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

 

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CleanBirth – Saving Lives for $5

As part of our mission to contribute to safe motherhood around the globe, DTP is promoting the work of CleanBirth.org. This organization works to make birth safer in southern Laos, which has the highest rates of infant and maternal mortality in the region[1]. CB1 Mum baby red hat The vast majority of women give birth without a trained attendant or clean supplies, but CleanBirth.org is making a difference, improving outcomes through simple initiatives that provide life-saving birthing supplies and information.

To promote hygienic birth, CleanBirth.org partners with a Lao non-profit, Our Village Association (OVA) to train local nurses to distribute Clean Birth Kits – the life saving birth supplies that cost a mere $5 each. The nurses then train a volunteer from each village to distribute and track the kits and spread information about safe birthing practices.

CB2 KitClean Birth Kits have been shown to prevent infection – a major birth-related killer – and village health volunteers have been shown to reduce neonatal and maternal deaths[2-5]. Along with providing these kits, CleanBirth.org is involved with the education for nurses and Village volunteers. Because they are part of the local culture, they are respected and can provide the kits, explain how to use them and give information on how to be safe during pregnancy and birth.

More kits and more training are needed. A nurse in the Tahoy District trained a local midwife who noted that using the kit is convenient and easy and keeps the mother and baby clean. CB3 Tahoy volunteer

During 2013, CleanBirth.org supplied 2,000 birth kits and trained 16 local nurses and 20 Village volunteers. To keep up this momentum, CleanBirth.org has formed an alliance with the Yale University School of Nursing to improve the training. Right now, you can help! CleanBirth.org is currently fundraising via startsomegood.com/cleanbirth to fund training for 15 nurses and 20 volunteers by Yale midwives during July 2014, as well as providing 500 Clean Birth Kits.

If you can, please donate to this mission:

  • $5 provides a life-saving Clean Birth Kit
  • $100 trains a Village volunteer
  • $250 sponsors a nurse who serves as many as 1o villages

Think of this as your Valentine present to the world. Safe Motherhood is a major global movement, and organizations such as CleanBirth.org are the on-the-ground work force that is bringing about improvements in maternal and newborn survival.

Thank you!!

1. “At a glance: Lao People’s Democratic Republic.” Accessed 29July 2013. http://unicef.org/infobycountry/laopdr_statistics.html

2. Brierly, C. “Clean delivery kits linked to substantial reduction in neonatal death is South Asia, study shows,” Wellcome Trust (2012). Accessed 8 August 2013. http://wellcome.ac.uk/News/Media-office/Press-releases/2012/WTVM054518.htm

3. “Clean Birth Kits – Potential to Deliver.” Accessed 8 August 2013. http://healthynewbornnetwork.org/sites/default/files/resources/CBK_brief-LOW-RES.pdf

4. Gogia S and Sachdev H. “Home visits by community health workers to prevent neonatal deaths in developing countries: a systematic review.” Accessed 5 August 2013. http://who.int/bulletin/volumes/88/9/09-069369/en/

5. Wilson A et al. “effectiveness of strategies incorporating taining and support of traditional birth attendants on perinatal and maternal mortality: meta-analysis.” BMJ 2011 Dec. Accessed 13 August 2013. http://ncbi.nlm.nih.gov/pubmed/22134967

Ina May’s Guide to Childbirth – book review

Ina May’s Guide to Childbirth by Ina May Gaskin.

NY; Bantam, 2003.

The physiology of birth is complicated and still not well understood. Our subjective experiences of birth are richly textured. Personal accounts spill over with combinations of intense sensations, strong emotions, vague impressions and fine details. What is astonishing about Ina May’s Guide to Childbirth is how exquisitely she traffics in the language of an internal landscape to describe and explain this complex process. She truly captures the uniqueness and universality of birth. I am adding this book to the list of recommendations I give my clients, as well as suggesting it to other teachers.

Devoting nearly the first third of the book to positive first-hand birth stories provides a substantial grounding. Many times I found myself thinking: Yes! That woman is describing this or that essential bit of wisdom I want to impart to my clients. Let me point out one example.

On pages 24 and 25, one of narrators describes 3 slices of her experience. First, she got advice not to read or learn too much and not to make a plan because the more details she had in mind, the less likely she would get what she wanted. Too much reading would interfere with her ability to go with her body, she was told.

Second, she describes her experience of being in a tub and how she needed a lot of reassurance because she was both scared and aware of the great power in her body. The physiological phenomena occurring in her brain and motor systems indeed would be described as these subjective states of being. She definitely perceived what was happening.

Third, she describes turning from looking at things during a contraction to listening because looking made her think, while listening allowed her to feel and be instinctive, which felt better than thinking and was not so overwhelming. Thus, she was going with her body. We see her process in this narrative.

The stories all got me thinking about whether I am telling my clients too much or too little! One of my teaching goals is to insure that clients distinguish between strategy and tactics. Example:  In the case of the story above, the strategy was to go with her body. The tactics she used were to not get too much information so she did not have too many expectations and to use sound rather than vision as her way of connecting inner and outer reality.

As a teacher, I see my job as insuring that my clients who might hear this story do not think that they must use sound rather than vision in order to go with their bodies, but rather that this was a piece of the process for this woman to reach her objective. It might work, but it might not. To get this across to clients, I tell stories about births in which I have been present when opposite tactics accomplished the same strategy or where the same tactic led to different outcomes.

The multitude of stories she presents in part I allow part II – the textbook part – to come to life. Whether she is discussing stages of labor, pain or release, she calls up stories and because the reader is already receptive to the notion of examples, the illustrations help the reader grasp whatever point she is making about the process.

However, the complex physiologic sequence of birth, including its variation from woman to woman, is less well served – in part because there is still so much to be learned about how birth happens, and in part because the birth community in general (whether having had professional or academic training) is not as well versed in normal physiology as it could be.

Let me focus on two issues: One is pain/pleasure and the other is hormones/behavior. Regarding pain/pleasure, Ina May makes a lot of important points, among them that how we experience an intensely sensational experience depends to a great degree on our preparation and that different women have different pain/pleasure experiences during birth. What she doesn’t tell us, though (and I suspect because it’s not common knowledge), is that some of the factors that control how we experience sensations are beyond our control. We experience pain/pleasure through a series of sensations, mental foci and behaviors such as breathing and muscle release. These nerve impulses are forwarded throughout the brain, some sensations taking on emotional content – some terrifying and others ecstatic – depending on the neural pattern. This is the basis of both the fear/tension/pain syndrome and the orgasmic pattern. But the precise pattern is dependent on genetics, as well as environment and behavioral training.

Some individuals become aware of sensations at a very low neurological threshold; others do not. Some individuals quickly find sensation of which they are aware to be uncomfortable or emotionally intolerable; others do not. Some people need comfort measures for their discomfort soon; some later, or not at all. Tolerance of what finally becomes pain or pleasure (or just a sense of stretching or motion through space) is also variable from person to person. Thus, the point at which we start has both biological and psychosocial determinants within this already variable process. In describing the variation in how women experience pain and pleasure in labor, Ina May is great at giving us examples and identifying psychosocial or cultural variations identified in research, but not so enlightening on the biology of why and how. This may or may not matter to the reader.

The issue of hormones that govern the vicious cycle we call labor is much less well understood. We have a pretty good concept of how prostaglandins, oxytocin and endorphins are stimulated and affect the process, and Ina May describes these in accessible ways. But while adrenaline is thought to inhibit early release of oxytocin, there has been little discussion of its importance in the pushing or ejection phase (she does cite Michel Odent’s notion that adrenaline might play a part in the ejection reflex when a labor is slowing down). But, there is little recognition outside of the physiology field that what happens in transition is our energy system shifting to a sympathetic [adrenal] source to give us more power to push. That’s why contractions change, why some women have a rest period between, and why – back in the day – we used to say to a woman having difficulty culling up her resources to push that she could get mad! Going through the effort and discomfort is key to inducing the rush of beta-endorphins. We know this, in a scientific way, from research that tells us runners who listen to music (relaxing and dissociative) experience lower rates of beta-endorphins at the end of the run than runners who do not listen to music, but work through the effort and discomfort they experience (stress inducing).

One of the things that makes Ina May’s book so valuable, in my mind, is the discussion near the end about midwifery, statistical support for natural birth and enumeration of the risks associated with surgical birth that are often glossed over when a family experiences dystocia. There are many elements within the birthing community striving to create an accessible spectrum of choices for birth. Let’s face it, birthing at home for low risk women, seamless transport alternatives, birthing centers attached to medical facilities, and readily available medical options when emergencies arise, would be a wonderful future. Birth attendants with universal acceptance, variable but rigorous training, and delineated scopes of practice would be ideal. Whether we get there remains to be seen, but I am glad Ina May exists, has her track record and is being listened to in this effort.

Mom-Baby Fitness: Modeling Healthy Lifestyle Habits

Guest Blog by Alana Abbott, DTP certified instructor, writer and mom.

My daughter has been taking Mom-Baby Fitness with me since she was six weeks old. When I became an instructor, she did, too. She is older than the children of most of my students, and, although she has a mind of her own on many of our activities, she enjoys dancing along with the mommies.

Her favorite Christmas gift this past year was a stroller and her own baby doll. The enthusiasm she showed for this pairing of toys reflects to me just how much of an example we moms set for our babies and toddlers – just by showing up and going to class. We often think of going to Mom-Baby Fitness as doing something good for our own fitness and our children’s social development. But it is also good for our children’s fitness!

Childhood Obesity

The media bombards us with facts about the growing childhood obesity epidemic. According to the CDC, childhood obesity in the United States has more than tripled over the last thirty years. To combat the risk of obesity, the CDC recommends healthy lifestyle habits, including healthy eating and physical activity. Diet and physical activity are influenced, unsurprisingly, by the child’s family.

Exercise doesn’t just combat obesity, however; it also lowers the risk of children developing type 2 diabetes and helps children develop stronger muscles and bones. By creating an environment where moms show that exercise is fun – through dancing, walking strollers side by side, or chatting while doing strength training – our babies are shown exercise and activity as an enjoyable activity and a behavior that is an everyday part of life.

Active Together

Recent evidence shows that new parents exercise less than they did pre-children, according to a recent report in Pediatrics. Fitting in exercise is a challenge! Involving your child in your exercise helps you create a healthy lifestyle for yourself – and a healthy example for your child. In a recommendation from the Mayo Clinic, the first step in getting your kids off the couch is to set a good example: “Your active lifestyle can be a powerful stimulus for your child. If you want an active child, be active yourself.”

I let my daughter bring her stroller and baby doll to class, so she can do what the mommies are doing. Her active approach is catching on, too – other toddlers are starting to join in!

It is never too early to start modeling healthy habits!

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!!

One World Birth, Video Trailer

This is a must see…

http://www.youtube.com/watch?v=sCPZrK8C2ZY&feature=player_embedded