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.
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!
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.
There is no birth of consciousness without pain.
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.
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!
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.
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!
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.
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.
No. No. No. Only meds from your prenatal care provider are okay.
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!
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 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 — 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!
Hot topic for today: Toxins and infections in pregnancy.
Pregnancy Exposure to Toxins and Infections
A mother-to-be needs to be aware of items that can have adverse effects on the health and development of her fetus, as well as her own health. Two of these factors are toxins and infections.
1. Toxins can be food, environmental factors, and medications, alcohol or drugs. Let’s start with food. Interestingly, many plants have slight toxins in them that can have a small negative impact during early fetal development. One theory of nausea and vomiting in early pregnancy is that this helps the mother’s body prevent these toxins from interfering with normal development. Pica — especially eating dirt that is largely clay — may be another manifestation of how the body strives to counter plant toxins, as clay can counteract some of the effects of these toxins. So, plant toxins can be one food source in early pregnancy.
Another source is food additives (things you cannot pronounce, so read the ingredients!). We have no idea how many chemicals and hormones added to foods affect fetal development.
Environmental factors that may affect fetal development can include air pollution, household cleansers, mold and other items encountered anywhere one goes. Things we breathe can be particularly dangerous, so be sure to keep cleanser use to simple items such as vinegar, ammonia or chlorine bleach. Wearing a mask while cleaning is also a good idea.
Medications, drugs or alcohol that might normally be considered safe for a non-pregnant person — something as simple as aspirin — can be dangerous as they affect blood clotting factors and threaten the placenta. Or, because they cross the placental barrier but cannot be metabolized by the immature fetal liver, they are toxic and induce damage to the fetus.
2. Infections are of concern, as well. It is possible that an active infection at the time of fertilization and implantation can contribute to dysfunction in pregnancy because it interferes with the normal immune responses of early pregnancy. Hypertension in pregnancy may be related to infection in the early days of pregnancy. Some infections — particulary sexually transmitted infections — are known to have detrimental effects on the baby’s health. Preterm premature rupture of membranes (P-PROM) almost always reflects active infection.
Taking Precautions: First, be sure to let your health care provider know about any illness or infection. Second, take care of yourself. Follow recommendations for frequent handwashing and carry sterile hand gel in your purse or backpack. Avoid places where hygiene might be compromised. Practice safe sex.
Since Health Care Reform is a hot topic, let’s look at it from the perspective of pregnancy and birth.
What revisions would most benefit pregnant women, their offspring, families and communities?
1. Reward healthy behaviors. A system that provides reduced premiums for health care for women who exercise, eat well, do not smoke and are in a normal weight range is evidence-based.
Yes! We could provide financial incentives for being healthy during pregnancy. Why? Healthy moms have healthy babies; healthy babies cost the payer less money.
2. Review best practices. Is a 40 or 50% cesarean rate the best practice? Accompanying the rise in cesarean births is growing information that babies born by cesarean are at increased risk for a number of immune disorders. But the business model of medicine rewards cesarean because it both pays the provider more and is defensive medical practice.
Fetal monitoring to determine if a cesarean may be necessary, is wrong 3/4 of the time. In an effort to change this, guidelines are changing for the use of monitors during labor. What is the evidence that this change of practice is beneficial? Will it lead to more or less monitoring, which may itself be an intervention that can disrupt normal labor?
3. Change the business model for health care. When we make financial incentives for care providers, base them on best practice, not on enriching the middle man. Currently the payers (insurance companies) are middle men, making money (i.e., conducting business) by charging fees. They ration payments for services in order to pay their own salaries and overhead. They do not actually do anything productive. This is why single payer, government, and health care coop options have been proposed. They eliminate most of the cumbersome middle layer.
Why does insurance pay for cesareans? Well, they will do it once. After all, the care providers have to practice defensive medicine. But, once you have a cesarean, you become a risk for the insurance company (they know what the research says about cesareans and offspring health problems) and may be denied insurance. They can no longer afford you.
Because care providers are paid fee for service and must practice defensive medicine, pregnancy and birth have become increasingly burdened with intervening procedures that do not necessarily promote a healthy pregnancy or birth process. How is this playing out? Increasingly, we see women giving birth in what they perceive as a more supportive and health-inducing setting: their own homes. Think of it this way: many women now believe that it is safer to stay home than go to a hospital to give birth.
Unless health care becomes about best practices and healthy outcomes — not price, size, and getting paid for passing money back and forth — the U.S. will continue to have some of the worst maternal/infant outcomes in the developed world.
Let’s start at the beginning…in the first trimester you feel sick and tired, right? Three things:
1) your immune system is pro-inflammatory (causing nausea and fatigue), 2) your body is protecting your fetus from some toxins (if you eat something not so great for the fetus, you throw up), and 3) you have extreme swings in blood sugar levels so that after you eat, the level soars and you feel sick.
Number 3 can be fixed with behavior, but you may have to wait out 1 & 2. To fix number 3 eat very small meals frequently (6 or 8 times a day) and be sure to eat protein, that is, eggs, meat, fish, fowl, cheese, nuts, rice & beans, soy, etc. with each small meal. This stabilizes blood sugar and prevents dramatic elevations that can cause nausea.
In most healthy pregnancies, the immune system will rebound in the second trimester so that you feel good; it is protecting you again! But, those wicked toxins and infections are still out there in the environment, so the message is beware bad air (smog, smoking, industrial air pollution), highly processed foods (lunchmeats, things with names you can’t pronounce), any drugs or meds not prescribed or okayed by your ob or midwife, alcohol, and dangerous bacteria, viruses and other microbes!
Exercise wisely…no sky-diving or scuba diving! Eat healthy food and get enough sleep. De-stress through relaxation and meditative techniques. Don’t take risks with your health, but do stay active and start to prepare for birth and bringing home a baby (or two?).
Third trimester & the immune system goes on the fritz again — can’t keep this baby in here forever; must expel! You may feel sick and tired again. BUT, keep your prenatal care appointments, keep moving, get good nutrition, rest and stay focused. Before you know it the real work begins, not to mention the 18 years of sleep deprivation.
Getting from here…
Being Fully Present in Your Pregnancy…
Being Fully Present as Mom.
…is a journey like no other. The adaptations of your body to the demands of pregnancy are amazing. If you pay attention, you will learn more about the meaning of existence from this than from anything else.
BE HERE NOW!!
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