To Kegel or Not to Kegel? That is the Question!

Every few years, the Kegel exercises come under attack. Practicing Kegels is often cited as the cause of difficulty during the pushing stage of birth, due to bearing down against contracted rather than relaxed pelvic floor muscles. This increases resistance to fetal movement, potentially damaging soft tissue, as well as stressing maternal cardiac reserve and the fetal heart. So, a call goes out to stop doing Kegels. But, Kegels were invented for a reason, and contracting the pelvic floor during birth is not it.

So, to kegel or not to kegel? Two things help us understand how to answer the question of whether or not – and when – to do Kegels. One is history (ever a useful tool) and the other is identifying the anatomy and physiological functions of the female pelvic floor.

1) History

Hands and knees is mechanically efficient for mom's body to "cradle" the fetus.

Hands and knees is mechanically efficient for mom’s body to “cradle” the fetus.

 

First thing, a quick peek at evolution. The pelvic floor did not originally support the contents of the abdomen. Starting out as 4-legged creatures, our pelvic floor originally served more as the back door.

Sacrum & Coccyx at top. Pubis at bottom. Evolution position.

Sacrum & Coccyx at top. Pubis at bottom. Evolution position.

Thus, the opening and closing of outlets were primary functions, and support of abdominal contents was largely a job for the Transverse Abdominals.

We could rock into an upright posture (squatting or sitting on our “sitsbones”), allowing gravity to assist in downward emptying of abdominal contents. When we relax our skeletal muscles, the involuntary muscles and neuro-motor emptying pathways proceed unfettered.

Squatting

Squatting

Once we discovered we could stand on our feet and still reach much of the fruit in the trees, a fast transition to upright (in evolutionary terms) placed strain on movement and support in the pelvis, spine and hip joints. Reviewing all the details involved in the ensuing adaptations is another story for another day. Suffice it to say, supporting the abdominal contents was not included in the original design of the pelvic “floor.”

Fast forward to the end of the 19th Century when birth began moving into a clinical setting and women were routinely placed on their back for labor and birth.

Pubis at top. Sacrum and coccyx at bottom. Supine position.

Pubis at top. Sacrum and coccyx at bottom. Supine position.

Yes, this slowed down the process and made it more painful. Thus, the next steps emerge in the early 20th Century: “Twilight Sleep” and increased forceps birth.

For a good understanding of this era, I recommend the following 1916 article:

  • Haultain FWN and Swift BH. The Morphine-Hyoscine method of painless childbirth or so-called “Twilight Sleep,” British Medical Journal, 1916 Oct 14;2(2911):513-5. Full text here:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2354830/pdf/brmedj07070-0003.pdf

  • The reader can also learn more about Twilight Sleep and its adaptations in the U.S. by entering “twilight sleep childbirth” into the PubMed search field.

Next: Urinary incontinence! Or, the reason Kegels were invented.

So, what was the product of placing women on their backs, putting them into a semi-conscious state, amnesia of events, and sometimes dragging the baby out of the vagina with forceps? Likely, increasing incidence of pelvic floor dysfunction. However, additional factors also influence maternal pelvic floor outcomes, including the Valsalva maneuver during pushing, and instrumental birth. Who invented “pushing” anyway? Male doctors.

  • For more on such matters, I recommend the reader examine Sheila Kitzinger’s work. She is a renowned British anthropologist who studied, wrote and spoke on global birth customs throughout her life.

Pushing, or bearing down, occurs naturally during coughing, sneezing, emesis, forced exhalation (as when a tennis player grunts while hitting a ball), urination, defecation and – when occurring without analgesia – parturition (birth). Identifying the “best” way to push remains illusive. What is the goal? Speed, damage control, fetal outcome? The Cochrane Library concludes only that maternal preferences and medical imperatives should guide the method of pushing.

  • Lemos A et al. Pushing/bearing down methods for the second stage of labour. Cochrane Database Syst Rev. 2015 Oct 9;10:CD009124. doi:10.1002/14651858.CD009124.pub2.

And, what about organ prolapse? How does that figure in here? Is weakness in the pelvic floor muscles a cause? It is becoming more clear that, even in the absence of trauma, genetic factors play a significant role in the occurrence and severity of pelvic floor dysfunction. There is great variability in how connective tissues respond to stress and stretching. A good recent account of one possible gene avenue is this article:

  • He K, Niu G, Gao J, Liu JX, Qu H. MicroRNA-92 expression may be associated with reduced estrogen receptor β1 mRNA levels in cervical portion of uterosacral ligaments in women with pelvic organ prolapse. Eur J Obstet Gynecol Reprod Biol. 2016 Mar;198:94-9. doi: 10.1016/j.ejogrb.2016.01.007. Epub 2016 Jan 11.

In the early-mid 20th Century, much less was understood about how genetics, physical training, postural sway and practice protocols might affect these matters. In 1948, Dr. Arnold Kegel, an American gynecologist, published on a non-surgical method of toning the pelvic floor in order to help women control incontinence following childbirth. By exercising the pubococcygeus muscles (PC muscles or sphincters) of the pelvic floor, he found that women could reduce their likelihood of experiencing bladder problems after pregnancy and birth. Here are the two publications that give rise to calling these exercises “Kegels.”

  • Kegel AH. Progressive resistance exercise in the functional restoration of the perineal muscles. Am J Obstet Gynecol. 1948 Aug;56(2):238-48.
  • Kegel AH. The nonsurgical treatment of genital relaxation; use of the perineometer as an aid in restoring anatomic and functional structure. Ann West Med Surg. 1948 May;2(5):213-6.

Keep these factors in mind: The experiments leading to publication included measurement of the strength of contraction of these muscles. Several devices (balls, cones and devices that read muscle strength) were developed to provide tactile aid in contracting and releasing the PC or sphincter muscles, and continue to be used today by physiotherapists. These actions are aimed at squeezing the detrusor (or urinary flow mechanism) to prevent incontinence with weak or relaxed sphincters.

What about the issue of organ prolapse? How does that tie in? Over time, the term “Kegel” has also come to refer to tightening the levator muscles (the sling-like muscles that lift the pelvic floor). This action is the opposite of what happens when bearing down. Which nicely brings us to the second topic:

2) Anatomy and Functions of the Female Pelvic Floor

There are three rings of muscles and four muscle actions that govern the opening and closing of the bony structures and soft tissue of the pelvic floor. The overall bony shape of the pelvic floor is similar to a baseball diamond, as seen in the first graphic.

Pelvic outlets, lithotomy position.

Pelvic outlets, lithotomy position.

 

The three rings are – from outside to in:

  1. Gluteals, transverse perineals and ischiocavernous that create two triangles of the pyramidal bony structure and create a rigid fence when contracted or a mobile structure when released. The deep rotators, including piriformis, and the pyramidalis also function to close the pelvic outlet.
  2. Levator and diaphragm muscle that lift and close the pelvic floor and/or support the contents of the abdomen by contracting when the woman is vertical.
  3. Sphincter muscles that squeeze and release the three orifices: urethra, vagina and anus, closing and opening these outlets.

The four muscle actions are:

  1. Contraction – tightening the muscle as in strength training. Can be done to shorten muscle (concentric) or as muscle extends (eccentric). Muscles can shorten approximately half their resting or relaxed length. Contracting muscle against resistance increases cardiovasculature and improves delivery of nutrients and oxygen, as well as improving innervation and awareness of motion.
  2. Release/Relaxation – letting go of contraction, allowing muscle to rest, relax or be stretched.
  3. Stretching – muscles can be lengthened approximately a third of their resting length by applying leverage to the bony structures the muscle controls. Stretching is also affected by genetic factors regarding elasticity of the connective tissue within and attaching to muscle and bone.
  4. Bulging or Distending – Some muscles can extend beyond their stretching range by pressure from the diaphragm, often termed “bearing down.” Both the Transverse Abdominals (TA) and pelvic floor muscles do this during parturition (efforts to expel the baby). The TA tighten in a distending position to assist in the emptying of the abdominal contents and the pelvic floor extends beyond the bony structure defined by the sit bones (ischial tubersoities) on either side of the vagina. To get a sense of how this occurs, I recommend two things: first, cough hard enough that you can sense the action of TA and pelvic floor; second, next time you take a poop, sense how your body is working. It is the same for parturition, although the target is the vagina rather than the anus and the voluntary assisting effort needed is much more intense. Two practices help prevent damage to the pelvic floor. One is following the urge to push and the other is to “labor down” when their is no urge, when the mother needs to rest a bit during pushing. Avoiding, as much as possible, the Valsalva maneuver (holding the breath while pushing) reduces strain on maternal cardiac reserve and the fetal heart.

An excellent way to get a sense of how the pelvic floor functions in birth is to view the 1974 Brazilian film, Birth in the Squatting Position. Here is the link:

https://www.youtube.com/watch?v=ZHHHcIZEi9U&oref=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DZHHHcIZEi9U&has_verified=1

So, do we do Kegels? Yes, but we also release/relax, stretch and learn the coordination of bulging/distending these muscles. After birth and as we age, we also do them as a method of recovery and because we are upright animals who have to support the contents of the abdomen. Learning to sit in an anatomically neutral position in a chair and many other healthy postural habits – not to mention understanding our genetic factors regarding elasticity – will also help us maintain a healthy pelvic floor. But these ideas are another story for another day.

 

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About Pain and Birth

That Was Then…

As I became involved in the birthing field, one of the nurse-midwives with whom I was acquainted introduced me to Jung’s quotation: “There is no birth of consciousness without pain.” (Alternately, “There is no coming to consciousness without pain.”) It struck a deep chord in me.

At the time, I was going through a painful divorce and creating a new sense of self. As a dancer, I had long since learned that the acquisition of new movement and performance skills involved a painful relationship with one’s body and mind that results in a new identity: I am a person who can do this. At that time, I also had my first pregnancy loss – painful in every definition of the word. Even ideas required painful “births” in my educational process. “Aha!” was usually preceded by muddled difficulty in disciplining my thought processes.

So, when I first saw the saying, “There is no birth of consciousness without pain,” intertwined with a drawing of a woman literally giving birth, the truth of the image seemed obvious to me. It become hard-wired into my underlying assumptions about giving birth. The process itself combines intense noxious sensations with mid brain emotional input into what neural science calls pain. For years, this realization has driven what and how I teach: Being fit and educated in body/mind are the tools of enlightenment and self-empowerment.

…And This Is Now

A little while ago I came across a NY Times article “Profiting From Pain.” While the article concerns the huge increase in the legitimate opioid business – products, sales, hospitalizations, legal expenses and workplace cost – it restarted my thinking about a topic fermenting in my brain between That Was Then And This Is Now: The sense of entitlement to a pain-free existence. The idea that pain free is better than painful. And the selling of this idea for profit.

Where does this come from? Trying to obliterate pain has led to increased addiction, death and other adverse side effects. A new topic has shown up in women’s health discussions: Increasing use and overdose from prescription pain killers by women, including during pregnancy.

Could it be that human fear of pain is being used to generate financial profit? (the opium-is-the-opiate-of-the-masses model). Perhaps once the notion of palliative care reached a certain level of acceptance for the dying within the medical community, it began to spill over into other human conditions (the slippery-slope model). Or, perhaps we don’t want transparency at all (the denial model).

In the last few days, NPR has raised the question of whether the high cesarean birth rate is tied to the payment for procedure rather than outcome model? The recovery from cesarean is more painful than the recovery from vaginal birth, has adverse side-effects for mother and baby, and was originally designed for use only for the 15% +/- of real complications that arise in normal birth. So, how is it being sold to 35% of women in the U.S,? At one point, there was a serious discussion within the medical community that if women were afraid of the pain of birth and wanted a cesarean, a care provider should do one. No discussion of why it seems painful or how to deal with pain.

The Affordable Care Act aims to improve some of the cost issues in medical care by shifting the payment incentive away from procedures and on to outcome assessment. As a result, the cesarean rate and even such seemingly innocuous procedures as fetal monitoring are coming under scrutiny. If we truly want to do a service to the mothers-to-be in the ACA transition period and beyond, I think we must discuss the question of birth and pain. 

I can think of many questions that fall under this topic…Why do we call the intense phenomenon of birth “painful”? How do our genetics, behavior, training and thought-processes affect our experience of pain? What about the health care culture – has it focused on relieving pain at the expense of what we gain from working with pain short of trauma or imminent death? How do we prepare women for working with sensation without automatically labeling it pain? Is the “empowerment” often attributed to giving birth what is learned by going through the center of the “there is no birth of consciousness without pain” experience? These questions are just a start.

In closing…

Let me address the childbirth educators and pregnancy exercise instructors. This is our present challenge. In my work, I feel the necessity to make all pain management strategies understandable to my clients. I find that most of the women I see in classes must deal first with self-discovery before they can assess their commitment to the view of birth they carry in their minds. The images of birth we lay out for them to consider need to include an understanding that you cannot escape the work of birth. Being present – mindfulness – can be scary and intense but it is the medium by which our consciousness expands. Cardiovascular fitness and strength are the source of our endurance and power.

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.

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!

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

Active Pregnancy – the rationale

Moving into Motherhood

It’s time to hit the main theme again:  Aerobically fit women are at reduced risk for things that go wrong in pregnancy, improve their tolerance for labor and birth, and recover more rapidly in the postpartum period.

The arrival of the holidays provides a good reason to bring this up, yet again! Pregnancy is a gateway time in women’s lives…we become more aware of our bodies, our sensations, our feelings, our needs, and how versatile and amazing our bodies are. We can make people with our bodies! During pregnancy, we often take precautions…we eat more carefully, avoid toxins, try to avoid stress. When the holidays arrive, we see indulgent behavior in a different light.

Yet, even with all this focus on behavior, we sometimes miss the biggest aid to a healthy pregnancy:  physical fitness. Research clearly demonstrates that fit women do better, are healthier and happier. More and more in the U.S. we see disorders of normal organ function that accompany sedentary pregnancy.

Let’s look at this a little closer (yes, I am going to repeat myself some more, but it is an important concept to spread). We live in a body model that rewards an active lifestyle.

Being sedentary causes things to go wrong

Not moving creates biochemical imbalances because the cardiovascular system atrophies and molecules created in the brain or brought in through the digestion may not get where they need to go for a healthy metabolism.

Your cardiovasculature is the highway that brings usable substances to the place they are used. You have to help it grow and develop, use it to pump things around and give it a chance to be healthy. Aerobic fitness does all these things.

Advice for young women of childbearing age

If you are thinking of pregnancy, have recently become pregnant, or work with women of childbearing age, we encourage you to open avenues of activity for yourself or others in this population. You can learn more from our website dancingthrupregnancy.com. You can also read backwards in this blog to get specific ideas. Or, you can seek out local pre/postnatal fitness experts (you can also do this on our site). Yoga is nice…we use some of it in our work, along other specific exercises for which there is a direct health benefit. But, we also see yoga converts who come into our program in mid pregnancy unable to breathe after walking up a flight of stairs. How will they do in labor? Not as well as those who have been doing aerobic dance or an elliptical machine 2 or 3 times a week.

The AHA/ACSM guidelines for the amount of aerobic exercise needed to improve cardiovascular status hold true for pregnant women just as they do for the rest of the population – a minimum of 150 minutes of moderate, or 75 minutes of vigorous, or a combination of these levels of intensity, per week. If you are not getting this level of activity, you are putting your health – and that of your offspring – at risk.

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.