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).

References:

  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

photo credit: lewishamdreamer via photopin cc

Great Expectations: Pamela @ 22 weeks

Where did the time go this summer?  I am amazed that I sit here and write my 22 week post already because part of me feels as though I just discovered this little baby growing inside of me.  Over the past two weeks I feel as though I have hit cruise control.  I am no longer nauseous, I have a bit more energy than I did in my first trimester (but my kids really like to challenge that), and my belly continues to grow.

Despite feeling relatively good over the past couple of weeks, I have hit a point in my pregnancy where I vaguely remember what my body was like before I got pregnant.  I remember a time when my waist was smaller than my hips and bust and I could look down and actually see my toes.  Rolling over at night is no longer a simple task (what I wouldn’t give to sleep on my belly), and everything seems to feel heavy.  I look in the mirror and see a swollen version of myself and wonder if I’m as puffy as I think I am.  Sometimes, I see a reflection of myself and forget that it is me.

Maybe because this is my third pregnancy in five years but I feel as though my body has not truly been ‘my own’ in a very, very long time.  I see women with perky boobs and tight little tummies and I can’t help feel a bit jealous.  Sometimes, I question if my body will ever truly be ‘my own’ again.  Even though I’ve been through this before, part of me still holds out hope that I’ll bounce back to my pre-pregnancy body once this little tyke is born.  … Nice idea, isn’t it?

When I got pregnant with my first, I was just coming off a fabulous year of racing.  I had completed sprint distance triathlons as well as trained a team to hike in the Grand Canyon.  I was in the best shape and I felt strong.  Once I got pregnant, however, odd cravings of milk (I’m lactose intolerant), beef (I was a vegetarian), and chocolate cake (I knew where every good chocolate cake was sold within a 5 mile radius of us) were too strong to ignore and I went on to gain over 50 lbs. throughout my pregnancy.  Sure, I did water aerobics and yoga throughout my pregnancy but this did not hold off the weight or the by-products of that weight.  By the end of my pregnancy I was so big I swear I had a gravitational pull.  I had no ankles, only legs.  Thick, round, legs.  Due to pre-eclampsia I was induced a day before my due date and after an unexpected c-section, my postpartum recovery took a very long time.  I was scared to exercise despite desperately needing to feel active again, and it took me until Julian was almost 6 months old to set foot in a gym. By the time he was 8 months old, my husband and I committed to train for a 10k together through Team in Training and by the time Julian turned one year old I was about 20 days into P90, the baby training program before P90X.  I was still not at my pre-pregnancy weight and after nursing a baby my breasts were definitely not as perky as they used to be, but hey, I was out there being active!

Within a few weeks of Julian’s first birthday we got some news:  we were expecting another little bundle!  This news came a year before we expected to add on to our family.   I was excited but nervous.  I did not want to have a repeat pregnancy and birth that I just had.  I knew that this time around I had to do things differently to prevent any difficulties and I changed everything.  I changed my provider, I changed my diet and did not eat anything white during my pregnancy.  I did not eat sugar, wheat, rice, potatoes, and corn.  I minimized my milk intake and took my blood sugar after every meal to keep my blood sugar low and ensure my ‘small baby.’  I went on to have a most wonderful pregnancy, gaining only 18 pounds, and having a perfect home birth after cesarean.  We couldn’t have asked for a better experience this time around.  After Dash’s birth I tried to get back to the gym faster, doing Zumba and added bikram yoga into my schedule, too.  While I never got back to my pre-Julian body and weight, I felt good going into this pregnancy because I know what I have to do now to have a successful pregnancy and healthy birth.

Maybe it’s because I am five years older than I was with Julian or maybe because I’ve had back to back pregnancies, but the aches and pains of this pregnancy have been the worst of all three pregnancies.  My back and hips hurt and I wish I could visit my chiropractor daily.  Despite exercising leading up to this pregnancy, I was/am not feeling very strong or prepared for labor so to give me some time to prepare, as well as give me some ‘me time,’  I began working with a personal trainer last week.  Stefanie is wonderful; she is 45 and has 4 children, ages 5 to 19.  She knows what it’s like to be pregnant, recover from pregnancy, and beyond.  I am so grateful for this experience because she’s a constant reminder to me that my life does not end with pregnancy or birth, or postpartum healing for that matter.  I don’t know what she was like before she had kids, but honestly, it doesn’t matter because she’s a strong, healthy woman and I can only hope to be in as good as shape as her when I’m 45!

Me (22 weeks) and my trainer, Stefanie, with J standing to the side

Ultimately, I think pregnancy can be a big exercise of self-love.  Can we love and accept ourselves despite all these changes we go through?  I admit, this is very difficult for me.  Some days it’s hard not to feel a bit of self-loathing for how much my body has changed, and some days it’s hard to look beyond all of these changes and know that it’s all for a purpose.  I’m growing a baby that will some day come out and grow into his own person.  I have to remember that I have the rest of my life to make myself what I want to be but now, this is his and our time together. I recommend the website Shape of a Mother.  If you have time, check it out.  It’s a realistic and honest reminder that as mothers the changes we go through in order to become mothers is something to be cherished and honored.  I have to remember to see the beauty in what we’re doing.

If I sit still long enough to pay attention, I am periodically reminded that my space is shared.  Little kicks and hiccups are felt and even though I can’t easily stand up and down anymore, I know this time is limited.  Forget the air-brushed postpartum photos of Hollywood moms and embrace your round, stretch-marked belly.  It’s a beautiful and magical thing.

Choosing a Prenatal Yoga Class

By Deena H. Blumenfeld, RYT, RPYT, LCCE

You’ve heard from your doctor or a friend that it’s a good idea to take a prenatal yoga class when you are pregnant.  There are some things you should know before you sign up for a class.

If I’ve never taken a yoga class before, can I start with prenatal yoga?

Yes! Prenatal yoga classes are structured for women at all levels of physical fitness, and yoga experience.  Let your teacher know that this is your first class and she’ll make sure you are comfortable.

 

I’ve been practicing yoga for a long time.  Do I need a prenatal class or can I stick with my regular yoga class?

You should be able to stay in your regular yoga class for your first trimester.  Somewhere between weeks 15-20, you’ll find your practice needs to change to accommodate your changing shape and needs.  A prenatal yoga class will also introduce you to poses that will be specifically helpful to prepare you for birth and allow you to connect with other pregnant mothers.

 

What if there are no prenatal yoga classes in my area?  Can I take a regular yoga class?

If there are no prenatal yoga classes offered in the area, you should call and talk to those teaching a “regular” class.  Some instructors are not comfortable with a pregnant mother in class because they don’t know how to modify the practice to be safe for her.  Other instructors are comfortable with pregnant women in class.  Do check to see if there is a “gentle” practice available as that might be better suited than a Yoga 1.

 

Are there different styles of yoga?

There’s a wide variety of styles of yoga out there.  Most classes you will find are Hatha classes.  Don’t worry about the terminology so much. If the class description doesn’t give you enough information about the class, please contact the instructor for more information. Remember, there’s no one style fits all yoga class.  If you try it and you don’t like it, don’t give up on yoga, just try another class.

 

What about hot yoga?

Hot yoga is not appropriate when you are pregnant.  Practicing in a heated room for 90 minutes can raise your core body temperature – just like soaking in a hot tub can raise your core body temperature.  This is not healthy for you or baby.  Hot yoga is contraindicated for pregnancy.

 

How is the class offered?

Some classes are session based, so you pay for 6 or 8 weeks of a class.  Other classes are drop-in classes where you pay per class and join the class as fits your schedule.  If you are nearing the end of your pregnancy or you are worried about liking the class, or if your schedule is erratic, a drop-in class might be better suited for you.  Find out if they offer an introductory single class.  That might be a good way to test out a class and see if it’s a good fit for you.

 

Where is the class offered?  Hospital, gym or yoga studio?

Location is important.  How is the parking?  What are the amenities?  One local hospital here in Pittsburgh offers prenatal yoga, however, you are required to buy your own mat and it is hosted in an open lobby area.  A gym may offer a class periodically if there is a need, so things like mats should be provided.  Expect a gym class to have a heavier focus on the physical side of yoga.  At a yoga studio you’ll have mats provided (or be able to rent them), and you will also have a wider array of blocks, bolsters, straps and other props to make your practice more comfortable.

 

What are your instructor’s qualifications?

Not all yoga teachers are created equal.  Ask your instructor where and with whom she did her prenatal yoga teacher training.  Find out if she’s certified by any organization to teach yoga, with an additional prenatal certification.  There are a number of organizations that do certify prenatal yoga instructors.  The requirements differ in not only the number of hours of training, but also the curriculum.  There are also a number of prenatal yoga teachers who teach with out certifications.  Don’t be afraid to ask in-depth questions.  You should feel comfortable with your instructor.

 

Staying within your instructor’s scope of practice

Your Yoga instructor should always work within her scope of practice.  This means, unless she’s a medical professional too, she should not be giving medical advice.  She should refer you back to your care provider for questions that are beyond her level of expertise.

 

Using modifications to poses (postures)

Your instructor should be able to modify the yoga poses for your changing shape.  She should acknowledge your baby and make accommodations for issues that come up, such as carpal tunnel, sciatica, etc.  She should know how and when to use additional props, like blankets or blocks to make your practice more comfortable for you.

 

Meditation and breathing

Meditation and Breathing should be incorporated into any prenatal yoga class.  The extent of the incorporation will vary from class to class.  You can expect your teacher to help you learn relaxation skills as well as how to synch your movements with your breath.  Speak with your individual teacher about how much of the class will cover these aspects.

 

Social Benefits to a Prenatal Yoga Class

In class you’ll be able to connect with other pregnant mothers.  You will have a shared experience, be able to commiserate over pregnancy woes, and celebrate each other’s pregnancy joys.  This community can also help you find a new care provider, decide on which car seat to buy and help you find other local resources for pregnancy, birth and parenting.  Many moms who meet in a prenatal yoga class will also go on to become friends and share baby play dates down the road.

 

Things to note for any prenatal yoga class:

  • Consult your doctor or midwife before beginning a yoga practice.
  • Call and ask questions regarding the specific class.  See if it’s a good fit for you.
  • Eat lightly before class and bring a snack for afterwards.
  • Bring a water bottle with you to class.
  • If you have an injury or a complication with your pregnancy, you must let your yoga teacher know.  She’ll be able to modify your practice to keep you safe.  Always check with your doctor or midwife if a complication arises before continuing your yoga practice.
  • Above all, listen to your body.  Accept your limitations and work within them.  You’ll find that you can have a great class at any level.

 

Namaste!

 

Deena is a Certified Khalsa Way™ Prenatal Yoga Teacher and Lamaze® Certified Childbirth Educator. She has been practicing yoga for more than 15 years. She became a certified Yoga instructor through 3rd Street Yoga in December 2008. She completed her 60 hour Prenatal Yoga training in February 2009 in Los Angeles at Golden Bridge Yoga with Gurmukh.

Her Lamaze certification was completed in October 2010, through Magee Women’s Hospital and Lamaze International. She is an advocate of empowered birth for women. Through the teaching of Prenatal Yoga and Childbirth Education classes, she helps women become more confident in their choices regarding pregnancy, birth and parenthood. Deena has also studied yoga with Doug Keller, Max Strom, KK Ledford and Shakta Kaur Khalsa. Her ongoing professional development as a Childbirth Educator has been with Ina May Gaskin, Penny Simkin, Gail Tully of Spinning Babies and other childbirth professionals.

Deena is also a mom of two – a son, born via c-section in April 2005, and a daughter in March 2009, a VBAC. She is an active member of the local ICAN chapter and a member of the Coalition for Improving Maternity Services.

Yoga and Pregnancy: Relax into the Restorative Pose!

By Debra Flashenberg, CD(DONA), LCCE, E-RYT 500 and Director of the Prenatal Yoga Center

The average pregnant woman is very capable of a doing a challenging asana (yoga) practice that can build confidence and stamina.  However, it is important to strike a balance by also practicing gentler, more restful poses that teach her how to soften and surrender when she needs to relax.  Perhaps one of the greatest benefits of quieter, restorative poses is that they offer the mother time to be with her baby, listen to her baby and to her own body and, if anything, the opportunity to gain a greater understanding of her inner thoughts and feelings.

Some of the other wonderful benefits of restorative poses include:

  • Helps reduce stress
  • Slows the heart rate
  • Lowers blood pressure
  • Slows the breathing rate
  • Increases blood flow to major muscles
  • Reduces muscle tension
  • Reduces hypertension
  • Renews energy
  • Helps concentration
  • Quiet time with baby!

Here are some yummy restorative poses the can be adjusted for all three trimesters.

Supta baddhakonasa (Reclined Goddess Pose)

We usually start with this restful pose at the beginning of the class.  Place two blocks on the mat, the first on the medium facet and the second on one the highest.  Place the bolster over the blocks forming a comfortable back rest which should be about a 45 degree angle.  Also, have several blankets available, one or two for knee support and two additional ones for forearm support.  Bring the soles of the feet together and then either place one blanket under each knee, or make a longer roll and wrap it around the ankles and under the shins.  It is also nice to place a trifolded blanket under the forearms to add a little extra support.

Keep in mind with these reclining poses, it is important to have the lower back well supported.  You do not want an excessive lumbar arch when reclining.  So when reclining back, make sure the lower back is snug up against the bolster.

Legs Up the Wall

This pose is particularly good if the mother is experiencing any edema in the legs or feet, suffers from varicose veins or her legs are just feeling tired.

If the mother is still comfortable with legs up the wall, place a bolster under the hips so that she is not lying flat for a prolonged period of time. The bolster should be placed so that the sitting bones are just hanging off the bolster.  This also creates a nice gentle chest opening pose.

Half Legs Up the Wall (Single Leg Drain)

This pose is an option for those that can no longer lay on the back, but still offers the wonderful benefits of having the legs elevated.  It is done with one leg up the wall while in a somewhat side lying pose and the bottom leg gently bent in the torso.

“V” Legs Up the Wall

If neither of the two previous “legs up” options work for the mother, the “V” leg up the wall pose may be a solution.  Take the same bolster/block set up as supta badhakonasana and place the bolster about 1 ½ to 2 feet away from the wall.  The distance will need to be adjusted depending on the height of the woman.  Then in a reclined position, bring the legs up the wall. This forms a “V” like shape in the body offering elevated legs and chest.  (This is a good opti

on if the mother wants to elevate her legs, but she is experiencing acid reflux and can’t have her head below her heart.)

Supported Child’s Pose

Some mothers prefer to rest in a long child’s pose if she feels a lot of pressure or discomfort in her lower back or suspects her baby is in the posterior position.  To do this pose, simply take a wide knee child’s pose and place a bolster under the head or even further down, under the under chest and head.



Tarasana with Block Under HeadIt can be very restful to allow the forehead to rest on something.  This takes pressure and strain off the neck while aiding in quieting the mind.  In this pose, the feet are further away from the groin, decreasing the bend in the knees and one or two blocks are placed in front of the feet.  An individual’s flexibility and the size of the belly will determine how to use and place the blocks.  Most women in their third trimester are not bending forward too easily, so two blocks may be needed.  Or another option is to place a bolster on top of two blocks and create a little “altar” to rest on. *Remember, moms with sacroiliac issues, place a block or rolled blanket under the knees in this pose.Eye Pillow or Head Wrap

Incorporating the use of an eye pillow or a head wrap can help relieve tension and promotes the withdrawal of the outer senses and stillness in the mind.  In yoga we refer to this as pratyahara.  By utilizing an actual object to help withdraw the senses, the eyes, which are often expressive and focused outward, are now encouraged to focus inward.  If you choose to use a headwrap, do not wrap too tightly and draw skin of forehead down, not up.

 

Hopefully, these restorative poses can allow the mother-to-be a little quiet time to rest, renew and restore her energy.

 

Photo © mahamamas.com and Janet MacFarlane, 2012 

Preparing for Birth Before Going Into Labor

By Gayle Sato

The words “easy labor” may seem like an oxymoron, but there are steps you can take, both throughout pregnancy and during labor, to make your experience less stressful and more comfortable, less clinical and more joyful. And although the following tips won’t guarantee you’ll have a sweat-free, pang-free birth, they can help make your labor and delivery more manageable.

1. Start preparing now. When you’re in the grip of labor, it’s too late to crack open that self-hypnosis book or locate a birthing ball. Preparation counts. Case in point: Squatting increases the size of the pelvic opening by about 28 percent. But if you wait until you’re in labor to try it for the first time, your squatting stamina won’t add up to … well, squat.

2. Seek higher education. Take a childbirth class, and enroll as early as possible: Not only do classes fill up fast, but some run 12 weeks, which means you need to start them in your second trimester. Learn about the different stages of labor so you know what to expect. Ask tough questions—and “stupid” ones, too. Find out your doctor’s philosophy on epidurals vs. nondrug ways of managing pain, as well as on Cesarean sections. “The better prepared you are, the more choices you have during labor,” says nurse practitioner Lynette Miya, M.N., R.N.P., co-owner of Bright Beginnings & Beyond, a childbirth and family resource
center in Redondo Beach, Calif. “You don’t want to arrive at the hospital without any idea of what’s going to happen.” Once labor starts, no surprise is a good surprise.

3. Take a prenatal yoga class. “The most important thing women learn through yoga is how to focus,” says Carmela Cattuti, L.P.N., founder of Yoga for Pregnancy & Fitness in Boston. “Yoga also strengthens the entire body, increases flexibility and gives you stamina. But maybe more importantly, it helps your mind relax.” This, in turn, leaves your body free to go about the business of birthing.

4. Hire a certified doula. Doulas are nonmedical professionals trained to provide emotional and physical support as well as information to women during pregnancy and labor. Studies have found that with a trained doula’s continuous support, epidural use decreased by 60 percent; C-sections, 50 percent; oxytocin use for induction, 40 percent; forceps use, 40 percent; and average length of labor, 25 percent. To locate a certified doula in your area, visit dona.org.

5. Give yourself options. During my first labor, breathing exercises gave me a massive sinus attack. Worse, I was out of tricks—no alternative pain-coping techniques, no weapon handy to beat my husband for getting me pregnant. Don’t let this happen to you. Learn several techniques to manage pain, such as self-hypnosis, position changes, heat packs and different breathing methods; bring music to play for relaxation. “If you don’t know what your options are, you don’t have any,” says Tracy Hartley, a certified doula and owner of BEST Doula Service in Southern California.

6. See no evil, hear no evil. Some childbirth educators believe graphic images, catastrophic tales and words of discouragement (“You’ll never be able to get that monster out without a C-section!”) can affect your subconscious and
create a mental block during labor. At best, negative thoughts make labor stressful; at worst, they’ll actually intensify pain. Change the channel, cover your eyes, tune out or walk away when the subject matter makes you uncomfortable. Bonus: Being able to do this will help you ignore all the unwanted advice you’ll get after the baby is born.

7. Set the mood. For most women, a dark, quiet environment is ideal during labor, so ask your nurse or partner to dim the lights and minimize noise. Little touches make a difference: a favorite pillow, pair of socks or soothing scent. “Aromatherapy, especially the scent of lavender, is very calming in labor,” says nurse practitioner Miya.

8. Don’t take labor lying down. Upright positions, such as standing, walking, kneeling, slow dancing, sitting and squatting, allow gravity to help move the baby down and out. “Sometimes, getting the baby into the pelvis is like fitting a key into a lock,” Hartley says. “You need to do a little jiggling. Rocking back and forth on your hands and knees may get the baby into position.”

9. Get wet. Early in labor, a warm bath is a blessing. Later, the sustained warmth and weightlessness that water provides can feel more like a miracle. If you have access to a warm tub during labor, run—OK, roll, if you have to—and take the plunge. (Be sure to get your doctor or midwife’s green light before doing so; there’s a risk of infection if your water has broken.) If a soak isn’t possible, take a shower.

10. Stand your ground. Labor transforms you, but it won’t make you suddenly love lime Jell-O, New Age music or the sight of your in-laws as you breathe through a contraction. People may press all kinds of suggestions on you during labor; listen but don’t feel you have to go along with them. It’s your body, your baby and your labor, so stick to your guns. Consider it practice for when your baby is a teenager.

Pregnancy: No Excuse For Ditching Your New Year’s Resolution To Get Fit

By Sonia Alvarado, CTIS Pregnancy Health Information Line Counselor
Reprinted with permission from CTIS

It’s a New Year, which for many people also means a renewed commitment to personal improvement – also called “New Year’s resolutions.” High on the list of New Year’s resolutions is either exercising more or starting an exercise routine. If you are not pregnant, most people take it for granted that maybe you should hop on the treadmill or dance your way to better health in rumba class (or another trendy exercise craze), but what about pregnant women?

It was not that long ago that pregnant women in the U.S. were seen as delicate, weak, sensitive creatures that could not – or should not – lift grocery bags, children, exercise, or work. Pregnant women were seen as human incubators that could be harmed by too much exertion or physical stress. In fact, many people still hold on to these types of ideas, some of which are also culturally-based. At one time, the American College of Obstetrics and Gynecologists (ACOG) also had a view that exercise should be low impact, and that the heart rate should not exceed 140 bpm. This recommendation was a source of irritation to many healthy pregnant women who exercised regularly and did not appreciate having to cut down on their normal routines.

Recommendations for Pregnant Women
ACOG currently recommends pregnant women continue an exercise routine if they already have one. They also recommend that sedentary pregnant women see their doctors about getting started on appropriate exercises. Pregnant women are recommended to exercise daily, or at least, on most days of the week for 30 minutes or more. Certain women may have health issues that make it risky for them and in those cases the doctor may have other suggestions for strengthening muscles during pregnancy.

The ACOG Education Pamphlet AP119 — Exercise During Pregnancy reports that exercise has a positive impact on pregnancy and reduces common complaints such as backaches, constipation, bloating, and swelling. More specifically, it reports that exercise “may help prevent or treat gestational diabetes, increases your energy, improves mood and posture, promotes muscle tone, strength, and endurance, and helps you sleep better.”

What Do the Studies Show?
A review article published in 2010 in the journal Sports Medicine, looked at studies specific to pregnant women and cardiovascular adaptations during exercise, compliance with current recommendations and the effects of exercise on pregnancy outcomes.

The authors report that regardless of whether pregnant women exercise or not, there is a change in heart rate that takes place from as early as two weeks of pregnancy and continues into the third trimester. There is an increase in blood volume that starts at between 10 and 20 weeks. This change, as well as others, however, has not been reported to be a barrier or disadvantage to exercising in pregnancy. Data suggests that pregnant women who exercise have a lower resting heart rate compared to non-exercising pregnant women and aerobically fit pregnant women have an improved V02, which means they take in more oxygen and use it better during exercise.

When women exercise their heart rate increases, and so does the fetal heart rate. However, this has not been reported to be a risk to the development of the baby and may have advantages for the baby during delivery and after. Studies suggest that women who regularly exercise tend to have infants that are leaner, however, this has also not been reported to be a disadvantage. Very fit women also have advantages in labor, including a decreased risk for c-sections.

What About Yoga and Qi?
Qi gong (pronounced chee guhng) and yoga are both gentle exercises with a focus on stretching, breathing and bringing calmness of mind to the practitioner. Qi is also reported to have an additional emphasis on “energy life force.”

There have been a few studies looking at the benefits of yoga on sleep during pregnancy, Qi and yoga on depression or anxiety in pregnancy, yoga on delivery-related stress and labor. The data on these exercises has been reassuring. The studies are generally interview-based and reflect how participants feel about their experience. For women who are interested in getting “fit,” but may not be interested in other types of exercise, this may be another option.

Which Exercises Should Be Avoided?
The ACOG Education Pamphlet AP119 — Exercise During Pregnancy, recommends avoiding contact sports, downhill snow skiing and scuba diving during pregnancy. Sports with a higher risk for falling are generally not recommended.

Whether your 2011 resolutions include walking, running, swimming, yoga, or Qi, I say, increase your chances of being successful! Try it with friends, your pets, include your significant other and your mother! Just make it fun and you’re more likely to still be at it in 2012!

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Sonia Alvarado is a bilingual (Spanish/English) Teratogen Information Specialist with the California Teratogen Information Service (CTIS) Pregnancy Health Information Line, a state-wide service that aims to educate women about exposures during pregnancy and lactation. Along with answering women’s and health professionals’ questions regarding exposures during pregnancy/lactation via CTIS’ toll-free hotline and email service, she’s provided educational talks regarding pregnancy health in community clinics and high schools over the past decade. In addition, Sonia contributes to the service’s website, develops training materials for new CTIS staff, and is the supervising Teratogen Information Specialist trainer. Sonia attended San Diego State University and has worked in Tuberculosis Control for San Diego County’s Public Health Department. Sonia’s work has also been published through several tuberculosis studies. In her spare time, she loves to volunteer with the March of Dimes as an expert speaker on themes related to pregnancy. 

CTIS Pregnancy Health Information Line is part of the The Organization of Teratology Information Specialists (OTIS), a non-profit with affiliates across North America. California women with questions or concerns about pregnancy exposures can be directed to (800) 532-3749 or by visiting CTISPregnancy.org. Outside of California, please call OTIS counselors at (866) 626-OTIS (6847).

References:

  • The ACOG Education Pamphlet AP119 — Exercise During Pregnancy
  • Melzer et al: Physical Activity and Pregnancy – Cardiovascular Adaptations, Recommendations and Pregnancy Outcomes.Sports Med 2010;493-507.
  • Eun Sun Ji and Hae-Rae Han: The Effects of Qi Exercise on Maternal/Fetal Interaction and Maternal Well-Being During Pregnancy.AWHONN 2010;310-318.

Get Moving: Staying in Shape, During & After Pregnancy

Giving Birth with Confidence is pleased to feature articles by the writers at FitPregnancy. FitPregnancy helps women make educated decisions for a joyful pregnancy, healthy baby and confident life as a new mom.

 

Use these nine months to find an activity you enjoy that won’t be too tough to continue after your tot makes his entrance. Aim to exercise at least 30 minutes a day, most days of the week, but watch the intensity: If you can’t talk without gasping, you’re working too hard.

5 Great Activities to Try

Walking
Why it’s wonderful now It’s easy, effective and can be done in 10-minute sessions if you get winded easily. Walking is also low-impact, which keeps stress off your joints so there’s less chance of injury.
Keep in mind Avoid uneven or slippery surfaces–you’re more prone to fall as your belly grows and your center of gravity shifts. Plus, your body is producing more relaxin, a hormone that causes the ligaments in your pelvis to soften. “Although this is helpful for delivery, it also means that all your joint ligaments become more lax, making you more likely to twist or sprain your wrists, ankles and knees,” says Anita Sadaty, M.D., attending physician in obstetrics and gynecology at North Shore University Hospital in Manhasset, N.Y. Cross trainers provide more lateral support than running shoes; you may need to go up a half size by your third trimester.
How to adapt it later Put your baby in a front carrier (later, a baby backpack), and pick up the pace by bending your arms and driving them back as fast as you can. Seek out hilly neighborhoods or scenic hiking paths you may have avoided for safety during your pregnancy.

Swimming
Why it’s wonderful now Water provides resistance with a low risk of injury, allowing you to work harder without overheating, whether you’re treading it or swimming, walking or even dancing in it. And even in your ninth month, you can still look and feel graceful in the pool. (We promise!)
Keep in mind Swimming with poor technique could make neck, shoulder or back pain worse. Stop if you’re hurting.
How to adapt it later Raise a water baby! Check into mommy-and-infant water programs at the YMCA, your local gym or a swim center.

Pilates
Why it’s wonderful now Pilates strengthens all your core muscles, helping to lessen lower-back pain.
Keep in mind Avoid lying flat on your back during the second and third trimesters; speak to your instructor about using a wedge, pillow or bolster to keep your head higher than your belly while performing exercises.
How to adapt it later Pop in a Pilates DVD while your baby is napping, or ask the instructor at your local gym if it’s OK to let your child watch in a carrier from the sidelines (free entertainment for your baby!).

Yoga
Why it’s wonderful now Yoga improves balance, which is affected by pregnancy body-weight shifts; relieves stress with breathing and meditation techniques; and helps soothe the aches and pains of pregnancy. Yoga postures can also open hip joints, which could benefit you during delivery, says Chicago certified personal trainer Michael Sena, author of Lean Mom, Fit Family (Rodale, 2005).
Keep in mind Avoid inverted and extreme positions, especially those in which your legs are far apart (like Pigeon or Tailor pose). Although relaxin will allow you to stretch farther than usual, this can lead to muscle tears, so take it easy. Also, avoid lying on your back after the first trimester. Prenatal yoga is safe for all trimesters, and (bonus!) you may meet some new friends.
How to adapt it later Try power yoga to work up a sweat and build muscle endurance. Put your baby in a bouncy seat next to your sticky mat (or give your baby his own). Some studios also offer mommy-and-me yoga classes.

Strength Training
Why it’s wonderful now Lifting weights helps counteract the higher risk for injury during pregnancy by strengthening muscles surrounding the joints, Sena says. It’ll also help prepare you for the heavy lifting of motherhood.
Keep in mind Make sure to breathe in and out evenly, rather than tax your pelvic area by exhaling too forcefully. You’ll avoid overloading your loosening joints by working to fatigue (doing a lot of reps) using lighter (3- or 5-pound) weights rather than 10-pounders.
How to adapt it later Shoot for heavier weights that you can lift for only about 8 to 12 reps. If you’re joining a gym, make sure it offers day care–many do–at hours that fit your schedule. And find a good postnatal DVD.

Start Active Family Rituals
Begin these routines, or your own versions, today. Even a simple morning stretch gets your body moving.
Go for a weekly early-evening hike Choose flat, wide paths as your pregnancy progresses. Once your baby is born, continue the tradition by putting her in a front carrier and, later, a baby backpack. Your child will love the sights and sounds of nature (especially during the notorious “witching hour” of 4 to 6 p.m.); plus, he’ll learn from the movement. “Muscle has memory, and feeling you move will help him emulate that skill later in his life,” says Sena.
Plant a small flower or vegetable garden Wear gloves and wash your hands afterward to avoid contracting toxoplasmosis–an infection spread via soil or cat feces that can harm a fetus. As your child grows, he’ll delight in digging for earthworms, picking veggies and smelling the roses. Plus, just 30 minutes of gardening burns 145 calories.
Throw a Sunday morning dance party After you’ve lazed around reading the paper, crank up some tunes and bust a move.