“We labored at home for six intense hours, went to the hospital, and he was born forty minutes later. J did such a good job coaching the doctor asked, “Have you taken a birth preparation class?” We got a lot out of your class — thanks a million!!” — A, J & E
“We both feel we had a beautiful birth story that was made up of well educated decisions. From the entire birth team, even though it was not at all what we had envisioned. Thanks Ann for your instruction and class that equipped us for such success!” — O.A .& S.Q.
“We’re happy to report our baby 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 I’d been practicing my c‑curves twice a week!” — 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 have long known that vaginal birth and breastfeeding are key factors in the development of a healthy immune system in infants. Passing through the vagina exposes the baby to an array of bacteria that help stimulate its unchallenged immune system. Breast-fed babies receive anti-bodies, proteins and other molecules that protect it from infection and teach the immune system to defend the infant.
Breastfeeding is key for long-term health.
Recent research at UC Davis has shown that a strain of the bifido bacteria — acquired from the mother — thrives on complex sugars (largely lactose) that were previously thought to be indigestible. The bacterium coats the lining of the immature digestive tract and protects it from noxious bacteria.
This combination of interactions affects the composition of bacteria in the infant gut as it matures. Another example of how evolution has “invented” the perfect nutrition for infants, this research contributes to the notion that evolution has selected for many genes that serve normal birth and breastfeeding by protecting the newborn. Intervening with the normal progression of birth and breastfeeding — while occasionally necessary — interrupts these beneficial adaptations and contributes to allergies and autoimmune disorders.
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.
I love Yoga. But…Power Yoga, Hot Yoga, Fast Yoga, Pilates-Yoga, Fresh Yoga, Baby Yoga and even Prenatal Yoga…not so much. I find these phenomena strange.
Why? Well, 40 years ago – when I first learned Yoga – it was a privilege. A person came to Yoga in the search for a meaningful life path. It was a blend of the spiritual and the physical, and it required a commitment to what was revealed within the practice. Before being allowed to take my first class, I had to demonstrate that I already practiced meditation. It was not exercise per se.
It was not adaptable like it is today. Depending on the teacher, you learned an ancient system – Hatha, Vinyasa, Ashtanga, Iyengar, or Kundalini. Those were the major methods that have Hindu roots, and those who practiced these art forms knew what they were doing. The teachers themselves had worked on their craft for decades. Today, I know only a few teachers who have a profound grasp of each of these methods.
Why is Yoga so popular?
Is there something within the work itself – even in the diluted forms, hybrid versions and the celebrity/competitive studios – that allows it to thrive in the self-centered, free-wheeling, branding-crazy marketplace of the early 21st century developed world?
I find the answer to this in a strange place: Zen practice, Bhuddism. One of my favorite notions is from Suzuki’s text Zen Mind, Beginner’s Mind. “When you feel disagreeable, it is best to sit.” This is an element of nin – constancy – or being present in the moment. Not patience, which requires a rejection of impatience and therefore cannot accept the present as it is. When you sit – just sit period, that’s it – all that is real is the moment. This is at the heart of all spiritual experience.
I’m not an expert in Yoga. I don’t teach Yoga, although I have integrated Yoga-based skills into my work. I have practiced Hatha and Vinyasa over the years enough to learn how certain skills are treated…belly breathing, slow deep breathing, maintaining position and listening to the wisdom of the body, and isometric strengthening in preparation for more expansive shapes or motions. Long ago, I integrated these skills from my Yoga experience into my teaching style because these skills are effective for the populations with which I work. But, I do not teach Yoga.
Can Research Help Us?
Researchers find Yoga a nightmare. There is so much variance now in the practice that findings from any one study cannot be transferred to the general population. One of the most revealing experimental-design studies found that none of the claims of Yoga improving metabolism could be demonstrated. When asked why they thought this outcome had occurred, the teachers who were used in the study said they thought the participants in the study were not fit enough to do Yoga!
One of the most successful Yoga teachers in my area, and one of my favorites, has for decades used a bicycle for her primary mode of transportation. She credits her longevity and success to Yoga. I attribute it to bicycling. Dr. Cooper is right…fitness (which means aerobic fitness) is the biggest bang for the buck. Unless you are fit, it is hard to execute some of the more subtle demands of many exercise regimens.
Some Yoga teachers will say that you can make Yoga aerobic or that some forms are aerobic. OK, then it’s aerobics, not Yoga. Whenever I see “aerobic Yoga” it reminds me of aerobic dancing. It’s helpful to remember that Yoga developed in a time and place where survival was dependent upon fitness. People didn’t need to do more aerobics to find enlightenment. They needed reflection and to be present in the moment.
So, I insist on aerobic fitness as the first goal of a fitness regimen. In the pre/postnatal field, this is the only consistently demonstrated factor in improved outcomes. As a birth preparation there are Yoga-based factors that will help in labor and birth IF THE WOMAN IS FIT ENOUGH. It is the fact that some Yoga-based skills help fit people find nin that is my justification for continuing to use them in conjunction with aerobics and special pre/postnatal preparation and recovery exercises.
But, there are cautions. Not all Yoga assanas (positions) are safe for pregnancy. Down-dog, in particular, scares me because of incidents reported in obstetrical literature in the 1980s and 1990s that indicate such a position is implicated in fatal embolisms. Some shapes are just not doable and others become less comfortable over time. The ones that work have been identified since the 1940s and 1950s and integrated into birth preparation courses.
What’s Next?
All exercise components -
Mind/Body
Strength
Flexibility
Aerobic or Cardiovascular Fitness
- are necessary for a balanced fitness routine. Too much emphasis on any one factor often results in injury. Aerobics is where the greatest health benefits reside. Recent research has demonstrated that it is physical “fitness” (which we can measure) as opposed to just spending time in physical activity (which can be a wide range of intensities) that is responsible for improved health outcomes. Strength and flexibility training need to be purposive. There are things we don’t need to do unless we are going to play pro football or dance Swan Lake! Mind/Body skills help us recover and prepare.
I for one will be glad when we get beyond yoga and back to cross training!
Find out about the latest in evidence-based practices for a healthy pregnancy, birth and recovery. We support Safe Motherhood in the U.S. and worldwide. Twice a year we review important findings from valid research in the field of pre/postnatal fitness and healthy pregnancy behavior. We also discuss environmental influences that moms-to-be and new moms need to be on the watch for.
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What is fetal programming? Every person living on earth was first exposed to a uterine environment that helped determine their lifetime health and development. The term for this phenomenon is fetal programming. It is a hot topic and deserves attention.
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.
Rachael Blum of Santa Monica, CA, has alerted us to an excellent article in the New England Journal of Medicine concerning the evidence for the role of exercise in pregnancy in helping prevent childhood obesity: http://healthcarereform.nejm.org/?p=3321&query=home. Rachael, our newest DTP family member, has also alerted us to an LA Times article on this subject: LA Times article.
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.
In the U.S. and most of the developed world, approximately 51% of the population is female. Most females give birth at some point in their lives, although, in any year, only about 2% of the population gives birth.
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
Here are two important facts regarding physical activity following birth:
1. Women who return to vigorous (vigorous, as in jogging or aerobic dance) prior to six weeks postpartum…
have less weight to lose
experience a more joyful state of mind
do better on the Lederman Maternal Adaptation scales (how well they adapt to motherhood)
…than women who are sedentary during this period (Sampselle, 1999…this is not new information)
2. Postpartum obesity is a dangerous short and long term health risk (Leddy, 2008).
Who should exercise and when, following birth?
Day 1: If you have a vaginal birth, begin your “body scan” the first chance you get. Within the first day, the first chance you get to focus on yourself, take a mental trip through your body. See if you can squeeze the kegel muscles. Try exhaling and sucking in your deep abdominal muscles. Note if your shoulders need to relax. Take some deep breathes and begin to help your body recover.
If you had a cesarean: Wait a few days to 2 weeks at most to work on this.
After that: As soon as you can, get up and walk around. Start walking in 5 or 10 minute strolls several times a day (ask someone to hold or watch baby so you can allow your body to recover a non-pregnant upright). If you had a cesarean, hold a pillow to your abdomen until you have control of your abdominal muscles and stand tall.
Find a class. If you had a typical birth and your baby has been slowly and safely exposed to new people, by four to six weeks you and baby should be ready for a structured activity session that includes baby. It will also provide focus and adult interaction during the week.
You have to teach your abdomen to be flat.
How do you know if you did too much?
Your lochia, or the bleeding/discharge from the placental site, will increase if you have been too vigorous. If you are healthy and have no anemia issues, your lochia will likely cease by three to four weeks, six at most.
What are safety issues?
Don’t exercise if you have a fever, a warm red spot on your leg that may be painful (or not), or sore nipples that need attention. Call your care provider. If you or your baby are sick, it is best not to go into a group setting. If your baby is not well or just doesn’t seem right, call your pediatrician.
The most important reason to join a mom-baby fitness program may be that it will help keep you sane.
DTP offers correspondence/online teacher training. If you are a group fitness instructor, personal trainer, or thinking about becoming one, check out the training options.
Click on the Become a Teacher tab!
Reading, class planning, and operations information are part of Teacher Training
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.
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