DTP Offspring Guest Blog – Ebony Knight & Powerful Pioneers

Doula Ebony Knights became a Dancing Thru Pregnancy teacher in 2014 through the Healthy Start Brooklyn program. Together with her husband, Ebony runs Powerful Pioneers, a program to empower women, seniors and young adults through special workshops, activities and services.

DTP: Tell us about your work as a DTP teacher and a Doula.

EK: We start our class greeting each other, introducing ourselves to newcomers and start off with warm ups, stretching, etc. I have incorporated a Caribbean dance workout, which is a simple dance routine that gave us the opportunity to perform at BMS on stage out doors recently.

After we dance we relax and visualize and end with a discussion (sharing our thoughts and experiences to encourage each other).

To find out more about Ebony’s Doula service, click on this link, then click on the title:
Ebony doula

DTP: What do you most enjoy about your work?

EK: I truly enjoy what I do and was inspired when you traveled so far to teach such an amazing class. Also I have enjoyed getting a chance to meet these lovely ladies; my most committed and dedicated moms have recently had their babies. Some of these moms come back to visit and surprise me. 

DTP: Tell us more about Powerful Pioneers and your activities.

EK: My husband and I have an organization called Powerful Pioneers and our mission is to empower women, seniors and children by offering workshops such as vegetarian cooking classes, dance, health education, drama classes and women and youth empowerment workshops.  You are welcome to visit our website to see what we do. If you happen to know any moms or organizations that would like to partner with us or utilize any of our services feel free to share.

Healthy Pregnancy & Birth Essentials – Be Fit! Be Prepared!

Moving relieves stress.

Do you want a healthy pregnancy, labor, birth and early mothering experience?

This post is designed to provide basic information about achieving this goal. As with any life situation, there are things you can do to help achieve the best outcome of your pregnancy. Some things will be outside your control. Your baby will have blue eyes or brown hair or attached ear lobes depending on genetic factors. But many things are in your control. If you are fit and eat well you will help your baby’s development.

Circumstances can also play a role. For example, where you live can impact how much you walk or whether you are exposed to second-hand smoke. Sometimes you can change these things, but not always. We have put together just the basics, the things you CAN do to help yourself have a healthy pregnancy and birth!

1. PRENATAL CARE – Repeated studies show that women who have regular health care started early in pregnancy have the best outcomes.
2. AIR & FOOD – Your muscles need oxygen and blood sugar in order to achieve activities of daily living (ADL), fitness activities, labor, birth, and caring for a newborn. Muscles – including the uterus – need these two essentials in order to this work. Therefore you must do these things:
   • Breathe deeply to strengthen your breathing apparatus.
   • Eat in a way that is balanced (carbs, fats & proteins in every meal or snack) and colorful (fresh fruit & veggies) to train your body to
     

     Fresh fruit provides vitamins & minerals!!

     produce an even supply of blood sugar and provide needed vitamins & minerals. You need 200 – 300 calories every 2 – 3 hours, depending on your size. Prenatal vitamins are your backup safety mechanism. Eat real food, not edible food-like products (example: potatoes, not potato chips).

   • Drink fluids (primarily water) and eat protein to maintain an adequate blood volume. Blood delivers oxygen and sugar to your muscles, placenta and baby. Pregnancy increases needed blood volume by about 40%. More if you exercise regularly.
   • You don’t need other items, especially things that are dangerous, like alcohol, cigarettes and drugs. Continue safe sex.
3. PHYSICAL FITNESS – Pregnancy, labor, birth and parenting are ENDURANCE events. Strength, flexibility and mindfulness will help, but only if you have stamina to tolerate the stress to your cardiovascular and respiratory systems.
   

   Aerobic Dancing improves stamina while having fun!

   • Cardiovascular conditioning or aerobics is the cornerstone of fitness. Make sure to get 20 – 30 minutes of moderate to vigorous aerobic activity 3 or 4 days a week. Find a qualified prenatal aerobic fitness teacher. If you are more than 26 weeks pregnant, start very, very slowly.
   • Core, shoulders, hips, pelvic floor – these areas need adequate strength training and gentle flexibility for range of motion.
   • Relaxation practice has been shown to help reduce the active phase of labor.
   • Mindfulness can be a big help in birth if you have adequate endurance and are not in oxygen debt, out of blood sugar, dehydrated or too tired.
   • Find classes here: DTP Take-a-Class
4. EDUCATION – Be sure these items are included in your childbirth education course:
   • Landmarks of labor & birth progress
   • Sensations at various points in labor
   • Physical skills that promote labor progress and help achieve a healthy birth
     

     Learn the benefits “skin-to-skin” after birth.

   • Pain Management techniques to help you deal with the intensity of birth
   • How to maintain oxygen and sugar supply in labor before going to the hospital and while in the hospital
   • Standard hospital procedures (so you can decide when to go to the hospital)
   • Complications that can lead to medical interventions, including surgery
5. GET SUPPORT – Make sure you will have continuous support for your labor and birth
   • Spouses, partners, and female family members can be helpful if they accompany you to your Childbirth Education class and know how to help you during the process.
   • A Doula is a great option for support because they are trained to guide a mom and family through the birth process.
6. POSTPARTUM ACTIVITY WITH BABY – This is a great way to get in shape after birth.
   • Early General Fitness in the first few weeks: walk with the baby in a stroller or carrier, work on kegels and suck in your belly.
   • After 4 – 8 weeks you will be ready to join a Mom-Baby fitness group!

Birth begins the bond or unique love between mother and child.

About Dancing

“When a normal, healthy child is born, usually in the father’s compound, the women perform the nkwa to rejoice. Then…they sing and dance their way to the compounds of the mother’s kin to inform them of the joyous event through the dance-play, gathering additional dancers as it moves from compound to compound. In this nkwa, in which only married women who have given birth perform, the dancers highlight procreative body parts, birth exercises and child care gestures.” – page 164, Hanna JL, To Dance is Human: a theory of non-verbal communication, 1979. Rev. ed. 1987.

From its inception in 1979, Dancing Thru Pregnancy® has been inspired by this passage from Judith Lynne Hanna’s amazing text, in which she describes how the Ubakala of Nigeria “announce” the birth of a child. The dance serves a dual purpose – it tells of the birth, but it also teaches the uninitiated how pregnancy and birth occur. For the dancers it also serves as a catharsis.

As a professional dancer, I long ago recognized the transformative power of dance to make experiences accessible. Through Hanna’s writing we see how dance is itself one of the earliest and most profound ways in which common human experiences are taught and learned. Contemporary culture often removes this type of learning from our environment. Employing dance to help women approach birth has always struck me as an obvious first choice in preparing women for the physical, emotional, identity-forming and joyful process of birth.

In the intervening years, science and technology have reinforced our understanding of how this non-verbal learning happens. A most excellent discussion of mirror neurons appears in Acharya and Shukla’s article, Mirror Neurons: Enigma of the metaphysical modular brain, J Nat Sci Biol Med. 2012 Jul-Dec; 3(2): 118–124. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3510904/. Mirror neurons are key to how empathy and understanding of experience are produced when people view movement and gesture. The mere perception of an action sets off a low level firing of the neural pathway that executes the actions we are seeing. The authors provide a thorough grounding in the history of how we have come to recognize that mirror neurons exist and how they work.

There are more arenas in which dance also shines as a preparation. Appropriately choreographed, dance enables excellent physical fitness and includes all the elements of physical activity that research demonstrates are effective for optimal health in pregnancy and coping with the rigors of birth. From the perspective of exercise physiology, labor is an ultra-distance endurance event, followed by a strength test (birth), a long physical recovery period and 18 years or more of sleep deprivation. And, further, such a preparation aids the mother in achieving a physiologic birth as described in Buckley’s “Hormonal Physiology of Childbearing: Evidence and implications for women, babies, and maternity care.” This recent groundbreaking article describes how labor, birth and breastfeeding are promoted through hormonal actions, as well as why some technological advances in childbirth are working against these processes.

Achieving cardiovascular endurance (aerobic fitness) is essential. There are so many benefits of aerobic fitness that a full recitation and hundreds of citations will not fit in a blog. Our teacher training aerobic component takes several days, even for experienced fitness pros. But, to summarize: cardiovascular fitness improves implantation, enhances nutrient and oxygen delivery, reduces the incidence or severity of some pregnancy disorders, reduces the risk of fetal distress, reduces stress on maternal cardiac reserve while pushing, reduces the risk of cesarean, hastens recovery, helps maintain a healthy weight, alleviates anxiety, builds body-image confidence (Cochrane) and enhances long term maternal and fetal health. The two forms of cardio or aerobic activity most often cited for effectiveness are running and aerobic dancing.

Two other elements of dance that are useful for pregnant, birthing and parenting moms are strength and flexibility. There are many movement actions derived from numerous dance forms that promote both power and elasticity in the muscles, connective tissue and skeletal structure. Some effective positions, movements and skills are shared with other disciplines: Traditional childbirth preparation, weight training, gymnastics, physical therapy, yoga, t’ai chi, pilates, boot camp, plyometrics, proprioceptor neuromuscular facilitation (PNF) techniques, Feldenkrais, Alexander, somatic therapies, posture training, etc.

This letter I received recently from a (not pregnant) ballet student willing to share her experience is a clear reminder of how a well-designed dance class accomplishes enhancement of strength and flexibility, along with confidence about working with one’s body:

“Hi Ann,

I just wanted to let you know that I lifted weights at the gym last night… It had been at least 6 months since I had lifted weights at all, and so I figured I’d need to start at a relatively low weight and I’d be really sore the next day regardless. I was very surprised to find that I could easily lift the maximum weight I’ve ever lifted, which was the weight I used to lift at a time when I was lifting weights routinely several times a week. Every muscle group was strong. And today I am not sore at all. This is all to say that I am shocked at how much strength I’ve gained from ballet. I had no idea that just lifting my limbs against gravity could be so effective.

Thank you so much for having a class for beginner adults, and for your patience with all of us! I’m 42 years old at this point, and started ballet because I had noticed my core strength, flexibility and balance starting to really decline…I am so thrilled with the results from ballet even though I have such a long way to go!!! Plus it’s really fun. How I wish I would have discovered ballet in my 20s or 30s, since I didn’t learn it as a child!

Glenda G. Callender, MD FACS“

An additional arena in which dance shines is in building mind-body skills. Dancing relies on centering – aligning with gravity to produce the greatest efficiency for movement (balance) along with breathing as a component of movement. Centering also reduces the load on the nervous system and allows the brain to modulate into the parasympathetic nervous system state, also known as the relaxation response (autogenic training, hypnosis, meditation, progressive relaxation), the zone (athletes’ term), mindfulness (big in research presently), the trophotropic response (the scientific term) or the alpha state (the current fad term). Dancers sometimes refer to this as tuning in to the unconscious. The actual coordination of motions, such as pushing, is primarily unconscious. The conscious piece is keeping a clear image of the goal, while allowing the body to work. This is the skill that allows the birthing mother to follow her body’s urges, flowing with the labor rather than trying to control what is going on. It gives her access to the cathartic nature of birth as a dance.

Align

Breathe

Focus on the breath

Sense the movement within

Then, allow the body to dance…

A part of the dance experience I truly enjoy is a phenomenon known as muscle bonding. When a group does vigorous physical activity together – dancing together, a sports team, a drill team – a special kind of bond forms. Part of the euphoria is this muscle bonding experience.  Those of us whose interest lies in understanding the mechanics of such things have a pretty good idea how this works – some of which is laid out in this blog and the reading links. But, that is not the wonder of it. The wonder of it is what the Ubakala women experience moving together to announce the birth of a child.

When I am dancing with my pregnant ladies and we are in the grove with our modified hip hop routine, we are smiling at each other and feeling completely alive. We are breathing hard and working hard, but we are strong. My hope is always that when she senses that labor and birth are starting, a mom-to-be can get in that groove with the baby and support person. Birth as a dance.

No blog on pregnancy or birth is complete without a caveat. Every pregnancy and birth is unique. Sometimes things go wrong. But, mostly they go right! And, moms can optimize the experience. One of the greatest dangers to pregnancy and birth is sedentary behavior. Regular, vigorous, strength-inducing, flexibility gaining, mindfulness, relaxation muscle bonding fun is available. Check our U.S. and International Find-a-Class listing. If there is nothing near you, start something!

Dispelling Myths on Pregnancy Exercise

At regular intervals, it becomes necessary to dispel two persistent myths that are often perpetuated by well-meaning care providers. Both of them were debunked long ago, in research literature that is readily available and about which I have written a great deal, including in my chapters on Women and Exercise (editions 3 & 4) and Health Promotion in Varney’s Midwifery (edition 5), in posts on the DTP website, on my Twitter feed (@anncowlin), on DTP’s Facebook page and in a textbook.

The more common myth is that pregnant women should never let their pulse get over 140 beats per minute. But, more on that one at another time. That was an ACOG guess in 1985 that long ago (1994) was rescinded.

The other is that pregnant women should never begin a new exercise regimen, but only modify (i.e., reduce) what they are already doing. What brings me to write this blog after a blog break (to respond to our expanding pre/postnatal fitness teacher training program) is that this evening I was told the latter myth was promoted by a CNM at a recent nearby conference. A childbirth education colleague alerted me to this occurrence and also to the happy response by an unknown person in the audience, who chose to differ with the midwife, citing Dancing Thru Pregnancy® as her example!! Thank you to this responder.

Let me address – yet again – the issue of whether it is safe for pregnant women to begin an exercise regimen after they become pregnant. The caveat I offer at the outset is that doing so should be under the supervision of a knowledgeable certified pre/postnatal fitness specialist. Within the profession, the resolution of this question is generally agreed to be the Cochrane Review conducted in 2002, which found that aerobic fitness can be improved or maintained in pregnancy. Improvement requires increasing the level of aerobic challenge. More recently, researchers concluded “….pregnant women benefit from regular physical activity the same way as non pregnant subjects…” and that “…[t]he adoption or continuation of a sedentary lifestyle during pregnancy may contribute to the development of certain disorders such as hypertension, maternal and childhood obesity, gestational diabetes, dyspnoea, and pre-eclampsia.” (Melzer et al. Physical activity and pregnancy: cardiovascular adaptations, recommendations and pregnancy outcomes. Sports Med. 2010 Jun 1;40(6):493-507. 

Put another way, the female is not put together to be sedentary in pregnancy. It is only in recent decades that this is an option. Until the mid 20th Century, activities of daily living required physical fitness, and obesity was rare, along with sedentary behavior. In the last few decades, those who are knowledgeable about the interactions of pregnancy and exercise, and who have the experience of teaching movement to this population, have come to understand how to present activities that improve the factors that improve maternal and fetal outcomes.

Those who are extremely well-versed in the field all agree that cardiovascular (aerobic) fitness during the 6 – 12 month pre-pregnancy period may be the greatest pregnancy enhancement a woman can have. Why? Because endothelial function is greatly enhanced, oxidative stress is reduced, and vascularity is increased by aerobic fitness, and these capacities underly healthy implantation and placental development (see Research Updates 2001-2005, Winter 2005 and Winter 2004 and Update on Immune Function). Barring that, beginning early in pregnancy is helpful because placental development is still underway. Barring that, mild to moderate aerobic activity introduced by 25-30 weeks will produce cardiovascular enhancement by the time of labor. My caveat goes here, too.

All conditions mediated by inflammation are a problem in pregnancy. Physical fitness is a major preventive strategy for inflammation, and pregnancy does not stand in the way.

 

 

Blood Pressure in Pregnancy

I was recently asked some questions regarding blood pressure during pregnancy by my colleagues at Physiquality. In preparing material, I wrote this blog, which includes very basic clinical information and explanations about this topic.

What is the normal range for blood pressure for pregnant women? What readings would fall under high blood pressure?

Blood Pressure (BP) in pregnancy is a complex topic.

First, we need to know: What are the classifications of BP?

The chart below is from the evidence-based 2014 Guidelines of the American Heart Association and the National Heart, Blood and Lung Institute of the NIH. The first number is Systolic BP or during the heart beat. The second number is Diastolic BP or between beats. These numbers are relevant for women of childbearing age.

• Normal                        <120 mm Hg and <80 mm Hg
• Pre-hypertensive          120-139 or 80-89
• High BP Stage 1            140-159 or 90-95
• High BP Stage 2            ≥ 160 or ≥ 10

Why does low BP (hypotension) occur in a healthy pregnancy?

A healthy pregnant woman with normal BP and no cardiovascular or immune system complications, will have pregnancy BP lower than her non-pregnant BP due to increased progesterone relaxing her vasculature. To create the placental and uterine blood flow, blood volume (V) expands rapidly increasing by around 40%, but stroke volume increases less, so beats per minute (pulse) may increase, systolic BP may drop 5 mm Hg and diastolic may drop 10-15 mm Hg. If V is not adequate with this relaxed vasculature, BP may drop even lower. To help maintain normal BP, women are encouraged to drink sufficient water (about 8 glasses/day) and eat enough protein (about 20-25% of daily intake) to produce a blood volume that will sustain an adequate BP. Other more severe conditions – often genetic – may also be relevant, such as postural orthostatic tachycardia syndrome.

Other causes of hypotension include lying still on the back with legs extended for long periods of time after the first trimester. The weight of the uterus impinges on the vena cava returning blood to the heart, thus reducing BP and blood flow to the uterus and placenta. Also, standing for long periods of time with a minimum of motion, as happens with teachers, cashiers, line workers and nurses in the second half of pregnancy when increasing relaxin and elastin cause further softening of vasculature. This results in difficulty returning blood from the lower limbs and reducing blood flow to the uterus and placenta.

What are hypertensive disorders of pregnancy?

According to the National High Blood Pressure Education Working Group on High Blood Pressure in Pregnancy, hypertensive disorders of pregnancy are presently classified into four categories:

• Chronic hypertension (pre-existing)
• Preeclampsia-eclampsia
• Preeclampsia superimposed on chronic hypertension
• Gestational hypertension

[The Society of Obstetricians and Gynecologists of Canada categorize these disorders as pre-existing or gestational, with the addition of preeclampsia to either category.]

Chronic hypertension is BP >140/90 prior to pregnancy or before 20 weeks. New onset of high BP after 20 weeks may indicate preeclampsia (PE), which requires further consideration. PE involves other symptoms and organs. It occurs in about 5% of all pregnancies, 10% of first pregnancies and 20-25% of women with a history of chronic hypertension. It is a serious disorder and major cause of adverse maternal and fetal outcomes, including strokes, seizures and restricted fetal growth and development.

The underlying pathogenesis of preeclampsia-ecclampsia is not yet fully understood, but is a fundamental dysfunction of the placenta leading to endothelial dysfunction and vasospasm. Possible causes include pre-existing endothelial dysfunction, metabolic dysfunction, auto-immune responses and infection. It is likely that the placenta is affected very early on, during implantation, trophoblast invasion of the uterus and opening of the spiral arteries to form the blood pool on the maternal side of the placental circulation.

Gestational hypertension is the onset of BP >140/90 after 20 weeks without other features of preeclampsia. About 1/3 of these women develop preeclampsia. Gestational hypertension is highly associated with hypertensive disorders later in life. Diabetes can also be a factor associated with hypertension.

Whenever a woman has elevated BP in pregnancy, she needs to be evaluated and have a follow up course of observation and treatment. At its most severe, a hypertensive disorder can affect all the body’s organs and systems, and can be fatal.

What can pregnant women do (diet, exercise, healthy habits) to keep their blood pressure within a normal range?

Some risk factors for hypotension or hypertensive disorders of pregnancy are inherited, others are a consequence of behavior, and many are a combination.

What can a woman do before pregnancy?

Because the events that pre-dispose a woman to hypertensive disorders may occur before she knows she is pregnant, some efforts at prevention may be helpful in the six months to a year prior to pregnancy. Preparing for the implantation period by maintaining optimal health and fitness is likely the most helpful behavior. Cardiovascular or aerobic fitness, which prevents or reduces the severity of endothelial dysfunction is highly valuable. An adequate daily nutrient intake along with sufficient water, and maintaining a BMI <25 are important factors. Women with elevated blood pressure should discuss with their care provider the balance of sodium and potassium intake, along with the total allowable amounts.

Avoiding infections or illness around the time of conception may be a factor. Hypertensive disorders are mediated by inflammation. Unfortunately, another factor may be the maternal immune response to the fetal DNA. This may also be dependent on combined maternal/paternal immune system responses.

What can a woman do once she is pregnant?

Once a woman is pregnant, maintaining optimal health and fitness continue to be important. Even if there are pre-disposing factors for disorders, she may be able to reduce the severity by staying fit, well nourished and well rested. A balanced and colorful diet, along with avoidance of alcohol, drugs and unsafe behaviors are critical.

The ability to achieve the Relaxation Response, meditation, deep breathing and hypnosis are valuable for acute BP reduction. Each of these skills is mediated by the parasympathetic nervous system response (or alpha brain rhythm) and mitigates the effects of stress on a temporary basis. Cardiovascular or aerobic fitness is effective for long-term BP reduction, as well as cardiovascular health.

Resting on the left side maximizes circulation and – if possible – finding 15 or 20 minutes to rest this way during the day is beneficial, especially if a woman’s work involves standing for long periods of time. Avoiding lying on the back or standing for long periods of time is advisable. Finding a community of support for having a healthy pregnancy can be a great asset, as well.

DTP Guest Blog – Renee Crichlow: REAC Fitness

In Part 4 of our continuing series on DTP’s offspring, meet Renee Crichlow, ACSM Certified Personal Trainer from Barbados, whose REAC Fitness business includes Mum-me 2 B Fitness Series (prenatal), After Baby Fitness Series  (postnatal) and 6 week Jumpstart Body Transformation Program (general female population). 

Renee (left) leads her moms-to-be in a well-rounded program that includes some cool moves in her aerobic dancing section!

The adventures of one of her students is featured in a recent series of articles in Barbados Today.

DTP:  When did you begin working with DTP?

Renee: I started studying in March 2012 and I completed the practicum in May 2012.

DTP:  Describe the focus or mission of your work.

Renee: I am a women’s fitness specialist, targeting all stages of a woman’s life cycle from adolescent, child bearing years, prenatal, postnatal to menopause. I design various exercise programmes to help women get into shape. As a trainer, friend and coach, I am committed to guiding, motivating and educating women to exceed their fitness goals and to permanently adopt healthy lifestyles.

DTP: What do you most enjoy about your work?

Renee: The good feeling associated with knowing that I am helping women to positively change their lives through exercise.

DTP: What is the most important or interesting thing you have learned from working with moms, moms-to-be, or other women clients?

Renee: I have learned that we are connected and not separate from each other. Sharing our challenges and triumphs enable each of us to grow and have a sense of belonging like a sisterhood. The baby and pregnancy stories always amaze me and I learn a lot considering I don’t have children of my own.  I am also fascinated by the fact that as the pregnant mummies bellies grow, they are still moving with lots of energy and I feed off of that energy.  I just love working with pregnant ladies and mothers.

DTP: What are your future plans for your program?

Renee: Starting in May, I will be adding an informational workshop to cover various topics and an outdoor stroller class.

DTP: What is the feedback you have had about your program?

Renee: They really enjoy the class and interaction with each other. Please see the testimonials below:

Latoya Greaves, Patient of Dr. Thomas

I’m Latoya and I’ve been participating in the class for the past 4 months. It is very exciting, energizing and fun. During the work out, we participate in various stretches, breathing techniques, and even a little zumba session. I never thought exercising during pregnancy could be so much fun. The exercises are simple to do, so anyone who is pregnant and still wants to look well toned, loves to dance or just want to learn to what to expect during labour and what techniques can be used to help, this is the class for you. I can guarantee you, that after one workout with Renee, u will feel sexier than ever. Try it and you’ll see. I’ve already spoken to her regarding post-natal classes, that’s how excited I am.

Janalee Harris – Patient of Dr. Tracy Archer

Being part of the Mum-me 2 B Fitness Series is incredible! Whilst at the doctor, I was introduced to Renee and decided to join the program and never once regretted it. The exercises are wonderful, they help expecting mummies stay in shape, one thing I thought, was pregnant women had to take it easy and exercise very slow; that I realized was not true especially with the aerobics session.

We do various exercises: strengthening, breathing, relaxation, stretching, cardiovascular… when combined helps you stay in great shape. I feel healthy and overall better about myself and thank God for the opportunity to be able to exercise during pregnancy. I would encourage any woman who is pregnant to join the class, it’s a wonderful experience! A great program to follow when expecting and I am sure benefits will be achieved and goals will be reached in order to maintain a good weight throughout pregnancy

Toni Moore – Patient of  Dr. James Boyce

I joined the Mum-me 2 B class in my 20^th week of pregnancy. I have found them to be very useful; not only in preparing me mentally and physically for welcoming my baby into this world but also in informing me of safe exercises that I can do on my own. Renee is very professional and makes the time to check-in on her preggers outside of class times: diet, doctor’s visits etc. I would recommend it to anyone; I would further recommend that you commence the classes earlier.

Contact info: Renee Crichlow (246) 242-2850, info@reacfitness.com

DTP Guest Blog – Elyse Hoffman: Live Fully Fitness

Elyse Hoffman, CPCC, is an expert in Fitness Training Specialized for Pre/Post Natal and Women Over Fifty. Her company – based in San Fransisco – is Live Fully Fitness, geared toward helping women be fit at every stage of their lives. Elyse has certifications and continuing education credits from Dancing thru Pregnancy, Health and Fitness Institute, Coaching Training Institute, Moms on the Move, Resist-a-Ball, Mat Pilates, and Zumba.

E-mail: elyse@livefullyfitness.com

Website: www.livefullyfitness.com

DTP: Describe the mission or focus of your program.

Elyse: To me, being healthy and engaged in every aspect of your life, at every stage of your life is what it’s all about.  I believe that integrating physical fitness and a mind/body connection plays a vital role in overall wellness.

My mission is to use both aspects to help women shift adverse patterns that may be holding them back and affect lasting change.  This way my clients create new patterns both in their muscles and psyche.

DTP: What do you most enjoy about your work?

Elyse: I love when a client accomplishes something they didn’t think was possible.  Whether that breakthrough occurs in increased strength, shedding of excess pounds, or releasing emotional blocks, it gets me so excited! Their success is my success. I feel elated and honored to be part of their process.

I especially love working with pre- and post-natal women. Helping clients get strong during pregnancy and helping them get back into shape after giving birth is very rewarding to me.

Simply put, I LOVE what I do.  Working with my clients is a real gift.  I’m lucky enough to get daily reinforcement that what I do has a positive impact on my clients’ quality of life.

DTP: What is the most important thing you have learned from working with moms and moms-to-be?

Elyse: I’ve learned to really listen to each woman individually–every woman has a different experience with her body. The same exercise is not always correct for each woman.

I have learned that although it’s important to stay healthy and fit, it is just as important to relax and breathe. I tend to ask women when they come in, ”What will best serve you today?” Sometimes it is a powerful workout and sometimes a slower pace and lots of breath. Each is wonderful and powerful in its own way.

I have learned that it’s really about listening and hearing my clients’ needs in the moment.

DTP: What is your future outlook for your program?  

Elyse: I enjoy working with pre- and post-natal women and with women over the age of 50.  I see myself continuing to blend my expertise as a life coach and as a fitness specialist to guide women to live the lives they want to live.

DTP: Any comments from clients?

“Just 4 weeks after having my second child, Elyse helped me to begin rebuilding the (core) strength I needed to keep up with the demands of caring for both a newborn and an energetic toddler. A year and a half later she continues to challenge my strength and I am stronger than ever.”
– Valerie Saroyan

This is the third in a series of Dancing Thru Pregnancy offspring program guest blogs. Elyse has a long history with our program and is one of the best trainers we know; we love being able to send her clients!

Dancing Thru Pregnancy 33; Ann 66

September is a big month on my calendar. It signals my birthday (1946), the birth of DTP (1979), the incorporation of DTP®, Inc (1982), and the month I met my husband (1983). All of this would be cause for celebration if it weren’t also the start of the semester at Yale and the arrival of 150+ individuals whose names I really want to learn! Consequently, here we are in October and I am just getting around to my ruminations on the fact that this year DTP is half my age.

Another milestone has me thinking a lot about this fact. This is the year I can apply for my full social security benefits yet continue working. The beauty of this plan is that I can start to work less!! Not that I will for a while, but reality is setting in. I have spent a significant portion of the last half my life preparing women physically for birth and recovery, educating movement teachers to do so as well, and researching, writing and speaking about the impact of physical fitness on maternal and fetal outcomes.

This has me thinking about my professional offspring. What I want to celebrate here on this blog are the pre/postnatal health and fitness professionals whose lives have intersected with mine. Individuals who have taken off from the training they received under our auspices and moved out into women’s health fitness in meaningful ways. So, in weeks to come, we will be featuring DTP “offspring” – discussing their evolution and current work. We have already prepared several posts and would like to hear from any health care or fitness professionals who would like to be included in our series. The only requirement is that you successfully participated in our education program at some point since 1984 when we began training teachers.

On the personal level, I have reaped many benefits from interactions with the millions of women who take classes, thousands of educators we trained, faculty members, research associates, and interns with the program. You have all enriched my life immeasurably and I celebrate you all!

To start this series, I am posting this very recent photograph of myself [left] with our current intern, Shannon [right], and one of our newest babies, Jack. The photo – taken by Jack’s mom, Angelica – provides a glimpse into the happiness that this program brings into my life. There are so many benefits that a healthy, active pregnancy provides to the mother and baby. This photo makes manifest the joy in the lives of those of us who work with the pre/postnatal population.

It is likely that Shannon is the last of the young women that I will personally take under my wing. I am so grateful to all of our college interns who have spent time here. But, it’s time for me to move into the next phase of my life. More writing, less teaching and – definitely – more time spent in my neglected gardens.

In a couple of weeks I will travel to Singapore to present a session on relief of the deep external rotators of the ilio-femoral joint at the IADMS dance medicine conference. This is one of the subjects in which my work as a ballet dancer, and now teacher, and my work in pregnancy fitness intersect in a meaningful way. From both fields I have learned a great deal about alleviating the biomechanical stresses that afflict both dancers and moms-to-be.

It is a great honor to work with moms-to-be and new moms. Over the next few weeks this spot will feature some of DTP’s “offspring” and their work. What a reward for me! Thank you all.

Pregnancy Exercise and Home Birth

The web is abuzz with news of the rising rate of home births. Increasingly women are electing to stay home for three major reasons: perceived safety, a desire to avoid medical interventions, and a previous negative hospital experience. There is also a lot of discussion about the need for more trained midwives, qualified to attend home births in low risk situations, as well as more midwives to attend in-hospital births. Some physicians are even complaining that the current insurance and liability situation forces them to practice defensive medicine, executing procedures and recording them to maintain a legal paper trail rather than care for their patients.

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

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