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)
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.
The Second Stage of Birth is different from the First Stage. The actual expulsion of the baby requires a change in energy axis. During dilation (first stage), oxytocin is most easily released from the pituitary gland during relaxation (see previous post), but during transition, a change occurs so that the ergotropic response takes over and adrenaline is key in helping oxytocin to spike.
What does this mean as far as preparation is concerned? While it is important to learn to relax or maintain positions such as one does in yoga, the ability to sprint, or turn on an aggressive action at the end, is critical. You need good aerobic conditioning. Begin exercise with easy breathing and movement, then practice aerobic endurance and power moves at the end of your workout! Finish up with cool down and stretching.
The contractions themselves change. They remain intense for a longer stretch, but the time between them increases. Pushing involves not only the uterus contracting, but the pressure exerted by the transverse abdominal (TrA) muscle. Similar to squeezing a tube of toothpaste, TrA pressure helps press the baby toward the exit – yes, that is the vaginal opening. If the laboring mother is not able to apply adequate pressure, labor assistants sometimes apply pressure manually to the top of the uterus or – if need be – forceps or a vacuum extraction may be necessary.
How can a mom best prepare so that the TrA can provide the needed pressure? Strength training the TrA! Like any other motion requiring power strength, this muscle can be strengthened to do its job! Here’s how:
picture 1: sit upright, inhale
picture 2: exhale, compress abdomen and curl down
Return to upright and repeat 8 times. Rest. Repeat 8 more times.
What if something goes awry? Cesarean, or surgical birth is an alternative. Major complications before labor include a placenta previa, infection or undeliverable breech position. During labor, the most common problem is dystocia – stalled progress through dilation (first stage) or pushing (second stage). In the pushing stage, head to large for pelvis is the most common difficulty.
What happens next? If the birth is natural, you will feel a tremendous euphoria. Bring the baby right up onto your chest for skin-to-skin contact. If you have had medications, your response may be slightly blunted, but you will definitely be overwhelmed by the emotions of birth.
Third Stage is expulsion of the placenta, which can no long remain connected to the shrinking uterus. When it detaches, the nurses or midwives will ask you to push and !plop! out it comes. It can be interesting to see what has nourished your baby for so long!
A detour: We received a question about nutrition and exercise for multiples. So, here is some information for those with twins and triplets. Add a comment if you have a question or experience to share on this topic! Next comes birth, we promise!!
If one is a girl and one is a boy, they're fraternal!
Nutrition for Multiples:
The primary thing we tell people with twins or more is that the protein needs rise about 30 grams/baby/day above the 70 – 90 grams/day needed for a singleton. Water intake also needs to rise. Avoid thirst and as much as possible, drink until urine runs clear rather than yellow (as best as you can).
Multiples is considered a risk factor, and for each risk factor (multiples, underweight, teenage mom, inter-pregnancy period less than a year) an additional 200 calories is often recommended, with 400 extra calories the upper limit.
Exercise with Multiples:
A critical factor in successful implantation and growth of the placenta appears to be aerobic fitness in the six months prior to and the first half of pregnancy. Once biomechanics become difficult in mid-pregnancy, women with multiples can continue activity safely as long as monitoring show the babies are growing appropriately. A belly support can be extremely helpful when exercising.
Contraindications for exercise include the discovery that one fetus is growing at a significantly slower rate than the other(s), that both/all are too small, that the placenta(s) is/are malfunctioning, or some other condition occurs, such as an incompetent cervix or placenta previa, that would be a factor in any case.
Absolute size difference does not necessarily mean that one baby is growing more slowly, as some fetuses may be a couple weeks younger than their uterus-mate(s) if the mother ovulated twice in the fertility cycle. Or, s/he might be smaller if genetically destined to be a smaller infant at birth. Thus, growth rate is the measurable factor that helps determine if a fetus is at risk of not receiving adequate energy. This can happen when there are two placentas and one placenta is working more poorly than the other, or for some reason there is a flaw in the umbilical cord of an identical. The competition for energy places a slower growing baby at risk.
Protecting Mom and Baby:
The placenta is designed to nourish the baby and will do so at a cost to the mother first if there is inadequate nutrition. Thus, activity to the level the mother can tolerate and following nutritional guidelines above – in the absence of medical complications – produces healthy offspring. Multiples will garner all the same benefits a singleton does.
Note about images: we strive to use images we own or that are advertised as free on the internet. We want to thank google, bing and yahoo for making free images available.
Hot topic for today: Toxins and infections in pregnancy.
Pregnancy Exposure to Toxins and Infections
A mother-to-be needs to be aware of items that can have adverse effects on the health and development of her fetus, as well as her own health. Two of these factors are toxins and infections.
1. Toxins can be food, environmental factors, and medications, alcohol or drugs. Let’s start with food. Interestingly, many plants have slight toxins in them that can have a small negative impact during early fetal development. One theory of nausea and vomiting in early pregnancy is that this helps the mother’s body prevent these toxins from interfering with normal development. Pica – especially eating dirt that is largely clay – may be another manifestation of how the body strives to counter plant toxins, as clay can counteract some of the effects of these toxins. So, plant toxins can be one food source in early pregnancy.
Another source is food additives (things you cannot pronounce, so read the ingredients!). We have no idea how many chemicals and hormones added to foods affect fetal development.
Environmental factors that may affect fetal development can include air pollution, household cleansers, mold and other items encountered anywhere one goes. Things we breathe can be particularly dangerous, so be sure to keep cleanser use to simple items such as vinegar, ammonia or chlorine bleach. Wearing a mask while cleaning is also a good idea.
Medications, drugs or alcohol that might normally be considered safe for a non-pregnant person – something as simple as aspirin – can be dangerous as they affect blood clotting factors and threaten the placenta. Or, because they cross the placental barrier but cannot be metabolized by the immature fetal liver, they are toxic and induce damage to the fetus.
2. Infections are of concern, as well. It is possible that an active infection at the time of fertilization and implantation can contribute to dysfunction in pregnancy because it interferes with the normal immune responses of early pregnancy. Hypertension in pregnancy may be related to infection in the early days of pregnancy. Some infections – particulary sexually transmitted infections – are known to have detrimental effects on the baby’s health. Preterm premature rupture of membranes (P-PROM) almost always reflects active infection.
Taking Precautions: First, be sure to let your health care provider know about any illness or infection. Second, take care of yourself. Follow recommendations for frequent handwashing and carry sterile hand gel in your purse or backpack. Avoid places where hygiene might be compromised. Practice safe sex.
Back to work! Thank you for your forebearance while we wrote a chapter for a nursing textbook!
During the course of pregnancy, the mother/fetus dance is ongoing. The maternal immune system and the trophoblast cells continue to influence each other even beyond the implantation.
Because the mother’s immune response modulates near the start of each trimester, the fetus is affected to some degree and mounts a response, as well. For a long time it was thought that maternal and fetal DNA material was not exchanged across the placental membrane, however recent findings indicate that there is some exchange of material. Thus, we all carry some portion of our mother’s DNA and our mother carries some of ours.
What is the impact of this chimeric effect? It depends on how well our DNA gets along!
How does this affect the fetus in utero? The fetus may be affected by clotting issues. Depending on maternal health status s/he may be subject to a stronger or weaker immune system.
How does this affect the mother? Women are more likely than men to develop autoimmune disorders (pregnancy playing a role here), and those who bear male offspring are more likely than those who only have girls to have these disorders.
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 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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Please refer to February 5 entry for entire graphic. Today: Environmental Preconditions to Pregnancy.
Our environment is with us all the time. Even if we think we are preventing or controlling environmental factors that impinge on our bodies and minds, they are lurking here, there, everywhere, and they are myriad. Our environmental influences are everything from the air we breathe to the persons who raise or teach us, from the food available to our housing, from our job stresses to cultural forces or even the weather in our part of the world. These things help shape who we are physically and mentally, over the long term and from moment to moment.
Are you prepared to become a parent? One way to tell is to look at your environment…is it healthy? Are you living in a situation that you can count on? What about clean air, safe paint or safe food? What about water? What about people around you? Are they supportive? Does your environment help you stay healthy?
What about your body? Factors in the environment that affect fertility (or lack of it) may determine if you can even become pregnant, or when you can become pregnant. Think about this: Women who work together often cycle together. What if you work alone, say at home…does this affect your ovulation? One factor identified in the lowering age of menstruation in girls is the increasing number of hormones in various meats. Another factor is the presence of non-biologically related older males in the household. If these things are known, imagine what is not known about situations, chemicals or people in our environment that affect our reproduction!
There is not an absolute separation of genetics, environment and behavior. If we are genetically predisposed to certain disorders, for example, we may or may not develop them, depending on environment. Some persons are inclined toward autoimmune disorders, but they may do well or poorly depending on the air pollution where they live. Some individuals may develop immune disorders. And, this situation may adversely impact inflammatory responses during implantation.
People who strive to take care of themselves even if they live in horrible conditions can use their behavior to improve their chances for success in everything from a healthy pregnancy to a meaningful existence. Even if genetics and the environment are against the process, behavior can sometimes overcome the odds. Granted, it’s not likely you can produce 6’5″ offspring (see last post on genetics!) if the egg person is 5’2″ and the sperm person is 5’7″, but much is possible beyond that.
So, what do you do about your environment if you are thinking about becoming pregnant? Take stock. Ask yourself what, if anything, might have to change. Ask what you can or can’t accept for your offspring, if you know there are environmental factors that aren’t perfect. Fetuses are amazing creatures; the placentas that supply and defend them are ruthless and will protect a fetus at all costs. But, you can give your body and potential baby a good chance to do well by providing a six month span of a healthy environment leading up to conception. And, healthy for mind as well as body.
When your baby comes into the world, a door opens in your heart to a room you didn’t even know was there. In that room is a certain kind of love and caring that cannot be described. It is love for this being who is and isn’t you. As a mother, you have been her/his environment for nine months or however long you have shared. The womb is a small, protected, organized environment, one that reflects your larger environment. So, take stock now, ahead of time.
Please refer to February 5 entry for complete graphic. The Precondition we will discuss today is Genetics.
There are genetic factors totally outside your control that determine things as simple as your offspring’s hair or eye color, how the earlobe attaches to the side of the head and whether or not s/he can roll the tongue. More complex things, such as a predisposition to types of cancers, bleeding disorders or various other diseases, also have a genetic basis.
Because the male contributes the sex of the offspring, once conception happens, the sex off the fetus is determined — at least genetically. But, it turns out not everything genetic is set in stone. In utero, hormone exposures may affect how male and female characteristics develop, so that some girls will be very girlie, some will be tomboys, and some may be gay. A similar effect will influence how boys develop.
Genetic, environmental and behavioral preconditions can be intertwined. Environmental factors can alter genes, causing them to express proteins that would otherwise be dormant. Likewise, our behavior affects some of our genes. If we have a family propensity for heart disease, but we eat a healthy diet, exercise and avoid risky behaviors, we alter the impact of our genetic code.
Keep in mind that some things will be completely determined by genes. It is not reasonable to hope, for example, that our offspring will be 6’5″ if both parents are short (or vice versa). If the mother has “thrifty genes” — that is, genes that make it easy for her to gain weight — she may well do so during pregnancy, even if she follows a reasonably healthy lifestyle. If the immune systems of both parents have some similarities, it may affect the maternal immune response to the implanting trophoblast cells, thus affecting the placenta and, indeed, the entire pregnancy.
So, how do we advise people who are thinking of pregnancy to prepare themselves for a healthy pregnancy genetically? Surely, to determine all the potential genetic possibilities is not feasible or affordable at this point. Maybe in another century! But, we can know some factors: Is there sickle cell anemia in both families? Is there a Mediterranean type of sickle cell disorder? What about clotting factors or differences in Rh? What about diseases or disorders that are not common, like ALS? These are things that potential parents may want to discuss.
Like so much of life, we can’t know everything. There are no guarantees. There is a lot to be learned still about human genes and how they work.
This blog has at its heart the notion that physical activity has tremendous benefits for mother and offspring…and for partners, too. How does the genetic component affect this? First, preconception fitness lowers some risk factors for mothers and babies. Second, each mother’s genes will make it easier or more difficult for her to enjoy or benefit from the activity of exercise. We appreciate this and encourage young moms-to-be to find something enjoyable that you like doing and find people or situations that support you in being active now before you become pregnant.
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