pushing

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

About Pain and Birth

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This is excerpt­ed from our Danc­ing Thru Preg­nan­cy blog.

That Was Then…

As I became involved in the birthing field, one of the nurse-mid­wives with whom I was acquaint­ed intro­duced me to Jung’s quo­ta­tion: “There is no birth of con­scious­ness with­out pain.” (Alter­nate­ly, “There is no com­ing to con­scious­ness with­out pain.”) It struck a deep chord in me.

When I first saw the say­ing, “There is no birth of con­scious­ness with­out pain,” inter­twined with a draw­ing of a woman lit­er­al­ly giv­ing birth, the truth of the image seemed obvi­ous to me. It become hard-wired into my under­ly­ing assump­tions about giv­ing birth. The process itself com­bines intense nox­ious sen­sa­tions with mid brain emo­tion­al input into what neur­al sci­ence calls pain. For years, this real­iza­tion has dri­ven what and how I teach: Being fit and edu­cat­ed in body/mind are the tools of enlight­en­ment and self-empow­er­ment.

…And This Is Now

A lit­tle while ago I came across a NY Times arti­cle “Prof­it­ing From Pain.” While the arti­cle con­cerns the huge increase in the legit­i­mate opi­oid busi­ness – prod­ucts, sales, hos­pi­tal­iza­tions, legal expens­es and work­place cost – it restart­ed my think­ing about a top­ic fer­ment­ing in my brain between That Was Then And This Is Now: The sense of enti­tle­ment to a pain-free exis­tence. The idea that pain free is bet­ter than painful. And the sell­ing of this idea for prof­it.

Where does this come from? Try­ing to oblit­er­ate pain has led to increased addic­tion, death and oth­er adverse side effects. A new top­ic has shown up in women’s health dis­cus­sions: Increas­ing use and over­dose from pre­scrip­tion pain killers by women, includ­ing dur­ing preg­nan­cy.

Could it be that human fear of pain is being used to gen­er­ate finan­cial prof­it? (the opi­um-is-the-opi­ate-of-the-mass­es mod­el). Per­haps once the notion of pal­lia­tive care reached a cer­tain lev­el of accep­tance for the dying with­in the med­ical com­mu­ni­ty, it began to spill over into oth­er human con­di­tions (the slip­pery-slope mod­el). Or, per­haps we don’t want trans­paren­cy at all (the denial mod­el).

In the last few days, NPR has raised the ques­tion of whether the high cesare­an birth rate is tied to the pay­ment for pro­ce­dure rather than out­come mod­el? The recov­ery from cesare­an is more painful than the recov­ery from vagi­nal birth, has adverse side-effects for moth­er and baby, and was orig­i­nal­ly designed for use only for the 15% +/- of real com­pli­ca­tions that arise in nor­mal birth. So, how is it being sold to 35% of women in the U.S,? At one point, there was a seri­ous dis­cus­sion with­in the med­ical com­mu­ni­ty that if women were afraid of the pain of birth and want­ed a cesare­an, a care provider should do one. No dis­cus­sion of why it seems painful or how to deal with pain.

The Afford­able Care Act aims to improve some of the cost issues in med­ical care by shift­ing the pay­ment incen­tive away from pro­ce­dures and on to out­come assess­ment. As a result, the cesare­an rate and even such seem­ing­ly innocu­ous pro­ce­dures as fetal mon­i­tor­ing are com­ing under scruti­ny. If we tru­ly want to do a ser­vice to the moth­ers-to-be in the ACA tran­si­tion peri­od and beyond, I think we must dis­cuss the ques­tion of birth and pain.

I can think of many ques­tions that fall under this topic…Why do we call the intense phe­nom­e­non of birth “painful”? How do our genet­ics, behav­ior, train­ing and thought-process­es affect our expe­ri­ence of pain? What about the health care cul­ture – has it focused on reliev­ing pain at the expense of what we gain from work­ing with pain short of trau­ma or immi­nent death? How do we pre­pare women for work­ing with sen­sa­tion with­out auto­mat­i­cal­ly label­ing it pain? Is the “empow­er­ment” often attrib­uted to giv­ing birth what is learned by going through the cen­ter of the “there is no birth of con­scious­ness with­out pain” expe­ri­ence? These ques­tions are just a start.

In closing…

Let me address the child­birth edu­ca­tors and preg­nan­cy exer­cise instruc­tors. This is our present chal­lenge. In my work, I feel the neces­si­ty to make all pain man­age­ment strate­gies under­stand­able to my clients. I find that most of the women I see in class­es must deal first with self-dis­cov­ery before they can assess their com­mit­ment to the view of birth they car­ry in their minds. The images of birth we lay out for them to con­sid­er need to include an under­stand­ing that you can­not escape the work of birth. Being present – mind­ful­ness – can be scary and intense but it is the medi­um by which our con­scious­ness expands. Car­dio­vas­cu­lar fit­ness and strength are the source of our endurance and pow­er.

Safe Motherhood

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The chal­lenges to safe moth­er­hood vary depend­ing where in the world you live. In some areas the chal­lenge may be to get ade­quate nutri­tion or clean water; in oth­er areas, it may be to pre­vent infec­tion; and in still oth­er loca­tions it may be try­ing to avoid preg­nan­cy before your body is ready or get­ting access to pre­na­tal care. In the U.S., it may mean avoid­ing being seden­tary and mak­ing poor food choic­es, or hav­ing to deal with the high tech­nol­o­gy envi­ron­ment of med­ical birth that can sab­o­tage the innate phys­i­o­log­i­cal process of labor and birth.

Birth begins the bond­ing or unique love between moth­er and child.

The biol­o­gy of birth is a com­plex series of cause-effect process­es…baby’s brain releas­es chem­i­cal sig­nals to the moth­er and the pla­cen­ta begins to man­i­fest the mater­nal immune system’s rejec­tion of the fetus.

To help the ball get rolling, relax­ation (the trophotrop­ic response) helps pro­mote the release of oxy­tocin. With the help of grav­i­ty, the head press­es on the cervix, ampli­fy­ing the uter­ine con­trac­tions. After an ultra-dis­tance aer­o­bic endurance test, the cervix opens enough to let the baby move into the vagi­na and the mother’s dis­com­fort moves from sharp cramp­ing into the bony struc­ture as she tran­si­tions to the strength test of push­ing. She tran­si­tions. Relax­ation mod­u­lates into an ergotrop­ic — adren­al — response to gath­er her pow­er.

Push­ing is an inter­est­ing term…more mas­cu­line, I think, than the one I pre­fer:  Releas­ing. Releas­ing or let­ting go of the baby. It’s a cathar­sis. In this por­tion of the labor anoth­er set of impor­tant process­es help the baby clear its lungs of amni­ot­ic flu­id, stim­u­late its adren­al sys­tem and chal­lenge its immune sys­tem, as the con­trac­tions dri­ve the baby down­ward. The mother’s deep trans­verse abdom­i­nal mus­cles — if strong enough — squeeze the uterus like a tube of tooth paste, to aid this expul­sion. In the mean­time, the labor is help­ing set up the moth­er to fall in love and pro­duce milk. When the baby emerges and moves onto the mother’s chest, s/he smells and tastes the moth­er, rec­og­niz­ing her mother’s fla­vor and set­ting up the poten­tial for bond­ing.

Any way you slice it, there are two parts to safe moth­er­hood. One is a safe preg­nan­cy…healthy nutri­tion, phys­i­cal fit­ness, safe water, infec­tion pre­ven­tion, sup­port and a safe envi­ron­ment. The oth­er is a safe labor. In a safe labor, there is both an envi­ron­ment that pro­motes the nat­ur­al process of labor and the means nec­es­sary for med­ical assis­tance when need­ed. Women die at an alarm­ing rate from preg­nan­cy or birth-relat­ed prob­lems. Despite some progress made in recent years, women con­tin­ue to die every minute as a result of being preg­nant or giv­ing birth.

What keeps us from hav­ing a bet­ter record on moth­er­hood is often lack of care in the devel­op­ing world and too much inter­ven­tion in the U.S.. They are two sides of a coin. Moth­ers’ expe­ri­ence and health needs are not on equal foot­ing with oth­er cul­tur­al val­ues. In places where basic pre­na­tal care or fam­i­ly plan­ning are low pri­or­i­ties, at-risk women are vul­ner­a­ble to the phys­i­cal stress­es of preg­nan­cy and birth. In the U.S., machine-mea­sured data is para­mount, even if it pro­duces high rates of false pos­i­tives, unnec­es­sary inter­ven­tions or coun­ter­pro­duc­tive pro­ce­dures. We are learn­ing that obe­si­ty and seden­tary lifestyles have detri­men­tal effects, but few­er preg­nant women than their non-preg­nant coun­ter­parts exer­cise.

Despite the mon­ey spent to sup­port the tech­no­log­i­cal mod­el of preg­nan­cy and birth in the U.S., there are parts of the world with low­er rates of mater­nal deaths — espe­cial­ly Scan­di­navia, North­ern Europe and parts of the Mediter­ranean and Mid­dle East (Greece, the Unit­ed Arab Emi­rates, Israel, Italy and Croa­t­ia). In fact, in the U.S., mater­nal deaths are on the rise.

It’s a tricky busi­ness. Clear­ly West­ern med­i­cine has a lot to offer the devel­op­ing world when there are med­ical con­cerns. On the oth­er hand, import­ing the U.S. mod­el could cre­ate more prob­lems than it solves. Instead, the micro-solu­tions now being devel­oped in many loca­tions will be observed and evi­dence col­lect­ed by orga­ni­za­tions such as the White Rib­bon Alliance and UNICEF.

There is an effec­tive inter­na­tion­al mid­wives mod­el adopt­ed by JHPIEGO, the Johns Hop­kins NGO work­ing toward improved birthing out­comes. It assess­es the local pow­er struc­ture, social con­nec­tions, poten­tial for trained birth assis­tants, and loca­tion of avail­able trans­porta­tion to cre­ate a net­work so that locals will know when a labor is in trou­ble and who can get the woman to the near­est hos­pi­tal.

In the U.S., there are in-hos­pi­tal birth cen­ters that allow low-risk moth­ers the oppor­tu­ni­ty to labor and birth in a set­ting designed to encour­age the innate process­es. Women are begin­ning to vote with their feet…staying home for birth. Women are going abroad to give birth. At the same time, women are com­ing to this coun­try to give birth, believ­ing it is safer than where they are. There are sev­er­al ways these scenes could play out.

But, I’ll wager, improv­ing out­comes will involve com­pro­mise:  Watch­ful­ness and sup­port in most births, plus bet­ter ways to assess dan­ger and pro­vide tech­nol­o­gy. No mat­ter where you live in the world, the solu­tion may be essen­tial­ly the same.

Pregnancy Pathway, Birth — Birth Mode

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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!

CONGRATULATIONS!  YOU’RE A MOM!

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™