Tree Life Birth Care in White River Junction, VT, is our newest location for Total Pregnancy Fitness. The center is dedicated to providing balanced, evidence-based support to women and their families during pregnancy, labor and postpartum. They offer doula care, childbirth education, prenatal dance classes, and lactation consulting in the Upper Valley region of Vermont and New Hampshire. For more information, visit http://LifeTreeBirth.com or email Mary Etna Haac at DoulaMaryEtna@gmail.com.
Mary Etna R Haac, MPH, PhD, DONA-trained Birth Doula. Bilingual: English-Spanish. 703-447-98-94.
Women’s Health & Fitness Programs
Many important health issues for girls and women involve matters of reproductive
health, childbearing, fertility and aging. Research informs us that an active, healthy
lifestyle provides a number of benefits throughout a woman’s life span:
reduced discomforts from pregnancy, labor, birth, recovery & menopause
reduced risk of hypertensive disorders of pregnancy and premature birth
potentially shorter active labor and reduced risk of cesarean delivery
more rapid return to joyful activities, less excess weight following birth
mother-infant interaction, leading to infant psychomotor enhancement
reduced rates of obesity, cardiovascular disease, and type 2 diabetes
reduction of some cancers, osteoporosis, falls and loss of muscle mass
improved social support, networking and stress management skills
greater belief in one’s ability to be strong and capable (self-efficacy)
DTP: When did you first work or study with DTP? HSB: We first discovered DTP in 2011 while researching evidence-based exercise programs for pregnant women. DTP was exactly what we were looking for! So in January of 2012, Healthy Start Brooklyn trained three former clients and one staff member to teach free DTP classes to low-income pregnant women in Central Brooklyn. It took some time for us to get the program up and running, but we have been offering classes since March of this year and they have been continuing successfully ever since.
DTP: Describe the focus or mission of your work. HSB: Healthy Start Brooklyn is a federally funded program that seeks to improve the health and wellness of women, infants and families in Central Brooklyn. Rates of infant death, premature birth and illness in the neighborhoods of Bedford-Stuyvesant, Brownsville, Bushwick, East New York, and Flatbush are far higher than elsewhere in New York City and the U.S. as a whole. HSB provides support services, education and training to reduce these inequalities and improve the lives of Central Brooklyn residents. Our DTP classes, as with our childbirth education and doula programs, are aimed at trying to offer our clients free services that are available to more affluent women to help offset some these inequalities that can have a negative impact on birth outcomes.
DTP: What do you most enjoy about your work? HSB: We enjoy seeing our clients coming back to class every week. Some of them have very little support systems in their lives, and it is extremely rewarding to see them participate in class each week and stay after class to talk to each other and share stories. It is our hope that the class not only positively affects their physical health, but also their mental health as well, serving as a place where they can de-stress and socialize with other women in similar situations. We also really enjoy receiving pictures of the babies that our class had some part in helping enter the world healthy!
DTP: What is the most important or interesting thing you have learned from working with moms, moms-to-be, or other women clients? HSB: Pregnant women can move! In the beginning, we were nervous about making our class routines too high intensity for some of the women who were further along in their pregnancies. We were surprised to find that they could all keep up and were even requesting the higher intensity routines.
To learn more and see more photos, go to the DTP Blog:
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.
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!
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.
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.
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….
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!!
It’s time to hit the main theme again: Aerobically fit women are at reduced risk for things that go wrong in pregnancy, improve their tolerance for labor and birth, and recover more rapidly in the postpartum period.
Moving into Motherhood
The arrival of the holidays provides a good reason to bring this up, yet again! Pregnancy is a gateway time in women’s lives…we become more aware of our bodies, our sensations, our feelings, our needs, and how versatile and amazing our bodies are. We can make people with our bodies! During pregnancy, we often take precautions…we eat more carefully, avoid toxins, try to avoid stress. When the holidays arrive, we see indulgent behavior in a different light.
Yet, even with all this focus on behavior, we sometimes miss the biggest aid to a healthy pregnancy: physical fitness. Research clearly demonstrates that fit women do better, are healthier and happier. More and more in the U.S. we see disorders of normal organ function that accompany sedentary pregnancy.
Let’s look at this a little closer (yes, I am going to repeat myself some more, but it is an important concept to spread). We live in a body model that rewards an active lifestyle.
Being sedentary causes things to go wrong
Not moving creates biochemical imbalances because the cardiovascular system atrophies and molecules created in the brain or brought in through the digestion may not get where they need to go for a healthy metabolism.
Your cardiovasculature is the highway that brings usable substances to the place they are used. You have to help it grow and develop, use it to pump things around and give it a chance to be healthy. Aerobic fitness does all these things.
Advice for young women of childbearing age
If you are thinking of pregnancy, have recently become pregnant, or work with women of childbearing age, we encourage you to open avenues of activity for yourself or others in this population. You can learn more from our blog dancingthrupregnancy.wordpress.com. You can seek out local pre/postnatal fitness experts on this site. Yoga is nice…we use some of it in our work, along other specific exercises for which there is a direct health benefit. But, we also see yoga converts who come into our program in mid pregnancy unable to breathe after walking up a flight of stairs. How will they do in labor? Not as well as those who have been doing aerobic dance or an elliptical machine 2 or 3 times a week.
The AHA/ACSM guidelines for the amount of aerobic exercise needed to improve cardiovascular status hold true for pregnant women just as they do for the rest of the population – a minimum of 150 minutes of moderate, or 75 minutes of vigorous, or a combination of these levels of intensity, per week. If you are not getting this level of activity, you are putting your health – and that of your offspring – at risk.
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.
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.