BIRTH AS A MOTOR SKILL. part 3.

THE CONCEPT

Labor and birth are intense physical challenges that require endurance and stamina over an extended period of time, the ability to cope with high intensity intervals and quick recovery, strength, mobility, emotional support, and the ability to enter a parasympathetic or alpha brain wave driven state. These factors point to a physical preparation based on evidence of exercise principles that produce progress in these areas.

These well-established principles in exercise physiology – listed below – help us meet these needs. Note these are physiological principles, not methods. Some validated methods of achieving outcomes derived from applying these principles are given as examples in the discussion that follows.

  • Training Specificity (covered in post 1)
  • Overload and Progression (covered in post 2)
  • Muscle Bonding (discussed in this post)
  • Flow (or The Zone)

MUSCLE BONDING

“Synchronized motion triggers a sublimation of selfish drives and needs in order to function as a single organism” – Left, Right, Left, Right, Muscular Bonding and the Hive Trigger http://www.abovetopsecret.com/forum/thread840994/pg1

The evolving concept of muscle bonding through synchronized motion emerged primarily in two fields of study, military behavior and ritual practices in the arts, sports and celebrations. These discussions center on the development of group cohesiveness and support that evolve over time via intense synchronized motion [16,17]. Raising the pain threshold has also been noted in exercise science due to the release of endorphins in response to the stress of intense exercise [18,19]. Recently, the effects of elevated pain threshold and bonding have been demonstrated independent of each other in synchronized dancing[20].

Figure 5: The presenting affect of the hive trigger is joy.

Muscle bonding and its hive trigger are useful for labor preparation. Cooperation needs practice. Lowering one’s pain threshold requires practice. In labor, continuous support of the mother is critical. Working as a team includes the mother accepting support. Hence, fairly intense synchronized group movement can serve as a method of enhancing these skills and helps explain why [group] aerobic activities contribute greatly to reduced needs for interventions[4,5,10].

Figure 6: Note the same joyful expression on the face of a new mom who prepared to “dance” with her birth team .

The cooperative – or “hive” – effect is independent of another outcome: alteration of the pain threshold through release of endorphins due to intense movement. Both effects are helpful in labor and birth.  Note the joyful look on the faces of active moms-to-be, moving together.

In recovery, this type of activity might also be examined as a means to reduce the incidence of postpartum mood disorders.

________

References for Post #3:

  1. Owe KM et al. Exercise during pregnancy and risk of cesarean delivery in nulliparous women: a large population-based cohort study. Am J Obstet Gynecol. 2016 Dec;215(6):791.e1-791.e13. doi: 10.1016/j.ajog.2016.08.014. Epub 2016 Aug 23.
  2. Barakat R et al. Exercise during pregnancy is associated with a shorter duration of labor. A randomized clinical trial. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2018 224:33–40. https://doi.org/10.1016/j.ejogrb.2018.03.009
  1. Newton EF, May L. Adaptation of Maternal-Fetal Physiology to Exercise in Pregnancy: The Basis of Guidelines for Physical Activity in Pregnancy. Clin Med Insights: Women’s Health. 2017; 10: 1179562X17693224. Published online 2017 Feb 23. doi: 10.1177/1179562X17693224.
  1. Wray H. All together now: The universal appeal of moving in unison. Scientific American Mind. April 1, 2009. https://www.scientificamerican.com/article/were-only-human-all-together-now/
  2. Wiltermuth SS, Heath C. Synchrony and cooperation. Psychol Sci.2009 Jan;20(1):1-5. doi: 10.1111/j.1467-9280.2008.02253.x.
  3. Cohen EEA Ejsmond-Frey R, Knight N, Dunbar RIM. 2009. Biology Letters, 6, 106-108. (doi:10.1098/rsbl.2009.0670)
  4. Dishman RK, O’Connor, PJ. 2009. Lessons in exercise neurobiology: The case of endorphins. Mental Health and Physical Activity, 2: 4-9. (doi:10.1016/j.mhpa.2009.01.002)
  5. Tarr B, Launay J, Cohen E, Dunbar R. 2015 Synchrony and exertion during dance independently raise pain threshold and encourage social bonding. Biology Letters11:20150767.http://dx.doi.org/10.1098/rsbl.2015.0767

 

Pregnancy Pathway, Outcome – Mom & Baby Health Status

This 2/1/2010 entry seems to draw attention consistently, so we decided it was worth re-posting it. The discussion concerns determinants of the health outcome for mom & baby in the Pregnancy Pathway. It reviews the pathway, and then continues 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.

 

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.

Labor & Birth: The Big Push…Let the Woman Lead

“Let the Woman Lead in the Dance of Birth”

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.

Birth of Pregnancy Exercise: Evolution of DTP

Sometimes it is fun to look back at the long road to the present! Recently, I was interviewed by our local online media outlet (the Branford CT Patch) and was really thrilled with the resulting story. It focused on the 30 year road of DTP and I thought you might find it interesting.

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!

Pregnancy Exercise Safety

Included in this Blog

There are three sections to this blog. One is for moms-to-be, the second for pregnancy fitness teachers and personal trainers and the third includes specific contraindicated and adapted exercises.  All information presented is based on peer-review research and evidence collected over a 30 year period of working with this population. More information is available at http://dancingthrupregnancy.com.

1) Safety & Exercise Guidelines for Moms-To-Be

First and foremost, be safe. Trust your body. Make sure your teacher or trainer is certified by an established organization that specializes in pre/postnatal exercise, has worked under master teachers during her preparation, and can answer or get answers to your questions.

These are the safety principles that we suggest to our participants:

  • get proper screen­ing from your health care provider
  • pro­tect yourself
  • do not over­reach your abilities
  • you are respon­si­ble for your body (and its contents)

Squatting is an example of a standard pregnancy exercise used for childbirth preparation that must be adapted by each individual based on body proportions, flexibility, strength and comfort.

Second, make sure you are getting the most from your activity. Keep these findings in mind when choosing your workout routine:

  • Aerobics and strength training provide the greatest health benefits, reduce the risk for some interventions in labor, help shorten labor, and reduce recovery time
  • Cen­ter­ing helps to prevent injury; relaxation and deep breathing reduce stress; and mild stretching can relieve some discomforts
  • Avoid fatigue and over-training; do reg­u­lar exer­cise 3 — 5 times a week
  • Eat small meals many times a day (200–300 calo­ries every 2–3 hours)
  • Drink at least 8 cups of water every day
  • Avoid hot, humid places
  • Wear good shoes dur­ing aer­o­bic activities
  • BE CAREFUL!   LISTEN TO YOUR BODY!

If you experience any of the following symptoms, stop exercising and call your health care provider:

  • Sudden pelvic or vaginal pain
  • Excessive fatigue
  • Dizziness or shortness of breath
  • Leaking fluid or bleeding from the vagina
  • Regular contractions, 4 or more per hour
  • Increased heartbeat while resting
  • Sudden abnormal decrease in fetal movement (note: it is completely normal for baby’s movements to decrease slightly during exercise)

2) Safety & Exercise Guidelines for Teachers & Trainers

A principle of practice that increases in importance for fitness professionals working with pregnant women is having the knowledge and skills to articulate the rationale and safety guidelines for every movement she asks clients to perform.

This goal requires adherence to safety as the number one priority. Here is how we delineate safety and the procedures we require of our instructors for achieving safety in practice:

First priority:  safety [First, do no harm]

  • sometimes medical conditions preclude exercise
  • find an appropriate starting point for each individual
  • individual tolerances affect modification
  • general safety guidelines are physical
  • pregnant women also need psychological safety

Mind-Body Safety Procedures

Centering enhances movement efficiency and safety. Always begin with…

  • balanced, neutral posture
  • deep or rhythmic breathing
  • mindfulness
  • safe range of motion

Strength Training Cautions

  • avoid Valsalva maneuver
  • avoid free weights after mid pregnancy (open chain; control issue)
  • avoid supine after 1st trimester
  • avoid semi-recumbent 3rd trimester
  • keep in mind the common joint displacements, and nerve and blood vessel entrapment when designing specific exercises

Aerobics or Cardiovascular Conditioning Procedures

Monitor for safety..

  • take a pulse
  • assess perceived exertion (RPE)

Instructional style needs to be appropriate…

Walking steps with natural gestures can be done throughout pregnancy

Vigorous steps with large gestures are more intense, appropriate as fitness increases

The ability to create movement that will be safe and work for various levels of fitness and at different points in pregnancy is one of the most critical skills for pregnancy fitness instructors.

  • steps with leg gestures and/or arm gestures increase intensity
  • size affects intensity of movement
  • speed affects intensity of movement
  • jumping increases the ground force or impact on the joints
  • stepping up (e.g., step aerobics or stair climbing) increases intensity
  • some effort/shapes are ballistic and should be avoided
  • movement needs to be modified for each woman’s comfort

Venue Safety

  • Setting should provide physical and emotional safety
  • Equipment must be well-maintained

3) Contraindicated  and adapted exercises

Exercises for which case studies and research have shown that there are serious medical issues include the “down dog” position, resting on the back after the 4th month, and abdominal crunches and oblique exercises. Here is more information and adaptation suggestions:

Contraindicated: “Down Dog” requires that the pelvic floor and vaginal area are quite stretched, bringing porous blood vessels at the surface of the vagina close to air. There are records of air entering the blood stream in this position and moving to the heart as a fatal air embolism.

Adaptation: Use the child’s pose, with the seat down resting on the heels and the elbows on the ground, hands one on top of the other, and forehead resting on the hands. Keep the heart above the pelvis.

_________

Contraindicated: Resting on the back during relaxation.

Adaptation: Rest in the side-lying position. About 75% prefer the left side, 25% prefer the right side.

_________

Contraindicated: Abdominal crunches and oblique exercises can contribute to diastasis recti in some women. The transverse abdominal muscle is not always able to maintain vertical integrity at the linea alba, and thus there is tearing and/or plasticity of that central connective tissue.

Adaptation: Splinting with curl-downs, see positions below. By pressing the sides of the abdomen toward the center, women can continue to strengthen the transverse abdominals without the shearing forces that place lateral pressure on the linea alba.

Splint by crossing arms and pulling toward center

Or, splint by placing hands at sides and pressing toward center

Active Pregnancy – the rationale

Moving into Motherhood

It’s time to hit the main theme again:  Aerobically fit women are at reduced risk for things that go wrong in pregnancy, improve their tolerance for labor and birth, and recover more rapidly in the postpartum period.

The arrival of the holidays provides a good reason to bring this up, yet again! Pregnancy is a gateway time in women’s lives…we become more aware of our bodies, our sensations, our feelings, our needs, and how versatile and amazing our bodies are. We can make people with our bodies! During pregnancy, we often take precautions…we eat more carefully, avoid toxins, try to avoid stress. When the holidays arrive, we see indulgent behavior in a different light.

Yet, even with all this focus on behavior, we sometimes miss the biggest aid to a healthy pregnancy:  physical fitness. Research clearly demonstrates that fit women do better, are healthier and happier. More and more in the U.S. we see disorders of normal organ function that accompany sedentary pregnancy.

Let’s look at this a little closer (yes, I am going to repeat myself some more, but it is an important concept to spread). We live in a body model that rewards an active lifestyle.

Being sedentary causes things to go wrong

Not moving creates biochemical imbalances because the cardiovascular system atrophies and molecules created in the brain or brought in through the digestion may not get where they need to go for a healthy metabolism.

Your cardiovasculature is the highway that brings usable substances to the place they are used. You have to help it grow and develop, use it to pump things around and give it a chance to be healthy. Aerobic fitness does all these things.

Advice for young women of childbearing age

If you are thinking of pregnancy, have recently become pregnant, or work with women of childbearing age, we encourage you to open avenues of activity for yourself or others in this population. You can learn more from our website dancingthrupregnancy.com. You can also read backwards in this blog to get specific ideas. Or, you can seek out local pre/postnatal fitness experts (you can also do this on our site). Yoga is nice…we use some of it in our work, along other specific exercises for which there is a direct health benefit. But, we also see yoga converts who come into our program in mid pregnancy unable to breathe after walking up a flight of stairs. How will they do in labor? Not as well as those who have been doing aerobic dance or an elliptical machine 2 or 3 times a week.

The AHA/ACSM guidelines for the amount of aerobic exercise needed to improve cardiovascular status hold true for pregnant women just as they do for the rest of the population – a minimum of 150 minutes of moderate, or 75 minutes of vigorous, or a combination of these levels of intensity, per week. If you are not getting this level of activity, you are putting your health – and that of your offspring – at risk.

Childhood Obesity Prevention Strategy: Pregnancy Fitness

Stopping The Epidemic

The Childhood Obesity Epidemic may best be stopped by creating a healthy environment in utero. Public discussion on the topic of childhood obesity is turning from children to infants. The image of the rolly polly baby as a healthy infant is fading. Evidence is mounting that babies born to overweight mothers and those with insulin resistance or glucose intolerance are already at risk for obesity, type 2 diabetes and cardiovascular disease. We have to ask the question: How do we prevent childhood obesity at its root?

DTP® suggests that pregnancy fitness – especially aerobics or cardiovascular conditioning – can play a critical role in the effort to prevent childhood obesity. While scientists have yet to do direct studies on this theory, there is enough information available to indicate that moms who exercise vigorously prior to and during pregnancy are at reduced risk for disorders of pregnancy such as gestational diabetes and preeclampsia that lead to later metabolic and cardiovascular disease for themselves and their offspring. There is also some evidence that babies of exercising mothers see health benefits during their childhood.

Vigorous exercise produces the best health outcomes for mom and baby.

Why Is Pregnancy Fitness Important?

The first and most obvious answer is that if a pregnant woman exercises vigorously enough, she is burning sugar, thus reducing the type of metabolic stress that can result in gestational diabetes. We know that overweight women who require insulin reduce the amount of insulin needed if they exercise. At the same time, they are reducing the impact of the disorder on their offspring. Recently, we have begun seeing reports of children as young as three years old having coronary artery disease, in part due to the conditions of their gestation.

Second, and the more intricate possibility, is that the whole biochemical milieu in which the exercising mother’s fetus develops is teaching it to survive in a fit environment. Think:  The cells drive the behavior of the organism. If the cells are used to a bath of healthy chemicals, the bottom up drive to provide that environment will help produce behavior achieving the desired result. In a manner of speaking, an exercising mom-to-be helps provide her offspring with an appetite for motion.

How Do We Get There From Here?

There are two major steps that need to be taken to help bring at-risk moms/babies into the realm of the active.

1. Care providers – midwives and obstetricians – need to support their patients in finding appropriate cardiovascular conditioning activities or programs.

2. Pre/postnatal fitness professionals need to insure that appropriate and enjoyable activities are available not only to those likely to exercise in any case, but also to those who would like to be active, but for whom social support and a safe psychological environment are necessary.

For more information, visit our website: www.dancingthrupregnancy.com.