behavior

What is Fetal Programming?

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What is fetal programming? Every person living on earth was first exposed to a uterine environment that helped determine their lifetime health and development. The term for this phenomenon is fetal programming. It is a hot topic and deserves attention.

Accepting the importance of fetal programming places responsibility on the mother-to-be to do all she can to insure her body provides nutrients and oxygen to her growing infant while avoiding possible risks and toxins. At the same time, genetic and environmental factors contribute greatly to the potential for some disorders and problems that arise. Thus, we must be careful in assigning guidelines for acceptable behavior or blame for poor outcomes to pregnant women.

On the one hand, we can all see the negative consequences of something like fetal alcohol syndrome…clearly the result of maternal behavior. Is a pregnant woman whose baby has been damaged in this way guilty of abuse?

But, what if a mother is obese, eats poorly and ends up with an infant with a disturbed metabolism. Is this abuse? What if the mother has an infection that results in cerebral palsy? Or what if she lives near a highway and involuntarily inhales fumes that negatively affect the placenta?

How do you get a healthy baby? Of course, there are no guarantees. There remain many unknown factors that can affect the course and outcome of a pregnancy. Some factors we are aware of, such as avoiding certain fumes or chemicals.  There are some behaviors we know can maximize the potential for a good outcome, such as eating adequate protein, aerobic conditioning and strength training. [Note for new readers…lots of these factors have been covered in our previous posts.]

But, what about all the things we don’t know about?

If these goats eat the wrong grass, will they go into labor?

Here is a cautionary tale:  There is a species of goat that, if they eat a certain type of skunk grass on day 14 (and only day 14) of pregnancy, will not go into labor. Why? Plant toxins in this grass interfere with the development of a small portion of fetal brain, the paraventricular nucleus. This nucleus is involved in the signaling cycle of labor. Without it, the mother will not go into labor!

What are the take-home messages here?

  • Probably no one is ever a perfect fetus…too many possible threats.
  • There are some threats we can avoid…being lazy, over-eating, smoking.
  • There are some threats we cannot avoid, so we do the best we can.

Do the best you can by your baby…aerobic fitness, good nourishment, sleep, good hygiene and de-stressing your life.

Fitness Starts Early!

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Pregnancy fitness is not only important for moms, but for the fetus as well. Evidence is clear that aerobic fitness improves brain, heart, immune and metabolic function…at all ages, including in utero. If continued early in life, healthy physical adaptations that occur in the uterus become reinforced behavior, preparing a good foundation for a healthy lifestyle. Babies are acute observers of movement and activity, and learn from each other. A key component of a good mom-baby program is the interaction of the babies themselves. A good teacher will facilitate healthy activity among our smallest class members!

There is growing evidence that at all ages, aerobic fitness produces the greatest number of benefits. Recently, researchers determined that aerobic fitness in 9 and 10 year olds produced benefits in the development of two important brain regions – the basal ganglia and the hippocampus – that are significant factors in problem-solving intelligence. This is just one of the latest reports that tells us the capacity to absorb and use oxygen (which improves with aerobic fitness) is a key to health, quality and length of life…beginning in the womb!

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.

Fetal Programming

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What is fetal programming? Every person living on earth was first exposed to a uterine environment that helped determine their lifetime health and development. The term for this phenomenon is fetal programming. It is a hot topic and deserves attention.

Accepting the importance of fetal programming places responsibility on the mother-to-be to do all she can to insure her body provides nutrients and oxygen to her growing infant while avoiding possible risks and toxins. At the same time, genetic and environmental factors contribute greatly to the potential for some disorders and problems that arise. Thus, we must be careful in assigning guidelines for acceptable behavior or blame for poor outcomes to pregnant women.

On the one hand, we can all see the negative consequences of something like fetal alcohol syndrome…clearly the result of maternal behavior. Is a pregnant woman whose baby has been damaged in this way guilty of abuse?

But, what if a mother is obese, eats poorly and ends up with an infant with a disturbed metabolism. Is this abuse? What if the mother has an infection that results in cerebral palsy? Or what if she lives near a highway and involuntarily inhales fumes that negatively affect the placenta?

How do you get a healthy baby? Of course, there are no guarantees. There remain many unknown factors that can affect the course and outcome of a pregnancy. Some factors we are aware of, such as avoiding certain fumes or chemicals.  There are some behaviors we know can maximize the potential for a good outcome, such as eating adequate protein, aerobic conditioning and strength training. [Note for new readers…lots of these factors have been covered in our previous posts.]

But, what about all the things we don’t know about?

If these goats eat the wrong grass, will they go into labor?

Here is a cautionary tale:  There is a species of goat that, if they eat a certain type of skunk grass on day 14 (and only day 14) of pregnancy, will not go into labor. Why? Plant toxins in this grass interfere with the development of a small portion of fetal brain, the paraventricular nucleus. This nucleus is involved in the signaling cycle of labor. Without it, the mother will not go into labor!

What are the take-home messages here?

  • Probably no one is ever a perfect fetus…too many possible threats.
  • There are some threats we can avoid…being lazy, over-eating, smoking.
  • There are some threats we cannot avoid, so we do the best we can.

Do the best you can by your baby…aerobic fitness, good nourishment, sleep, good hygiene and de-stressing your life.

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.

Rant: Health Care Reform/Pregnancy

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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.

Pregnancy Pathway, Pregnancy

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Time for an entre: Pregnancy!!

Up for discussion…

Health Influences in Pregnancy

Health Influences in Pregnancy

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 in Your Pregnancy...

…to here..

Being Fully Present as Mom

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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