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

 

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.

Ebony 8DTP: 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.

Ebony 9Ebony 4After 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. Ebony 6

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.

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.

Pregnany & Parenting Coaching

Looking through incoming emails, tweets, fb notifications and e-newsletters that inhabit my inbox more and more, I noticed something interesting:  Lifestyle Coaches for people entering the pregnancy and parenting pathway. After some investigation, I found a plethora (many, many) web business/sites that offer services on everything from getting pregnant to getting your kid into college.

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

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

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

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

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

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

Pregnancy Pathway, Outcome – Mom & Baby Health Status

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

So, the big question is: How can we predict the health outcome of mom and baby, given all the variables of preconception, conception, pregnancy, labor and birth?

Well, there are some things for which we can predict or estimate risk/benefit ratios, and there are some for which we cannot. Let’s start by going over the major things that are not very predictable. At the moment, genetics is pretty much unpredictable. Down the road…maybe…but for now, not so much. Some IVF labs claim they can slightly slightly increase the odds for one sex or the other.

Post-conception, chorionic villi sampling and amniocentesis are methods by which the genetic make-up of the fetus can be identified. These are done mainly to give parents a choice about continuing a pregnancy if there is a question about genetically transmitted disorders or conditions, such as Down Syndrome. But, for now, the best way to manipulate the genetic odds of health outcome for your offspring is to mate with someone who is healthy and has health-prone genes!

Once you are pregnant, it is clear that prenatal health care, exercise, healthy nutrition, stress management and adequate sleep play significant roles in increasing the potential for a healthy outcome for mother AND baby. In fact, not only short term, but also long term healthy outcomes are linked to these factors. These are factors within our control.

Risk factors – most of which are within in our control – that can adversely affect outcomes include environmental toxins, risky behaviors (unsafe sex, drinking, smoking or drugs), poor nutrition, sedentary behavior, stress and isolation (lack of social support). These risks, as well as the benefits, are all discussed in the previous posts.

At this point, it is important to note that there is a lot that goes into making a healthy pregnancy, birth and outcome that is within the control of the mother, providing she has family and/or social support to take good care of herself.

The labor process and birth mode can also affect health outcome, but in general the effect is short-lived. For moms who have received regular care and are in excellent health, the occurrence of a truly devastating birth outcome for mother and/or baby is extremely rare. The exception may be mental or emotional turmoil that can accompany a difficult, unexpected and uncomfortable situation, such as an unplanned cesarean birth.

 

Group exercise programs are a source of social support.

Three interesting research outcomes point to the importance of exercise groups. One is that exercise can help prevent some disorders of pregnancy, such as preeclampsia or gestational diabetes. Second is that the health benefits of exercising during pregnancy and the postpartum period are beneficial for both short and long term for mother and infant. Disorders of pregnancy are risk factors for future cardiovascular disease and metabolic disorders. Third is that exercise is most likely to occur when there is good social support.

Moving together is a “muscle bonding” experience that helps bind moms-to-be and new moms into a community of support. Within the group, moms can get help with tips for healthy eating and living, along with the support of others who know what she is experiencing. There are a lot of ways to get adequate exercise. When you are pregnant or a new mom, an exercise group can be one critical path to health and well-being.

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?

Postpartum Exercise: Creating Your 3rd Body

Recently, while talking with some moms in our postpartum exercise class, DTP’s Mom-Baby Fitness™ program, I realized it has been a while since I have addressed the notion of what we call “the 3rd body.” This stems from the idea that before you are pregnant, you live in your 1st body; then, while pregnant, you live in your 2nd body. After giving birth, many women feel their options are to try to get their first body back or live in what they are left with after birth. We suggest another way:  create your 3rd body.

We discovered this 3rd body in working with women to gain the fitness necessary to have a healthy recovery and enjoy motherhood. What we found was that women were often becoming more fit than they had been before pregnancy, with less body fat and more muscle, yet their clothes did not fit the same.  Sometimes the flaring of the ribs and/or hip bones made for a larger waist – despite less fat!

Many clients also feel a new, deeper sense of their core developed. In fact, over time they realized they actually liked this body better in some ways! After all, they came into the world with the pre-pregnancy body, but this body they actually created out of the profound experience of the physical self that pregnancy and birth provide. It extended the empowerment of birth into motherhood.

Extending this metaphor even further, of course, leads to the 4th and 5th bodies, if you have another child. Eventually, there are more bodies as women go through perimenopause, menopause, post menopause, and what I like to call the phenomenal wisdom stage. Each body represents a new opportunity to become someone strong and profound.

I figure I am to body #8 now, and in each stage I have found something incredible that I could not have at other stages. Long ago I gave up looking for my past bodies. Each one has been brilliant in some way, but in the end it had to be left behind if I was to enjoy life’s path to the fullest.

Living in the moment does require knowing where you are in time, space and energy. So, discard your past bodies with delight and move on. Use your energy to create yourself in the present.

It’s a process and you won’t fully live in your next body until you own the toll of the last one. A postpartum mom may experience hair loss, bigger feet, a mal-aligned spine, constant thirst if she is breastfeeding, exhaustion and a jelly belly. But, all these things will pass with time, if you eat right and exercise regularly. Oh, and you can bring the baby, who will have a blast meeting other babies!!