In Part 4 of our continuing series on DTP’s offspring, meet Renee Crichlow, ACSM Certified Personal Trainer from Barbados, whose REAC Fitnessbusiness 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.
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!
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.
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.
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!
In the U.S. and most of the developed world, approximately 51% of the population is female. Most females give birth at some point in their lives, although, in any year, only about 2% of the population gives birth.
No one living on earth got here any other way than gestation, so there ought to be some power attached to being part of that 51%. Historically, it might be said that the power has been merely for survival…the good breeders survived long enough to produce heirs and those who lived on knew where the roots and fruit grew.
Only women can make more people with their bodies.
Here are some things to consider:
Women make people
Women’s health and fitness before pregnancy affects whether the pregnancy is healthy
Women’s health and fitness during pregnancy affects her lifetime health and that of her offspring
Maternal survival is important to offspring well-being
Maternal health and fitness affects maternal adaptation and thereby offspring well-being
Thus, is it not a sanguine notion that the health and survival of women is critical to the health of everyone? After all, the health of nations is associated with this slight majority of females, and the wealth of nations is associated with its health.
The good news is that people working from this understanding are making some headway around the globe. Recently, the World Health Organization noted that maternal death among pregnant and birthing women world-wide has been dramatically reduced from the 1980’s to recently. This is very good news!
Here is the interesting footnote: Maternal death in the U.S. has risen 42% in the same period. While the absolute numbers remain small, this is a disturbing picture. What could be causing this?
Time will tell if we can figure it out and fix it. I venture to suggest some directions for consideration:
The elevated cesarean birth rate with its sequellae of cardiovascular and immune system disorders
Why am I hopeful, then? I see among our current educated generation of new moms and moms-to-be a willingness to exert their influence – as breeders – over the health care scene. They want less technological birth. They want support. They want more information. They want to be healthy. These are wonderful things. I salute these young women…they also make my job easier in the process.
In addition, I see among young health care practitioners an understanding of the value of these things. Among practitioners working in public health clinics there is a sense of desperation on the one hand that the poor and indigent have no capacity or will to take care of themselves. On the other hand, the first step is always education and there are a lot of people working on this issue.
Which brings me to the closing point: How do we bring more resources and intelligence to helping women be healthy, prepare for pregnancy, have healthy babies, reduce pregnancy complications, and improve infant and maternal death rates? I, for one, will keep blogging on this issue. You, I hope, will vote for people who understand this issue. The political power and will is in our hands.
51% of us are women…some day 51% of us can set priorities
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.
The following are notes from co-author Robyn Brancato, CNM (certified nurse midwife) who practices in New York City, or, as she is know here: Wonderrobyn! You can read about both authors in the About tab above. Here they are on the beach in San Diego, when they gave a talk at conference there a couple years ago. Robyn on the left, Ann on the right.
Robyn and Ann, Pathway authors
1. Addition to Small Rant: “Resist the temptation to watch A Baby Story on TLC! It does not portray birth accurately, as they condense 15 hours of labor into 30 minutes and play up the drama so that you will be on the edge of your seat! In the majority of women, birth is not that dangerous.”
2. Regarding: When does conception occur? “This is a really interesting post… I love the discussion about at what point conception occurs! Personally, I like the Biblical notion of quickening. Even though this varies from woman to woman and can range anywhere from 16 to 22 weeks gestation, it seems like the most natural theory.”
Dear Reader: What do YOU think? Did you read the conception post on March 23, ’09?
3. About sperm & preeclampsia. “Is the connection between barrier methods and preeclampsia actually established? I have read studies stating the contrary — that barrier methods have no effect on preeclampsia rates.”
HURRAY! THIS REQUIRES FURTHER CONSIDERATION.
More information: The immune maladaptation theory suggests that tolerance to paternal antigens, resulting from prolonged exposure to sperm, protects against the development of preeclampsia. Thus, barrier methods and being young may predispose women to this major disorder of pregnancy.
Evidence exists on both sides of this theory. Here are two recent studies (one of each) that readers may find helpful in understanding this idea. Keep in mind that other factors than just sperm exposure may be affecting research findings. But, it does seem that under some conditions, barrier methods and amount of exposure to sperm can affect the pregnancy itself.
Ness RB, Markovic N, Harger G, Day R. Barrier methods, length of preconception intercourse and preeclampsia, Journal: Hypertension in Pregnancy 23(3):227–235. 2005. Results did not support the immune maladaption theory.
Yousefi Z, Jafarnezhad F, Nasrollai S, Esmaeeli H. Assessment of correlation between unprotected coitus and preeclampsia, Journal of Research in Medical Sciences 11(6):370–374. 2006. In a matched controls study, women with <4 months cohabitation or who used barrier methods had higher risks of developing preeclampsia than those with >4 months cohabitation. Oral contraception users had a lower preeclampsia rate than those who used no oral contraception.
In a commentary article in OB/GYN News ‚ July 1, 2002, the following note was made by Dr. Jon Einarsson: With insufficient exposure, pregnancy may induce an immune response and preeclampsia in some women with predisposing factors such as an endothelium that already is sensitive to injury due to age, insulin resistance, or preexisting hypertension.
Is there a plain and simple truth about sperm exposure and pregnancy risks? Alas, no. But, know your circumstances. If you are young, protect yourself. Wear a condom. When you are ready to be a mom, you will be ready to figure out your risks. So, this, too follows the axiom:
Events in life are rarely plain and never simple.
REVIEW: Evidence is clear - pre-pregnancy maternal health status, including physical fitness, healthy nutrition and an uncompromised immune system affect the health and well-being of both mother and offspring, in both short and long term.
This is the message summary from our first two areas of discussion: Preconditions and Conception — the green and sand colored sections on the chart below.
COMING ATTRACTIONS: We are about to move on to the blue section — Pregnancy!! So, bookmark this Blog for future reference!
Also, you can subscribe to this Blog by clicking on Blog Info in the upper right corner and then clicking on Subscribe in the drop down menu.
But, yes, you guessed it, first we have a small rant!
SMALL RANT: When we note that fitness, nutrition and a healthy immune system play significant roles in the outcome of pregnancy and the future health of mother and child, we are appealing to young people of childbearing age to be careful about your bodies. The alliance of egg and sperm shapes the world. With 6.5 Billion egg/sperm combinations (yes, people) presently living on earth, our resources are stretched. With time, either we get more picky about doing this, or the 3rd rock from the sun (remember that show?) is cooked.
Humorous incursion: In case you need further enlightenment on this whole area, there is a great website that will help you out. Be prepared to be amused and amazed!
Small Rant — Women, their pregnancies, births and mothering styles are all unique. The big issue in childbearing these days is control. Fear of losing control, who controls birth (do YOU give birth or are you delivered by others?), having the self confidence and skills to know when to let go of control yet be okay. It’s interesting to hear what happened to someone else, but (here’s the rant part) this can often be frightening because — let’s face it — catastrophe gets our attention. Whatever you’ve heard, you still have to do it yourself. Pregnancy, birth and parenting create a steep learning curve.
Review — Our job at the DTP Blog is to help with the learning curve through evidence-based information. We are moving along a pathway. Here it is, in a small version (see Feb. 5 for full version):
So far, we have dealt with Preconditions (the Green items). If you understand what you can and cannot control along your Pregnancy Pathway it can help prevent you from spinning your wheels or wasting money. Some things are worth doing (self care, good food, exercise) and some are not (self-indulgence, toxins, stress). Preconditions to pregnancy — genetics, environment and behavior — are worth paying attention to if you are of childbearing age and think or know you are moving along this pathway.
References - We have used hundreds so far and will use many, many more, but only some of you will find the science something you want to pursue, so please go to our DTP website (use the Blogroll) for more information on research in this field. Here are some texts that explain much more: “Women and Exercise” in Varney’s Midwifery (editions 3, 4 & 5), Jones & Bartlett Pub.; Women’s Fitness Program Development by Ann Cowlin, Human Kinetics Pub.; and Immunology of Pregnancy by Gil Mor, Springer Pub.
Coming Attractions — next, we talk about conception. Yes, this is an exciting part, though not perhaps why you think (!). It turns out conception is fraught with many twists and turns.
Q: Why does it take a million sperm to fertilize just one egg?
A: Because none of them will stop and ask directions.
[Sorry, couldn’t resist.]
After that we will likely rant and review again, have more humorous incursions, proceed on to the pregnancy and birth experiences, then discuss health outcomes for mom and baby in the short and long term.
Why do we spend our time on this? From a biological perspective, humans can do nothing more important than create healthy offspring. Wars may be fought, the banks fail or cars become a thing of the past; we might even become post-racial; but, having babies doesn’t really change. It remains a primal experience. It’s nestled in a high tech world, but its still primal. Women have always had guides; we take this role seriously.