Pregnancy Pathway

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Recent­ly, we have expe­ri­enced grow­ing inter­est in infor­ma­tion includ­ed in the text­book, Women’s Fit­ness Pro­gram Devel­op­ment. So, we decid­ed that site read­ers might want to pur­chase this text if they are seri­ous­ly inter­est­ed in sub­jects per­tain­ing to women’s health fit­ness. The book opens with a chap­ter on how women dif­fer from men in their phys­i­cal, men­tal, emo­tion­al and social devel­op­ment and how these dif­fer­ences affect our moti­va­tion to be active. Sec­tions on ado­les­cence, preg­nan­cy, the post­par­tum peri­od and menopause explain what hap­pens dur­ing these crit­i­cal and unique­ly female life tran­si­tions, what is known about the impact of exer­cise on health dur­ing these times, and how to devel­op effec­tive pro­gram­ming for these pop­u­la­tions. It is avail­able through the pub­lish­er, Human Kinet­ics, or through Ama­zon or Barnes & Noble.

High Birth Weight: The New Adverse Outcome

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While pub­lic aware­ness of low birth weight and pre­ma­ture infants is becom­ing — at long last — inter­est­ing to the main­stream cul­ture and media, anoth­er phe­nom­e­non is begin­ning to shake the pro­fes­sion­al birthing world:  high birth weight. Because it is occur­ring in a more afflu­ent ele­ment of soci­ety, it is alarm­ing. This tells us that you can­not buy your way out of preg­nan­cy risks that are cre­at­ed by a seden­tary, tox­ic food life-style.

Here is the dilem­ma:

Nor­mal weight and some over­weight women who eat too much in preg­nan­cy tend to have babies who are, basi­cal­ly, already obese at birth. There­fore, these infants already have meta­bol­ic and car­dio­vas­cu­lar dys­func­tion. Babies born over 8 lbs. 14 oz. are at increased risk for Type 2 Dia­betes and heart dis­ease.

Inter­est­ing­ly, the Insti­tute of Med­i­cine  recent­ly issued new guide­lines on preg­nan­cy weight gain. After near­ly 20 years of adher­ing to the “nor­mal” weight gain being 25 to 35 pounds, the Insti­tute rec­og­nized that pre­na­tal BMI plays a role in how much weight gain is nec­es­sary for a healthy preg­nan­cy.

The evi­dence that under­lies this change demon­strates that gains greater than 22 pounds — for all clas­si­fi­ca­tions of pre­na­tal BMI — is the demarka­tion point for increased health prob­lems.  More infor­ma­tion on this is avail­able at:  New IOM Guide­lines.

We have known for a while now that obe­si­ty in preg­nan­cy puts moth­er and infant at risk for a num­ber of prob­lems from car­dio­vas­cu­lar, meta­bol­ic and immune dis­or­ders to pre­ma­tu­ri­ty, low birth weight, increased need for cesare­an birth and slow recov­ery. Add anoth­er one:  Obese new­borns with increased risk for heart and metab­o­lism prob­lems.

Ref­er­ence on weight gain and high birth weight:

Lud­wig DS, Cur­rie J. The asso­ci­a­tion between preg­nan­cy weight gain and birth­weight: a with­in-fam­i­ly com­par­i­son. Lancet. 2010 Sep 18;376(9745):984–90. Epub 2010 Aug 4.

A good ref­er­ence for issues sur­round­ing obese preg­nan­cy:

Led­dy MA et al. The Impact of Mater­nal Obe­si­ty on Mater­nal and Fetal Health. Rev Obstet Gynecol 2008;1(4):170–178.

CDC Fitness Guidelines Include Pregnancy

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Recent CDC Guide­lines on Exer­cise for the gen­er­al pop­u­la­tion include preg­nant and post­par­tum women. Spe­cif­ic infor­ma­tion for preg­nant women is includ­ed at this URL:

http://www.cdc.gov/physicalactivity/everyone/guidelines/pregnancy.html

James Pivarnik, PhD, pres­i­dent of the Amer­i­can Col­lege of Sports Med­i­cine has released a Med­scape video for health care providers encour­ag­ing them to be aware of the fact that the CDC con­sid­ers a min­i­mum of 150 min­utes per week of mod­er­ate activ­i­ty (or 75 min­utes of vig­or­ous activ­i­ty for ath­let­ic women, or a com­bi­na­tion of inten­si­ty for fit women) to be impor­tant for preg­nant women, along with the gen­er­al pop­u­la­tion.

DTP’s Total Preg­nan­cy Fit­ness instruc­tors learn how to com­bine activ­i­ties so that women receive an ade­quate amount of exer­cise each week dur­ing their preg­nan­cy. To find out about becom­ing a teacher, click on Become a Teacher above.

New Breastfeeding Research: More Baby Protections

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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.

Safe Birth — Who’s in Charge?

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Who Controls Birth? Defining the Argument.

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.

Beyond Yoga

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Beyond Yoga

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!

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More on Preventing Childhood Obesity!

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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.

Recess for every­one!!!