This is the time of year many of us consider where to make our charitable contributions. We have assembled a list of groups to which you might want to consider giving this year. By donating to these organizations you can help improve the lives of mothers, newborns,children and families around the world. Most will also send a card or email message to a 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.
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.
Clean Birth. Clean Birth Kits are designed to provide birth attendants and/or expecting moms with the tools they need to ensure a clean birthing environment. The Kits ensure the WHO’s “6 Cleans”: clean hands, clean perineum, clean delivery surface, clean cord cutting implement, clean cord tying, and clean cord care.
March of Dimes. The “mother” of all charities for helping prevent and treat disorders and diseases that affect children.
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:
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 ®
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.
It’s time to hit the main theme again: Aerobically fit women are at reduced risk for things that go wrong in pregnancy, improve their tolerance for labor and birth, and recover more rapidly in the postpartum period.
Moving into Motherhood
The arrival of the holidays provides a good reason to bring this up, yet again! Pregnancy is a gateway time in women’s lives…we become more aware of our bodies, our sensations, our feelings, our needs, and how versatile and amazing our bodies are. We can make people with our bodies! During pregnancy, we often take precautions…we eat more carefully, avoid toxins, try to avoid stress. When the holidays arrive, we see indulgent behavior in a different light.
Yet, even with all this focus on behavior, we sometimes miss the biggest aid to a healthy pregnancy: physical fitness. Research clearly demonstrates that fit women do better, are healthier and happier. More and more in the U.S. we see disorders of normal organ function that accompany sedentary pregnancy.
Let’s look at this a little closer (yes, I am going to repeat myself some more, but it is an important concept to spread). We live in a body model that rewards an active lifestyle.
Being sedentary causes things to go wrong
Not moving creates biochemical imbalances because the cardiovascular system atrophies and molecules created in the brain or brought in through the digestion may not get where they need to go for a healthy metabolism.
Your cardiovasculature is the highway that brings usable substances to the place they are used. You have to help it grow and develop, use it to pump things around and give it a chance to be healthy. Aerobic fitness does all these things.
Advice for young women of childbearing age
If you are thinking of pregnancy, have recently become pregnant, or work with women of childbearing age, we encourage you to open avenues of activity for yourself or others in this population. You can learn more from our blog dancingthrupregnancy.wordpress.com. You can seek out local pre/postnatal fitness experts on this site. Yoga is nice…we use some of it in our work, along other specific exercises for which there is a direct health benefit. But, we also see yoga converts who come into our program in mid pregnancy unable to breathe after walking up a flight of stairs. How will they do in labor? Not as well as those who have been doing aerobic dance or an elliptical machine 2 or 3 times a week.
The AHA/ACSM guidelines for the amount of aerobic exercise needed to improve cardiovascular status hold true for pregnant women just as they do for the rest of the population – a minimum of 150 minutes of moderate, or 75 minutes of vigorous, or a combination of these levels of intensity, per week. If you are not getting this level of activity, you are putting your health – and that of your offspring – at risk.
Recently, we have experienced growing interest in information included in the textbook, Women’s Fitness Program Development. So, we decided that site readers might want to purchase this text if they are seriously interested in subjects pertaining to women’s health fitness. The book opens with a chapter on how women differ from men in their physical, mental, emotional and social development and how these differences affect our motivation to be active. Sections on adolescence, pregnancy, the postpartum period and menopause explain what happens during these critical and uniquely female life transitions, what is known about the impact of exercise on health during these times, and how to develop effective programming for these populations. It is available through the publisher, Human Kinetics, or through Amazon or Barnes & Noble.
While public awareness of low birth weight and premature infants is becoming — at long last — interesting to the mainstream culture and media, another phenomenon is beginning to shake the professional birthing world: high birth weight. Because it is occurring in a more affluent element of society, it is alarming. This tells us that you cannot buy your way out of pregnancy risks that are created by a sedentary, toxic food life-style.
Here is the dilemma:
Normal weight and some overweight women who eat too much in pregnancy tend to have babies who are, basically, already obese at birth. Therefore, these infants already have metabolic and cardiovascular dysfunction. Babies born over 8 lbs. 14 oz. are at increased risk for Type 2 Diabetes and heart disease.
Interestingly, the Institute of Medicine recently issued new guidelines on pregnancy weight gain. After nearly 20 years of adhering to the “normal” weight gain being 25 to 35 pounds, the Institute recognized that prenatal BMI plays a role in how much weight gain is necessary for a healthy pregnancy.
The evidence that underlies this change demonstrates that gains greater than 22 pounds — for all classifications of prenatal BMI — is the demarkation point for increased health problems. More information on this is available at: New IOM Guidelines.
We have known for a while now that obesity in pregnancy puts mother and infant at risk for a number of problems from cardiovascular, metabolic and immune disorders to prematurity, low birth weight, increased need for cesarean birth and slow recovery. Add another one: Obese newborns with increased risk for heart and metabolism problems.
Reference on weight gain and high birth weight:
Ludwig DS, Currie J. The association between pregnancy weight gain and birthweight: a within-family comparison. Lancet. 2010 Sep 18;376(9745):984–90. Epub 2010 Aug 4.
A good reference for issues surrounding obese pregnancy:
Leddy MA et al. The Impact of Maternal Obesity on Maternal and Fetal Health. Rev Obstet Gynecol 2008;1(4):170–178.
Pregnancy fitness is not only important for moms, but for the fetus as well. Evidence is clear that aerobic fitness improves brain, heart, immune and metabolic function…at all ages, including in utero. If continued early in life, healthy physical adaptations that occur in the uterus become reinforced behavior, preparing a good foundation for a healthy lifestyle. Babies are acute observers of movement and activity, and learn from each other. A key component of a good mom-baby program is the interaction of the babies themselves. A good teacher will facilitate healthy activity among our smallest class members!
There is growing evidence that at all ages, aerobic fitness produces the greatest number of benefits. Recently, researchers determined that aerobic fitness in 9 and 10 year olds produced benefits in the development of two important brain regions — the basal ganglia and the hippocampus — that are significant factors in problem-solving intelligence. This is just one of the latest reports that tells us the capacity to absorb and use oxygen (which improves with aerobic fitness) is a key to health, quality and length of life…beginning in the womb!
Recent CDC Guidelines on Exercise for the general population include pregnant and postpartum women. Specific information for pregnant women is included at this URL:
James Pivarnik, PhD, president of the American College of Sports Medicine has released a Medscape video for health care providers encouraging them to be aware of the fact that the CDC considers a minimum of 150 minutes per week of moderate activity (or 75 minutes of vigorous activity for athletic women, or a combination of intensity for fit women) to be important for pregnant women, along with the general population.
DTP’s Total Pregnancy Fitness instructors learn how to combine activities so that women receive an adequate amount of exercise each week during their pregnancy. To find out about becoming a teacher, click on Become a Teacher above.
This is the time of year many of us consider where to make our charitable contributions. We have assembled a list of groups to which you might want to consider giving this year. By donating to these organizations you can help improve the lives of mothers, newborns,children and families around the world. Most will also send a card or email message to a mom in whose honor you give the gift.
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.
