Let’s Have Mother’s Day Every Day

By anncowlin | Published May 7, 2011

This post is excerpted from our blog post­ing “Mother’s Day for the Com­pas­sion­ate” on 5/5/11 at http://dancingthrupregnancy.wordpress.com.

Mother’s Day is an impor­tant day!  It is set aside because – let’s face it – with­out our moth­ers, none of us would be here. Not only do moms carry us inside their own bod­ies for those crit­i­cal nine months, but once we are here our mom, or some­one who can sub for our mom, is essen­tial to our early survival.

Many presents cel­e­brate moth­er­hood. We can also give gifts that save mother’s lives, help them nur­ture their chil­dren, and improve the lives of fam­i­lies in our own coun­tries and the devel­op­ing world.

Here are a few groups to which you might want to con­sider giv­ing this year. By donat­ing to these orga­ni­za­tions you can help improve the lives of moth­ers and chil­dren. Most will send a card or email mes­sage to the mom in whose honor you give the gift.

UNICEF Inspired Gifts.  You can choose gifts that improve edu­ca­tion, water, health, nutri­tion, emer­gency care and other fac­tors that affect the well-being of women and children.

White Rib­bon Alliance for Safe Moth­er­hood. You can advo­cate for every mother and every child in 152 nations when you give to this organization.

Inter­na­tional Con­fed­er­a­tion of Mid­wives. This group exists to raise aware­ness of the global role of mid­wives in reduc­ing mater­nal and new­born child mortality.

The Fis­tula Foun­da­tion. This group exists to raise aware­ness of and fund­ing for fis­tula treat­ment, pre­ven­tion and edu­ca­tional pro­grams world­wide. Fis­tula is the dev­as­tat­ing injury cause by untreated obstructed labor.

The Preeclamp­sia Foun­da­tion. This orga­ni­za­tion sup­ports research to pre­vent and treat one of the most dan­ger­ous dis­or­ders of preg­nancy, one that accounts for a large per­cent­age of pre­ma­ture births and low birth weight infants. Hav­ing preeclamp­sia is also a risk fac­tor for later heart dis­ease for the mother.

March of Dimes. The “mother” of all char­i­ties for help­ing pre­vent and treat dis­or­ders and dis­eases that affect children.

Happy Mother’s Day to you and – hope­fully – to all moth­ers everywhere!

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Pregnancy Exercise Safety

By anncowlin | Published March 20, 2011

This post is adapted from the 3/17/11 DTP Blog on Preg­nancy Exer­cise Safety. For more evidence-based infor­ma­tion on Pre/postnatal Health & Fit­ness, check out the DTP Blog. The Blog includes infor­ma­tion start­ing prior to con­cep­tion and con­tin­u­ing through post­par­tum and mom-baby fitness.

There are three sec­tions to this post: 1) moms-to-be, 2) preg­nancy fit­ness teach­ers and per­sonal train­ers and 3) some spe­cific con­traindi­cated and adapted exer­cises. All infor­ma­tion pre­sented is based on peer-review research and evi­dence col­lected over a 30 year period of work­ing with this pop­u­la­tion. More infor­ma­tion on safety can be found on this site on the page Ben­e­fits, Safety & Guide­lines.

1) Safety & Exer­cise Guide­lines for Moms-To-Be

First and fore­most, be safe. Trust your body. Make sure your teacher or trainer is cer­ti­fied by an estab­lished orga­ni­za­tion that spe­cial­izes in pre/postnatal exer­cise, has worked under mas­ter teach­ers dur­ing her prepa­ra­tion, and can answer or get answers to your questions.

These are the safety prin­ci­ples that we sug­gest to our participants:

  • get proper screen­ing from your health care provider
  • pro­tect yourself
  • do not over­reach your abilities
  • you are respon­si­ble for your body (and its contents)

Squat­ting is an exam­ple of a stan­dard preg­nancy exer­cise used for child­birth prepa­ra­tion that must be adapted by each indi­vid­ual based on body pro­por­tions, flex­i­bil­ity, strength and comfort.

Don’t assume that because your teacher and some par­tic­i­pants can do a cer­tain move­ment or posi­tion that you should be able to do it just like they do. If your teacher is well trained, she will be able to help you select vari­a­tions that are appro­pri­ate for your body.

When you are exer­cis­ing, make sure you are get­ting the most from your activ­ity. Keep these find­ings in mind when choos­ing your work­out routine:

  • Aer­o­bics and strength train­ing pro­vide the great­est health ben­e­fits, reduce the risk for some inter­ven­tions in labor, help shorten labor, and reduce recov­ery time
  • Cen­ter­ing helps to pre­vent injury; relax­ation and deep breath­ing reduce stress; and mild stretch­ing can relieve some discomforts
  • Avoid fatigue and over-training; do reg­u­lar exer­cise 3 — 5 times a week
  • Eat small meals many times a day (200–300 calo­ries every 2–3 hours
  • Drink at least 8 cups of water every day
  • Avoid hot, humid places
  • Wear good shoes dur­ing aer­o­bic activities
  • BE CAREFUL! LISTEN TO YOUR BODY!

If you expe­ri­ence any of the fol­low­ing symp­toms, stop exer­cis­ing and call your health care provider:

  • Sud­den pelvic or vagi­nal pain
  • Exces­sive fatigue
  • Dizzi­ness or short­ness of breath
  • Leak­ing fluid or bleed­ing from the vagina
  • Reg­u­lar con­trac­tions, 4 or more per hour
  • Increased heart­beat while resting
  • Sud­den abnor­mal decrease in fetal move­ment (note: it is com­pletely nor­mal for baby’s move­ments to decrease slightly dur­ing exercise)

2) Safety & Exer­cise Guide­lines for Teach­ers & Trainers

A prin­ci­ple of prac­tice that increases in impor­tance for fit­ness pro­fes­sion­als work­ing with preg­nant women is hav­ing the knowl­edge and skills to artic­u­late the ratio­nale and safety guide­lines for every move­ment she asks clients to perform.

This goal requires adher­ence to safety as the num­ber one pri­or­ity. Here is how we delin­eate safety and the pro­ce­dures we require of our instruc­tors for achiev­ing safety in practice:

First pri­or­ity: safety [First, do no harm]
  • some­times med­ical con­di­tions pre­clude exercise
  • find an appro­pri­ate start­ing point for each individual
  • indi­vid­ual tol­er­ances affect modification
  • gen­eral safety guide­lines are physical
  • preg­nant women also need psy­cho­log­i­cal safety
Mind-Body Safety Procedures
  • Cen­ter­ing enhances move­ment effi­ciency and safety.
  • Always begin with centering.
Strength Train­ing Cautions
  • avoid Val­salva maneuver
  • avoid free weights after mid preg­nancy (open chain; con­trol issue)
  • avoid supine after 1st trimester
  • avoid semi-recumbent 3rd trimester
  • keep in mind the com­mon joint dis­place­ments, and nerve and blood ves­sel entrap­ment when design­ing spe­cific exercises
Aer­o­bics or Car­dio­vas­cu­lar Con­di­tion­ing Procedures
  • Mon­i­tor for safety
  • Instruc­tional style needs to be appropriate.
  • Walk­ing steps with nat­ural ges­tures can be done through­out pregnancy
  • Vig­or­ous steps with large ges­tures are more intense, appro­pri­ate as fit­ness increases
  • The abil­ity to cre­ate move­ment that will be safe and work for var­i­ous lev­els of fit­ness and at dif­fer­ent points in preg­nancy is one of the most crit­i­cal skills for preg­nancy fit­ness instructors.
Venue Safety
  • Set­ting should pro­vide phys­i­cal and emo­tional safety
    Equip­ment must be well-maintained

3) Con­traindi­cated and adapted exercises

Exer­cises for which case stud­ies and research have shown that there are seri­ous med­ical issues include the “down dog” posi­tion, rest­ing on the back after the 4th month, and abdom­i­nal crunches and oblique exer­cises. Here is more infor­ma­tion and adap­ta­tion suggestions:

Con­traindi­cated: “Down Dog” requires that the pelvic floor and vagi­nal area are quite stretched, bring­ing porous blood ves­sels at the sur­face of the vagina close to air. There are records of air enter­ing the vagi­nal blood ves­sels in this posi­tion and mov­ing to the heart as a fatal air embolism.

Adap­ta­tion: Use the child’s pose, with the seat down rest­ing on the heels and the elbows on the ground, hands one on top of the other, and fore­head rest­ing on the hands. Keep the heart above the pelvis.

_________

Con­traindi­cated: Rest­ing on the back dur­ing relaxation.

Adap­ta­tion: Rest in the side-lying posi­tion. About 75% pre­fer the left side, 25% pre­fer the right side.

_________

Con­traindi­cated: Abdom­i­nal crunches and oblique exer­cises can con­tribute to dias­ta­sis recti in some women. The trans­verse abdom­i­nal mus­cle is not always able to main­tain ver­ti­cal integrity at the linea alba, and thus there is tear­ing and/or plas­tic­ity of that cen­tral con­nec­tive tissue.

Adap­ta­tion: Splint­ing with curl-downs, see posi­tions below. By press­ing the sides of the abdomen toward the cen­ter, women can con­tinue to strengthen the trans­verse abdom­i­nals with­out the shear­ing forces that place lat­eral pres­sure on the linea alba.

Curl-downs are gen­er­ally the safest and most effec­tive abdom­i­nal stren­then­ing exercise.

Splint by cross­ing arms and pulling toward cen­ter (L)

Or, splint by plac­ing hands at sides and press­ing toward center ®

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Safe Motherhood

By anncowlin | Published December 27, 2010

The chal­lenges to safe moth­er­hood vary depend­ing where in the world you live. In some areas the chal­lenge may be to get ade­quate nutri­tion or clean water; in other areas, it may be to pre­vent infec­tion; and in still other loca­tions it may be try­ing to avoid preg­nancy before your body is ready or get­ting access to pre­na­tal care. In the U.S., it may mean avoid­ing being seden­tary and mak­ing poor food choices, or hav­ing to deal with the high tech­nol­ogy envi­ron­ment of med­ical birth that can sab­o­tage the innate phys­i­o­log­i­cal process of labor and birth.

Birth begins the bond­ing or unique love between mother and child.

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.

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Safe Birth — Who’s in Charge?

By anncowlin | Published July 23, 2010
Who Con­trols Birth? Defin­ing the Argument.

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.

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Worthy Global Human Endeavors

By dancingthrupregnancy | Published July 21, 2009

There are only two truly wor­thy global human endeavors:

1. Humane Birthing. Find out more from the White Rib­bon Alliance for Safe Motherhood.

2. Space Explo­ration. Find out more from the Augus­tine Com­mis­sion.

Pass it on.

If you are not yet con­vinced about the global need for humane care for preg­nant and birthing women, google (or bing, or yahoo…) “fis­tula.” If you want more first world infor­ma­tion, com­pare med­ical birth with what’s on YouTube; while these two approaches to birth are at odds in con­tem­po­rary med­i­cine, in a humane set­ting they are both necessary.

As for space, let me para­phrase Craig Nelson’s notion:  In time, the Earth will per­ish. This is noth­ing you need to lose sleep over. It will be a long, long time before this hap­pens. But, we need to start now to pre­pare. In time, the Earth will per­ish, and we will need to be some­where else when that happens.

These two things will reap all the rewards that need be reaped. The enabling of safe moth­er­hood and our move­ment into space are the only things that ensure human survival.

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