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.

About Dancing

“When a normal, healthy child is born, usually in the father’s compound, the women perform the nkwa to rejoice. Then…they sing and dance their way to the compounds of the mother’s kin to inform them of the joyous event through the dance-play, gathering additional dancers as it moves from compound to compound. In this nkwa, in which only married women who have given birth perform, the dancers highlight procreative body parts, birth exercises and child care gestures.” – page 164, Hanna JL, To Dance is Human: a theory of non-verbal communication, 1979. Rev. ed. 1987.

From its inception in 1979, Dancing Thru Pregnancy® has been inspired by this passage from Judith Lynne Hanna’s amazing text, in which she describes how the Ubakala of Nigeria “announce” the birth of a child. The dance serves a dual purpose – it tells of the birth, but it also teaches the uninitiated how pregnancy and birth occur. For the dancers it also serves as a catharsis.

As a professional dancer, I long ago recognized the transformative power of dance to make experiences accessible.Molly and Miri Through Hanna’s writing we see how dance is itself one of the earliest and most profound ways in which common human experiences are taught and learned. Contemporary culture often removes this type of learning from our environment. Employing dance to help women approach birth has always struck me as an obvious first choice in preparing women for the physical, emotional, identity-forming and joyful process of birth.

In the intervening years, science and technology have reinforced our understanding of how this non-verbal learning happens. A most excellent discussion of mirror neurons appears in Acharya and Shukla’s article, Mirror Neurons: Enigma of the metaphysical modular brain, J Nat Sci Biol Med. 2012 Jul-Dec; 3(2): 118–124. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3510904/. Mirror neurons are key to how empathy and understanding of experience are produced when people view movement and gesture. The mere perception of an action sets off a low level firing of the neural pathway that executes the actions we are seeing. The authors provide a thorough grounding in the history of how we have come to recognize that mirror neurons exist and how they work.

There are more arenas in which dance also shines as a preparation. Appropriately choreographed, dance enables excellent physical fitness and includes all the elements of physical activity that research demonstrates are effective for optimal health in pregnancy and coping with the rigors of birth. From the perspective of exercise physiology, labor is an ultra-distance endurance event, followed by a strength test (birth), a long physical recovery period and 18 years or more of sleep deprivation. And, further, such a preparation aids the mother in achieving a physiologic birth as described in Buckley’s “Hormonal Physiology of Childbearing: Evidence and implications for women, babies, and maternity care.” This recent groundbreaking article describes how labor, birth and breastfeeding are promoted through hormonal actions, as well as why some technological advances in childbirth are working against these processes.

DTP at YH 12:13Achieving cardiovascular endurance (aerobic fitness) is essential. There are so many benefits of aerobic fitness that a full recitation and hundreds of citations will not fit in a blog. Our teacher training aerobic component takes several days, even for experienced fitness pros. But, to summarize: cardiovascular fitness improves implantation, enhances nutrient and oxygen delivery, reduces the incidence or severity of some pregnancy disorders, reduces the risk of fetal distress, reduces stress on maternal cardiac reserve while pushing, reduces the risk of cesarean, hastens recovery, helps maintain a healthy weight, alleviates anxiety, builds body-image confidence (Cochrane) and enhances long term maternal and fetal health. The two forms of cardio or aerobic activity most often cited for effectiveness are running and aerobic dancing.

Two other elements of dance that are useful for pregnant, birthing and parenting moms are strength and flexibility. There are Elongemany movement actions derived from numerous dance forms that promote both power and elasticity in the muscles, connective tissue and skeletal structure. Some effective positions, movements and skills are shared with other disciplines: Traditional childbirth preparation, weight training, gymnastics, physical therapy, yoga, t’ai chi, pilates, boot camp, plyometrics, proprioceptor neuromuscular facilitation (PNF) techniques, Feldenkrais, Alexander, somatic therapies, posture training, etc.

This letter I received recently from a (not pregnant) ballet student willing to share her experience is a clear reminder of how a well-designed dance class accomplishes enhancement of strength and flexibility, along with confidence about working with one’s body:

“Hi Ann,

I just wanted to let you know that I lifted weights at the gym last night… It had been at least 6 months since I had lifted weights at all, and so I figured I’d need to start at a relatively low weight and I’d be really sore the next day regardless. I was very surprised to find that I could easily lift the maximum weight I’ve ever lifted, which was the weight I used to lift at a time when I was lifting weights routinely several times a week. Every muscle group was strong. And today I am not sore at all. This is all to say that I am shocked at how much strength I’ve gained from ballet. I had no idea that just lifting my limbs against gravity could be so effective.

Thank you so much for having a class for beginner adults, and for your patience with all of us! I’m 42 years old at this point, and started ballet because I had noticed my core strength, flexibility and balance starting to really decline…I am so thrilled with the results from ballet even though I have such a long way to go!!! Plus it’s really fun. How I wish I would have discovered ballet in my 20s or 30s, since I didn’t learn it as a child!

Glenda G. Callender, MD FACS

An additional arena in which dance shines is in building mind-body skills. Dancing relies on centering – aligning with gravity to produce the greatest efficiency for movement (balance) along with breathing as a component of movement. Centering also reduces the load on the nervous system and allows the brain to modulate into the parasympathetic nervous system state, also known as the relaxation response (autogenic training, hypnosis, meditation, progressive relaxation), the zone (athletes’ term), mindfulness (big in research presently), the trophotropic response (the scientific term) or the alpha state (the current fad term). Dancers sometimes refer to this as tuning in to the unconscious. The actual coordination of motions, such as pushing, is primarily unconscious. The conscious piece is keeping a clear image of the goal, while allowing the body to work. This is the skill that allows the birthing mother to follow her body’s urges, flowing with the labor rather than trying to control what is going on. It gives her access to the cathartic nature of birth as a dance.

Centering 2:08Align

Breathe

Focus on the breath

Sense the movement within

Then, allow the body to dance…

A part of the dance experience I truly enjoy is a phenomenon known as muscle bonding. When a group does vigorous physical activity together – dancing together, a sports team, a drill team – a special kind of bond forms. Part of the euphoria is this muscle bonding experience.  Those of us whose interest lies in understanding the mechanics of such things have a pretty good idea how this works – some of which is laid out in this blog and the reading links. But, that is not the wonder of it. The wdancing_overview from backonder of it is what the Ubakala women experience moving together to announce the birth of a child.

When I am dancing with my pregnant ladies and we are in the grove with our modified hip hop routine, we are smiling at each other and feeling completely alive. We are breathing hard and working hard, but we are strong. My hope is always that when she senses that labor and birth are starting, a mom-to-be can get in that groove with the baby and support person. Birth as a dance.

No blog on pregnancy or birth is complete without a caveat. Every pregnancy and birth is unique. Sometimes things go wrong. But, mostly they go right! And, moms can optimize the experience. One of the greatest dangers to pregnancy and birth is sedentary behavior. Regular, vigorous, strength-inducing, flexibility gaining, mindfulness, relaxation muscle bonding fun is available. Check our U.S. and International Find-a-Class listing. If there is nothing near you, start something!

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!!

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.

High Birth Weight: The New Bad Outcome

While public awareness of low birth weight and premature infants is becoming – at long last – interesting to the mainstream culture and media, another phenomenon is beginning to shake the professional birthing world:  high birth weight. Because it is occurring in a more affluent element of society, it is alarming. This tells us that you cannot buy your way out of pregnancy risks that are created by a sedentary, toxic food life-style.

Here is the dilemma:

Normal weight and some overweight women who eat too much in pregnancy tend to have babies who are, basically, already obese at birth. Therefore, these infants already have metabolic and cardiovascular dysfunction. Babies born over 8 lbs. 14 oz. are at increased risk for Type 2 Diabetes and heart disease.

Interestingly, the Institute of Medicine  recently issued new guidelines on pregnancy weight gain. After nearly 20 years of adhering to the “normal” weight gain being 25 to 35 pounds, the Institute recognized that prenatal BMI plays a role in how much weight gain is necessary for a healthy pregnancy.

The evidence that underlies this change demonstrates that gains greater than 22 pounds – for all classifications of prenatal BMI – is the demarkation point for increased health problems.  More information on this is available at:  New IOM Guidelines.

We have known for a while now that obesity in pregnancy puts mother and infant at risk for a number of problems from cardiovascular, metabolic and immune disorders to prematurity, low birth weight, increased need for cesarean birth and slow recovery. Add another one:  Obese newborns with increased risk for heart and metabolism problems.

Reference on weight gain and high birth weight:

Ludwig DS, Currie J. The association between pregnancy weight gain and birthweight: a within-family comparison. Lancet. 2010 Sep 18;376(9745):984-90. Epub 2010 Aug 4.

A good reference for issues surrounding obese pregnancy:

Leddy MA et al. The Impact of Maternal Obesity on Maternal and Fetal Health. Rev Obstet Gynecol 2008;1(4):170-178.

Fetal Programming

What is fetal programming? Every person living on earth was first exposed to a uterine environment that helped determine their lifetime health and development. The term for this phenomenon is fetal programming. It is a hot topic and deserves attention.

Accepting the importance of fetal programming places responsibility on the mother-to-be to do all she can to insure her body provides nutrients and oxygen to her growing infant while avoiding possible risks and toxins. At the same time, genetic and environmental factors contribute greatly to the potential for some disorders and problems that arise. Thus, we must be careful in assigning guidelines for acceptable behavior or blame for poor outcomes to pregnant women.

On the one hand, we can all see the negative consequences of something like fetal alcohol syndrome…clearly the result of maternal behavior. Is a pregnant woman whose baby has been damaged in this way guilty of abuse?

But, what if a mother is obese, eats poorly and ends up with an infant with a disturbed metabolism. Is this abuse? What if the mother has an infection that results in cerebral palsy? Or what if she lives near a highway and involuntarily inhales fumes that negatively affect the placenta?

How do you get a healthy baby? Of course, there are no guarantees. There remain many unknown factors that can affect the course and outcome of a pregnancy. Some factors we are aware of, such as avoiding certain fumes or chemicals.  There are some behaviors we know can maximize the potential for a good outcome, such as eating adequate protein, aerobic conditioning and strength training. [Note for new readers…lots of these factors have been covered in our previous posts.]

But, what about all the things we don’t know about?

If these goats eat the wrong grass, will they go into labor?

Here is a cautionary tale:  There is a species of goat that, if they eat a certain type of skunk grass on day 14 (and only day 14) of pregnancy, will not go into labor? Why? Plant toxins in this grass interfere with the development of a small portion of fetal brain, the paraventricular nucleus. This nucleus is involved in the signaling cycle of labor. Without it, the mother will not go into labor!

What are the take-home messages here?

  • Probably no one is ever a perfect fetus…too many possible threats.
  • There are some threats we can avoid…being lazy, over-eating, smoking.
  • There are some threats we cannot avoid, so we do the best we can.

Do the best you can by your baby…aerobic fitness, good nourishment, sleep, good hygiene and de-stressing your life. Check out more information on the website and let us know how you are doing!

Pregnancy Pathway: Importance of Postpartum Fitness

Physical Activity Following Birth.

As a transition to the hot topic approach we will now adopt on this blog, I want to discuss this important area of interest.

Recently I was talking with some of my pre/postnatal fitness clients and it was mentioned that one of the healthy new moms with a fairly easy birth story had been given extremely conservative guidelines about activity after birth by her care provider.

Two things occur to me when this sort of report comes up…one, did she hear the directions clearly? and two, if this is what the care provider said, why did s/he say this? Knowing the people involved, my reaction was:  I need to do some education. Inactivity following birth leads to deconditioning and weight gain, and this care provider should know this.

Here are two important facts regarding physical activity following birth:

1. Women who return to vigorous (vigorous, as in jogging or aerobic dance) prior to six weeks postpartum…

  • have less weight to lose
  • experience a more joyful state of mind
  • do better on the Lederman Maternal Adaptation scales (how well they adapt to motherhood)

…than women who are sedentary during this period (Sampselle, 1999…this is not new information)

2. Postpartum obesity is a dangerous short and long term health risk (Leddy, 2008).

Who should exercise and when, following birth?

Day 1: If you have a vaginal birth, begin your “body scan” the first chance you get. Within the first day, the first chance you get to focus on yourself, take a mental trip through your body. See if you can squeeze the kegel muscles. Try exhaling and sucking in your deep abdominal muscles. Note if your shoulders need to relax. Take some deep breathes and begin to help your body recover.

If you had a cesarean: Wait a few days to 2 weeks at most to work on this.

After that: As soon as you can, get up and walk around. Start walking in 5 or 10 minute strolls several times a day (ask someone to hold or watch baby so you can allow your body to recover a non-pregnant upright). If you had a cesarean, hold a pillow to your abdomen until you have control of your abdominal muscles and stand tall.

How can you get more information on this?

Go to our website:

http://dancingthrupregnancy.com/take-a-class/postpartum-exercise/

Find a class. If you had a typical birth and your baby has been slowly and safely exposed to new people, by four to six weeks you and baby should be ready for a structured activity session that includes baby. It will also provide focus and adult interaction during the week.

You have to teach your abdomen to be flat.

How do you know if you did too much?

Your lochia, or the bleeding/discharge from the placental site, will increase if you have been too vigorous. If you are healthy and have no anemia issues, your lochia will likely cease by three to four weeks, six at most.

What are safety issues?

Don’t exercise if you have a fever, a warm red spot on your leg that may be painful (or not), or sore nipples that need attention. Call your care provider. If you or your baby are sick, it is best not to go into a group setting. If your baby is not well or just doesn’t seem right, call your pediatrician.

The most important reason to join a mom-baby fitness program may be that it will help keep you sane.