In Labor? Eat for Endurance!!

For 30 years I have been reminding my pregnancy exercise and childbirth education classes – not to mention anesthesiologists – that the uterus is a bag of muscle, and that muscles need two things to function well: oxygen and sugar. To contract, muscles burn sugar in the presence of oxygen. Oxygen is renewed by regular, paced breathing. Sugar, on the other hand, has to be supplied first by glycogen at the muscle site, then by circulating blood glucose, optimally provided every few hours by food.

The amount of glycogen that rests at the muscle site in case the muscles need it for quick action lasts about 20 minutes at most. After that, during physical activity, the body will begin to break down fat to provide blood glucose. But. that also has time limits and acid begins to accumulate. Ultimately, nutrition of some kind is the only way that any ultra endurance activity ensures that adequate sugar is continuously supplied to the muscle. Without adequate energy, muscles do not work well.  Without nutrition, acid builds up.

For many decades, there has been a ban on food and water during labor once a laboring mom is in the hospital due to the risk of aspiration – inhaling food or water into the lungs. At last, anesthesiologists have looked at the risk of aspiration in labor and discovered that there has been only one case recorded between 2006 and 2013 associated with labor and birth. Logical conclusion: withholding food and water during the endurance event known as labor is not a great idea. Kudos to the researchers at Memorial University, St. John’s, Newfoundland, Canada, who suggest a change in practice. Yes, there are factors that might over-ride this conclusion, including obesity and preeclampsia, but for most healthy women, eating lightly in labor is a good thing.

Read the American Society of Anesthesiologists press release on this topic here: https://www.asahq.org/about-asa/newsroom/news-releases/2015/10/eating-a-light-meal-during-labor

 

Advertisements

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

Moving relieves stress.

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!!

      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!

    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.

      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.

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

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.

Beyond Yoga

Beyond Yoga

I love Yoga. But…Power Yoga, Hot Yoga, Fast Yoga, Pilates-Yoga, Fresh Yoga, Baby Yoga and even Prenatal Yoga…not so much. I find these phenomena strange.

Why? Well, 40 years ago – when I first learned Yoga – it was a privilege. A person came to Yoga in the search for a meaningful life path. It was a blend of the spiritual and the physical, and it required a commitment to what was revealed within the practice. Before being allowed to take my first class, I had to demonstrate that I already practiced meditation. It was not exercise per se.

It was not adaptable like it is today. Depending on the teacher, you learned an ancient system – Hatha, Vinyasa, Ashtanga, Iyengar, or Kundalini. Those were the major methods that have Hindu roots, and those who practiced these art forms knew what they were doing. The teachers themselves had worked on their craft for decades. Today, I know only a few teachers who have a profound grasp of each of these methods.

Why is Yoga so popular?

Is there something within the work itself – even in the diluted forms, hybrid versions and the celebrity/competitive studios – that allows it to thrive in the self-centered, free-wheeling, branding-crazy marketplace of the early 21st century developed world?

I find the answer to this in a strange place:  Zen practice, Bhuddism. One of my favorite notions is from Suzuki’s text Zen Mind, Beginner’s Mind. “When you feel disagreeable, it is best to sit.” This is an element of nin – constancy – or being present in the moment. Not patience, which requires a rejection of impatience and therefore cannot accept the present as it is. When you sit – just sit period, that’s it – all that is real is the moment. This is at the heart of all spiritual experience.

I’m not an expert in Yoga. I don’t teach Yoga, although I have integrated Yoga-based skills into my work. I have practiced Hatha and Vinyasa over the years enough to learn how certain skills are treated…belly breathing, slow deep breathing, maintaining position and listening to the wisdom of the body, and isometric strengthening in preparation for more expansive shapes or motions. Long ago, I integrated these skills from my Yoga experience into my teaching style because these skills are effective for the populations with which I work. But, I do not teach Yoga.

Can Research Help Us?

Researchers find Yoga a nightmare. There is so much variance now in the practice that findings from any one study cannot be transferred to the general population. One of the most revealing experimental-design studies found that none of the claims of Yoga improving metabolism could be demonstrated. When asked why they thought this outcome had occurred, the teachers who were used in the study said they thought the participants in the study were not fit enough to do Yoga!

One of the most successful Yoga teachers in my area, and one of my favorites, has for decades used a bicycle for her primary mode of transportation. She credits her longevity and success to Yoga. I attribute it to bicycling. Dr. Cooper is right…fitness (which means aerobic fitness) is the biggest bang for the buck. Unless you are fit, it is hard to execute some of the more subtle demands of many exercise regimens.

Some Yoga teachers will say that you can make Yoga aerobic or that some forms are aerobic. OK, then it’s aerobics, not Yoga. Whenever I see “aerobic Yoga” it reminds me of aerobic dancing. It’s helpful to remember that Yoga developed in a time and place where survival was dependent upon fitness. People didn’t need to do more aerobics to find enlightenment. They needed reflection and to be present in the moment.

So, I insist on aerobic fitness as the first goal of a fitness regimen. In the pre/postnatal field, this is the only consistently demonstrated factor in improved outcomes. As a birth preparation there are Yoga-based factors that will help in labor and birth IF THE WOMAN IS FIT ENOUGH. It is the fact that some Yoga-based skills help fit people find nin that is my justification for continuing to use them in conjunction with aerobics and special pre/postnatal preparation and recovery exercises.

But, there are cautions. Not all Yoga assanas (positions) are safe for pregnancy. Down-dog, in particular, scares me because of incidents reported in obstetrical literature in the 1980s and 1990s that indicate such a position is implicated in fatal embolisms. Some shapes are just not doable and others become less comfortable over time. The ones that work have been identified since the 1940s and 1950s and integrated into birth preparation courses.

What’s Next?

All exercise components –

  • Mind/Body
  • Strength
  • Flexibility
  • Aerobic or Cardiovascular Fitness

– are necessary for a balanced fitness routine. Too much emphasis on any one factor often results in injury. Aerobics is where the greatest health benefits reside. Recent research has demonstrated that it is physical “fitness” (which we can measure) as opposed to just spending time in physical activity (which can be a wide range of intensities) that is responsible for improved health outcomes. Strength and flexibility training need to be purposive. There are things we don’t need to do unless we are going to play pro football or dance Swan Lake! Mind/Body skills help us recover and prepare.

I for one will be glad when we get beyond yoga and back to cross training!

Pregnancy Pathway, Birth

There is no birth of consciousness without pain.

Birth is a process with two major components

Birth is a life process with two major components

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

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

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

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

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

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

Pregnancy Pathway, Pregnancy – Behavior: Avoiding Risks

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

Risk Factor #1:

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

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

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

Risk Factor #2:

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

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

Risk Factor #3:

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

Smog can endanger your fetus!

Smog can endanger your fetus!

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

Risk Factor #4:

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

Read labels!

Read labels!

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

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

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

Risk Factor #5:

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

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

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


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

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


Caffeine? Only one cup & only if you must.

Caffeine? Only one cup & only if you must.

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

Risk Factor #6:

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

Risk Factor #7:

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

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

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

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

What’s next?  BIRTH!!

Pregnancy Pathway, Pregnancy – Behavior, part 1: Exercise continued!

MORE?!! You didn’t think that was it? Only a few comments on evidence as to WHY moving around, burning calories, being strong and learning to relax while pregnant is beneficial? No, of course not. You know there is more to it, like WHAT movement is safe and effective during pregnancy?

So, what is safe? Well, first, unless you have a very few conditions that your health care provider considers unsafe, every woman – fit, currently sedentary, young or a little older – can exercise safely in pregnancy. How much of what kind depends on your fitness level and exercise history. Get medical screening first.

If you are fit, you can do vigorous exercise

If you are fit, you can do vigorous exercise

If you are fit, you just need to learn how to modify some movements to accommodate your biomechanics. As your body changes, stress on the joints and tissues means a little less jumping or ballistic motion will be more comfortable and safer. If you are fit, you can continue with vigorous exercise and it will be of benefit to you and your baby.

If you are not so fit or are sedentary, find a certified pre/postnatal instructor and join a group where you will have fun, get some guidance and be monitored for safety. How do you find such a person? Try our Find A Class or Trainer page.

What is effective? Don’t spend your time on things that may be nice to do but don’t help you focus and prepare for birth, relieve discomforts or have the stamina for birth and parenting. There is substantial scientific evidence and information from large surveys that these things are helpful.

Cardiovascular or aerobic activity is the most important activity you can do. Already fit? Keep working out; join a class if you want support or new friends. If you are sedentary or somewhat active, you can improve your fitness by doing at least 20 – 30 minutes of aerobic activity 3 times a week. Work at a moderate pace – somewhat hard to hard – so that you can talk, but not sing an aria! If you are more than 26 weeks and have not been doing cardio, you can walk at a comfortable pace. Aerobics is key because it gives you endurance to tolerate labor and promotes recovery.

Strength and flexibility exercises that do not hurt and are done correctly are also safe. There are some special pregnancy exercises that actually help you prepare for birth. Essential exercises that aid your comfort, alignment and birth preparation include:

Kegels (squeezing and relaxing pelvic floor muscles) – squeezing strengthens them and thus supports the contents of the abdomen, and learning to release these muscles is necessary for pushing and birth.

Abdominal hiss/compress and C-Curve® – contracting the transverse abdominal muscles reduces low back discomfort and strengthens the muscle used to push and later to recover abdominal integrity after birth.

Squatting

Squatting

Squatting – getting into this position strengthens the entire leg in a deeply flexed position; start seated and use arms for support, stability and safety. Leg strength improves mobility and comfort in pregnancy and postpartum; plus, deep flexion is a component of pushing in almost all positions.

Strengthening for biomechanical safety – strengthening some parts of the body helps prevent injury to bone surfaces, nerves and blood vessels within joints re-aligned in pregnancy. This can be done using resistance repetitions (weights, bands, calisthentics or pilates) or isometrics (yoga or ballet). A responsible class will focus on upper back (rowing), push-ups, abdominals, gluteals, hamstrings, and muscles of the lower leg.

Stretching of areas that tend to get tight – relieving some discomforts through flexibility helps you maintain a full range of motion. Static stretches, used in combination with strength exercises or following aerobics, is most effective. Stretching prior to exercise tends to produce more injuries than not stretching. Areas needing stretching include the chest, low back, hamstrings and hip flexors (psoas).

Mind/Body skills are very important. There are two activities that exercisers constantly tell us are a big help in pregnancy, birth and parenting.

• Centering employs a balanced or neutral posture, deep breathing and mindfulness to help you work in a relaxed way. Athletes and dancers call this “the zone.” Starting your workout in association with your body establishes economy of motion, something very useful in birth and parenting, and reduces risk of injury.

• Relaxation is another key activity; it relieves stress, promotes labor in the early stages and helps you enter the zone!

Remember: Birth is a Motor Skill™