Pregnancy Pathway

DTP Blog: Dispelling Myths on Pregnancy Exercise

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DTP Blog: Dis­pelling Myths on Preg­nan­cy Exer­cise by Ann Cowl­in MA CSM CCE, direc­tor

At reg­u­lar inter­vals, it becomes nec­es­sary to dis­pel two per­sis­tent myths that are often per­pet­u­at­ed by well-mean­ing care providers. Both of them were debunked long ago, in research lit­er­a­ture that is read­i­ly avail­able and about which I have writ­ten a great deal, includ­ing in my chap­ters on Women and Exer­cise (edi­tions 3 & 4) and Health Pro­mo­tion in Varney’s Mid­wifery (edi­tion 5), in posts on the DTP web­site, on my Twit­ter feed (@anncowlin), on DTP’s Face­book page and in a text­book. The more com­mon myth is that preg­nant women should nev­er let their pulse get over 140 beats per minute. But, more on that one at anoth­er time. That was an ACOG guess in 1985 that long ago (1994) was rescind­ed. The oth­er is that preg­nant women should nev­er begin a new exer­cise reg­i­men, but only mod­i­fy (i.e., reduce) what they are already doing. What brings me to write this blog… read more...

Exercise and Body Trust in Birth

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In the gen­er­a­tions since birth moved from the home to the hos­pi­tal set­ting, it has become less and less fre­quent that women in devel­oped nations see birth first hand and accept it as a nat­ur­al part of life pri­or to their own first birth expe­ri­ence. The “epi­dem­ic” of fear sur­round­ing birth may well be part­ly a result of this phe­nom­e­non. In a recent post pub­lished in Mid­wives mag­a­zine, a pub­li­ca­tion of the UK’s Roy­al Col­lege of Mid­wives, DTP direc­tor Ann Cowl­in wrote a blog enti­tled ‘Exer­cise and Body Trust in Birth.’ The post address­es the con­fi­dence in one’s body that accom­pa­nies train­ing spe­cif­ic exer­cise and how this applies to preg­nant women and their prepa­ra­tion for birth. Here is the link to the blog post: http://community.rcm.org.uk/blogs/exercise-and-body-trust-birth

About Pain and Birth

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This is excerpt­ed from our Danc­ing Thru Preg­nan­cy blog.

That Was Then…

As I became involved in the birthing field, one of the nurse-mid­wives with whom I was acquaint­ed intro­duced me to Jung’s quo­ta­tion: “There is no birth of con­scious­ness with­out pain.” (Alter­nate­ly, “There is no com­ing to con­scious­ness with­out pain.”) It struck a deep chord in me.

When I first saw the say­ing, “There is no birth of con­scious­ness with­out pain,” inter­twined with a draw­ing of a woman lit­er­al­ly giv­ing birth, the truth of the image seemed obvi­ous to me. It become hard-wired into my under­ly­ing assump­tions about giv­ing birth. The process itself com­bines intense nox­ious sen­sa­tions with mid brain emo­tion­al input into what neur­al sci­ence calls pain. For years, this real­iza­tion has dri­ven what and how I teach: Being fit and edu­cat­ed in body/mind are the tools of enlight­en­ment and self-empow­er­ment.

…And This Is Now

A lit­tle while ago I came across a NY Times arti­cle “Prof­it­ing From Pain.” While the arti­cle con­cerns the huge increase in the legit­i­mate opi­oid busi­ness – prod­ucts, sales, hos­pi­tal­iza­tions, legal expens­es and work­place cost – it restart­ed my think­ing about a top­ic fer­ment­ing in my brain between That Was Then And This Is Now: The sense of enti­tle­ment to a pain-free exis­tence. The idea that pain free is bet­ter than painful. And the sell­ing of this idea for prof­it.

Where does this come from? Try­ing to oblit­er­ate pain has led to increased addic­tion, death and oth­er adverse side effects. A new top­ic has shown up in women’s health dis­cus­sions: Increas­ing use and over­dose from pre­scrip­tion pain killers by women, includ­ing dur­ing preg­nan­cy.

Could it be that human fear of pain is being used to gen­er­ate finan­cial prof­it? (the opi­um-is-the-opi­ate-of-the-mass­es mod­el). Per­haps once the notion of pal­lia­tive care reached a cer­tain lev­el of accep­tance for the dying with­in the med­ical com­mu­ni­ty, it began to spill over into oth­er human con­di­tions (the slip­pery-slope mod­el). Or, per­haps we don’t want trans­paren­cy at all (the denial mod­el).

In the last few days, NPR has raised the ques­tion of whether the high cesare­an birth rate is tied to the pay­ment for pro­ce­dure rather than out­come mod­el? The recov­ery from cesare­an is more painful than the recov­ery from vagi­nal birth, has adverse side-effects for moth­er and baby, and was orig­i­nal­ly designed for use only for the 15% +/- of real com­pli­ca­tions that arise in nor­mal birth. So, how is it being sold to 35% of women in the U.S,? At one point, there was a seri­ous dis­cus­sion with­in the med­ical com­mu­ni­ty that if women were afraid of the pain of birth and want­ed a cesare­an, a care provider should do one. No dis­cus­sion of why it seems painful or how to deal with pain.

The Afford­able Care Act aims to improve some of the cost issues in med­ical care by shift­ing the pay­ment incen­tive away from pro­ce­dures and on to out­come assess­ment. As a result, the cesare­an rate and even such seem­ing­ly innocu­ous pro­ce­dures as fetal mon­i­tor­ing are com­ing under scruti­ny. If we tru­ly want to do a ser­vice to the moth­ers-to-be in the ACA tran­si­tion peri­od and beyond, I think we must dis­cuss the ques­tion of birth and pain.

I can think of many ques­tions that fall under this topic…Why do we call the intense phe­nom­e­non of birth “painful”? How do our genet­ics, behav­ior, train­ing and thought-process­es affect our expe­ri­ence of pain? What about the health care cul­ture – has it focused on reliev­ing pain at the expense of what we gain from work­ing with pain short of trau­ma or immi­nent death? How do we pre­pare women for work­ing with sen­sa­tion with­out auto­mat­i­cal­ly label­ing it pain? Is the “empow­er­ment” often attrib­uted to giv­ing birth what is learned by going through the cen­ter of the “there is no birth of con­scious­ness with­out pain” expe­ri­ence? These ques­tions are just a start.

In closing…

Let me address the child­birth edu­ca­tors and preg­nan­cy exer­cise instruc­tors. This is our present chal­lenge. In my work, I feel the neces­si­ty to make all pain man­age­ment strate­gies under­stand­able to my clients. I find that most of the women I see in class­es must deal first with self-dis­cov­ery before they can assess their com­mit­ment to the view of birth they car­ry in their minds. The images of birth we lay out for them to con­sid­er need to include an under­stand­ing that you can­not escape the work of birth. Being present – mind­ful­ness – can be scary and intense but it is the medi­um by which our con­scious­ness expands. Car­dio­vas­cu­lar fit­ness and strength are the source of our endurance and pow­er.

DTP Offspring – Renee Crichlow: REAC Fitness

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In Part 4 of our con­tin­u­ing series on DTP’s off­spring, meet Renee Crichlow, ACSM Cer­ti­fied Per­son­al Train­er from Bar­ba­dos, whose REAC Fit­ness busi­ness includes Mum-me 2 B Fit­ness Series (pre­na­tal), After Baby Fit­ness Series (post­na­tal) and 6 week Jump­start Body Trans­for­ma­tion Pro­gram (gen­er­al female pop­u­la­tion).

See pho­tos and read more about Renee’s busi­ness on the DTP Blog here. The adven­tures of one of her stu­dents is fea­tured in a recent series of arti­cles in Bar­ba­dos Today.

Renee is a women’s fit­ness spe­cial­ist, tar­get­ing all stages of a woman’s life cycle from ado­les­cent, child bear­ing years, pre­na­tal, post­na­tal to menopause. I design var­i­ous exer­cise pro­grammes to help women get into shape. As a train­er, friend and coach, I am com­mit­ted to guid­ing, moti­vat­ing and edu­cat­ing women to exceed their fit­ness goals and to per­ma­nent­ly adopt healthy lifestyles. She start­ed study­ing with DTP in March 2012 and com­plet­ed the practicum in May 2012.

I most enjoy the good feel­ing asso­ci­at­ed with know­ing that I am help­ing women to pos­i­tive­ly change their lives through exer­cise. I have learned that we are con­nect­ed and not sep­a­rate from each oth­er. Shar­ing our chal­lenges and tri­umphs enable each of us to grow and have a sense of belong­ing like a sis­ter­hood. The baby and preg­nan­cy sto­ries always amaze me and I learn a lot con­sid­er­ing I don’t have chil­dren of my own.  I am also fas­ci­nat­ed by the fact that as the preg­nant mum­mies bel­lies grow, they are still mov­ing with lots of ener­gy and I feed off of that ener­gy.  I just love work­ing with preg­nant ladies and moth­ers.

Brain Rules for Babies — book review

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Brain Rules for Babies by Dr. John Med­i­na

Seat­tle WA; Pear Press. 2010

I strong­ly rec­om­mend this book and its accom­pa­ny­ing web­site by the author of the NY Times best­seller, Brain Rules. http://www.brainrules.net/.

The new text brings togeth­er much of the dis­parate research on fetal-infant-child brain devel­op­ment of the last few decades into a read­able whole. At the same time, it asso­ciates these find­ings with effec­tive, con­crete prac­tices and pro­vides tips for new and expect­ing par­ents. What are some of the big, take-home mes­sages of this text? Sur­vival, or safe­ty, is the pri­ma­ry goal of the brain. Hap­pi­ness is most close­ly linked to hav­ing friends. Aca­d­e­m­ic suc­cess is asso­ci­at­ed with self-con­trol. And, reward­ing effort pro­duces the great­est pos­i­tive feed­back. There’s a lot more here and on the web­site. Plus the web­site has pages of ref­er­ences and a ter­rif­ic quiz for par­ents. Links: Brain Rules for Baby: http://brainrules.net/brain-rules-for-baby. Brain Rules for Baby Quiz: http://brainrules.net/brain-rules-for-baby-parenting-quiz.

Dr. Med­i­na starts with that noto­ri­ous parental con­cern:  How do par­ents raise a smart, suc­cess­ful, calm and hap­py child? He con­sid­ers the job of par­ent­ing to be sup­port­ing healthy brain devel­op­ment – some­thing achieved large­ly by liv­ing a healthy and emo­tion­al­ly acces­si­ble life! He has the facts to back this up. Start­ing with preg­nan­cy, he pro­vides infor­ma­tion to demon­strate that the com­mon ear­ly preg­nan­cy issues of tired­ness and nau­sea serve the fetus’ need to be left alone to fol­low the genet­ic code for pro­duc­ing the body’s organs and sys­tems.

The sec­ond half of preg­nan­cy, he notes, is large­ly con­sti­tut­ed by the devel­op­ment of the sens­es, which bring infor­ma­tion to the brain, and – in the last months – the expan­sive growth of brain cells and the ear­li­est phas­es of neu­ronal con­nec­tion. He dis­pels the myths about com­mer­cial prod­ucts aimed at improv­ing IQ in utero, reviews find­ings on the adverse effects of stress, poor nutri­tion and a seden­tary lifestyle dur­ing preg­nan­cy, and reminds us that we are faced with cer­tain pecu­liar­i­ties of human birth. Ever since we became erect, we have had to get that brain out of the pelvis before it is real­ly ready.

Dr. Med­i­na moves on to the rela­tion­ship dynam­ics of the par­ents and/or extend­ed fam­i­ly and its impact on the off­spring brain. Most fam­i­lies expe­ri­ence dis­tress when an infant arrives. Rela­tion­ships are out of bal­ance, demands increase, com­fort is less­ened and there are a lot of unknowns about the nature of this new being. Learn­ing, he reminds us, takes place best when the num­ber one brain demand is met: Safe­ty. Sit­u­a­tions fraught with stress and con­flict are keen­ly sensed by infants and mit­i­gate against a sense of safe­ty.

Much of this dis­cus­sion rein­forces recent find­ings about the impor­tance of vagi­nal birth, skin-to-skin con­tact and breast­feed­ing – chem­i­cal, mechan­i­cal and emo­tion­al needs that appear in the moments sur­round­ing birth that, when met, set the stage for a bond of trust (safe­ty) that enables devel­op­ment of high­er func­tions. He reminds us that the best pre­dic­tor of aca­d­e­m­ic suc­cess is impulse con­trol, a behav­ior that results part­ly from genet­ic pre­dis­po­si­tion, but is equal­ly gleaned by observ­ing adult behav­ior from the first moments of life. This sets the stage for much of the rest the book’s dis­cus­sion using a Seed/Soil metaphor, akin to the tra­di­tion­al nature/nurture dis­cus­sion – that some of what a child becomes is inborn, and some is envi­ron­ment.

Med­i­na focus­es on preg­nan­cy through age 5. He notes that will­ing emo­tion­al respon­sive­ness com­bined with appro­pri­ate demands or expec­ta­tions appears to pro­duce the most effec­tive learn­ing con­di­tions in young chil­dren. Once they are in a safe state of mind/brain, infants learn quick­ly by watch­ing [he cites Ban­dura]. Empa­thy and clear delin­eation of bound­aries fall into line behind safe­ty as fea­tures par­ents need to pro­vide for healthy psy­chic devel­op­ment. Med­i­na gives a num­ber of exam­ples, includ­ing one about empathiz­ing with a child who needs a drink of water when there is none avail­able by say­ing: Yes, how thirsty you must be and if I could, I would get you a big drink. I’m glad you let me know how thirsty you are so we can work on fix­ing that first chance we get. [NB: I have para­phrased here for the pur­pose of my own learn­ing]. This sort of response feeds back the child’s expe­ri­ence, lets him/her know he/she is heard, sup­ports the child’s state, but lets him/her know that the solu­tion is still a bit off and that the par­ent expects the child to coop­er­ate.

There are many top­ics cov­ered with just this sort of technique…empathy and expec­ta­tions. Among them is the descrip­tion of pos­i­tive and neg­a­tive rein­force­ment. I find it is fre­quent­ly dif­fi­cult for par­ents to grasp the notion that if a child has a tantrum and the par­ent yells and screams and makes a big deal about it, that is pos­i­tive rein­force­ment, which encour­ages the child to behave that way again. Where­as walk­ing into anoth­er room and doing some­thing else till the child is qui­et – that is neg­a­tive rein­force­ment.

I like Medina’s way of explain­ing it with sci­ence bet­ter than my own, which requires too much explain­ing about how nerve cells trans­mit infor­ma­tion and how neur­al path­ways become hard­wired. His relies on more macro expla­na­tions (he is a devel­op­men­tal mol­e­c­u­lar biol­o­gist, so I real­ly bow to him on this one). Basi­cal­ly, he tells us to praise behav­ior that is good and also to praise the absence of “bad” behav­ior, because praise for effort feels good. He also tells us to let the flow of events do the pun­ish­ing. Either let a child con­tin­ue to walk around in the snow with no shoes because s/he will fig­ure out it hurts and is a ter­ri­ble idea, or remove a child from the table when s/he refuse to eat because it is bor­ing alone and s/he will fig­ure out one can get hun­gry that way. The for­mer is pun­ish­ment by appli­ca­tion; the lat­ter is pun­ish­ment by removal.

In case you are won­der­ing what these rules might be, here they are:

EXERCISE | Rule #1: Exer­cise boosts brain pow­er.
SURVIVAL | Rule #2: The human brain evolved, too.
WIRING | Rule #3: Every brain is wired dif­fer­ent­ly.
ATTENTION | Rule #4: We don’t pay atten­tion to bor­ing things.
SHORT-TERM MEMORY | Rule #5: Repeat to remem­ber.
LONG-TERM MEMORY | Rule #6: Remem­ber to repeat.
SLEEP | Rule #7: Sleep well, think well.
STRESS | Rule #8: Stressed brains don’t learn the same way.
SENSORY INTEGRATION | Rule #9: Stim­u­late more of the sens­es.
VISION | Rule #10: Vision trumps all oth­er sens­es.
GENDER | Rule #11: Male and female brains are dif­fer­ent.
EXPLORATION | Rule #12: We are pow­er­ful and nat­ur­al explor­ers.

Ina May’s Guide to Childbirth – book review

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Ina May’s Guide to Child­birth by Ina May Gaskin.

NY; Ban­tam, 2003.

The phys­i­ol­o­gy of birth is com­pli­cat­ed and still not well under­stood. Our sub­jec­tive expe­ri­ences of birth are rich­ly tex­tured. Per­son­al accounts spill over with com­bi­na­tions of intense sen­sa­tions, strong emo­tions, vague impres­sions and fine details. What is aston­ish­ing about Ina May’s Guide to Child­birth is how exquis­ite­ly she traf­fics in the lan­guage of an inter­nal land­scape to describe and explain this com­plex process. She tru­ly cap­tures the unique­ness and uni­ver­sal­i­ty of birth. I am adding this book to the list of rec­om­men­da­tions I give my clients, as well as sug­gest­ing it to oth­er teach­ers.

Devot­ing near­ly the first third of the book to pos­i­tive first-hand birth sto­ries pro­vides a sub­stan­tial ground­ing. Many times I found myself think­ing: Yes! That woman is describ­ing this or that essen­tial bit of wis­dom I want to impart to my clients. Let me point out one exam­ple.

On pages 24 and 25, one of nar­ra­tors describes 3 slices of her expe­ri­ence. First, she got advice not to read or learn too much and not to make a plan because the more details she had in mind, the less like­ly she would get what she want­ed. Too much read­ing would inter­fere with her abil­i­ty to go with her body, she was told.

Sec­ond, she describes her expe­ri­ence of being in a tub and how she need­ed a lot of reas­sur­ance because she was both scared and aware of the great pow­er in her body. The phys­i­o­log­i­cal phe­nom­e­na occur­ring in her brain and motor sys­tems indeed would be described as these sub­jec­tive states of being. She def­i­nite­ly per­ceived what was hap­pen­ing.

Third, she describes turn­ing from look­ing at things dur­ing a con­trac­tion to lis­ten­ing because look­ing made her think, while lis­ten­ing allowed her to feel and be instinc­tive, which felt bet­ter than think­ing and was not so over­whelm­ing. Thus, she was going with her body. We see her process in this nar­ra­tive.

The sto­ries all got me think­ing about whether I am telling my clients too much or too lit­tle! One of my teach­ing goals is to insure that clients dis­tin­guish between strat­e­gy and tac­tics. Exam­ple:  In the case of the sto­ry above, the strat­e­gy was to go with her body. The tac­tics she used were to not get too much infor­ma­tion so she did not have too many expec­ta­tions and to use sound rather than vision as her way of con­nect­ing inner and out­er real­i­ty.

As a teacher, I see my job as insur­ing that my clients who might hear this sto­ry do not think that they must use sound rather than vision in order to go with their bod­ies, but rather that this was a piece of the process for this woman to reach her objec­tive. It might work, but it might not. To get this across to clients, I tell sto­ries about births in which I have been present when oppo­site tac­tics accom­plished the same strat­e­gy or where the same tac­tic led to dif­fer­ent out­comes.

The mul­ti­tude of sto­ries she presents in part I allow part II – the text­book part – to come to life. Whether she is dis­cussing stages of labor, pain or release, she calls up sto­ries and because the read­er is already recep­tive to the notion of exam­ples, the illus­tra­tions help the read­er grasp what­ev­er point she is mak­ing about the process.

How­ev­er, the com­plex phys­i­o­log­ic sequence of birth, includ­ing its vari­a­tion from woman to woman, is less well served – in part because there is still so much to be learned about how birth hap­pens, and in part because the birth com­mu­ni­ty in gen­er­al (whether hav­ing had pro­fes­sion­al or aca­d­e­m­ic train­ing) is not as well versed in nor­mal phys­i­ol­o­gy as it could be.

Let me focus on two issues: One is pain/pleasure and the oth­er is hormones/behavior. Regard­ing pain/pleasure, Ina May makes a lot of impor­tant points, among them that how we expe­ri­ence an intense­ly sen­sa­tion­al expe­ri­ence depends to a great degree on our prepa­ra­tion and that dif­fer­ent women have dif­fer­ent pain/pleasure expe­ri­ences dur­ing birth. What she doesn’t tell us, though (and I sus­pect because it’s not com­mon knowl­edge), is that some of the fac­tors that con­trol how we expe­ri­ence sen­sa­tions are beyond our con­trol. We expe­ri­ence pain/pleasure through a series of sen­sa­tions, men­tal foci and behav­iors such as breath­ing and mus­cle release. These nerve impuls­es are for­ward­ed through­out the brain, some sen­sa­tions tak­ing on emo­tion­al con­tent – some ter­ri­fy­ing and oth­ers ecsta­t­ic – depend­ing on the neur­al pat­tern. This is the basis of both the fear/tension/pain syn­drome and the orgas­mic pat­tern. But the pre­cise pat­tern is depen­dent on genet­ics, as well as envi­ron­ment and behav­ioral train­ing.

Some indi­vid­u­als become aware of sen­sa­tions at a very low neu­ro­log­i­cal thresh­old; oth­ers do not. Some indi­vid­u­als quick­ly find sen­sa­tion of which they are aware to be uncom­fort­able or emo­tion­al­ly intol­er­a­ble; oth­ers do not. Some peo­ple need com­fort mea­sures for their dis­com­fort soon; some lat­er, or not at all. Tol­er­ance of what final­ly becomes pain or plea­sure (or just a sense of stretch­ing or motion through space) is also vari­able from per­son to per­son. Thus, the point at which we start has both bio­log­i­cal and psy­choso­cial deter­mi­nants with­in this already vari­able process. In describ­ing the vari­a­tion in how women expe­ri­ence pain and plea­sure in labor, Ina May is great at giv­ing us exam­ples and iden­ti­fy­ing psy­choso­cial or cul­tur­al vari­a­tions iden­ti­fied in research, but not so enlight­en­ing on the biol­o­gy of why and how. This may or may not mat­ter to the read­er.

The issue of hor­mones that gov­ern the vicious cycle we call labor is much less well under­stood. We have a pret­ty good con­cept of how prostaglandins, oxy­tocin and endor­phins are stim­u­lat­ed and affect the process, and Ina May describes these in acces­si­ble ways. But while adren­a­line is thought to inhib­it ear­ly release of oxy­tocin, there has been lit­tle dis­cus­sion of its impor­tance in the push­ing or ejec­tion phase (she does cite Michel Odent’s notion that adren­a­line might play a part in the ejec­tion reflex when a labor is slow­ing down). But, there is lit­tle recog­ni­tion out­side of the phys­i­ol­o­gy field that what hap­pens in tran­si­tion is our ener­gy sys­tem shift­ing to a sym­pa­thet­ic [adren­al] source to give us more pow­er to push. That’s why con­trac­tions change, why some women have a rest peri­od between, and why – back in the day – we used to say to a woman hav­ing dif­fi­cul­ty culling up her resources to push that she could get mad! Going through the effort and dis­com­fort is key to induc­ing the rush of beta-endor­phins. We know this, in a sci­en­tif­ic way, from research that tells us run­ners who lis­ten to music (relax­ing and dis­so­cia­tive) expe­ri­ence low­er rates of beta-endor­phins at the end of the run than run­ners who do not lis­ten to music, but work through the effort and dis­com­fort they expe­ri­ence (stress induc­ing).

One of the things that makes Ina May’s book so valu­able, in my mind, is the dis­cus­sion near the end about mid­wifery, sta­tis­ti­cal sup­port for nat­ur­al birth and enu­mer­a­tion of the risks asso­ci­at­ed with sur­gi­cal birth that are often glossed over when a fam­i­ly expe­ri­ences dys­to­cia. There are many ele­ments with­in the birthing com­mu­ni­ty striv­ing to cre­ate an acces­si­ble spec­trum of choic­es for birth. Let’s face it, birthing at home for low risk women, seam­less trans­port alter­na­tives, birthing cen­ters attached to med­ical facil­i­ties, and read­i­ly avail­able med­ical options when emer­gen­cies arise, would be a won­der­ful future. Birth atten­dants with uni­ver­sal accep­tance, vari­able but rig­or­ous train­ing, and delin­eat­ed scopes of prac­tice would be ide­al. Whether we get there remains to be seen, but I am glad Ina May exists, has her track record and is being lis­tened to in this effort.

Pregnancy Exercise — The Evolutionary Imperative for Vigorous Activity

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This arti­cle is from my blog, Danc­ingTh­ruPreg­nan­cy on Word­Press.

I have long want­ed to write this post. Recent­ly two arti­cles appeared in the NY Times prompt­ing me to move for­ward. One arti­cle dealt with how it is that ongo­ing vig­or­ous exer­cise pro­duces brain enhance­ments. The sec­ond arti­cle dealt with how run­ning cre­ates its “high” and explained why the result­ing addic­tion is an evo­lu­tion­ary ben­e­fit for human sur­vival.

Every day in Africa a gazelle wakes up.

It knows it must run faster than the fastest lion or it will be killed.

Every morn­ing a lion wakes up.

It knows that it must out­run the slow­est gazelle or it will starve to death.

It doesn’t mat­ter whether you are a lion or a gazelle.

When the sun comes up, you bet­ter be run­ning.

Abe Gubegna
Ethiopia, circa 1974

The preg­nant mom who exer­cis­es vig­or­ous­ly and reg­u­lar­ly — the one who runs or swims or does aer­o­bic danc­ing — is not the one at risk, or whose infant is at risk, of a lack of tol­er­ance for the rig­ors of labor or for lifestyle health prob­lems. It is the seden­tary or low activ­i­ty moth­er and her off­spring who are at risk. I have writ­ten at length on this real­i­ty in my chap­ter on Women and Exer­cise in Varney’s Mid­wifery.

This real­iza­tion has plagued me for ages, and the two arti­cles in the Times con­vinced me to make this state­ment, explain why it is true and exhort women of child­bear­ing age to become aer­o­bic ani­mals.

In the con­tem­po­rary world, we are not as active as pre­vi­ous gen­er­a­tions. Few women exer­cise to the extent required to devel­op the capac­i­ty to with­stand the rig­ors of birth. It is lit­tle won­der that so often health care providers hear that women are afraid to exer­cise, and child­birth edu­ca­tors hear that preg­nant moms are afraid of birth and don’t have con­fi­dence in their abil­i­ty to do it. There are solu­tions for these issues…

The biggest bang for the buck is aer­o­bics. This gets almost every­thing that helps you in labor. It increas­es endurance, strength and range of motion. It improves breath­ing capac­i­ty (you get more oxy­gen + less fatigue). It reduces your need to tap your car­diac reserve (your body works hard in labor but not to the degree it must if you are not fit). Plus, reg­u­lar par­tic­i­pa­tion in a good car­dio or aer­o­bic work­out gives you the men­tal tough­ness and con­fi­dence you need to know that your body is capa­ble of the work and the recov­ery — what we call body trust. Fit Preg­nan­cy has dis­cussed the myths sur­round­ing how hard a preg­nant woman can work out.

Learn­ing use­ful posi­tions and move­ments is extreme­ly help­ful. Be sure that your work­out also includes strength and coor­di­na­tion move­ments — such things as squat­ting, core move­ments for pelvis and spine, and oth­er motions that aid your progress in labor. Being upright and mov­ing are keys to a healthy labor. These require strength and coor­di­na­tion.

Men­tal focus and being present teach you to work with your body. Activ­i­ties such as relax­ation train­ing, yoga, pilates for preg­nan­cy and dance help you devel­op the men­tal skills (mind­ful­ness and deep breath­ing) that accom­pa­ny your move­ment. Learn to rec­og­nize your body’s sig­nals so you know when it’s time to push.

A tru­ly effec­tive use of your time is a one hour class a cou­ple times a week that com­bines all these ele­ments. We have known this for decades. The evi­dence is clear that it works. Keep moving…right into labor and birth!

Find a safe and effec­tive class or train­er.

How to Get Pregnant — Coaching Topic #1

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So let’s get on with the top­ic of How to Get Preg­nant, start­ing with why do we need to know this?

In the past few decades, the aver­age age for a first preg­nan­cy in the U.S. has moved from the mid twen­ties into the mid thir­ties. In the same time peri­od, the facts of con­cep­tion — sperm enters egg released in mid cycle, then zygote implants in the uterus, along with how sex allows this to hap­pen and how to pre­vent it — seems to have dis­ap­peared from mid­dle and high school health class­es. If that weren’t enough, as women have become more and more essen­tial in the work force, the cost of hav­ing chil­dren as well as start­ing lat­er, have dri­ven down the birth rate. Sim­i­lar con­di­tions exist in most devel­oped nations, although teen preg­nan­cy rates are low­er every­where else.

The birthing pop­u­la­tion has bifur­cat­ed — we see old­er women (over 35) and teens as the major groups hav­ing chil­dren. On the one hand we have been work­ing to reduce teen preg­nan­cy while help­ing old­er and old­er women become first time moms. To a cer­tain extent, they need the same infor­ma­tion; its just that with teens we use this infor­ma­tion to pre­vent preg­nan­cy and with old­er women we use infor­ma­tion to help them increase their odds of get­ting preg­nant.

Under­stand­ing the men­stru­al cycle, ovu­la­tion, chart­ing tem­per­a­ture — all the basic tech­niques of using the “nat­ur­al” method of birth con­trol — have become the first steps of the how-to-get-preg­nant coach­es. Beyond this, a num­ber of sites have their own essen­tial lists to help women be healthy and ready. Sites such as gettingpregnant.com, pregnancy.org/getting-pregnant, and storknet.com/cubbies/preconception/ pro­vide addi­tion­al infor­ma­tion. Many sug­ges­tions — things to avoid eat­ing, what pro­teins are need­ed for ovu­la­tion, how to reduce stress, what to do if there are sperm prob­lems, how to find IVF clin­ics, donors and sur­ro­gates — are addressed.

How effec­tive are these sug­ges­tions? Well, research tells us they are some­what effec­tive. None of the sites I con­tact­ed answered my query about how they mea­sure or assess con­sumer out­comes when fol­low­ing their sug­ges­tions.

An inter­est­ing arti­cle in the NY Times 9/1/2011, enti­tled Are You as Fer­tile as You Look? openened with this sen­tence: “FORTY may be the new 30, but try telling that to your ovaries.” The real­i­ty is that being under 35 is still the best pre­dic­tor of how dif­fi­cult it may be for you to become preg­nant. As the arti­cle makes clear, look­ing 30 and being 30 are not the same thing. Even healthy liv­ing does not pre­vent the loss of good eggs.

So, what con­clu­sions can we draw? First, even if you come from a “fer­tile fam­i­ly,” it may behoove you to have your chil­dren in your late 20s or ear­ly 30s. Sec­ond, if you are putting off hav­ing chil­dren beyond that time, ask your­self what extremes you are will­ing to go to to have your own bio­log­i­cal off­spring. And, third, con­sid­er adop­tion. Frankly, it would be won­der­ful if adop­tion were eas­i­er, but in the dri­ve to con­ceive at lat­er and lat­er ages we see the hand of biol­o­gy and under­stand why adop­tion is not easy:  Our own off­spring — our own DNA out there in the world — is a heady moti­va­tion.

If you are on the path­way of becom­ing preg­nant, being under 35 is the best ally you have. If not, maybe some of the sug­ges­tions on the web will work for you. What­ev­er you decide, all the best.

One part­ing com­ment:  Reg­u­lar mod­er­ate exer­cise — while it helps you stay young and healthy — will not pre­vent your eggs from being popped out every month. It will help you have a healthy preg­nan­cy if you con­ceive, so stay with it!

Birth of Pregnancy Exercise: Evolution of DTP

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Some­times it is fun to look back at the long road to the present! Recent­ly, I was inter­viewed by our local online media out­let (the Bran­ford CT Patch) and was real­ly thrilled with the result­ing sto­ry. It focused on the 30 year road of DTP and I thought you might find it inter­est­ing.

Here is the link to the sto­ry and the sub­ti­tle:

http://branford.patch.com/articles/ann-cowlin-a-prenatal-fitness-pioneer-celebrates-30-years-of-work

What start­ed as a “fledg­ling exper­i­ment” has become one Bran­ford woman’s life work.

Thank you for tak­ing a look!

Still look­ing for new ways to devel­op core strength & coor­di­na­tion for new moms…start with the pos­ture on the left (inhale) and move to the one on the right (exhale). Keep the trans­verse abdom­i­nal sucked in. Repeat.…

Postpartum Exercise: Creating Your 3rd Body

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Recent­ly, while talk­ing with some moms in our post­par­tum exer­cise class, DTP’s Mom-Baby Fit­ness™ pro­gram, I real­ized it has been a while since I have addressed the notion of what we call “the 3rd body.” This stems from the idea that before you are preg­nant, you live in your 1st body; then, while preg­nant, you live in your 2nd body. After giv­ing birth, many women feel their options are to try to get their first body back or live in what they are left with after birth. We sug­gest anoth­er way:  cre­ate your 3rd body.

We dis­cov­ered this 3rd body in work­ing with women to gain the fit­ness nec­es­sary to have a healthy recov­ery and enjoy moth­er­hood. What we found was that women were often becom­ing more fit than they had been before preg­nan­cy, with less body fat and more mus­cle, yet their clothes did not fit the same.  Some­times the flar­ing of the ribs and/or hip bones made for a larg­er waist – despite less fat!

Many clients also feel a new, deep­er sense of their core devel­oped. In fact, over time they real­ized they actu­al­ly liked this body bet­ter in some ways! After all, they came into the world with the pre-preg­nan­cy body, but this body they actu­al­ly cre­at­ed out of the pro­found expe­ri­ence of the phys­i­cal self that preg­nan­cy and birth pro­vide. It extend­ed the empow­er­ment of birth into moth­er­hood.

Extend­ing this metaphor even fur­ther, of course, leads to the 4th and 5th bod­ies, if you have anoth­er child. Even­tu­al­ly, there are more bod­ies as women go through per­i­menopause, menopause, post menopause, and what I like to call the phe­nom­e­nal wis­dom stage. Each body rep­re­sents a new oppor­tu­ni­ty to become some­one strong and pro­found.

I fig­ure I am to body #8 now, and in each stage I have found some­thing incred­i­ble that I could not have at oth­er stages. Long ago I gave up look­ing for my past bod­ies. Each one has been bril­liant in some way, but in the end it had to be left behind if I was to enjoy life’s path to the fullest.

Liv­ing in the moment does require know­ing where you are in time, space and ener­gy. So, dis­card your past bod­ies with delight and move on. Use your ener­gy to cre­ate your­self in the present.

It’s a process and you won’t ful­ly live in your next body until you own the toll of the last one. A post­par­tum mom may expe­ri­ence hair loss, big­ger feet, a mal-aligned spine, con­stant thirst if she is breast­feed­ing, exhaus­tion and a jel­ly bel­ly. But, all these things will pass with time, if you eat right and exer­cise reg­u­lar­ly. Oh, and you can bring the baby, who will have a blast meet­ing oth­er babies!!