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.Molly and Miri 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.

DTP at YH 12:13Achieving 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 Elongemany 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.

Centering 2:08Align

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 wdancing_overview from backonder 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.

DTP_mover1_pregnantThe 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.

Healthy Moms Having Healthy Babies – the Challenge in 2011

Welcome to 2011! We want to take this opportunity to say, once again, that our main goal here is to provide credible, evidence-based information on how to prepare for a healthy pregnancy and birth, recover quickly and begin your mothering experience in good health. Why? Because that is what you can do to help get your baby off to a healthy start in life.

Helping women be healthy during the childbearing period is our primary goal. Not everything is within your control, especially genetic factors. But your baby’s life is determined – in part – by your behavior before pregnancy, during pregnancy, during birth and in the early mothering stages. More and more, we are coming to understand that the environment within the uterus is largely affected by the mother’s behavior (exercise, nutrition, stress, breastfeeding and avoidance of risky behaviors such as smoking) and environmental exposures (toxins in chemicals, the air we breathe and food products).

We are recommitting to making up-to-date and well-documented information available through this blog. Now and then you will get a rant, but for the most part, we want to help people have terrific experiences during the childbearing period. Of course, since we are part of Dancing Thru Pregnancy and its Total Pregnancy Fitness and Mom-Baby Fitness programs, you will hear a lot about being fit before, during and after pregnancy BECAUSE fitness has more benefits for mom and baby than any other single factor!

Here are some of the well-documented findings about being fit during the childbearing period:

  • assists in healthy implantation and improves placental function
  • reduces the risk or severity of gestational diabetes
  • reduces the risk of preeclampsia
  • reduces the risk of prematurity and low birth weight
  • reduces the risk for childhood obesity
  • may reduce the risk of surgical (cesarean) birth
  • improves long term maternal heart health
  • reduces the risk of postpartum depression
  • increases the likelihood that a woman will be fit in mid life

You can find references for these findings on this blog, on our website (dancingthrupregnancy.com) or through the American College of Sports Medicine and other organizations listed in our blogroll.

Our secondary goal is adding to the effort to assure Safe Motherhood around the globe. We do this, in part, by supporting the White Ribbon Alliance for Safe Motherhood and helping sponsor projects that improve mother’s lives locally. We are also committed to spreading the word that improving the lives of women and children involves a reality change…namely that helping women plan their families, have healthy pregnancies and give birth in safety are more important human goals than wars and violence.

Please join us this year in this important endeavor.

Thank you.

Ann Cowlin, founder/director, DancingThruPregnancy.com, twitter@anncowlin

Preventing Prematurity

Today is a day for bloggers to raise awareness of the growing rate of prematurity in the U.S.  As a pre/postnatal fitness specialist who has been working in the field for more than 30 years, I have a number of thoughts on this topic.

I like to start thinking about this problem by thinking back 50,000 years. Back in the day when survival meant hard physical work. 

Which pregnant women survived?  The strongest, fittest and best fed.

Does it make sense, therefore, that becoming sedentary and eating junk food is going to produce healthy offspring at full term? Well, the evidence says no. This behavior is responsible for some of the growing prematurity. Women who are aerobically fit, eat a healthy diet and maintain a healthy weight generally enjoy these benefits over those who do not:

  • a healthier endometrium into which the zygote will implant
  • a healthier placenta with more nutrient delivery surface
  • reduced risk that the necessary immune system modulations of pregnancy go awry
  • better control of metabolic and cardiovascular factors that can threaten pregnancy, such as gestational diabetes or preeclampsia
  • a greater ability to physically cope with some environmental toxins

There are – of course – factors that affect prematurity in any case. But, to a certain degree, the growing rate of prematurity is another example of lifestyle-caused disorders. Some of the fix therefore requires a lifestyle that is active and health-conscious.

But, I am hopeful. I see – for the first time in a couple of decades – growing numbers of young women interested in living a healthy lifestyle…exercising, eating healthy and seeking to improve environmental conditions. I also see young women interested in preventing poor living conditions and infection rates in this country and in the developing world that have hindered progress in preventing disorders such as gestational diabetes and preeclampsia.

To these young women I say:  kudos. Keep working. We have much work to do.

To young women contemplating pregnancy in their future I say:  become aerobically fit, eat a balanced and colorful diet, spend 15 minutes in the sun most days (or, if you are at risk for skin cancer, take vitamin D), practice meditation or a simple progressive relaxation with deep breathing for 10 or 15 minutes most days.

To all the moms whose babies came too soon, my heart is with you. I know this pain.

Twins & Triplets – Exercise & Nutrition Tips

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

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

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

Nutrition for Multiples:

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

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

Exercise with Multiples:

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

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

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

Protecting Mom and Baby:

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

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

Pregnancy Pathway, Pregnancy – Maternal Immunological Response

Today: Maternal Immunological Response…or…the Mother/Fetus Dance!

Maternal Immune Response During Pregnancy

Maternal Immune Response During Pregnancy

Back to work! Thank you for your forebearance while we wrote a chapter for a nursing textbook!

During the course of pregnancy, the mother/fetus dance is ongoing. The maternal immune system and the trophoblast cells continue to influence each other even beyond the implantation.

Because the mother’s immune response modulates near the start of each trimester, the fetus is affected to some degree and mounts a response, as well. For a long time it was thought that maternal and fetal DNA material was not exchanged across the placental membrane, however recent findings indicate that there is some exchange of material. Thus, we all carry some portion of our mother’s DNA and our mother carries some of ours.

What is the impact of this chimeric effect? It depends on how well our DNA gets along!

How does this affect the fetus in utero? The fetus may be affected by clotting issues. Depending on maternal health status s/he may be subject to a stronger or weaker immune system.

How does this affect the mother? Women are more likely than men to develop autoimmune disorders (pregnancy playing a role here), and those who bear male offspring are more likely than those who only have girls to have these disorders.

The maternal/fetal dance goes on….

Be Prepared for Birth!

Be Prepared for Birth!