moms-to-be

NEW: Upper Valley — Vermont + New Hampshire!

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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.

Building a Global Team of Teachers for Healthy Pregnancy, Birth & Baby

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Danc­ing Thru Preg­nancy®, Inc.

Women’s Health & Fit­ness Pro­grams
found­ed 1979
MISSION STATEMENT
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)

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

DTP Guest Blog — Healthy Start Brooklyn

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Healthy Start Brook­lyn (HSB) recent­ly added Danc­ing Thru Preg­nan­cy to its ser­vices with ter­rif­ic results. Find out more about HSB at http://fphny.org/programs/giving-brooklyn-families-a-healthy-start. This blog describes how DTP became a part of the pro­gram.

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:

http://dancingthrupregnancy.wordpress.com/

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.

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!

Holiday Contributions That Make a Difference.

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This is the time of year many of us con­sid­er where to make our char­i­ta­ble con­tri­bu­tions. We have assem­bled a list of  groups to which you might want to con­sid­er giv­ing this year. By donat­ing to these orga­ni­za­tions you can help improve the lives of moth­ers, newborns,children and fam­i­lies around the world. Most will also send a card or email mes­sage to a mom in whose hon­or you give the gift.

UNICEF Inspired Gifts.  You can choose gifts that improve edu­ca­tion, water, health, nutri­tion, emer­gency care and oth­er fac­tors that affect the well-being of women and chil­dren.

White Rib­bon Alliance for Safe Moth­er­hood. You can advo­cate for every moth­er and every child in 152 nations when you give to this orga­ni­za­tion.

Inter­na­tion­al Con­fed­er­a­tion of Mid­wives. This group exists to raise aware­ness of the glob­al role of mid­wives in reduc­ing mater­nal and new­born child mor­tal­i­ty.

The Fis­tu­la Foun­da­tion. This group exists to raise aware­ness of and fund­ing for fis­tu­la treat­ment, pre­ven­tion and edu­ca­tion­al pro­grams world­wide. Fis­tu­la is the dev­as­tat­ing injury cause by untreat­ed obstruct­ed labor.

The Preeclamp­sia Foun­da­tion. This orga­ni­za­tion sup­ports research to pre­vent and treat one of the most dan­ger­ous dis­or­ders of preg­nan­cy, one that accounts for a large per­cent­age of pre­ma­ture births and low birth weight infants. Hav­ing preeclamp­sia is also a risk fac­tor for lat­er heart dis­ease for the moth­er.

Clean Birth. Clean Birth Kits are designed to pro­vide birth atten­dants and/or expect­ing moms with the tools they need to ensure a clean birthing envi­ron­ment. The Kits ensure the WHO’s “6 Cleans”: clean hands, clean per­ineum, clean deliv­ery sur­face, clean cord cut­ting imple­ment, clean cord tying, and clean cord care.

March of Dimes. The “moth­er” of all char­i­ties for help­ing pre­vent and treat dis­or­ders and dis­eases that affect chil­dren.

Peace, Love and Joy to all.

Pregnancy Exercise Safety

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This post is adapt­ed from the 3/17/11 DTP Blog on Preg­nan­cy Exer­cise Safe­ty. For more evi­dence-based infor­ma­tion on Pre/postnatal Health & Fit­ness, check out the DTP Blog. The Blog includes infor­ma­tion start­ing pri­or to con­cep­tion and con­tin­u­ing through post­par­tum and mom-baby fit­ness.

There are three sec­tions to this post: 1) moms-to-be, 2) preg­nan­cy fit­ness teach­ers and per­son­al train­ers and 3) some spe­cif­ic con­traindi­cat­ed and adapt­ed exer­cis­es. All infor­ma­tion pre­sent­ed is based on peer-review research and evi­dence col­lect­ed over a 30 year peri­od of work­ing with this pop­u­la­tion. More infor­ma­tion on safe­ty can be found on this site on the page Ben­e­fits, Safe­ty & Guide­lines.

1) Safety & Exercise Guidelines for Moms-To-Be

First and fore­most, be safe. Trust your body. Make sure your teacher or train­er is cer­ti­fied by an estab­lished orga­ni­za­tion that spe­cial­izes in pre/postnatal exer­cise, has worked under mas­ter teach­ers dur­ing her prepa­ra­tion, and can answer or get answers to your ques­tions.

These are the safe­ty prin­ci­ples that we sug­gest to our par­tic­i­pants:

  • get prop­er screen­ing from your health care provider
  • pro­tect your­self
  • do not over­reach your abil­i­ties
  • you are respon­si­ble for your body (and its con­tents)

Squat­ting is an exam­ple of a stan­dard preg­nan­cy exer­cise used for child­birth prepa­ra­tion that must be adapt­ed by each indi­vid­ual based on body pro­por­tions, flex­i­bil­i­ty, strength and com­fort.

Don’t assume that because your teacher and some par­tic­i­pants can do a cer­tain move­ment or posi­tion that you should be able to do it just like they do. If your teacher is well trained, she will be able to help you select vari­a­tions that are appro­pri­ate for your body.

When you are exer­cis­ing, make sure you are get­ting the most from your activ­i­ty. Keep these find­ings in mind when choos­ing your work­out rou­tine:

  • Aer­o­bics and strength train­ing pro­vide the great­est health ben­e­fits, reduce the risk for some inter­ven­tions in labor, help short­en labor, and reduce recov­ery time
  • Cen­ter­ing helps to pre­vent injury; relax­ation and deep breath­ing reduce stress; and mild stretch­ing can relieve some dis­com­forts
  • Avoid fatigue and over-train­ing; do reg­u­lar exer­cise 3 — 5 times a week
  • Eat small meals many times a day (200–300 calo­ries every 2–3 hours
  • Drink at least 8 cups of water every day
  • Avoid hot, humid places
  • Wear good shoes dur­ing aer­o­bic activ­i­ties
  • BE CAREFUL! LISTEN TO YOUR BODY!

If you expe­ri­ence any of the fol­low­ing symp­toms, stop exer­cis­ing and call your health care provider:

  • Sud­den pelvic or vagi­nal pain
  • Exces­sive fatigue
  • Dizzi­ness or short­ness of breath
  • Leak­ing flu­id or bleed­ing from the vagi­na
  • Reg­u­lar con­trac­tions, 4 or more per hour
  • Increased heart­beat while rest­ing
  • Sud­den abnor­mal decrease in fetal move­ment (note: it is com­plete­ly nor­mal for baby’s move­ments to decrease slight­ly dur­ing exer­cise)

2) Safety & Exercise Guidelines for Teachers & Trainers

A prin­ci­ple of prac­tice that increas­es in impor­tance for fit­ness pro­fes­sion­als work­ing with preg­nant women is hav­ing the knowl­edge and skills to artic­u­late the ratio­nale and safe­ty guide­lines for every move­ment she asks clients to per­form.

This goal requires adher­ence to safe­ty as the num­ber one pri­or­i­ty. Here is how we delin­eate safe­ty and the pro­ce­dures we require of our instruc­tors for achiev­ing safe­ty in prac­tice:

First priority: safety [First, do no harm]
  • some­times med­ical con­di­tions pre­clude exer­cise
  • find an appro­pri­ate start­ing point for each indi­vid­ual
  • indi­vid­ual tol­er­ances affect mod­i­fi­ca­tion
  • gen­er­al safe­ty guide­lines are phys­i­cal
  • preg­nant women also need psy­cho­log­i­cal safe­ty
Mind-Body Safety Procedures
  • Cen­ter­ing enhances move­ment effi­cien­cy and safe­ty.
  • Always begin with cen­ter­ing.
Strength Training Cautions
  • avoid Val­sal­va maneu­ver
  • avoid free weights after mid preg­nan­cy (open chain; con­trol issue)
  • avoid supine after 1st trimester
  • avoid semi-recum­bent 3rd trimester
  • keep in mind the com­mon joint dis­place­ments, and nerve and blood ves­sel entrap­ment when design­ing spe­cif­ic exer­cis­es
Aerobics or Cardiovascular Conditioning Procedures
  • Mon­i­tor for safe­ty
  • Instruc­tion­al style needs to be appro­pri­ate.
  • Walk­ing steps with nat­ur­al ges­tures can be done through­out preg­nan­cy
  • Vig­or­ous steps with large ges­tures are more intense, appro­pri­ate as fit­ness increas­es
  • The abil­i­ty to cre­ate move­ment that will be safe and work for var­i­ous lev­els of fit­ness and at dif­fer­ent points in preg­nan­cy is one of the most crit­i­cal skills for preg­nan­cy fit­ness instruc­tors.
Venue Safety
  • Set­ting should pro­vide phys­i­cal and emo­tion­al safe­ty
    Equip­ment must be well-main­tained

3) Contraindicated and adapted exercises

Exer­cis­es for which case stud­ies and research have shown that there are seri­ous med­ical issues include the “down dog” posi­tion, rest­ing on the back after the 4th month, and abdom­i­nal crunch­es and oblique exer­cis­es. Here is more infor­ma­tion and adap­ta­tion sug­ges­tions:

Con­traindi­cat­ed: “Down Dog” requires that the pelvic floor and vagi­nal area are quite stretched, bring­ing porous blood ves­sels at the sur­face of the vagi­na close to air. There are records of air enter­ing the vagi­nal blood ves­sels in this posi­tion and mov­ing to the heart as a fatal air embolism.

Adap­ta­tion: Use the child’s pose, with the seat down rest­ing on the heels and the elbows on the ground, hands one on top of the oth­er, and fore­head rest­ing on the hands. Keep the heart above the pelvis.

_________

Con­traindi­cat­ed: Rest­ing on the back dur­ing relax­ation.

Adap­ta­tion: Rest in the side-lying posi­tion. About 75% pre­fer the left side, 25% pre­fer the right side.

_________

Con­traindi­cat­ed: Abdom­i­nal crunch­es and oblique exer­cis­es can con­tribute to dias­ta­sis rec­ti in some women. The trans­verse abdom­i­nal mus­cle is not always able to main­tain ver­ti­cal integri­ty at the lin­ea alba, and thus there is tear­ing and/or plas­tic­i­ty of that cen­tral con­nec­tive tis­sue.

Adap­ta­tion: Splint­ing with curl-downs, see posi­tions below. By press­ing the sides of the abdomen toward the cen­ter, women can con­tin­ue to strength­en the trans­verse abdom­i­nals with­out the shear­ing forces that place lat­er­al pres­sure on the lin­ea alba.

Curl-downs are gen­er­al­ly the safest and most effec­tive abdom­i­nal stren­then­ing exer­cise.

Splint by cross­ing arms and pulling toward cen­ter (L)

Or, splint by plac­ing hands at sides and press­ing toward cen­ter ®