In the U.S. and most of the developed world, approximately 51% of the population is female. Most females give birth at some point in their lives, although, in any year, only about 2% of the population gives birth.

No one living on earth got here any other way than gestation, so there ought to be some power attached to being part of that 51%. Historically, it might be said that the power has been merely for survival…the good breeders survived long enough to produce heirs and those who lived on knew where the roots and fruit grew.

Only women can make more people with their bodies.

Here are some things to consider:

• Women make people
• Women’s health and fitness before pregnancy affects whether the pregnancy is healthy
• Women’s health and fitness during pregnancy affects her lifetime health and that of her offspring
• Maternal survival is important to offspring well-being
• Maternal health and fitness affects maternal adaptation and thereby offspring well-being

Thus, is it not a sanguine notion that the health and survival of women is critical to the health of everyone? After all, the health of nations is associated with this slight majority of females, and the wealth of nations is associated with its health.

The good news is that people working from this understanding are making some headway around the globe. Recently, the World Health Organization noted that maternal death among pregnant and birthing women world-wide has been dramatically reduced from the 1980′s to recently. This is very good news!

Here is the interesting footnote:  Maternal death in the U.S. has risen 42% in the same period. While the absolute numbers remain small, this is a disturbing picture. What could be causing this?

Time will tell if we can figure it out and fix it. I venture to suggest some directions for consideration:

• The elevated cesarean birth rate with its sequellae of cardiovascular and immune system disorders
• Obesity
• Metabolic syndromes
• Diabetes
• Heart disease

Why am I hopeful, then? I see among our current educated generation of new moms and moms-to-be a willingness to exert their influence – as breeders – over the health care scene. They want less technological birth. They want support. They want more information. They want to be healthy. These are wonderful things. I salute these young women…they also make my job easier in the process.

In addition, I see among young health care practitioners an understanding of the value of these things. Among practitioners working in public health clinics there is a sense of desperation on the one hand that the poor and indigent have no capacity or will to take care of themselves. On the other hand, the first step is always education and there are a lot of people working on this issue.

Which brings me to the closing point:  How do we bring more resources and intelligence to helping women be healthy, prepare for pregnancy, have healthy babies, reduce pregnancy complications, and improve infant and maternal death rates? I, for one, will keep blogging on this issue. You, I hope, will vote for people who understand this issue. The political power and will is in our hands.

51% of us are women…some day 51% of us can set priorities

So let’s get on with the topic of How to Get Pregnant, starting with why do we need to know this?

In the past few decades, the average age for a first pregnancy in the U.S. has moved from the mid twenties into the mid thirties. In the same time period, the facts of conception – sperm enters egg released in mid cycle, then zygote implants in the uterus, along with how sex allows this to happen and how to prevent it – seems to have disappeared from middle and high school health classes. If that weren’t enough, as women have become more and more essential in the work force, the cost of having children as well as starting later, have driven down the birth rate. Similar conditions exist in most developed nations, although teen pregnancy rates are lower everywhere else.

The birthing population has bifurcated – we see older women (over 35) and teens as the major groups having children. On the one hand we have been working to reduce teen pregnancy while helping older and older women become first time moms. To a certain extent, they need the same information; its just that with teens we use this information to prevent pregnancy and with older women we use information to help them increase their odds of getting pregnant.

Understanding the menstrual cycle, ovulation, charting temperature – all the basic techniques of using the “natural” method of birth control – have become the first steps of the how-to-get-pregnant coaches. Beyond this, a number of sites have their own essential lists to help women be healthy and ready. Sites such as gettingpregnant.com, pregnancy.org/getting-pregnant, and storknet.com/cubbies/preconception/ provide additional information. Many suggestions – things to avoid eating, what proteins are needed for ovulation, how to reduce stress, what to do if there are sperm problems, how to find IVF clinics, donors and surrogates – are addressed.

How effective are these suggestions? Well, research tells us they are somewhat effective. None of the sites I contacted answered my query about how they measure or assess consumer outcomes when following their suggestions.

An interesting article in the NY Times 9/1/2011, entitled Are You as Fertile as You Look? openened with this sentence: “FORTY may be the new 30, but try telling that to your ovaries.” The reality is that being under 35 is still the best predictor of how difficult it may be for you to become pregnant. As the article makes clear, looking 30 and being 30 are not the same thing. Even healthy living does not prevent the loss of good eggs.

So, what conclusions can we draw? First, even if you come from a “fertile family,” it may behoove you to have your children in your late 20s or early 30s. Second, if you are putting off having children beyond that time, ask yourself what extremes you are willing to go to to have your own biological offspring. And, third, consider adoption. Frankly, it would be wonderful if adoption were easier, but in the drive to conceive at later and later ages we see the hand of biology and understand why adoption is not easy:  Our own offspring – our own DNA out there in the world – is a heady motivation.

If you are on the pathway of becoming pregnant, being under 35 is the best ally you have. If not, maybe some of the suggestions on the web will work for you. Whatever you decide, all the best.

One parting comment:  Regular moderate exercise – while it helps you stay young and healthy – will not prevent your eggs from being popped out every month. It will help you have a healthy pregnancy if you conceive, so stay with it!

There are sites by enduring public health organizations that cover the range of conception, pregnancy, birth and early parenting issues – such sites as those by the Mayo Clinic, the March of Dimes, and WebMD – starting with how to get pregnant. You can also find business sites for these range of topics – such as The Bump and BabyCenter.

In addition, there are individualized sites that cover coaching for one or more parts of the process. Sites specialize in getting pregnant, being pregnant, giving birth, caring for a newborn, finding childcare, finding early childhood education, how to talk to toddlers, what to do with children of all ages, how to get them ready for school, how to encourage them in school and so on. Some specialize in a combination of two or more of these topics. Some started out specializing in one topic and are moving along as the owners or writers evolve in their lives.

I realize that this is an outgrowth of the “mommy bloggers.” Many computer literate women found blogging a way to deal with the life-changing event of having a child. For some, the internet became a means of making a living while staying home. Realizing that there was a large audience in this realm, the mommy entrepreneurs evolved…and, not all of them are mommies.

We are beginning to see the next generation:  pregnancy and parenting life coaches – individuals who may or may not have professional backgrounds in one of these areas, but are learning to turn their own experiences into businesses that help – or purport to help – others along this part of life’s path. Where does the impetus for this come from? Is it just that the internet makes a new business model possible? What else might be happening here?

For some time, I have thought that young persons entering parenthood these days are at a distinct disadvantage. Bearing and raising children is not easy or cheap. It requires a network of support and advice that used to be present in the extended family. But, we leave home and are much more mobile these days. We may live in Texas, but our baby’s grandparents live in Oregon or Brazil or Turkey. I asked my own exercise, childbirth education, and parenting clients about this. I found that many were in the classes precisely because they felt they had no firsthand experience or knowledge about what it was like to hold, feed or change a baby, let alone be prepared for birth and the sleep deprivation that followed. I also found mommy bloggers and entrepreneurs who found the impetus for their new work sprang from these issues in their own lives.

So, over the next series of blogs, I will be writing about some of these sites and services…both the professional organizations and the new mom entrepreneurs who have turned a difficult life transition into a way of simultaneously helping others while putting food on their tables. It looks to be an interesting journey and I hope you will follow along! I will get the next blog up in a few days, as soon as I am in the next location with internet access. My office is temporarily in the hurricane blackout zone of CT, but they promise me service soon. The first topic:  How to get pregnant!

Question:  I am a hip hop dance teacher and this is my first pregnancy. I am 6 months going on 7 months (due in Nov.). I have been experiencing a lot of Braxton Hicks with pain along with fibroid pain. I realize Braxton Hicks are very common in pregnancy, however the pain I experience at times can be debilitating. I have been dancing throughout my pregnancy so far, but had to cut back due to the pain. My class season is starting back up this month and I am getting worried about my ability to teach. What are some suggestions for teaching while pregnant? Any tips on warm up and movement modifications? Also, how does maternity leave work in the dance world? I am trying to figure out exactly how much time to take off. Everything is so unpredictable..lol. I am more familiar with what is common in the corporate world than dance.

Answers

1) Braxton-Hicks & fibroid pain – Braxton Hicks, or practicecontractions, are common from mid-pregnancy forward. The extent to which women are aware of them and how much discomfort they produce depends on several things – some genetic, some situational. One factor is fibroids. If your pain is so extreme that it limits activities of daily living (ADL), then you need to confer with your care provider to determine if there is something that can be done to alleviate the pain and/or whether you need to restrict ADL. If it is limiting your dance movement, you need to back off and find a way to tell or indicate to your students what you want them to do.

2) Tips for teaching during pregnancy – By mid-pregnancy your alignment is shifting enough that all of your normal movement patterns are becoming inefficient. In addition to this changing alignment, your joints are at risk for damage due to hormonal changes in connective tissue, which normally helps maintain joint integrity. The bone facets that articulate together shift their relationship and nerves and blood vessels can be impinged. Therefore, making your movements smaller and less percussive are good strategies for preventing injury.

Check the pregnancy exercise tips on our website to find exercises especially designed for pregnancy. You may find some of these are useful warm-ups. Also, do side-lying relaxation every day for 10 to 20 minutes. Check the page on nutrition for childbearing, too, as nutrition plays a major role in keeping up your resources and energy.

3) How much time off will I need? - Yes, you are definitely entering the world of the unpredictable! Surely people have told you that your life will never be the same…in a good way! Well, it is true and one of the things that will be different is that priorities change and it is not always possible to predict how long things will take. Since you are fit and active and are remaining so during your pregnancy, your recovery time will be fairly quick. However, other factors will affect how long it takes you to get back into the studio. The course of your labor and birth, as well as the adjustments you and your baby and partner need to make in the immediate postpartum period, will influence when you are ready to start dancing.

With professional dancers and athletes, it has been my experience that if the birth is vaginal, within a week new moms are working on their core strength and endurance and within a month are able to do an easy class for themselves. By two months, many are back at work, rehearsing and sometimes performing. Of course, breastfeeding – which is very important for both mom and baby – may affect how long you can work at any one time. If the birth is surgical (cesarean), it may take a week or two longer to get to each milestone.

Follow up thoughts – This is an exciting and meaningful time in your life. You will not believe how amazing you will feel when you first see your baby. Be fully present and relish in the moment. Be careful now; it’s better to take precautions and make sure you and your soon-to-be-newborn are safe. When we train DTP teachers the first priority we teach is safety!

I hope this is helpful and that you will keep me posted on your progress.

- Ann Cowlin, DTP director

Her first contribution is that, as a dancer for Martha Graham, she brought new awareness to the field of modern dance, an art forged and shaped largely by women. The presence of Betty Ford was palpable. Whenever we saw her on the TV screen as First Lady in the late 1970′s, we were aware of her strength and mindfulness of being.

Betty Ford put breast cancer on the map. While First Lady, she underwent a mastectomy. She did not hide her disease, but rather was public with her disclosure, encouraging women to have mammography and seek early care for this cancer.

As a mother, she raised interesting and independent children. She championed women’s rights and was an avid supporter of the Equal Rights Amendment. And, she participated in the effort to bring about a woman’s right to reproductive self-determination and the right to abortion.

She is – of course – the founder of the Betty Ford Center, which has long provided support and rehabilitation for persons with substance addition. Her commitment to this effort began with her own path to sobriety following her addiction to pain killers and alcohol.

She changed forever the role of First Lady, asking women to step out and seek the recognition and respect that men routinely expected. She remains for those of us old enough to remember her influence as one of the tall trees in a small forest of feminine heroes. For those of you too young to have a memory, take a moment and do a google search. She was a quiet, but oh so powerful voice in the creation of the society in which you now operate. Without women like Betty Ford, you might not be so free.

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.

 

Group exercise programs are a source of social support.

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.

Today I attended an in-service training for labor nurses and educators in our hospital maternity services (Yale-New Haven Hospital) concerning the new guidelines on second stage, or pushing, from AWHONN. These guidelines are being implemented on our labor and birth floor. This change comes not a moment too soon!

Not only are women telling us that they dislike the medicalization of birth, but also that they perceive potential dangers to them and their offspring inherent in some common in-hospital practices. One such practice is the use of the Valsalva maneuver, also called “directed” pushing, in which you hold your breath and bear down hard. Unfortunately, it causes hemodynamic problems, damages tissue and stresses mother and baby.

Our educator today, Louise Ward, RN, MSN, took us through the second edition of the AWHONN guidelines, with their focus on following the woman’s urges, helping her stay mobile and upright, and supporting her physically, emotionally, instructionally and psychologically. She covered laboring down, the process of allowing the mother to wait until she felt sufficient pressure or has the urge to begin pushing. She covered accommodating women with epidurals, helping them distinguish between pain and pressure. And, we discussed how to help women accept and focus on letting the baby emerge.

Many of the topics we covered were items I had learned about by reading the research studies that allowed AWHONN to develop these evidence-based guidelines. But, it was an exciting moment for me.  Many of the women that I work with in various prenatal classes tell me they want to give birth at the hospital because they want to be in a safe place in case of an emergency, but do not want to be subjected to much of the medical intervention they hear about. I agree. And so, I am glad to learn what our hospital is doing to bring the evidence – which my clients have read – into practice.

Our hydrotherapy tub is up and running…plumbing finally fixed! We are committed to letting the mother lead in pushing, to support breastfeeding and nurture new families. Next, we may even get back to intermittent auscultation! These things are happening in part because of consumer pressure and in part because of mandates to reduce the number of unnecessary, ineffective and costly medical procedures throughout the health care system.

I’m glad to see that evidence, mother’s instincts and financial pressures are all pointing toward the same solution…birth is primal behavior and works best when we follow the woman’s lead.

Here is the link to the story and the subtitle:

http://branford.patch.com/articles/ann-cowlin-a-prenatal-fitness-pioneer-celebrates-30-years-of-work

What started as a “fledgling experiment” has become one Branford woman’s life work.

Thank you for taking a look!

Still looking for new ways to develop core strength & coordination!

That's it...try alternating this shape with the previous one...breathe out here!

What is at the core of this issue? Several things leap to mind…

Defensive medicine is certainly a major component. Mandated medical procedures and frequent measurements during labor tend to interfere with the natural process. For example, in first stage labor, interruptions force women out of the parasympathetic state (brain alpha rhythm associated with the relaxation response) that helps promote the release of oxytocin and progress in labor.

Allowing the body to work is a very different kind of experience from what many women discover about birth in a hospital setting. In my experience, women who are aerobically fit do well in any labor setting. Women from my fitness classes have a very low rate of cesareans. Having your vitals checked and your contractions and fetal heart beat measured every hour or sometimes continuously cannot promote labor, although fitness seems to protect women to some degree. Of course, the argument for measurement is that if anything goes wrong that could have been detected through measurement, the practitioner will be blamed for malpractice. Thus, if 3 out of 4 cases of late decels leading to cesareans result from false positives in fetal monitoring, that has been seen as an acceptable rate within the medical community.

But, clearly, it is less acceptable to women, fit or not. Attempts are being made to alter the amount of monitoring in hospitals. The fact that it is perceived as an interference speaks to the problems with the method of measuring. In home births and even some midwife-attended hospital births, attendants listen to the fetal heart, a skill that – while it produces more accurate assessment – is rarely taught in medical schools any more.

Additional elements of defensive medicine are suspect, as well:  induction, denial of food and adequate fluid intake, poor communication to patients about the risks of procedures, and a system that views the mother as merely the medium through which the fetus is produced.

Another component is surely the psychological safety that women associate with their home environment over a hospital setting. Hospitals have attempted to circumvent this by creating labor and birth rooms that mimic a home environment and by offering tours of the labor and birth floor to help acclimate parents-to-be. But, it is also factors like not wanting medications that may flatten their emotional response to the birth experience, and the perception that drugs will be pushed on them in a hospital setting, that cause women to simply stay out of the hospital. Obs and midwives will even tell their patients to stay out of the hospital as long as possible if they want to avoid drugs and interventions. Certainly, in my work as a childbirth educator, I see a large part of my task as providing all the information they are requesting to couples in their decision-making process about their approach to the hospital.

One component I find particularly difficult is the standard approach to second stage labor in a hospital setting. To be clear, the notion of using the valsalva maneuver to push out a baby was invented by a man. It speeds up the process (which strikes me as a particularly male goal – apologies to the anti-sexist contingent), but creates more damage than following the body’s urges (reference here). During transition, the body shifts from the parasympathetic state to the sympathetic state. Pushing is aggressive; urges allow a woman to summon strength and direct her efforts. At the end of a long endurance event lasting many hours, a strength test is required. It is very different from the quiet stamina needed during dilation.

As information to this effect gets disseminated, I think women have come to recognize that they have greater trust in a female-based approach. More and more, we are hearing that educated women prefer laboring in water, movement, upright positions, drinking water, eating, gentle monitoring and being around people they trust, to what they have heard about or learned in previous births at the hospital.

Which brings me to a point:  Being present and enjoying birth requires not only a safe setting, but also body trust. Body trust is something one gains by having successful experiences with one’s body. I wonder if women who choose to birth at home tend to have positive self-images? And, most of all, I would be curious to know about the exercise practices of women who choose to birth at home. Any thoughts?

Pregnancy Exercise Safety Tip: Stay Hydrated

By Monique Nemarch, DTP® Master Teacher

As a Dancing Thru Pregnancy instructor, the safety of mother and baby must be your number one priority. This holds true whether your class consists of one mother or twelve.  Throughout your first few years as a DTP instructor you will develop a myriad of concerns, ranging from the welfare of your students to your own competence as a teacher: Will I be able to teach the floor work properly? Will I remember to remind the class to breathe? (Will I remember to breathe?) Does this aerobic dance work?  The class is so quiet – do they like me?

Now add safety questions to the mix, and this can all seem daunting to a new teacher.

Throughout my years as an instructor I’ve encountered many safety concerns, and as a result, I’ve developed shortcuts to help keep the members of my classes safe.

Some years ago I had a client who refused to take water breaks.  She would jog or march in place while the others took sips from their water bottles.  To single her out from her peers and publically insist that she stay hydrated might have led her to drop the class. I decided to explain to the whole class the importance of staying hydrated during times of exertion.

She still refused.

So, I had to resort to catching her before class and discreetly asking if we could talk in the hallway.  I proceeded to explain, very gently, how concerned I was with her not taking water breaks during class.  I noted that her workout would benefit from these water breaks; however, going without them might jeopardize her pregnancy.  I commiserated with her about forgetfulness during one’s pregnancy, and promised that there would always be a pitcher of water provided for the class lest someone should forget their water bottle.

I’m happy to report that this approach worked.  She started taking breaks, and when she forgot her water bottle she used the water set out for the class.

From this I learned to be proactive.  Assume that someone in your class will forget their water, and have a pitcher and cups at their disposal.  Your class will appreciate your thoughtfulness!