Pregnancy Pathway, Outcome – Mom & Baby Health Status

Thank you for your patience while our new website was going up. Also, thanks to those who viewed the site! If you are interested in more research; in taking a class in the U.S. or parts of Europe, South America or South Africa; or, in teaching pre/postnatal fitness, please pop over to the renovated website: www.dancingthrupregnancy. com.

Now, let’s return to our Pregnancy Pathway, take a look where we’ve been, and then continue to the last stage of the Pathway – the health outcome.

Here’s the whole graphic:
So, the big question is:  How can we predict the health outcome of mom and baby, given all the variables of preconception, conception, pregnancy, labor and birth?

Well, there are some things for which we can predict or estimate risk/benefit ratios, and there are some for which we cannot. Let’s start by going over the major things that are not very predictable. At the moment, genetics is pretty much unpredictable. Down the road…maybe…but for now, not so much. Some IVF labs claim they can slightly slightly increase the odds for one sex or the other.

Post-conception, chorionic villi sampling and amniocentesis are methods by which the genetic make-up of the fetus can be identified. These are done mainly to give parents a choice about continuing a pregnancy if there is a question about genetically transmitted disorders or conditions, such as Down Syndrome. But, for now, the best way to manipulate the genetic odds of health outcome for your offspring is to mate with someone who is healthy and has health-prone genes!

Once you are pregnant, it is clear that prenatal health care, exercise, healthy nutrition, stress management and adequate sleep play significant roles in increasing the potential for a healthy outcome for mother AND baby. In fact, not only short term, but also long term healthy outcomes are linked to these factors. These are factors within our control.

Risk factors – most of which are within in our control – that can adversely affect outcomes include environmental toxins, risky behaviors (unsafe sex, drinking, smoking or drugs), poor nutrition, sedentary behavior, stress and isolation (lack of social support). These risks, as well as the benefits, are all discussed in the previous posts.

At this point, it is important to note that there is a lot that goes into making a healthy pregnancy, birth and outcome that is within the control of the mother, providing she has family and/or social support to take good care of herself.

The labor process and birth mode can also affect health outcome, but in general the effect is short-lived. For moms who have received regular care and are in excellent health, the occurrence of a truly devastating birth outcome for mother and/or baby is extremely rare. The exception may be mental or emotional turmoil that can accompany a difficult, unexpected and uncomfortable situation, such as an unplanned cesarean birth.

Three interesting research outcomes point to the importance of exercise groups. One is that exercise can help prevent some disorders of pregnancy, such as preeclampsia or gestational diabetes. Second is that the health benefits of exercising during pregnancy and the postpartum period are beneficial for both short and long term for mother and infant. Disorders of pregnancy are risk factors for future cardiovascular disease and metabolic disorders. Third is that exercise is most likely to occur when there is good social support.

Moving together is a “muscle bonding” experience that helps bind moms-to-be and new moms into a community of support. Within the group, moms can get help with tips for healthy eating and living, along with the support of others who know what she is experiencing. There are a lot of ways to get adequate exercise. When you are pregnant or a new mom, an exercise group can be one critical path to health and well-being.

DTP’s Total Pregnancy Fitness website!

DTP’s renovated website is now online at www.dancingthrupregnancy.com!

Full of new features, news and information for pregnant women and new moms & babies. In addition, there is information on how to become a pre/postnatal fitness instructor and start a program in your area. There’s a lot to see and do on the renovated site and more to come…stay tuned. Fan DTP on fb, while you’re at it!

Safe Motherhood & Holiday Giving

During the Holiday Season we are finding more and more individuals and companies that – like ourselves – give charitable contributions in lieu of gifts to family, friends and colleagues.

For those of us who work with pregnancy, birth and motherhood, we want to recommend the White Ribbon Alliance for Safe Motherhood: http://whiteribbonalliance.org/.

The White Ribbon Alliance (WRA) reminds us that: “Every minute of every day, a woman dies of pregnancy related complications, totaling more than one half million women each year.”

The WRA is “…an international coalition bound together by a common goal: to ensure that pregnancy and childbirth are safe for all women and newborns in every country around the world.” There are members in 143 countries.

Pregnancy and childbirth is one of the greatest killers of women. Preventing these deaths is something we can do. WRA supports efforts to train and supply medical personnel skilled in assisting women through pregnancy and birth to areas where these services are scant or non-existent. Why is this important?

Here are some facts that help us understand why preventing pregnancy-related deaths is a critical global goal:

• When a population has slightly more women than men, that society tends to be healthier, more economically viable, and more peaceful that those that do not.

• Even though the developed world has slightly more women than men, globally there are more men than women.

• Thus, world-wide, one way to improve humanity’s condition is to improve the lives of girls and women.

• Supporting Safe Motherhood is critical to meeting this goal.

Please visit and donate at http://whiteribbonalliance.org. It is totally tax deductible, too!

HAPPY HOLIDAYS TO ALL!!

Pregnancy Pathway, Birth – Birth Mode

How the baby is born is the birth mode

The Second Stage of Birth is different from the First Stage. The actual expulsion of the baby requires a change in energy axis. During dilation (first stage), oxytocin is most easily released from the pituitary gland during relaxation (see previous post), but during transition, a change occurs so that the ergotropic response takes over and adrenaline is key in helping oxytocin to spike.

What does this mean as far as preparation is concerned? While it is important to learn to relax or maintain positions such as one does in yoga, the ability to sprint, or turn on an aggressive action at the end, is critical. You need  good aerobic conditioning. Begin exercise with easy breathing and movement, then practice aerobic endurance and power moves at the end of your workout! Finish up with cool down and stretching.

The contractions themselves change. They remain intense for a longer stretch, but the time between them increases. Pushing involves not only the uterus contracting, but the pressure exerted by the transverse abdominal (TrA) muscle. Similar to squeezing a tube of toothpaste, TrA pressure helps press the baby toward the exit – yes, that is the vaginal opening. If the laboring mother is not able to apply adequate pressure, labor assistants sometimes apply pressure manually to the top of the uterus or – if need be – forceps or a vacuum extraction may be necessary.

How can a mom best prepare so that the TrA can provide the needed pressure? Strength training the TrA! Like any other motion requiring power strength, this muscle can be strengthened to do its job! Here’s how:

picture 1:  sit upright, inhale

picture 2:  exhale, compress abdomen and curl down

Return to upright and repeat 8 times. Rest. Repeat 8 more times.

What if something goes awry? Cesarean, or surgical birth is an alternative. Major complications before labor include a placenta previa, infection or undeliverable breech position. During labor, the most common problem is dystocia – stalled progress through dilation (first stage) or pushing (second stage). In the pushing stage, head too large for pelvis is the most common difficulty.

What happens next? If the birth is natural, you will feel a tremendous euphoria. Bring the baby right up onto your chest for skin-to-skin contact. If you have had medications, your response may be slightly blunted, but you will definitely be overwhelmed by the emotions of birth.

Third Stage is expulsion of the placenta, which can no longer remain connected to the shrinking uterus. When it detaches, the nurses or midwives will ask you to push and !plop! out it comes. It can be interesting to see what has nourished your baby for so long!

CONGRATULATIONS!  YOU’RE A MOM!

Pregnancy Pathway, Birth – Labor

The First Stage of Childbirth is the long, hard labor. It is the slow process that produces dilation, or opening, of the cervix – the “neck” or outlet at the bottom of the uterus. Once the baby’s head can fit through the open cervix, it is time for the Second Stage, but that is another topic for another post.

Labor is generally a long, slow process...there is no "enter" button for dilation!

Before the baby can leave the mother’s body, s/he must leave the uterus. The opening of the cervix to let the baby out of the uterus generally takes up the most time. For a first time mom it can be 10 or 12 hours…or, yes, a couple of days. Of course, for some moms, this time is difficult and for others it only becomes difficult in the last few hours.

But, you know all this, right? What you want to know is:  Why do I have to go through this? And, if I must, how can I make it the least painful?

Why labor is important. Let’s go to another question:  How important would your offspring be if it was no big deal to drop one out? If you were walking along the sidewalk and you could simply drop a newborn on the pavement, would you even stop to pick it up if you could do it again in a few days, when, of course, it will be much more convenient?

Frankly, pregnancy and labor remind us to pay attention. A newborn cannot survive on its own for at least two years. If we don’t pay attention, it will die.

Okay, now that labor has your attention, what else does it do that is beneficial? It stimulates the baby’s stress response and teaches the newborn to be alert during situations of duress. Each contraction is pulling the cervix, helping it slowly open. If you are upright, each contraction is also alerting the baby to the influence of gravity.

Why is labor painful? So, you need to go through this because it is the bridge from pregnancy to parenthood. Why does it have to be painful?

The first thing to keep in mind about pain is that pain is a combination of sensations and emotion, mainly fear. Fear makes you tense; tension reduces blood flow. Reduced blood flow to the uterus makes the contractions less effective. In addition, cortisol is released, making sensations stronger and evoking greater fear.

Fear is the emotion of fight or flight. Interestingly, the opposite response, the relaxation response, is very effective in promoting labor. So, relax. Breathe deeply and slowly, focus, move through the center of your experience. You don’t have to be in fear if you know what is happening and if you are physically fit and prepared. Both childbirth education and physical fitness teach your body to work with discomfort. By including them in your preparation, you give yourself a tremendous advantage.

Does this mean you will never feel like you want to stop in the middle of labor? No, but it does mean you can do it. It is finite. The notion that the baby will not do well is also tied to your physical fitness…babies of fit mothers less often experience fetal distress. Your care providers will let you know if there is some factor beyond your control that requires medical intervention.

Birth is an empowering event. But, before the baby can be born, it must escape the uterus. It is a classic conflict and the mother’s body is the venue. Give yourself over; go with it. Only women can do this.

Pregnancy Pathway, Birth

There is no birth of consciousness without pain.

Birth is a life process with two major components

Okay, be here now:  This is about a really major experience…bringing human consciousness into the world…opening a door to a room of love in your heart that you can only know by giving birth to this person…changing your identity forever.

Getting your mind around the image: If you have not taken the time yet to get your mind around this, take a moment. Breathe in deeply. Gently blow the air out. Repeat. Repeat. Let go of any resistance. Slow your heart. Slow your mind. Consider:  Your body has the power to create a person. Your body has the power to expel this person when the rent is up.

Your brain, glands and organs are having a conversation with the baby’s brains, glands and organs. At some point, this discussion reaches a place where it is time to end this arrangement of two people sharing one body. It is true that occasionally the passenger doesn’t want to leave, but that is rare. And, we have a remedy for that. Let’s just focus now on the what happens when it’s time to go.

Labor starts how? Well, it depends. Sometimes contractions start in fits and spurts and take a while to get organized. Sometimes they start strongly from the get go, and for others the process of getting rolling can take a few days. Sometimes it starts early, and sometimes has to be helped to start. Once in a while, the water breaks and labor starts…or not. So, the first lesson of having a child come to live with you is that you need to be flexible in your expectations.

In the next two posts, we’ll cover Labor and then the Birth Mode. Each of these processes is unique. They involve different energy systems. They require different mind-sets from the mother and her support team. The outcomes are different. Going through the center of these processes helps you deal with them, helps you recover from their strenuous nature and helps you move on to being a parent.

Remember: Breathe in deeply. Gently blow the air out. Repeat. Repeat. Let go of any resistance. Slow your heart. Slow your mind. Consider:  Your body has the power to create a person. Your body has the power to expel this person when the rent is up.

Pregnancy Pathway – Review and Labor begins!

Just to let readers know where we are on the pregnancy pathway, here is the large graphic. We have just finished Pregnancy and are getting ready for Birth. Labor is beginning…are you timing those contractions?!! If you have want to review any of the content prior to Birth, you can scroll down and find an entry for each bubble. Or, use the Search Topics tool on the right side bar for a faster find.

So far, the blog has covered through Pregnancy; next Birth (purple)

Twins & Triplets – Exercise & Nutrition Tips

A detour: We received a question about nutrition and exercise for multiples. So, here is some information for those with twins and triplets. Add a comment if you have a question or experience to share on this topic! Next comes birth, we promise!!

If one is a girl and one is a boy, they're fraternal!

Nutrition for Multiples:

The primary thing we tell people with twins or more is that the protein needs rise about 30 grams/baby/day above the 70 – 90 grams/day needed for a singleton. Water intake also needs to rise. Avoid thirst and as much as possible, drink until urine runs clear rather than yellow (as best as you can).

Multiples is considered a risk factor, and for each risk factor (multiples, underweight, teenage mom, inter-pregnancy period less than a year) an additional 200 calories is often recommended, with 400 extra calories the upper limit.

Exercise with Multiples:

A critical factor in successful implantation and growth of the placenta appears to be aerobic fitness in the six months prior to and the first half of pregnancy. Once biomechanics become difficult in mid-pregnancy, women with multiples can continue activity safely as long as monitoring show the babies are growing appropriately. A belly support can be extremely helpful when exercising.

Contraindications for exercise include the discovery that one fetus is growing at a significantly slower rate than the other(s), that both/all are too small, that the placenta(s) is/are malfunctioning, or some other condition occurs, such as an incompetent cervix or placenta previa, that would be a factor in any case.

Absolute size difference does not necessarily mean that one baby is growing more slowly, as some fetuses may be a couple weeks younger than their uterus-mate(s) if the mother ovulated twice in the fertility cycle. Or, s/he might be smaller if genetically destined to be a smaller infant at birth. Thus, growth rate is the measurable factor that helps determine if a fetus is at risk of not receiving adequate energy. This can happen when there are two placentas and one placenta is working more poorly than the other, or for some reason there is a flaw in the umbilical cord of an identical. The competition for energy places a slower growing baby at risk.

Protecting Mom and Baby:

The placenta is designed to nourish the baby and will do so at a cost to the mother first if there is inadequate nutrition. Thus, activity to the level the mother can tolerate and following nutritional guidelines above – in the absence of medical complications – produces healthy offspring. Multiples will garner all the same benefits a singleton does.

Note about images:  we strive to use images we own or that are advertised as free on the internet. We want to thank google, bing and yahoo for making free images available.

Pregnancy Pathway, Pregnancy – Behavior: Avoiding Risks

Sometimes it seems like pregnancy is a time of restrictions. Avoiding risks can be one thing that makes it seem that way. But, bear with us here in an interesting trip through danger and finding you find ways of enhancing your pregnancy!

Risk Factor #1:

Lack of prenatal care. More than anything else, be sure you have care. Having someone monitor your health and that of your baby during pregnancy is vital to a good outcome.

Exercise! Avoiding it is a risk factor for diabetes and preeclampsia.

Risk Factor #2:

Not exercising. Sedentary behavior increases the risk for metabolic, cardiovascular and immune disorders.

I know, I know, you don’t have time to exercise. Well, pay now or pay later, as they say. Make time to go to a class (make sure it includes 20 -30 minutes of aerobics) a couple times a week. A class will also provide social support, another factor that enhances your pregnancy. Take a walk at lunch time. Practice relaxation techniques.

Risk Factor #3:

Breathing dangerous fumes. Yes, this includes smoking and second-hand smoke. But, it also means avoiding environments where there is a lot smog (near highways), living with mold or dust, and fancy cleansers that may have dangerous chemicals in them. Stick with vinegar, ammonia or bleach as cleansers.

Smog can endanger your fetus!

We are learning that combustion exhaust from cars and trucks can negatively affect birth weight and prematurity. If you live or work near a highway or in an area where smog is prevalent, what are your options? Can you transfer or move? Can you wear a mask? Talk to your care provider and figure out the best protection for you and your fetus.

Risk Factor #4:

Poor Nutrition. Yup, just go back one entry and find out how food affects pregnancy. If you don’t eat enough protein and drink enough water, you don’t make sufficient blood volume to nourish your placenta and thus your fetus.

Read labels!

Eat whole foods and learn to read labels when you buy processed foods. What is a “processed” food? Anything with more than one ingredient!

Some processing (ex: homemade soup) takes little nutrition away, but some processing (ex: potato chips) takes everything good away and replaces it with unsafe substances. Look for low sodium, low sugar, high vitamin and mineral content items with no saturated or trans fats.

Read the ingredients; if you don’t know what the words mean, maybe you want to pass it up.

Risk Factor #5:

Alcohol and Drugs. Common items can be as dangerous as street drugs, which

There is plenty of time in life for a glass of wine...later.

No. No. No. Only meds from your prenatal care provider are okay.

Caffeine? Only one cup & only if you must.

can severely compromise you baby’s future. If you have a drug or alcohol habit, get help.

Risk Factor #6:

Genetics. You can have genetic predispositions for many pregnancy issues. However, that does not necessarily mean you will develop a given disorder. For example, nutrition and exercise greatly reduce the risk and severity of metabolic issues. Some genetic issues are unavoidable however, and your care provider will alert you to these, if they are relevant.

Risk Factor #7:

Social issues – isolation, lack of support, abuse, poverty. All of these factors can have negative effects.

If isolation is a simple matter of needing to meet other moms-to-be, join an exercise program. That way, you get both support and exercise; just be sure it includes aerobics, along with centering, relaxation and appropriate strength.

If your situation is more dire, seek the help of a care provider or social worker at your local hospital or clinic. Safety and support are critical for you at this time. Get the help you need. There are people who care. And, if you know of someone who needs help, help them.

If you have other risk factors to offer, please post them in the comments. Thanks!

What’s next?  BIRTH!!

Pregnancy Pathway, Pregnancy – Behavior, part 2: Nutrition

Let us discuss food!      Yeah, food!

Fresh fruit = vitamins & minerals!!

Question:

How many extra calories do you need in each trimester to offset the metabolic cost of pregnancy?

Answer:

First trimester – 0; Second trimester – 300; Third trimester – 500 (source: Institute of Medicine).

Keep in mind that you may also need calories for any fitness program you are doing. If you are continuing a program, the only change is due to the pregnancy.

If you begin or increase your activity, you need to take that into account. One yoga class = 100 – 150 calories. One aerobics class = 200-400 calories. Walk one mile = 100 calories.

1 slice whole grain bread = 50-100 calories

Be sure you read food labels so that you can balance your food intake and your calorie output. A small woman (under 5′3″ & 130 lbs.) probably needs about 1200 calories per day as a base. A medium sized woman needs about 1400, and a large woman (over 5′9″ & 160 lbs.) probably needs 1600 to 1800 calories. Add your activity and pregnancy needs to your base amount.

Question:

What foods are necessary for a healthy pregnancy?

Answer, part A:

PROTEIN. Lean proteins like turkey and those with omega 3 fats like ocean fish and eggs….yes! EGGS!

Turkey is a good protein

Ocean fish 1 or 2 times/wk = good protein & omega 3 fat

Eggs are a perfect pregnancy food!

70-90 grams of protein are necessary each day, along with  adequate water.  These are needed to make an extra 40% blood volume required to support the placenta.

Answer, part B:

WATER. Two (2) quarts of water…more if you are very active…are needed to make extra blood and to prevent dehydration.

Question: What else?

Fresh vegetables also provide fiber

Answer: CARBS. Fresh, colorful fruits & veggies provide necessary vitamins and minerals, as well as fiber. Eat 5 servings a day from all the colors:  yellow, orange, red, purple and green, and you will get live vitamins all day long that help your baby develop properly! Fruits, vegetables and whole grains are low glycemic index carbohydrates – the good ones!

Dairy provides calcium

Question:

Do I need dairy products and red meat? Can I get the needed minerals in other ways?

Answer:

Calcium is needed in adequate amounts for bones and teeth. It is most easily obtained by drinking milk or eating cheese, yogurt or cottage cheese. Soy, dark green leafy vegetables and calcium fortified juice are alternatives.

Iron is necessary for red blood cells to take up oxygen. It is found in high amounts in beef,  and lesser amounts in raisins, spinach, and prune juice. Prenatal vitamins are your insurance against deficiencies of these essential minerals.

Question:

Anything else that’s essential?

Answer:

Yes! Healthy FAT!!

Avocado is an excellent source of omega 6 fat

In addition to omega 3 fats found in fish, walnuts and flax seeds, you need also need omega 6 fats, which are found in avocados, olive oil and other vegetable oils. Healthy fats help balance cardiovascular constriction and dilation, reducing the risk for hypertension.

Last Question:

What is a healthy weight gain?

Answer:

In 2009, the National Academy of Sciences revised its recommendations. It now bases desirable weight gain on pre-pregnancy BMI (Body Mass Index…google this!).

BMI less than 18.5 (low) – 28 to 40 lbs.; BMI between 18.5-24.9 (normal) – 25 to 35 lbs.; BMI 25.0 to 29.9 (high) – 15 to 25 lbs.; obese women (BMI over 30.0) – 11 to 20 lbs.

Coming Next: Avoiding Risks.