!  — F.A.

• Our beautiful baby boy was born Tuesday night at 9:09 p.m. The delivery went well (drug free!) and I received many compliments on my 50 minutes of pushing. Thanks for everything and I hope to see you in 4 weeks or so!  — A.E.

So, what is safe? Well, first, unless you have a very few conditions that your health care provider considers unsafe, every woman — fit, currently sedentary, young or a little older — can exercise safely in pregnancy. How much of what kind depends on your fitness level and exercise history. Get medical screening first.

If you are fit, you can do vigorous exercise

If you are fit, you just need to learn how to modify some movements to accommodate your biomechanics. As your body changes, stress on the joints and tissues means a little less jumping or ballistic motion will be more comfortable and safer. If you are fit, you can continue with vigorous exercise and it will be of benefit to you and your baby.

If you are not so fit or are sedentary, find a certified pre/postnatal instructor and join a group where you will have fun, get some guidance and be monitored for safety. How do you find such a person? Try our Find A Class or Trainer page.

What is effective? Don’t spend your time on things that may be nice to do but don’t help you focus and prepare for birth, relieve discomforts or have the stamina for birth and parenting. There is substantial scientific evidence and information from large surveys that these things are helpful.

Cardiovascular or aerobic activity is the most important activity you can do. Already fit? Keep working out; join a class if you want support or new friends. If you are sedentary or somewhat active, you can improve your fitness by doing at least 20 — 30 minutes of aerobic activity 3 times a week. Work at a moderate pace — somewhat hard to hard — so that you can talk, but not sing an aria! If you are more than 26 weeks and have not been doing cardio, you can walk at a comfortable pace. Aerobics is key because it gives you endurance to tolerate labor and promotes recovery.

Strength and flexibility exercises that do not hurt and are done correctly are also safe. There are some special pregnancy exercises that actually help you prepare for birth. Essential exercises that aid your comfort, alignment and birth preparation include:

• Kegels (squeezing and relaxing pelvic floor muscles) — squeezing strengthens them and thus supports the contents of the abdomen, and learning to release these muscles is necessary for pushing and birth.

• Abdominal hiss/compress and C-Curve® - contracting the transverse abdominal muscles reduces low back discomfort and strengthens the muscle used to push and later to recover abdominal integrity after birth.

Squatting

• Squatting — getting into this position strengthens the entire leg in a deeply flexed position; start seated and use arms for support, stability and safety. Leg strength improves mobility and comfort in pregnancy and postpartum; plus, deep flexion is a component of pushing in almost all positions.

• Strengthening for biomechanical safety — strengthening some parts of the body helps prevent injury to bone surfaces, nerves and blood vessels within joints re-aligned in pregnancy. This can be done using resistance repetitions (weights, bands, calisthentics or pilates) or isometrics (yoga or ballet). A responsible class will focus on upper back (rowing), push-ups, abdominals, gluteals, hamstrings, and muscles of the lower leg.

• Stretching of areas that tend to get tight — relieving some discomforts through flexibility helps you maintain a full range of motion. Static stretches, used in combination with strength exercises or following aerobics, is most effective. Stretching prior to exercise tends to produce more injuries than not stretching. Areas needing stretching include the chest, low back, hamstrings and hip flexors (psoas).

Mind/Body skills are very important. There are two activities that exercisers constantly tell us are a big help in pregnancy, birth and parenting.

• Centering employs a balanced or neutral posture, deep breathing and mindfulness to help you work in a relaxed way. Athletes and dancers call this “the zone.” Starting your workout in association with your body establishes economy of motion, something very useful in birth and parenting, and reduces risk of injury.

• Relaxation is another key activity; it relieves stress, promotes labor in the early stages and helps you enter the zone!

Remember: Birth is a Motor Skill™