The 51% Factor: Pregnancy, Power & Health

Recently I came across this posting and thought it worth posting again. On one hand I see signs of continuing progress, and on another hand it seems to me there are fundamentalist influences popping up everywhere (including among U.S. evangelists) that threaten women’s right to reproductive freedom and health. There is no end to the need to be vigilant.

In the U.S. and most of the developed world, approximately 51% of the population is female. Most females give birth at some point in their lives, although, in any year, only about 2% of the population gives birth.

No one living on earth got here any other way than gestation, so there ought to be some power attached to being part of that 51%. Historically, it might be said that the power has been merely for survival…the good breeders survived long enough to produce heirs and those who lived on knew where the roots and fruit grew.

Only women can make more people with their bodies.

Here are some things to consider:

  • Women make people
  • Women’s health and fitness before pregnancy affects whether the pregnancy is healthy
  • Women’s health and fitness during pregnancy affects her lifetime health and that of her offspring
  • Maternal survival is important to offspring well-being
  • Maternal health and fitness affects maternal adaptation and thereby offspring well-being

Thus, is it not a sanguine notion that the health and survival of women is critical to the health of everyone? After all, the health of nations is associated with this slight majority of females, and the wealth of nations is associated with its health.

The good news is that people working from this understanding are making some headway around the globe. Recently, the World Health Organization noted that maternal death among pregnant and birthing women world-wide has been dramatically reduced from the 1980’s to recently. This is very good news!

Here is the interesting footnote:  Maternal death in the U.S. has risen 42% in the same period. While the absolute numbers remain small, this is a disturbing picture. What could be causing this?

Time will tell if we can figure it out and fix it. I venture to suggest some directions for consideration:

  • The elevated cesarean birth rate with its sequellae of cardiovascular and immune system disorders
  • Obesity
  • Metabolic syndromes
  • Diabetes
  • Heart disease

Why am I hopeful, then? I see among our current educated generation of new moms and moms-to-be a willingness to exert their influence – as breeders – over the health care scene. They want less technological birth. They want support. They want more information. They want to be healthy. These are wonderful things. I salute these young women…they also make my job easier in the process.

In addition, I see among young health care practitioners an understanding of the value of these things. Among practitioners working in public health clinics there is a sense of desperation on the one hand that the poor and indigent have no capacity or will to take care of themselves. On the other hand, the first step is always education and there are a lot of people working on this issue.

Which brings me to the closing point:  How do we bring more resources and intelligence to helping women be healthy, prepare for pregnancy, have healthy babies, reduce pregnancy complications, and improve infant and maternal death rates? I, for one, will keep blogging on this issue. You, I hope, will vote for people who understand this issue. The political power and will is in our hands.

51% of us are women…some day 51% of us can set priorities

How to Get Pregnant – Coaching Topic #1

Hurrah! We have power at last…a week after hurricane Irene romped through, we have juice! Thanks for bearing with us while we camped out.

So let’s get on with the topic of How to Get Pregnant, starting with why do we need to know this?

In the past few decades, the average age for a first pregnancy in the U.S. has moved from the mid twenties into the mid thirties. In the same time period, the facts of conception – sperm enters egg released in mid cycle, then zygote implants in the uterus, along with how sex allows this to happen and how to prevent it – seems to have disappeared from middle and high school health classes. If that weren’t enough, as women have become more and more essential in the work force, the cost of having children as well as starting later, have driven down the birth rate. Similar conditions exist in most developed nations, although teen pregnancy rates are lower everywhere else.

The birthing population has bifurcated – we see older women (over 35) and teens as the major groups having children. On the one hand we have been working to reduce teen pregnancy while helping older and older women become first time moms. To a certain extent, they need the same information; its just that with teens we use this information to prevent pregnancy and with older women we use information to help them increase their odds of getting pregnant.

Understanding the menstrual cycle, ovulation, charting temperature – all the basic techniques of using the “natural” method of birth control – have become the first steps of the how-to-get-pregnant coaches. Beyond this, a number of sites have their own essential lists to help women be healthy and ready. Sites such as gettingpregnant.com, pregnancy.org/getting-pregnant, and storknet.com/cubbies/preconception/ provide additional information. Many suggestions – things to avoid eating, what proteins are needed for ovulation, how to reduce stress, what to do if there are sperm problems, how to find IVF clinics, donors and surrogates – are addressed.

How effective are these suggestions? Well, research tells us they are somewhat effective. None of the sites I contacted answered my query about how they measure or assess consumer outcomes when following their suggestions.

An interesting article in the NY Times 9/1/2011, entitled Are You as Fertile as You Look? openened with this sentence: “FORTY may be the new 30, but try telling that to your ovaries.” The reality is that being under 35 is still the best predictor of how difficult it may be for you to become pregnant. As the article makes clear, looking 30 and being 30 are not the same thing. Even healthy living does not prevent the loss of good eggs.

So, what conclusions can we draw? First, even if you come from a “fertile family,” it may behoove you to have your children in your late 20s or early 30s. Second, if you are putting off having children beyond that time, ask yourself what extremes you are willing to go to to have your own biological offspring. And, third, consider adoption. Frankly, it would be wonderful if adoption were easier, but in the drive to conceive at later and later ages we see the hand of biology and understand why adoption is not easy:  Our own offspring – our own DNA out there in the world – is a heady motivation.

If you are on the pathway of becoming pregnant, being under 35 is the best ally you have. If not, maybe some of the suggestions on the web will work for you. Whatever you decide, all the best.

One parting comment:  Regular moderate exercise – while it helps you stay young and healthy – will not prevent your eggs from being popped out every month. It will help you have a healthy pregnancy if you conceive, so stay with it!

Hip Hop Pregnancy!

We recently received this query from hip hop dance teacher Aysha Cheatham Bowling on the DTP facebook page and we thought it was so important that it deserved a blog entry.

Question:  I am a hip hop dance teacher and this is my first pregnancy. I am 6 months going on 7 months (due in Nov.). I have been experiencing a lot of Braxton Hicks with pain along with fibroid pain. I realize Braxton Hicks are very common in pregnancy, however the pain I experience at times can be debilitating. I have been dancing throughout my pregnancy so far, but had to cut back due to the pain. My class season is starting back up this month and I am getting worried about my ability to teach. What are some suggestions for teaching while pregnant? Any tips on warm up and movement modifications? Also, how does maternity leave work in the dance world? I am trying to figure out exactly how much time to take off. Everything is so unpredictable..lol. I am more familiar with what is common in the corporate world than dance.

Answers

1) Braxton-Hicks & fibroid pain – Braxton Hicks, or practicecontractions, are common from mid-pregnancy forward. The extent to which women are aware of them and how much discomfort they produce depends on several things – some genetic, some situational. One factor is fibroids. If your pain is so extreme that it limits activities of daily living (ADL), then you need to confer with your care provider to determine if there is something that can be done to alleviate the pain and/or whether you need to restrict ADL. If it is limiting your dance movement, you need to back off and find a way to tell or indicate to your students what you want them to do.

If the practice contractions are occurring more than 4 times an hour regularly while you are dancing and/or doing ADL, you need to confer with your care provider. When this happens, empty your bladder and drink 3 or 4 cups of water, lie on your left side and rest. If the contractions do not subside, call your care provider right away. NOTE: a full bladder can irritate the uterus causing disordered but uncomfortable contractions, so void your bladder at regular intervals.

2) Tips for teaching during pregnancy – By mid-pregnancy your alignment is shifting enough that all of your normal movement patterns are becoming inefficient. In addition to this changing alignment, your joints are at risk for damage due to hormonal changes in connective tissue, which normally helps maintain joint integrity. The bone facets that articulate together shift their relationship and nerves and blood vessels can be impinged. Therefore, making your movements smaller and less percussive are good strategies for preventing injury.

Check the pregnancy exercise tips on our website to find exercises especially designed for pregnancy. You may find some of these are useful warm-ups. Also, do side-lying relaxation every day for 10 to 20 minutes. Check the page on nutrition for childbearing, too, as nutrition plays a major role in keeping up your resources and energy.

3) How much time off will I need? – Yes, you are definitely entering the world of the unpredictable! Surely people have told you that your life will never be the same…in a good way! Well, it is true and one of the things that will be different is that priorities change and it is not always possible to predict how long things will take. Since you are fit and active and are remaining so during your pregnancy, your recovery time will be fairly quick. However, other factors will affect how long it takes you to get back into the studio. The course of your labor and birth, as well as the adjustments you and your baby and partner need to make in the immediate postpartum period, will influence when you are ready to start dancing.

With professional dancers and athletes, it has been my experience that if the birth is vaginal, within a week new moms are working on their core strength and endurance and within a month are able to do an easy class for themselves. By two months, many are back at work, rehearsing and sometimes performing. Of course, breastfeeding – which is very important for both mom and baby – may affect how long you can work at any one time. If the birth is surgical (cesarean), it may take a week or two longer to get to each milestone.

Follow up thoughts – This is an exciting and meaningful time in your life. You will not believe how amazing you will feel when you first see your baby. Be fully present and relish in the moment. Be careful now; it’s better to take precautions and make sure you and your soon-to-be-newborn are safe. When we train DTP teachers the first priority we teach is safety!

I hope this is helpful and that you will keep me posted on your progress.

– Ann Cowlin, DTP director

The 51% Factor: Pregnancy, Power & Health

In the U.S. and most of the developed world, approximately 51% of the population is female. Most females give birth at some point in their lives, although, in any year, only about 2% of the population gives birth.

No one living on earth got here any other way than gestation, so there ought to be some power attached to being part of that 51%. Historically, it might be said that the power has been merely for survival…the good breeders survived long enough to produce heirs and those who lived on knew where the roots and fruit grew.

Only women can make more people with their bodies.

Here are some things to consider:

  • Women make people
  • Women’s health and fitness before pregnancy affects whether the pregnancy is healthy
  • Women’s health and fitness during pregnancy affects her lifetime health and that of her offspring
  • Maternal survival is important to offspring well-being
  • Maternal health and fitness affects maternal adaptation and thereby offspring well-being

Thus, is it not a sanguine notion that the health and survival of women is critical to the health of everyone? After all, the health of nations is associated with this slight majority of females, and the wealth of nations is associated with its health.

The good news is that people working from this understanding are making some headway around the globe. Recently, the World Health Organization noted that maternal death among pregnant and birthing women world-wide has been dramatically reduced from the 1980’s to recently. This is very good news!

Here is the interesting footnote:  Maternal death in the U.S. has risen 42% in the same period. While the absolute numbers remain small, this is a disturbing picture. What could be causing this?

Time will tell if we can figure it out and fix it. I venture to suggest some directions for consideration:

  • The elevated cesarean birth rate with its sequellae of cardiovascular and immune system disorders
  • Obesity
  • Metabolic syndromes
  • Diabetes
  • Heart disease

Why am I hopeful, then? I see among our current educated generation of new moms and moms-to-be a willingness to exert their influence – as breeders – over the health care scene. They want less technological birth. They want support. They want more information. They want to be healthy. These are wonderful things. I salute these young women…they also make my job easier in the process.

In addition, I see among young health care practitioners an understanding of the value of these things. Among practitioners working in public health clinics there is a sense of desperation on the one hand that the poor and indigent have no capacity or will to take care of themselves. On the other hand, the first step is always education and there are a lot of people working on this issue.

Which brings me to the closing point:  How do we bring more resources and intelligence to helping women be healthy, prepare for pregnancy, have healthy babies, reduce pregnancy complications, and improve infant and maternal death rates? I, for one, will keep blogging on this issue. You, I hope, will vote for people who understand this issue. The political power and will is in our hands.

51% of us are women…some day 51% of us can set priorities

Childhood Obesity Prevention Strategy: Pregnancy Fitness

Stopping The Epidemic

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

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

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

Why Is Pregnancy Fitness Important?

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

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

How Do We Get There From Here?

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

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

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

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

Rant: Health Care Reform/Pregnancy

Since Health Care Reform is a hot topic, let’s look at it from the perspective of pregnancy and birth.

What revisions would most benefit pregnant women, their offspring, families and communities?

1. Reward healthy behaviors. A system that provides reduced premiums for health care for women who exercise, eat well, do not smoke and are in a normal weight range is evidence-based.

Yes! We could provide financial incentives for being healthy during pregnancy. Why? Healthy moms have healthy babies; healthy babies cost the payer less money.

2. Review best practices. Is a 40 or 50% cesarean rate the best practice?  Accompanying the rise in cesarean births is growing information that babies born by cesarean are at increased risk for a number of immune disorders. But the business model of medicine rewards cesarean because it both pays the provider more and is defensive medical practice.

Fetal monitoring to determine if a cesarean may be necessary, is wrong 3/4 of the time. In an effort to change this, guidelines are changing for the use of monitors during labor. What is the evidence that this change of practice is beneficial? Will it lead to more or less monitoring, which may itself be an intervention that can disrupt normal labor?

3. Change the business model for health care. When we make financial incentives for care providers, base them on best practice, not on enriching the middle man. Currently the payers (insurance companies) are middle men, making money (i.e., conducting business) by charging fees. They ration payments for services in order to pay their own salaries and overhead. They do not actually do anything productive. This is why single payer, government, and health care coop options have been proposed. They eliminate most of the cumbersome middle layer.

Why does insurance pay for cesareans? Well, they will do it once. After all, the care providers have to practice defensive medicine. But, once you have a cesarean, you become a risk for the insurance company (they know what the research says about cesareans and offspring health problems) and may be denied insurance. They can no longer afford you.

Because care providers are paid fee for service and must practice defensive medicine, pregnancy and birth have become increasingly burdened with intervening procedures that do not necessarily promote a healthy pregnancy or birth process. How is this playing out? Increasingly, we see women giving birth in what they perceive as a more supportive and health-inducing setting:  their own homes. Think of it this way:  many women now believe that it is safer to stay home than go to a hospital to give birth.

Unless health care becomes about best practices and healthy outcomes – not price, size, and getting paid for passing money back and forth – the U.S. will continue to have some of the worst maternal/infant outcomes in the developed world.

Pregnancy Pathway…Important Notes from Wonderrobyn

The following are notes from co-author Robyn Brancato, CNM (certified nurse midwife) who practices in New York City, or, as she is know here: Wonderrobyn! You can read about both authors in the About tab above. Here they are on the beach in San Diego, when they gave a talk at conference there a couple years ago. Robyn on the left, Ann on the right.

Robyn and Ann, Pathway authors

Robyn and Ann, Pathway authors

1. Addition to Small Rant: “Resist the temptation to watch A Baby Story on TLC! It does not portray birth accurately, as they condense 15 hours of labor into 30 minutes and play up the drama so that you will be on the edge of your seat! In the majority of women, birth is not that dangerous.”

2. Regarding: When does conception occur? “This is a really interesting post… I love the discussion about at what point conception occurs! Personally, I like the Biblical notion of quickening. Even though this varies from woman to woman and can range anywhere from 16 to 22 weeks gestation, it seems like the most natural theory.”

Dear Reader:  What do YOU think? Did you read the conception post on March 23, ’09?

3. About sperm & preeclampsia. “Is the connection between barrier methods and preeclampsia actually established? I have read studies stating the contrary – that barrier methods have no effect on preeclampsia rates.”

HURRAY! THIS REQUIRES FURTHER CONSIDERATION.

More information: The immune maladaptation theory suggests that tolerance to paternal antigens, resulting from prolonged exposure to sperm, protects against the development of preeclampsia. Thus, barrier methods and being young may predispose women to this major disorder of pregnancy.

Evidence exists on both sides of this theory. Here are two recent studies (one of each) that readers may find helpful in understanding this idea. Keep in mind that other factors than just sperm exposure may be affecting research findings. But, it does seem that under some conditions, barrier methods and amount of exposure to sperm can affect the pregnancy itself.

Ness RB,  Markovic N, Harger G, Day R. Barrier methods, length of preconception intercourse and preeclampsia, Journal: Hypertension in Pregnancy 23(3):227-235. 2005.  Results did not support the immune maladaption theory.

Yousefi Z, Jafarnezhad F, Nasrollai S, Esmaeeli H. Assessment of correlation between unprotected coitus and preeclampsia, Journal of Research in Medical Sciences 11(6):370-374. 2006. In a matched controls study, women with <4 months cohabitation or who used barrier methods had higher risks of developing preeclampsia than those with >4 months cohabitation. Oral contraception users had a lower preeclampsia rate than those who used no oral contraception.

In a commentary article in OB/GYN News ,  July 1, 2002, the following note was made by Dr. Jon Einarsson: With insufficient exposure, pregnancy may induce an immune response and preeclampsia in some women with predisposing factors such as an endothelium that already is sensitive to injury due to age, insulin resistance, or preexisting hypertension.

Is there a plain and simple truth about sperm exposure and pregnancy risks? Alas, no. But, know your circumstances. If you are young, protect yourself. Wear a condom. When you are ready to be a mom, you will be ready to figure out your risks. So, this, too follows the axiom:

Events in life are rarely plain and never simple.