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Pregnancy Pathway, Birth – Labor

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The First Stage of Childbirth is the long, hard labor. It is the slow process that produces dilation, or opening, of the cervix – the “neck” or outlet at the bottom of the uterus. Once the baby’s head can fit through the open cervix, it is time for the Second Stage, but that is another topic for another post.

Labor is generally a long, slow process...there is no "enter" button for dilation!

Labor is generally a long, slow process...there is no "enter" button for dilation!

Before the baby can leave the mother’s body, s/he must leave the uterus. The opening of the cervix to let the baby out of the uterus generally takes up the most time. For a first time mom it can be 10 or 12 hours…or, yes, a couple of days. Of course, for some moms, this time is difficult and for others it only becomes difficult in the last few hours.

But, you know all this, right? What you want to know is:  Why do I have to go through this? And, if I must, how can I make it the least painful?

Why labor is important. Let’s go to another question:  How important would your offspring be if it was no big deal to drop one out? If you were walking along the sidewalk and you could simply drop a newborn on the pavement, would you even stop to pick it up if you could do it again in a few days, when, of course, it will be much more convenient?

Frankly, pregnancy and labor remind us to pay attention. A newborn cannot survive on its own for at least two years. If we don’t pay attention, it will die.

Okay, now that labor has your attention, what else does it do that is beneficial? It stimulates the baby’s stress response and teaches the newborn to be alert during situations of duress. Each contraction is pulling the cervix, helping it slowly open. If you are upright, each contraction is also alerting the baby to the influence of gravity.

Why is labor painful? So, you need to go through this because it is the bridge from pregnancy to parenthood. Why does it have to be painful?

The first thing to keep in mind about pain is that pain is a combination of sensations and emotion, mainly fear. Fear makes you tense; tension reduces blood flow. Reduced blood flow to the uterus makes the contractions less effective. In addition, cortisol is released, making sensations stronger and evoking greater fear.

Fear is the emotion of fight or flight. Interestingly, the opposite response, the relaxation response, is very effective in promoting labor. So, relax. Breathe deeply and slowly, focus, move through the center of your experience. You don’t have to be in fear if you know what is happening and if you are physically fit and prepared. Both childbirth education and physical fitness teach your body to work with discomfort. By including them in your preparation, you give yourself a tremendous advantage.

Does this mean you will never feel like you want to stop in the middle of labor? No, but it does mean you can do it. It is finite. The notion that the baby will not do well is also tied to your physical fitness…babies of fit mothers less often experience fetal distress. Your care providers will let you know if there is some factor beyond your control that requires medical intervention.

Birth is an empowering event. But, before the baby can be born, it must escape the uterus. It is a classic conflict and the mother’s body is the venue. Give yourself over; go with it. Only women can do this.

Pregnancy Pathway, Birth

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There is no birth of consciousness without pain.

Birth is a process with two major components

Birth is a life process with two major components

Okay, be here now:  This is about a really major experience…bringing human consciousness into the world…opening a door to a room of love in your heart that you can only know by giving birth to this person…changing your identity forever.

Getting your mind around the image: If you have not taken the time yet to get your mind around this, take a moment. Breathe in deeply. Gently blow the air out. Repeat. Repeat. Let go of any resistance. Slow your heart. Slow your mind. Consider:  Your body has the power to create a person. Your body has the power to expel this person when the rent is up.

Your brain, glands and organs are having a conversation with the baby’s brains, glands and organs. At some point, this discussion reaches a place where it is time to end this arrangement of two people sharing one body. It is true that occasionally the passenger doesn’t want to leave, but that is rare. And, we have a remedy for that. Let’s just focus now on the what happens when it’s time to go.

Labor starts how? Well, it depends. Sometimes contractions start in fits and spurts and take a while to get organized. Sometimes they start strongly from the get go, and for others the process of getting rolling can take a few days. Sometimes it starts early, and sometimes has to be helped to start. Once in a while, the water breaks and labor starts…or not. So, the first lesson of having a child come to live with you is that you need to be flexible in your expectations.

In the next two posts, we’ll cover Labor and then the Birth Mode. Each of these processes is unique. They involve different energy systems. They require different mind-sets from the mother and her support team. The outcomes are different. Going through the center of these processes helps you deal with them, helps you recover from their strenuous nature and helps you move on to being a parent.

Remember: Breathe in deeply. Gently blow the air out. Repeat. Repeat. Let go of any resistance. Slow your heart. Slow your mind. Consider:  Your body has the power to create a person. Your body has the power to expel this person when the rent is up.

Pregnancy Pathway – Review and Labor begins!

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Just to let readers know where we are on the pregnancy pathway, here is the large graphic. We have just finished Pregnancy and are getting ready for Birth. Labor is beginning…are you timing those contractions?!! If you have want to review any of the content prior to Birth, you can scroll down and find an entry for each bubble. Or, use the Search Topics tool on the right side bar for a faster find.

So far, the blog has covered through Pregnancy; next Birth (purple)

So far, the blog has covered through Pregnancy; next Birth (purple)

Twins & Triplets – Exercise & Nutrition Tips

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A detour: We received a question about nutrition and exercise for multiples. So, here is some information for those with twins and triplets. Add a comment if you have a question or experience to share on this topic! Next comes birth, we promise!!

If one is a girl and one is a boy, they're fraternal!

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.

Pregnancy Pathway, Pregnancy – Behavior: Avoiding Risks

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Sometimes it seems like pregnancy is a time of restrictions. Avoiding risks can be one thing that makes it seem that way. But, bear with us here in an interesting trip through danger and finding you find ways of enhancing your pregnancy!

Risk Factor #1:

Lack of prenatal care. More than anything else, be sure you have care. Having someone monitor your health and that of your baby during pregnancy is vital to a good outcome.

Risk Factor #2:

Not exercising. Sedentary behavior increases the risk for metabolic, cardiovascular and immune disorders.

I know, I know, you don’t have time to exercise. Well, pay now or pay later, as they say. Make time to go to a class (make sure it includes 20 -30 minutes of aerobics) a couple times a week. A class will also provide social support, another factor that enhances your pregnancy. Take a walk at lunch time. Practice relaxation techniques.

Risk Factor #3:

Breathing dangerous fumes. Yes, this includes smoking and second-hand smoke. But, it also means avoiding environments where there is a lot smog (near highways), living with mold or dust, and fancy cleansers that may have dangerous chemicals in them. Stick with vinegar, ammonia or bleach as cleansers.

Smog can endanger your fetus!

Smog can endanger your fetus!

We are learning that combustion exhaust from cars and trucks can negatively affect birth weight and prematurity. If you live or work near a highway or in an area where smog is prevalent, what are your options? Can you transfer or move? Can you wear a mask? Talk to your care provider and figure out the best protection for you and your fetus.

Risk Factor #4:

Poor Nutrition. Yup, just go back one entry and find out how food affects pregnancy. If you don’t eat enough protein and drink enough water, you don’t make sufficient blood volume to nourish your placenta and thus your fetus.

Read labels!

Read labels!

Eat whole foods and learn to read labels when you buy processed foods. What is a “processed” food? Anything with more than one ingredient!

Some processing (ex: homemade soup) takes little nutrition away, but some processing (ex: potato chips) takes everything good away and replaces it with unsafe substances. Look for low sodium, low sugar, high vitamin and mineral content items with no saturated or trans fats.

Read the ingredients; if you don’t know what the words mean, maybe you want to pass it up.

Risk Factor #5:

Alcohol and Drugs. Common items can be as dangerous as street drugs, which

There is plenty of time in life for a glass of wine...later.

There is plenty of time in life for a glass of wine...later.

No. No. No. Only meds from your prenatal care provider are okay.

No. No. No. Only meds from your prenatal care provider are okay.

Caffeine? Only one cup & only if you must.

Caffeine? Only one cup & only if you must.

can severely compromise you baby’s future. If you have a drug or alcohol habit, get help.

Risk Factor #6:

Genetics. You can have genetic predispositions for many pregnancy issues. However, that does not necessarily mean you will develop a given disorder. For example, nutrition and exercise greatly reduce the risk and severity of metabolic issues. Some genetic issues are unavoidable however, and your care provider will alert you to these, if they are relevant.

Risk Factor #7:

Social issues – isolation, lack of support, abuse, poverty. All of these factors can have negative effects.

If isolation is a simple matter of needing to meet other moms-to-be, join an exercise program. That way, you get both support and exercise; just be sure it includes aerobics, along with centering, relaxation and appropriate strength.

If your situation is more dire, seek the help of a care provider or social worker at your local hospital or clinic. Safety and support are critical for you at this time. Get the help you need. There are people who care. And, if you know of someone who needs help, help them.

If you have other risk factors to offer, please post them in the comments. Thanks!

What’s next?  BIRTH!!

Pregnancy Pathway, Pregnancy – Nutrition

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Fresh fruit = vitamins & minerals!!

Fresh fruit = vitamins & minerals!!

Question:

How many extra calories do you need in each trimester to offset the metabolic cost of pregnancy?

Answer:

First trimester – 0; Second trimester – 300; Third trimester – 500 (source: Institute of Medicine).

Keep in mind that you may also need calories for any fitness program you are doing. If you are continuing a program, the only change is due to the pregnancy.

If you begin or increase your activity, you need to take that into account. One yoga class = 100 – 150 calories. One aerobics class = 200-400 calories. Walk one mile = 100 calories.

1 slice whole grain bread = 50-100 calories

1 slice whole grain bread = 50-100 calories

Be sure you read food labels so that you can balance your food intake and your calorie output. A small woman (under 5’3″ & 130 lbs.) probably needs about 1200 calories per day as a base. A medium sized woman needs about 1400, and a large woman (over 5’9″ & 160 lbs.) probably needs 1600 to 1800 calories. Add your activity and pregnancy needs to your base amount.

Question:

What foods are necessary for a healthy pregnancy?

Answer, part A:

PROTEIN. Lean proteins like turkey and those with omega 3 fats like ocean fish and eggs….yes! EGGS!

Turkey is a good protein

Turkey is a good protein

Ocean fish 1 or 2 times/wk = good protein & omega 3 fat

Ocean fish 1 or 2 times/wk = good protein & omega 3 fat

Eggs are a perfect pregnancy food!

Eggs are a perfect pregnancy food!

70-90 grams of protein are necessary each day, along with  adequate water.  These are needed to make an extra 40% blood volume required to support the placenta.

Answer, part B:

WATER. Two (2) quarts of water…more if you are very active…are needed to make extra blood and to prevent dehydration.

Question: What else?

Fresh vegetables also provide fiber

Fresh vegetables also provide fiber

Answer: CARBS. Fresh, colorful fruits & veggies provide necessary vitamins and minerals, as well as fiber. Eat 5 servings a day from all the colors:  yellow, orange, red, purple and green, and you will get live vitamins all day long that help your baby develop properly! Fruits, vegetables and whole grains are low glycemic index carbohydrates – the good ones!

Dairy provides calcium

Dairy provides calcium

Question:

Do I need dairy products and red meat? Can I get the needed minerals in other ways?

Answer:

Calcium is needed in adequate amounts for bones and teeth. It is most easily obtained by drinking milk or eating cheese, yogurt or cottage cheese. Soy, dark green leafy vegetables and calcium fortified juice are alternatives.

Iron is necessary for red blood cells to take up oxygen. It is found in high amounts in beef,  and lesser amounts in raisins, spinach, and prune juice. Prenatal vitamins are your insurance against deficiencies of these essential minerals.

Question:

Anything else that’s essential?

Answer:

Yes! Healthy FAT!!

Avocado is an excellent source of omega 6 fat

Avocado is an excellent source of omega 6 fat

In addition to omega 3 fats found in fish, walnuts and flax seeds, you need also need omega 6 fats, which are found in avocados, olive oil and other vegetable oils. Healthy fats help balance cardiovascular constriction and dilation, reducing the risk for hypertension.

Last Question:

What is a healthy weight gain?

Answer:

In 2009, the National Academy of Sciences revised its recommendations. It now bases desirable weight gain on pre-pregnancy BMI (Body Mass Index…google this!).

BMI less than 18.5 (low) – 28 to 40 lbs.; BMI between 18.5-24.9 (normal) – 25 to 35 lbs.; BMI 25.0 to 29.9 (high) – 15 to 25 lbs.; obese women (BMI over 30.0) – 11 to 20 lbs.

Coming Next: Avoiding Risks.

Pregnancy Pathway – Exercise cont’d

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MORE?!! You didn’t think that was it? Only a few comments on evidence as to WHY moving around, burning calories, being strong and learning to relax while pregnant is beneficial? No, of course not. You know there is more to it, like WHAT movement is safe and effective during pregnancy?

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 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

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™

Pregnancy Pathway – Exercise

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How lucky is this? Just a few days ago, yet another study was released and has been circulating on Medscape and other medical sites that indicates exercise is beneficial in pregnancy, whether the mother is a previous exerciser or not. Just in time for this entry!

Behavior Affects Pregnancy Outcome

Behavior Affects Pregnancy Outcome

Physical exertion (we call it “exercise” nowadays) is a normal state for healthy humans. Only in the last century has the desire to rest or the need to store extra calories as fat become more possible to achieve than our need to move about to survive.

Pregnancy is a state in which both of these factors (resting and storing calories) are enhanced through organic changes in body chemistry, adaptations that favor fetal survival. The current sedentary lifestyle exaggerates these metabolic changes and results in syndromes that increase the risk for a number of metabolic, cardiovascular and immunological disorders of pregnancy.

When confronted by the idea that it is counterintuitive to think exercise in pregnancy might be safe (let alone beneficial) I am dumbfounded. To me, it is counterintuitive to think that a sedentary lifestyle in pregnancy might be safe!

Burning Calories in Pregnancy Improves Outcomes!

Burning Calories in Pregnancy Improves Outcomes!

What is the evidence that exercise in pregnancy is beneficial? Keep in mind that some studies have been executed more expertly than others. But, what is compelling is that numerous well-respected researchers have sought to test the hypothesis that exercise is not safe, but come away with results that indicate the opposite!

Here are some of the major findings:

• The placenta is larger and has more transport surface in exercisers than sedentary women

• The fetuses of (aerobic) exercising mothers make beneficial cardiovascular adaptations

• Women who do aerobic exercise are less likely to develop severe preeclampsia or gestational diabetes, and the long term health problems that accompany these disorders

• Women who are aerobically fit recover from birth 10 times faster than sedentary women (as measured by time needed to metabolize free radicals produced in labor)

• Women who exercise in pregnancy are more likely to be physically fit in midlife

• Babies of aerobically fit women are at reduced risk for prematurity and low birth weight
DTP_mover2
So, we have arrived at the take-home message: MOVE!! Pregnancy works best when you move and burn calories in a moderate to vigorous fashion. But, alternate this activity with rest and good nutrition, and be sure to stay well hydrated.
If you want more specifics and resources on this topic, try these:
“Women and Exercise” in Varney’s Midwifery.