Understanding the Effects of Alcohol on Your Body & Your Baby

By Sonia Alvarado, Senior Teratogen Information Specialist, MotherToBaby CA

Spring break 2014, which, for some, actually fell at the end of winter this year, is in full swing. Many students are back to school working diligently toward their degree. For some students, Spring break means a trip back home, a trip abroad for cultural education and for others, it’s a time to let loose on a warm beach, usually with one (or many) alcoholic beverages. One young woman went on holiday to the Caribbean after a particularly stressful semester at college. After returning to school and missing her period, she called the MotherToBaby service. She was frantic after recalling the amount of alcohol she had consumed during her seven days in the sun.

In the last two decades, a change in social conventions, increased disposable income, and marketing, media, and other societal influences have encouraged women to drink more alcohol than in years past. These various factors have contributed to a higher number of women drinking alcohol during college, binge drinking during college and risking alcoholism. According to the Centers for Disease Control (CDC), the issue of women and alcohol drinking is an under-recognized problem. The CDC reports that approximately 24% of women 18-24 and 20% of women 25 to 34 report binge drinking.  Binge drinking is classified as four or more drinks in one occasion. Studies suggest that college-age women may be binge-drinking in higher numbers than men. This may be due in part to the fact that many women do not know that the recommendations for alcohol drinking for men are different  – and higher – than for women. These issues are very concerning because most pregnancies are unplanned and binge drinking is a threat to the healthy development of a pregnancy.

Fortunately, in the now worried “Spring Breaker” we spoke with, our counselor was able to reassure her after identifying her exposure as having occurred very early in pregnancy, prior to placental communication being established. However, the amount of exposure she had reported, four or more drinks daily, may have been a risk had it occurred later in the first trimester.

The U.S. Department of Health and Human Services recommendation for alcohol use by non-pregnant women is one drink per day (maximum of seven per week). Men have a recommendation of maximum two drinks per day. The reason that women have a lower dose recommendation is that women are more sensitive to the effects of alcohol. Specifically, the average woman that takes two drinks will have more alcohol in her system compared to a man drinking the same amount. This is due to a size difference, genes, and maybe, hormones too. Women are generally smaller than men and that means having less blood. Having less blood means less water. A woman’s body is made up of about 52% water and a man’s about 61%. Water dilutes alcohol, both in a glass and in the body. More dilution means less impact. Also, women have more fat and unfortunately, alcohol in fat can’t be metabolized as quickly and it ends up concentrating in blood.

There is an important enzyme(s) called alcohol dehydrogenase that breaks down alcohol. These enzymes are primarily stored in the liver and the stomach. These enzymes are found in greater abundance in men than women. The lower number of enzymes means that more alcohol gets into the blood and stays there longer.

Hormones may also play an important role in breaking down alcohol. Studies suggest that the premenstrual phase slows down alcohol and results in higher blood alcohol levels. There is some evidence that birth control pills that contain estrogen also slow the breakdown of alcohol.

So what does this all mean? Should Spring break mean all work and no play? Not necessarily. However, part of feeling empowered and making responsible decisions is learning the facts about how alcohol can affect us all differently. During April’s Alcohol Awareness Month, I encourage everyone to take a moment to think about those differences – It could make the difference in your future baby’s life.





Jones, MK,,& Jones BM. (1984). Ethanol metabolism in women taking oral contraceptives. Alcohol Clin Exp Res, Jan-Feb;8(1):24-8


Sonia Alvarado is a bilingual (Spanish/English) Senior Teratogen Information Specialist with MotherToBaby California, a non-profit that aims to educate women about medications and more during pregnancy and breastfeeding. Along with answering women’s and health professionals’ questions regarding exposures during pregnancy/breastfeeding via MotherToBaby’s toll-free hotline, email and private chat counseling service, she’s provided educational talks regarding pregnancy health in community clinics and high schools over the past decade.

MotherToBaby is a service of the international Organization of Teratology Information Specialists (OTIS), a suggested resource by many agencies including the Centers for Disease Control and Prevention (CDC). If you have questions about alcohol, medications or other exposures, call MotherToBaby toll-FREE at 866-626-6847 or visit MotherToBaby.org to browse a library of fact sheets and find your nearest affiliate.
photo credit: opacity via photopin cc

Choose Wisely: Studies Show Increased Risk of Cesarean Linked to Choice of Doctor

By Jacqueline Levine

The cesarean rate in the United States has leveled off, as reported last year by the Center for Disease Control and Prevention (CDC). The information came from the National Center for Health Statistics, and it says, in sum: “After 12 years of consecutive increases [1998 to 2009], the preliminary cesarean delivery rate among singleton births was unchanged from 2009 to 2011”;  the report cites the current rate as 31.3%.  That the rate has stopped rising is good news. And that the rate is too high is not in dispute. The World Health Organization and other organizations that promote and support optimal maternity care have been making that case for a long time.

Most recently, the American Congress of Obstetricians and Gynecologists (ACOG) has come out with a report entitled “Safe Prevention of the Primary Cesarean Delivery,” with guidelines meant to prevent a first-time c-section. The study calls for revisiting the list of the common indications for cesarean. The various rationales for cesarean have held sway in maternity care for years.  These new guidelines can be seen as an admission that the rate of surgical birth is indeed far too high, and that current practices do not promote the ideal health of women and babies.

Added to this news are two studies that reveal additional factors that can affect a woman’s chance of having a cesarean. News from the American College of Obstetricians and Gynecologists’ (ACOG) 57th Annual Clinical Meeting, as reported in Medscape Today (Medscape Medical News, May 12, 2009), discussed an article entitled “Liability Fears May Be Linked to Rise in Cesarean Rates.”  The following is a direct quote (bold emphasis is mine):

“It has been suggested that medical-legal pressures are a factor in the high number of cesarean deliveries. A number of studies have borne this out.  Localio and colleagues (JAMA. 1993; 269:366-673) found a positive association between medical malpractice claims risk and the rate of cesarean delivery.   Murthy and colleagues (Obstetrics & Gynecology 2007; 110:1264-1269) found an association between professional liability premiums and rate of cesarean delivery — for every $10,000 increase in insurance premium there was a 15% increase in the rate of cesarean(s) delivery.  Dr. Barnhart said “First of all, I applaud the abstract, in that it quantifies a perceived problem,” ”We all anticipated that defensive medicine might be a reaction to litigation, and this paper demonstrates that that is indeed the case,”  ”So don’t just blame the doctor for doing a C-section, recognize that there’s probably a reason that [he or she is] doing it. And that fear of litigation is the reason,” Dr. Barnhart concluded.”

The study implies that what’s being done in the way of care might indeed be for the welfare of obstetricians who practice defensive medicine, and may not be for the best welfare of the woman in his care. The results of this study are not addressed in the recently released ACOG guidelines to eliminate the overuse of c-section, but it’s helpful to acknowledge the possible affect of malpractice insurance on women’s birth options.

We assume that the most fundamental tenet of care is that what a doctor does is for our benefit, and not for her or his well-being, convenience or safety. A doctor who picks up a scalpel and performs surgery for defensive reasons is behaving in a way that is the antithesis of ethical behavior, a betrayal of our trust in the doctor-patient relationship.

The other study addresses how an obstetrician’s personality affects your risk of having a cesarean. The article, “Women’s Risk of Having C-section May Depend on Her Obstetrician’s Personality,” discusses a study published in the Journal of Obstetrics and Gynecology in 2008. (Allcock, C., Griffiths, A., & Penketh, R., The effects of the attending obstetrician’s anxiety trait and the corresponding obstetric intervention rates. Journal of Obstetrics and Gynecology, 28(4), 390-393. [Abstract]). “Trait anxiety” is an integral and unchanging part of the human personality and is very different from “‘state anxiety’” which happens in response to a particular situation.

The results of the study are very concise (emphasis mine):

“Obstetricians were asked to complete a validated survey that measures ‘trait anxiety’ which is stable and enduring… The obstetricians with the least anxiety had the lowest emergency cesarean rates.  The obstetricians with the most anxiety had the highest rates.”

Statistical analysis revealed that the doctor’s trait anxiety levels were highly correlated with cesarean rates. 

These studies document just two of the many factors that affect a birthing mother’s chances of having a cesarean — factors that have nothing  to do with a mother’s or baby’s actual health status. The more we know about what influences doctors in the decisions they make about our care, the better our ability to recognize and request best-evidence care for ourselves and our babies. And so the question becomes, how can a birthing woman understand and avoid the influence of lesser-known factors on her chances of avoiding cesarean?

As our own best advocates, we must seek out the ethical caregivers who do not rely on routine interventions and who use surgery only to save the lives or health of babies and mothers. Before deciding  on a caregiver , it’s of critical importance to become familiar with best-evidence, optimal maternity care, so that you’re able to
question her/him about all the health care practices that will affect labor and birth. Knowing the facts about normal, healthy birth and conservative reasons for c-section based on our genuine health status help you make informed choices about your care.

Recommendations for OBs, hospitals and midwifery care from women across the United States can be found at the non-profit, all volunteer website www.thebirthsurvey.com. Question your prospective OB or midwife about his/her c-section rate, induction rate, episiotomy rate, and other routine and common practices that may not confer best-evidence care. If you perceive a defensive posture about his stats, or an air of reluctance to tell you what you want to know, consider it a red flag warning and seek a new caregiver for optimal care.


Looking for more information and resources surrounding cesarean and VBAC? Check out this list of online resources and test-your-knowledge quiz from Science & Sensibility.


About the Author

Jacqueline Levine, BA, LCCE, FACCE, CD(DONA), CLC has been a DONA doula and  lactation counselor  for 10 years, a Lamaze educator for twelve years, and a WIC educator.  She teaches Lamaze childbirth education at Planned Parenthood of Nassau County, where she volunteers birth doula services to the clients of Planned Parenthood, an underserved population.  She won the Lamaze Community Outreach Award for these services to the community, and she has taught and supported pregnant teens in local high schools.

She’s been a contributor to Science and Sensibility, the Lamaze research blog, since 2009, and writes for BreastfeedingUSA, the online peer-to-peer breastfeeding site as well.  Some of her articles for breastfeeding teens have been on the US Breastfeeding Committee site, and she is a guest lecturer in the Sociology Department of CW Post College of LIU, teaching a class in the History of Childbirth in the United States, as well as breastfeeding classes for DONA doula certification that stresses best-evidence care for mothers and newborns.

She is mother of three and grandmother of five, and came to the world of birth after she retired from a career as artist and designer in the Garment Center in NYC.

Marijuana & Pregnancy – Is it Safe?

By Sonia Alvarado, Senior Teratogen Information Specialist, MotherToBaby CA

Marijuana has been in the news a lot lately and for marijuana users who have had to smoke in illegally, it appears societal attitudes about pot smoking may be changing.  Twenty states have laws legalizing some form of marijuana use. Two states, Colorado and Washington, have legalized its recreational use. In an interview, the NFL Commissioner seemed to leave open the possibility that medicinal use could be considered for NFL players if there was scientific evidence that it was helpful to treat injuries and pain. Even President Obama has said that he doesn’t believe marijuana is any more dangerous than alcohol. Marijuana is currently listed as a Schedule I drug. Other Schedule I drugs include heroin, lysergic acid diethylamide (LSD), 3,4-methylenedioxymethamphetamine (ecstasy).


What The Research Shows Us

According to studies, pregnant women who use illicit substances are more likely to use marijuana compared to other drugs. This is often due to the belief that marijuana is less harmful to the developing embryo and fetus, compared to other drugs such as cocaine or heroin.

Marijuana is Cannabis. The delta-9-tetrahydrocannabinol (THC) in the Cannabis plant produces the psychoactive effect or “high.” Marijuana can be smoked in a joint, inhaled through a bong or vaporizer, eaten in food and teas/beverages, used in tinctures, and topical balms.  Smoking and ingestion exposes the user to THC, producing the high. When smoked in a joint, the user is exposed to carbon monoxide from the burning of the leaf as well as tar, which can stay behind in the lungs.

Marijuana use during pregnancy has been studied since the 1960’s. Like all studies, there are weaknesses that have been pointed out. For example, asking women about past drug use may not be the most accurate way to make a connection between the dose of the drug and the adverse effects because the women may have forgotten. Also asking women to volunteer information about drug use, which they may fear disclosing even in a confidential setting, may make it difficult to know how frequently pregnant women use drugs overall. Still, a number of experts have reviewed hundreds of reports in humans and animals. At least to this point, the studies do not support an association between marijuana smoking and birth defects. One large study of 12,825 interviews done after delivery, did not find a statistical association between marijuana use and birth defects.

However, the studies also show that marijuana is not risk free. Studies have reported associations between marijuana smoking and growth restriction and lower birth weight, particularly in women who keep smoking through delivery or late in pregnancy. An Australian study of almost 420,000 live births reported a higher risk for neonatal intensive care admission for newborns exposed prenatally to pot. Also, there are reports of abnormal responses or behaviors in the newborn period and this suggests a toxicity or withdrawal. The symptoms include exaggerated and prolonged startle reflexes (sleep cycle disturbances with high-pitched crying.) In a Brazilian study, exposed newborns were “more irritable and less responsive to calming, cried more during the examination, and exhibited more jitteriness and startles than the non-exposed neonates.” Pregnant women who smoke daily and/or through delivery, have a higher risk for complications in their pregnancy compared to women who quit in the first trimester.

Researchers have attempted to assess the long-term effects of prenatal marijuana exposure. Studies of 3, 10 and 14-year old prenatally exposed children suggest that the prenatal exposure to high doses of marijuana may make it harder for children to learn and may affect their emotions (increased aggression) and increase depression symptoms. Studies are needed to assess which prenatally exposed children are most at risk. Its important to note that the children in these studies often have had prenatal exposure to other drugs as well, struggles with poverty and other life challenges, making it difficult to know that the findings are due to a single drug exposure.


So Where Does Marijuana Rank Compared To Other Drugs?

Alcohol: Specific to use during pregnancy, marijuana is not alcohol. Alcohol is still the drug with the highest risk and the widest range of birth defects, including physical, mental and behavioral. Alcohol is a drug with the highest use throughout the world, easy legal access, and social acceptance.

Cocaine: Cocaine, by comparison, is associated with a small risk for birth defects, and a higher risk for admission to newborn intensive care for withdrawal and toxicity. Additionally, cocaine is associated with prenatal growth retardation, lower birth weight, shorter length, and smaller head circumference. Studies suggest the effects on height extend into childhood.

Heroin: Heroin has not been associated with an increased risk for birth defects, however, is associated with a higher risk for withdrawal and admission to newborn intensive care and sudden infant death syndrome.


Bottomline: Snuff Out Smoking It

Clearly, marijuana use in pregnancy is not preferable, nor less risky, compared to most other drugs when a side-by-side comparison is made. Changing societal attitudes doesn’t change the fact that the developing embryo (and fetus) is dependent on the mother for oxygen, nutrients and a balance of hormones, chemicals and other substances to grow normally. Disrupting the normal fetal environment, through the introduction of marijuana or other recreational drugs, puts the pregnancy at risk in the short-term and possibly the long term as well.


Sonia Alvarado is a bilingual (Spanish/English) Senior Teratogen Information Specialist with MotherToBaby California, a non-profit that aims to educate women about medications and more during pregnancy and breastfeeding. Along with answering women’s and health professionals’ questions regarding exposures during pregnancy/breastfeeding via MotherToBaby’s toll-free hotline, email and private chat counseling service, she’s provided educational talks regarding pregnancy health in community clinics and high schools over the past decade.


MotherToBaby is a service of the international Organization of Teratology Information Specialists (OTIS), a suggested resource by many agencies including the Centers for Disease Control and Prevention (CDC). If you have questions about beauty products, medications or other exposures, call MotherToBaby toll-FREE at 866-626-6847 or visit MotherToBaby.org to browse a library of fact sheets and find your nearest affiliate.
photo credit: MendezEnrique via photopin cc


Birth Stories that Empower and Teach

By Chelsea Wiley

Chelsea, founder of Birth with Balance

As a labor and delivery nurse I am truly passionate about the process of childbirth. Through my work, I have discovered that it is important for mothers to share their birth stories in order to heal, teach and empower one another through first hand experience. A birth is a transforming moment in life. The story of your birth has the potential to transfer important knowledge to other mothers, and heal unknown parts of yourself. I created the site Birth with Balance to provide a platform for mothers to share their stories and for other mothers and mothers-to-be to learn through reading other birth stories.

Despite the billions of women who have given birth over the centuries, it often strikes me that so many of my patients enter the hospital without any real knowledge or idea of what to expect. Others check in to deliver with a specific plan for how they want childbirth to happen, and cling to this plan even when things do not unfold the way they had hoped. After birth the mother’s story is often lost and so are the decisions she made. Some births are traumatic, and the let down can be devastating, and others are euphoric. Each powerful story helps women prepare for birth, reflect and learn from one another.

The intensity and harmony that accompanies childbirth is a place where both children and stories are born. I created Birth with Balance to tell each of these unique stories.

Your birth story matters!

I am not the first person to recognize the importance of sharing and reading birth stories. In fact, I give this award to Ina May Gaskin the most famous midwife in the world. She said, “Birth matters. It matters because it is the way we all begin our lives outside the source, our mother’s bodies… For each mother, it is an event that shakes and shapes her to the innermost core.”  It is a spiritual journey that offers women the opportunity to explore their strengths and weaknesses.  A journey so sacred it offers a glimpse into our deepest selves.

I had the opportunity to train with Ina May and she told us one of her own birth stories during class one day, a story that ultimately changed her life. During Ina’s first birth all of her limbs were tied down and her baby was “prophylactically” pulled out at high station using forceps – without much consent. This was the trend during the time as cesarean sections are the trend now.  This painful experience empowered her to make changes and become the woman she is today. By telling her birth story Ina demonstrated how important it is to heal after birth, and teach other women in order not to repeat the cycle.

I know that the best way to counter the effects of frightening birth stories is to hear or read inspiring ones.  Though it is important to share difficult stories in order to heal, it is just as vital to tell positive stories to reduce fear, build confidence, and transmit alternative knowledge.

The anxiety, fear, and disappointment that can surround childbirth have taught me that the most valuable thing a woman can do when giving birth is to simply surrender. If you can let go of your mind and let the power of your body take over—truly trust in your instincts—you will experience the full range of heightened emotion surrounding birth, including exhaustion, disappointment, ecstasy, frustration, love, and even euphoria. All of these emotions are teachers.

Birth with Balance is the only website available that focuses solely on birth stories, offers a questionnaire to help mothers write their story (in case anyone is feeling shy), and gathers stories from around the world.  This forum is a safe place for mothers to: remember, reflect, heal from a trauma, contribute their wisdom, role model, empower, and offer alternative birthing options.

Share your birth story and contribute your wisdom! Please visit the site to read some amazing stories and connect with other mothers around the globe. You can also find us on Facebook at https://www.facebook.com/birthwithbalance


Weight Loss During Pregnancy

There are many times during the year that many of us think about losing weight or getting in shape: New Year’s, before summer beach season, or when a big social event is coming up.

But what if you’re pregnant?

Pregnancy is different. We still want to look our best, but that baby growing inside us needs to get all of the nutrients needed to grow well. Yet, there is pressure on pregnant women to diet. Obstetricians recommend only gaining a limited amount of weight during pregnancy, and some doctors and midwives will put pressure on women to stop gaining weight at a certain point if they have gained “too much” weight too quickly. Additionally, some women may worry about gaining too much weight during pregnancy. Will it increase my risk? Will I look fat instead of pregnant? What if I can’t get the weight off again after I have my baby?

Yes, there are risks to gaining too much weight during pregnancy. However, there are also considerable risks to trying to lose weight during pregnancy, or not gaining enough. Some of those risks include a higher chance of baby being born prematurely, being too small (small for gestational age or low birthweight), having heart or lung problems,1 and even an increased risk that baby could die within the first year.2  ACOG (The American Council of Obstetricians and Gynecologists) recommends that ALL women gain weight during pregnancy. Even obese women should gain at least 11 pounds during pregnancy.3 To make this perfectly clear: a woman should never try to lose weight while pregnant.

Safe ways to look and feel better during pregnancy without dieting

Fortunately, there are things you can do to look and feel better, while also helping your baby be healthier. The ideas below may affect your appearance by improving muscle tone or by reducing the amount of weight gained during pregnancy. Using the ideas should help ensure that you gain the right amount of weight for you and your baby, without needing to count calories or watch the scale like a hawk. In addition, starting these healthy weight-influencing habits during pregnancy will help you feel better, help your baby to be healthier, and may help you reach a more ideal body composition more quickly after your baby is born.

Please understand that these are general suggestions for healthy, low-risk pregnant women. Please discuss any changes to your nutrition, exercise or other lifestyle habits with your doctor or midwife before making any changes.

  • Do aerobic exercise. Regular aerobic exercise, 30 minutes or more a day, helps condition your heart, train your body to burn sugar efficiently, use calories, and move toxins out of the body. Try walking, stationary bicycle, swimming, or another activity you enjoy.
  • Do strength training or toning exercises. Doing strength training and toning exercises, even for a few minutes most days of the week, will help your body to burn more calories overall in addition to toning your muscles. Try prenatal yoga or Pilates.
  • Eat more fruits and vegetables. Yes, I know. Who wants to eat more fruits and vegetables? They can be an acquired taste, and it is harder for some of us to acquire that taste than others. The benefits are well worth it, though. Not only are fruits and vegetables power-packed with nutrition for their calorie content, but their fiber helps you feel full for longer.
  • Swap some foods for healthier alternatives. Substituting healthier foods for some snacks and meals can make a big difference. These can be small changes, like eating low-fat or baked potato chips instead of conventional potato chips, or they can be big changes, like eating an apple, a handful of blueberries, or some carrots instead of potato chips. Start with just swapping one snack or food item a day for a healthier option.
  • Eat low glycemic. This basically means eating in a way to keep your blood sugar more stable. When we eat certain foods that digest quickly, it raises blood sugar quickly, but falls just as quickly. This can result in feeling tired or disoriented, getting moody, or feeling hungry even when our bellies feel stuffed. Low glycemic foods raise blood sugar more slowly, and will tend to keep blood sugar more stable longer, as well. So what makes a food low glycemic? Essentially, the more protein, fiber and fat that a food has compared to carbohydrates, the lower it is on the glycemic index and the slower it will digest. Some examples of low glycemic carbohydrates include berries, whole grain breads, sweet potatoes and brown basmati rice. We will explore low glycemic eating in more depth in a future post.
  • Watch what you drink. Many beverages contain a lot of calories, and our bodies do not really register those calories as filling us up. That means that it is possible for us to drink an extra meal or more’s worth of calories every day and not even realize it. Switching some or all of our beverages to water or healthy low- or no-calorie drinks can save a lot of unhealthy weight gain over time. Just try to avoid artificial sweeteners.
  • Learn to listen to your body. Our bodies know what we need, and how much we need, to be healthy. The voice of our bodies is usually quiet, though, and many of us are not used to paying attention to it. If we create opportunities, we can learn how to understand our body’s signals. Start by taking smaller portions of food, chewing well, and eating slowly. Before going back for seconds, sit and chat, read, or just relax for 10 minutes or so to let the signals for continued hunger or being satisfied become clearer. Often, we just do not give our body the time or focus to let us know what it needs. If you are not sure whether or not you are still hungry, wait. You can always snack later. It is ok to leave food on your plate. If you don’t want to throw it away, pack it up in a container and eat it later for a snack.
    On the other hand, if you do feel hungry, eat! As you would expect, eating when you are hungry help ensure that baby is getting what he or she needs. Also, depriving ourselves of food when we are hungry makes us more likely to overeat when we do finally get food. It can also wreak havoc with the way our bodies decide whether to burn sugar or store fat.

Pick one of the tips above to start with, and find a friend or two who is willing to make the shift with you. It helps to have other people to commiserate with – I mean support each other – while making lifestyle changes. Change does not happen right away. They say that it takes at least 21 days to create a new habit, so be patient with yourself. Also take it slowly. Choosing one or two changes at a time is easier for most of us to stick with than trying to revamp our entire lives. Add another habit each week if you want to make a number of changes.

While it is not safe to diet or try to lose weight during pregnancy, there are still ways to help keep your weight gain healthy. Focus on these healthy ways, taking any changes slowly, and trust your body! Our bodies are a lot smarter than we give them credit for being. We are able to see more of that innate intelligence as we learn better how to listen, and how to support those needs. During pregnancy, this helps women put on the right amount of weight for themselves and their babies. Postpartum, this helps us to eventually each reach our body’s ideal weight.


Melinda Delisle, LCCE, is a mom of two, a natural health researcher and advocate, and a Lamaze-certified childbirth educator. Melinda started teaching childbirth classes in 2000. She found that her students had much more comfortable and healthier pregnancies and births with fewer complications when they decided to follow healthy lifestyle principles. This led Melinda to develop the Pocket Pregnancy Guide ebook series, including “What to Eat When Pregnant” (learn more at www.pocketpregnancyplanner.com ). Melinda believes in the ability of women to make our own choices, and the strength of our bodies when we learn how to support them.


  1. Siega-Riz AM, Viswanathan M, Moos MK, Deierlein A, Mumford S, Knaack J, et al. A systematic review of outcomes of maternal weight gain according to the Institute of Medicine recommendations: birthweight, fetal growth, and postpartum weight retention. Am J Obstet Gynecol 2009;201:339.e1–14.
  2. Regina R. Davis, Sandra L. Hofferth, Edmond D. Shenassa. Gestational Weight Gain and Risk of Infant Death in the United States. American Journal of Public Health, 2013; : e1 DOI: 10.2105/AJPH.2013.301425
  3. Weight gain during pregnancy. Committee Opinion No. 548. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013;121:210–2.

Childbirth Challenges

The following and several more great resources can be found at Lamaze.org/PushForYourBaby

Every pregnant mom wants a healthy baby, but common maternity practices may actually make it harder to have a safe and healthy birth.

Many interventions may seem like they would make childbirth easier. But, did you know that some of the care that pregnant women routinely receive can have unintended consequences and potentially make birth more difficult and less safe?

Here is the straight scoop on some common interventions. This information, and what you learn in a Lamaze class, can help you partner with your care provider to have the best birth day possible for you and your baby.


Let’s be honest. Most of us would love to avoid the pain of labor and birth. But, epidurals have both “pros” and “cons.” We already know the good part – a reduction in pain for you. But there’s less talk about the downside. It’s important to know that epidurals can set the stage for slower labor, more difficult pushing and dangerous blood pressure changes all factors that can lead to a C-section.

Women don’t always get support for exploring other, more natural pain relief options like movementfocused breathing, or a warm tub or massage (ahhhh!) to keep pain in check. So, weigh the risks and benefits before agreeing to an epidural – it’s an important step in making this personal decision.

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Overuse of C-Sections

Cesarean surgery can save lives, plain and simple. But, it’s pretty major surgery, and like any other surgery, it carries risks for you and your baby. So, there should be a really good medical reason to use it, right?

It’s sad to say, but more and more babies are being delivered by cesarean, even when there’s not a good medical reason to do so. In the United States, about one in three women who give birth will end up in the operating room.

Some women are told they are too overweight, too short or too old for vaginal delivery. Others are told their babies are too big or coming out too slowly. Women who have already delivered a baby by cesarean often are told that a vaginal birth after cesarean (VBAC) is off-limits and another cesarean is their only option. Many of these reasons sound like good medical thinking, but aren’t actually supported by the research.

To help spot a cesarean you might not need, be prepared to ask your care provider questions like: “Can we wait a little longer?”, “Is my baby in any immediate danger?” and “What are the risks if I proceed with a C-section, and those if I don’t?”

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Induced Labor

An increasing number of hospitals are cracking down on inductions, and for good reason. Artificially starting labor may be good for a care provider juggling a busy calendar, or your mother-in-law who wants to book her plane tickets, but it can make labor harder and more painful for women, and stress babies and jeopardize their health. Studies have consistently shown that the risk of having a C-section for first time moms nearly doubles with induction. It also increases your baby’s chance of being born premature. That’s because due dates aren’t an exact science. Even if you and your care provider are positive about your dates, every baby matures at a different rate. Inducing labor can mean your baby is born before he or she is ready.

Aside from the risks of induction, there are specific benefits to letting labor start on its own. During the last part of your pregnancy, your baby’s lungs mature and get ready to breathe. He or she puts on a protective layer of fat, and develops critical brain function through 41 weeks of pregnancy. Cutting the pregnancy short can be tough on your baby.

Before going through with an induction, tell everyone to hold their horses, and take time to learn more about benefits of letting labor start on its own.

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The American Congress of Obstetricians and Gynecologists, as well as theSociety of Obstetricians and Gynaecologists recommends listening to your baby’s heartbeat at key points in your labor for low risk women.

Electronic Fetal Monitoring (EFM)

There isn’t a mom on the planet who wouldn’t love a way to monitor every moment of her baby’s in utero existence. We all want to know our babies are doing ok. Using the same thinking, most care providers will monitor you baby’s every heartbeat during labor using electronic fetal monitoring, or EFM. It’s worn like a belt around your belly, and as long as you don’t move, it will record every heartbeat on a little strip of paper. Your care provider will watch the monitor and that little strip of paper for signs of trouble.

Sounds great, right? Well, there’s a catch, actually, three big catches.

  1. It doesn’t work. It’s natural to think that using EFM would help care providers spot babies who are in trouble, but every study that’s ever been done has shown the same thing. Using EFM doesn’t help improve the health and well-being of babies.
  2. EFM can lie. Well, not on purpose, but studies show that EFM can frequently give a false signal that a baby is in trouble. This means an emergency cesarean for mom, even though baby is perfectly happy and healthy.
  3. EFM confines pregnant women to bed. The best way to move your baby OUT is to get yourself up and moving. If you’re stuck in bed, you’re not able to help your baby on that journey.

What’s the alternative? Studies show that a baby’s heart rate can be monitored just as safely with a nurse, doctor or midwife regularly checking in to listen at key points in your labor with a Doppler.

Talk with your health care provider about using intermittent listening, so you can move freely, relax between contractions, and avoid the anxiety that comes with being tied to a machine. Keep in mind that if you have a medical complication, if your labor is induced or sped up artificially, if you have an epidural, or if a problem develops during labor, you will likely need continuous EFM. Otherwise, it can be safer and healthier to have intermittent monitoring.

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Restricting Movement During Labor & Pushing

In contrast to what you see in movies and on TV, lying on your back in a hospital bed is not the only way to give birth! In fact, walking, moving around and changing positions throughout labor makes the birth of your baby easier. Movement is the best way for you to use gravity to help your baby move down the birth canal and through your pelvic bones. Staying upright actually increases the size of your pelvis to make it easier for your baby to fit and rotate as necessary.

When it comes time to push, staying off your back and pushing with your natural urges can be key to making it as easy as possible on you and your baby. Be wary of anyone trying to “direct” your pushing. Nobody should be counting for you or telling you to hold your breath. It increases the risk of pelvic floor damage and actually can deprive your baby of oxygen! Keep in mind that if you have an epidural or continuous EFM, this will drastically restrict your movement during labor.

Learn more about how movement in labor, as well as pushing upright and with your natural urges, can improve your chances of a healthy, safe birth.

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Restricting Eating and Drinking in Labor

They don’t call it labor for nothing! For many women, labor is a physically intense experience that puts many demands on the body. Unfortunately, women are routinely restricted from eating or drinking in labor, which can mean running out of energy when it’s needed it most. The restrictions come out of concerns that, if a woman ends up needing surgery, she should have an empty stomach. But research shows that modern anesthesia techniques make complications from food in the stomach exceedingly rare, and that laboring women can safely eat and drink in labor. So, be prepared. Make a point of discussing this with your care provider and be sure you’re able to get the nourishment you need to do the hard work for labor.

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Adequate Support

If you traveled to an exotic country and didn’t speak the language, you probably would consider hiring a tour guide to ensure your vacation was safe and fun. More and more, women are recognizing the same need in labor. Research shows that women who have continuous labor support from a friend, family member, and especially, the help of a professional labor assistant known as a “doula,” have easier and slightly shorter labors.

Many women count on having a nurse by their side to provide this support. Sometimes that happens, but most labor nurses are caring for several women at the same time and don’t have the time to provide contraction-by-contraction support. Dads often are expected to fill this role, but they are new to the process, too, and often need cues on how to best be supportive to their laboring partners.

So, think through interviewing a doula or consider whether you know someone who is especially knowledgeable about childbirth. Having someone you trust by your side can help you manage your labor, support good decision-making and help make sure you’re able to communicate your wishes to your health care provider.

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Separating Mom and Baby

Labor is over and your bundle of joy has finally arrived! But before you know it, your baby is whisked out of your arms or away to the nursery. That’s because in many hospitals, it’s standard procedure to separate mom and baby for a period of time, to complete some nursing tasks. However, research has shown that it’s best for mothers and their healthy baby to stay together after birth. Talk to your care provider and make sure they allow “rooming-in,” which will maximize your time with your little one and opportunities for breastfeeding. Don’t forget to talk about what will happen immediately after birth, too. Many things like weighing, measuring and bathing are not urgent and can be delayed, or done at your bedside or right on your tummy to ensure you and your new baby don’t miss a beat.

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What’s Next?

So, how do you get a better idea of the care your doctor or midwife will provide? Ask good questions! Take a look at some suggestions.

Talk Back

How about you? Are you hoping to avoid certain interventions in your baby’s birth? Have you experienced interventions that made your birth harder? Did you successfully avoid an intervention that helped make your birth easier and safer? Tell us your story in our comments section here.

The Attachment Pregnancy – A Book Review

By Valerie Rohde

Have you ever flipped through the pages of a book to dig in more deeply and as you’re reading you felt it was written specifically for you?  That is exactly how I felt when reading The Attachment Pregnancy by Laurel Wilson and Tracy Wilson Peters.  I found myself underlining, starring, and annotating right along just about every page, it is that resourceful.  As a biologist by education and a researcher by trade, as well as a semi-new mom to a 17 month old son, and trying to conceive our next child, this book came along at just the right time in my quest to gain more knowledge about attachment and our attitudes toward life and others in general.

The Attachment Pregnancy is laid out in such a way that is easy to read for any mom, yet very informative with many scientific processes that occur in the brain and body explained in detail and broken down so you can easily understand and make sense of the information as it applies to you.  Throughout the book, the authors emphasize and explain the importance of the motherbaby bond: “as you meet your baby’s needs for connection, pleasure, love, and affection, you literally change his or her brain chemistry and neurobiology, preparing your child for a lifetime of security, success, and psychological wellness.  This idea is no longer the stuff of sentimentality; it is underpinned by modern brain science and mother-infant attachment research” (p 10).  The book is divided into four parts – Be-ing, Observing, Nourishing, and Deciding – that each focus on a different part of your journey to motherhood and attachment.

In Part 1, the authors define Positive Mental Attitude (PMA), and how you can consciously make the decision every day by using the Three R’s to practice and find the positivity in any circumstance.  Chapters 4 and 5 discuss Conscious Agreement and Conscious Attachment, and how to build supportive relationships with those who come in contact with you during your pregnancy.  Anyone can benefit from understanding how external influences can have such an effect on us when we are acting unconsciously, and “because people often make decisions based on the expectations of others and their own subconscious reactions to others,” it is important to follow the four steps to practice Conscious Agreement and experience the freedom of tuning in to your intuition and to your “source” (“your reason for being, God, etc.,” p 54).

Part 2 of The Attachment Pregnancy focuses on the importance of observing your surroundings and circumstances during the first trimester of pregnancy, how to reduce stress using the four As, your physical bond with your baby, nutrition, and seeking out relationships grounded in “trust, security, and love [to teach] your child that the world is a safe and secure place” (p 130).

Part 3 hones in on the role that your partner plays in supporting your attachment to your baby.  The authors explain your partner’s experience of pregnancy and help demystify some of the differences between hormones in males and females.  Understanding these differences can help make the process into parenthood smoother when you can recognize the reasoning behind why your partner might be reacting in a way differently than you would.  It isn’t that he doesn’t want to be involved or supportive; he is just doing it in a different way.  I was also enlightened by chapter 12’s explanation of napping and the necessity of listening to our body’s cues for rest, rather than giving in to caffeine or sugar.

Part 4 is a wonderful conclusion to the book that discusses bonding through labor and birth, and just begins to scratch the surface of some of the decisions you may make for your family and gives some excellent resources to consider. I particularly loved the idea of creating a birth vision board as opposed to, or in conjunction with, a traditional birth plan to unleash your creativity and really focus on what speaks to your innermost being.

I encourage you to read this book now, even before you conceive, if possible!  Begin your conscious agreement journey right away with the practical tips and activities in each chapter to strengthen your positive mental attitude and set the stage for a joyful, healthy, attachment pregnancy from the start.  The more prepared you are now, the more natural your attachment will be when you get that positive pregnancy test.  For moms who are already pregnant, this is one book you will want to read as soon as possible to become knowledgeable about all the ways you can positively impact your growing baby and nourish your mind and spirit in the process.  No matter where you are on your parenting journey The Attachment Pregnancy is chock full of wisdom and you will be grateful for the chance to read it thoroughly.  I love the inspirational quotes throughout, and the chapter summaries make it easy to reference and remember specific key points.  This book is more than just a sentimental read about having a positive attitude for you and your baby; it is a resource you will return to again and again.  Thank you, Laurel Wilson and Tracy Wilson Peters, for the exceptional job on this resourceful guide!


Valerie lives in metro-Atlanta with her husband, son, and 3 pups. She is a biologist by education but is most passionate about her family and in supporting other women and their families during their own journeys to parenthood as a childbirth doula, educator, and lactation consultant. With her own journey to parenthood facing miscarriage and infertility, she has become very interested in nutrition and has experience preparing meals for those following the paleo lifestyle. She has an intrinsic love for writing and you can find her thoughts as a contributing blogger on several sites and on her own atwww.brilliantbeginningsbirth.com  

Enjoy the Holidays, Safe, Sane & Sound During Pregnancy

By Dr. Kecia Gaither

Deck the halls and hark the herald! Well ladies, the holiday season is upon us again.  Time for family and friends, shopping and travel, New Year’s resolutions and my personal favorite—cooking and eating.  So let’s  discuss a few things, from a medical  perspective, that will keep you and your precious cargo well and whole for the holiday season.

Travel: Recommendations for travel will vary depending on your destination, mode of transportation and the length of time spent traveling. Basic rules: being pregnant increases your risk of blood clots in the legs; long hours of sedentary travel further increases that risk—it’s important during your excursions to wear comfortable clothes, support stockings and to get up and stretch at least every two hours to get that blood pumping.  If you are going to an exotic destination, try to avoid those locales where vaccinations are needed; if you must go, consult your physician to verify which vaccinations are safe during pregnancy.  Be extra cautious about consuming the water in foreign countries to avoid stomach upset/traveler’s diarrhea—err on the side of drinking bottled water in these circumstances.

Flying during pregnancy, pending your medical status, is considered safe in the first and second trimesters.  Prior to making your reservation, it would be prudent to contact your airline carrier for their travel policies concerning  pregnant women as restrictions may vary.  Due to a lack of oxygen, it may be wise to avoid flying in small, unpressurized planes while pregnant.

Food: Food is the mainstay of any holiday celebration — however, there are some foods pregnant women should avoid due to the bacteria, viruses or parasites which may be present.  These critters can cross the placenta and not only affect mom, but baby as well.  Listeria, a bacteria, is top on the list of germs that can cause severe food borne illness, miscarriage, and stillbirth.  Foods such as unpasteurized cheese/milk, and poorly cooked hot dogs may contain this bacteria, so be vigilant in their consumption.  Foods with raw eggs,  (like eggnog), or  uncooked vegetables (particularly sprouts), or under-cooked poultry may contain E.coli and Salmonella, both of which can cause sickness for mom. Undercooked pork products  may contain a parasite which can cause trichinosis — this one can also cross the placenta and affect the fetus, causing stillbirth, so be sure that all pork is thoroughly cooked. Proper refrigeration of cooked food also is important. The USDA recommends pregnant women avoid foods which have been left out for more than 2 hours.

New Years’ Resolutions

When you’re pregnant, there are a few resolutions that are certainly worth thinking about, and that are attainable and maintainable.

  1.  Cut the mama drama – decrease the stress in your life.  Stress for anyone, but particularly pregnant women, affects both mother and fetus—presents with an increased risk of preterm labor/delivery, low birth weight infants.  Stress also contributes to the development of hypertension.  Anecdotally, mothers who are under immense stress tend to have crankier babies.  Stress busters—meditation, yoga, aromatherapy, professional counseling and therapy—all are safe, natural ways to de-stress.
  2. Open wide and say AAH! – pay attention to your dental health.  Infection is thought to play a major role, among other things, in the genesis of preterm labor and heart disease. Periodontal disease, is, in effect, a lingering oral infection.  A trip to the dentist for cleaning of plaque/attention to any gum disease decreases your incidence of preterm labor and delivery.  Make sure to schedule routine visits for maintenance of your oral health throughout the year.
  3. An apple a day keeps the doctor away– the old adage is true; nutrition contributes to great health. Pay attention to your nutritional choices with the new year—focus on increasing your fruit, vegetable, beans, and whole grains intake—cut down on fatty high cholesterol containing foods/processed foods. Lean meats like chicken and turkey are great. Increase your water consumption and eliminate drinks containing high fructose corn syrup.  Good nutrition contributes to a healthy growing fetus, and post delivery, helps with good milk production and keeping mom in a positive nutritional balance.

With those thoughts in mind, enjoy your holiday season, ladies!


Dr. Kecia Gaither serves as the Vice Chairman and the Director of Maternal Fetal Medicine in the Department of Obstetrics &
Gynecology at Brookdale University Hospital and Medical Center located in Brooklyn, N.Y. – one of the region’s largest and busiest nonprofit teaching hospitals. In her current position, Dr. Gaither oversees the hospital’s OB/GYN’s Ultrasound Unit and the Maternal Fetal Medicine Division. With more than 20 years of professional experience, Gaither’s expertise is grounded in the
research and care for women with diabetes, HIV and obesity in pregnancy.

A New York City native, Gaither’s mission as a medical professional is to offer exemplary prenatal care to those often
underserved and overlooked. The women who enter Dr. Gaither’s office are typically without the financial means nor the emotional support needed to receive the proper care needed while carrying a high-risk pregnancy.

photo credit: richiebits via photopin cc

Unlabored Breathing

By June Connell, ICCE, CD(DONA)

The breath is the link between the body and the mind.  In the yogic philosophy, how we breathe – long and deep or short and shallow – can affect and determine our overall emotional, physical and spiritual well-being.

Every time we breathe, messages are sent to the nervous system about the emotional state we are in at that particular moment.  The breath lets the nervous system know if we are feeling stress or fear, or if we are feeling safe and relaxed.  As soon as the nervous system picks up the emotional cues from the breath, it signals the glandular system to produce and disperse the appropriate hormones to the parts of the body that need them.

The pituitary gland, known in the yogic tradition as the “master gland” because it controls the entire hormonal system, is located below the hypothalamus, just outside the brain and behind the nose.  It has two lobes, the anterior and the posterior.  It produces a variety of hormones, many of them linked to reproduction.  But it is in the posterior pituitary gland where oxytocin, produced by the hypothalamus, is stored and ready to be released when the hypothalamus gives the signal.

Oxytocin, a Greek word that means “sudden delivery,” is called the love hormone because it is one of the key hormones that helps us find a mate, get pregnant, stay pregnant, go into labor, labor effectively, and ultimately birth a baby.  Immediately after birth, oxytocin is present at its highest levels ever so that a new mother can deeply bond with her new baby.  Without oxytocin, some scientists say, we might cease to behave in ways that “facilitate the propagation of the species.”

So the question is:  How can a woman in labor produce the most oxytocin possible to help her labor progress?  The consensus is that it is through her breath.  Study after study points to how conscious breathing can lower blood pressure, slow the heart rate and decrease stress.  It is also clear that yoga and meditation have direct and positive effects on both mother and baby.

In her book Mindful Birthing, Nancy Bardacke, CNM, teaches an “Awareness of Breath” meditation, a simple exercise where the participant focuses all of her attention on the breath, how it feels moving in and out of the body, and how to use the breath to quiet a wandering mind.  Bardacke says it is breath awareness that creates the foundation for a mindfulness practice that is key for childbirth.

“The conditions that encourage your body to produce lots of oxytocin include both the external birthing environment, and your inner birthing environment, which is deeply influenced by the state of your mind,” says Bardacke.  She adds that when we are in a state of stress during childbirth, we inadvertently trigger the fight or flight response and inhibit production of oxytocin just when it is needed most.   But a mindfulness practice can help a women let go of her “thinking mind” in labor, and instead create a positive internal environment where she can access her more primal state, release more oxytocin and help her hormones reach their fullest levels.

Another way to access that primal state during labor is by repeating a sound or mantra to help keep the mind focused, in the case of labor, on something other than the pain of a contraction.  One of the easiest sounds to make is “hmmmmmmm.”  This is the first conscious breath exercise I share in my birth classes, and I often use it as a warm-up in my prenatal yoga classes.  Some women are very self-conscious about making noises, so it’s good to practice during pregnancy.  Try it right where you are.  Close your eyes, place one hand on your belly, the other hand on your heart, inhale deeply, and hum on a long, deep exhale.  Hum on a low note, and feel the vibration it creates in the chest, in the nasal area, and behind the eyes.

According to Dharma Singh Khalsa, MD, in his book Meditation as Medicine, these vibrations can stimulate the glands, in particular, those located in the head, such as the pituitary and the hypothalamus which produce oxytocin.

“Sound currents also strongly influence the chakras by vibrating the upper palate of the mouth, which has 84 points connected to the body’s ethereal energy system,” says Dr. Khalsa.  “Some of these points carry energy directly to the hypothalamus and to the pituitary.”

Ina May Gaskin agrees that deep abdominal breathing is a positive practice in labor.  “It causes a general relaxation of the muscles of the body, especially muscles of the pelvic floor,” she states in her book Ina May’s Guide to Childbirth.  She says that when a woman is tense in her mouth and jaw, it can inhibit the cervix from opening, so she encourages women to relax their mouth and throat muscles “make a sound pitched low enough to vibrate your chest.”

The ultimate enlightenment in yoga is to develop a neutral mind, to be present in every moment, to become stillness in motion and to find peace during action.  It is hard to imagine that in the very active state of labor, a woman could be any of these, yet with good support, a positive external environment, a conscious breath and a focused sound, a laboring woman can produce the oxytocin she needs for her labor to progress without the need for external interventions, and find peace and calm in the internal stillness.


June Connell, ICCE, CD(DONA), is a Happy Birth Way professional childbirth educator.  She integrates her knowledge of the birth process in her roles as a birth doula and a yoga teacher (Yoga Alliance).  She teaches birth and yoga classes throughout Pinellas County and supports women in labor at hospitals and birth centers through the county. 

Weighing The Pros & Cons: CrossFit, Weight Lifting & Other Extreme Exercise In Pregnancy

By Lauren Bartell Weiss, Ph.D.

Regular exercise is an important lifestyle for many women, for aesthetics, overall health, and mental health benefits.  The question still remains as to how much and what type of exercise is beneficial during pregnancy and if too much or the wrong type of exercise can be harmful to the mother or the baby.  While light-to-moderate cardiovascular exercise has been shown to be beneficial, the potential impact of heavy weight lifting is still unknown.   New, intense exercises involving heavy weight lifting programs, such a CrossFit, have now raised concerns about the possible effect to mom and baby during pregnancy.

Though the research is scarce, it has been suggested that heavy exercise, whether cardiovascular or strength training, during pregnancy can have detrimental effects on both the mom and the baby.  When avid exercisers or athletes consult their OBGYN or other health care providers for advice, they are unable to receive evidence-based responses because there is insufficient data and no specific evidence-based recommendations on exercise during pregnancy have been established. Most of the research has been performed on strenuous “cardiovascular” exercise and not on strenuous “strength training” or “weight lifting”.  Epidemiologic studies have long suggested a link exists between strenuous physical activities and the development of intrauterine growth restriction, and this is particularly true for pregnant women engaged in physical work (e.g., lifting). A few studies, mostly performed in third world countries where occupational lifting during pregnancy is common, have found that heavy lifting is associated with increased risk of miscarriage in early pregnancy, increased pelvic pain, prematurity, low birth weight/ intrauterine growth restriction, mostly likely resulting from intermittent but prolonged reductions in blood flow to the uterus.

The state of pregnancy is associated with many physiological changes in mom which in turn, create changes to baby during exercise. While there are major changes in cardiovascular and respiratory functions at rest and during exercise in pregnant women, the changes in the musculoskeletal system may place a pregnant women at risk for severe injury with heavy lifting.  During pregnancy, there is a progressive increased curving of the spine causing a displacement in the woman’s center of gravity. To compensate for this, pregnant women increase the anterior flexion of the cervical spine and abduct the shoulders.  In addition, due to a hormone known as relaxin, there is increased laxity of joints and ligaments, especially the spine, sacrum and ilium joints, pubic bone joints, knees, and ankles, all increasing the risk of serious injuries. Pregnancy is also associated with metabolic changes as exercise causes blood glucose levels to drop, most likely as a result of simultaneous uptake of glucose by the developing baby and the exercising muscles.  Most importantly though, are the potential risks to baby, such as changes in heart rate and blood flow while mom is exercising.  The main concern about heavy exercise in pregnancy is that reduced blood flow to the uterus may cause hypoxia (deprivation of oxygen) to the baby.  Muscular activity alters blood distribution in the body, and circulatory blood flow in the uterus and the placenta decreases in the standing position.  Pronounced physical exercise may lead to hormonal disturbances, hyperthermia and nutritional deficits, all of which may have negative effects on the baby. Heavy lifting increases the intra-abdominal pressure and this may provoke uterine contractions or mild abdominal trauma.

The questions most likely to be asked concerning exercise and pregnancy are whether or not exercise affects the growth of the baby or causes the baby to be distressed or starts premature labor.  There are 4 potential adverse baby outcomes from maternal exercise in pregnancy:

  1. Risk of congenital malformations
  2. Risk of physical injury to the fetus
  3. Effects of exercise in pregnancy on growth
  4. Risk of premature labor

For the mother, the potential adverse effects of exercise are few — there may be an increased risk of physical injury from the increased ligament laxity which may affect joint stability and an increased risk of hemorrhage. However, for the growing baby, there may be several unknown risks.

The most recent ACOG guidelines are listed below. These recommendations are made for women who do not have any additional risk factors for adverse maternal or perinatal outcome:

American College of Obstetricians and Gynecologists’ Guidelines for Exercise During Pregnancy and Postpartum

1. Regular exercise (at least three times per week) is preferable to intermittent activity.
2. Avoid exercise in the supine position after the first trimester. This position is associated with decreased cardiac output in most pregnant women, causing a decreased distribution of blood to splanchnic beds including the uterus.
3. Pregnant women should stop exercising when fatigued and not exercise to exhaustion.
4. Non–weight-bearing exercises such as cycling or swimming will minimize the risk of injury and facilitate the continuation of exercise during pregnancy.
5. Adequate diet should be ensured.
6. Avoid types of exercise in which loss of balance could be detrimental to maternal or fetal well-being, especially in the third trimester. Further, any type of exercise involving the potential for even mild abdominal trauma should be avoided.
7. Adequate hydration, appropriate clothing, and optimal environmental surroundings during exercise should be ensured.
8. The physiologic and morphologic changes of pregnancy persist 4–6 weeks postpartum. Thus, prepregnancy exercise routines should be resumed gradually based on a woman’s physical capability.


Warning signs to stop exercise during pregnancy include: vaginal bleeding, dyspnea prior to exertion, dizziness, headache, chest pain, muscle weakness, calf pain or swelling (need to rule out blood clot), preterm labor, decreased fetal movement, and amniotic fluid leakage.

Many women stop exercising during pregnancy because of worries regarding the well-being of their baby. Although pregnancy is associated with several physiologic changes and response to exercise is different in the pregnant state than in the non-pregnant state, exercise can be beneficial for generally healthy moms-to-be (who are free of obstetric or medical complications).   Scientific research suggests that light-to-moderate exercise during pregnancy is safe, but the jury is still out on the potential detrimental effects to the baby after heavy lifting. This is possibly due to a reduction in blood flow from heavy exertion.  While exercise can definitely be part of a healthy pregnancy, including even structured programs like CrossFit, caution should be taken with heavy lifting routines that can compromise the baby’s health and have potentially life-long effects on baby.

Expectant mothers should consult with their care provider to help weigh the pros and cons of this type of exercise during pregnancy on their own health and the health of their baby, and use their best judgment and gut-instinct.

Lauren Bartell Weiss, PhD, is a Postdoctoral Research Fellow at UC San Diego’s Center for the Promotion of Maternal Health and Infant Development and former American College of Sports Medicine-certified trainer.

For more information on exercise during pregnancy, visit MotherToBaby.org. MotherToBaby has a library of fact sheets about the risks of various exposures during pregnancy and breastfeeding. For more information or to get a personalized risk assessment about exercise, medications or other exposures, call MotherToBaby toll-free at (866) 626-6847. MotherToBaby is a service of the Organization of Teratology Information Specialists (OTIS). MotherToBaby and OTIS are suggested resources by many agencies including the Centers for Disease Control and Prevention (CDC).


  1.  Exercise during pregnancy and the postpartum period: Number 267, January 2002 Committe on Obstetric Practice, International Journal of Gynecology & Obstetrics, Volume 77, Issue 1, April 2002, Pages 79–81

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