The positive impact of prenatal exercise

The following is a re-post of my August 2008 post Wanna Improve Your Odds?:

I mentioned back in April that I had been skimming the book Exercising Through Your Pregnancy, by James F. Clapp M.D. I was really impressed at that time with the amazing benefits of exercising through pregnancy. But I didn't read the book in-depth. I decided earlier this week that I wanted to take a closer look. Now that I've read several of the chapters and examined the data thoroughly, I am telling you... it absolutely blows me away.

There are risks inherent in pregnancy and childbirth, but we can do things to minimize those risks. We all know that good nutrition is essential for pregnant women. Poor nutrition often leads to pre-term and low-birthweight infants as well as pre-eclampsia in mothers. Eating well is one of the absolute best things you can do for your unborn child's physical and neurological growth. But now I'm convinced that exercise may be just as important.

I won't go into all the benefits of prenatal exercise here. I'd just like to focus on one set of benefits in particular--the effects of exercise on the course of labor. You might remember my very early post about the benefits of doulas. Having a doula assist your labor and delivery reduces many chidbirth risks significantly. Prenatal exercise has even more pronounced benefits.

Women who continue exercising regularly through the end of their pregnancies (three times a week for at least 20 minutes at a moderately hard to hard level of exertion) demonstrated the following reduced risks during the birth process...

* 35% decrease in the need for pain relief
* 75% decrease in the incidence of maternal exhaustion
* 50% decrease in the need to artificially rupture membranes
* 50% decrease in the need to induce or augment labor with pitocin
* 50% decrease in the need to intervene because of abnormalities in the fetal heart rate
* 55% decrease in the need for episiotomy
* 75% decrease in the need for operative intervention (forceps or cesarean section)

In addition, check these out...

* More than 65% of the exercising women delivered in less than four hours.
* 72% delivered before their due date (but fewer of them delivered before 37 weeks--preterm--than the control group). The exercising women delivered, on average, 5-7 days earlier than active women who did not exercise regularly.
* Significant reduction in the incidence of umbilical cord entanglement.
* Much lower incidence of fetus passing meconium from distress.
* Umbilical cord blood samples indicated that babies of exercising moms remained relatively stress-free with plenty of oxygen. They seemed to tolerate the stresses of labor and delivery better than the control group.
* The exercising mothers' infants were, on average, 14 oz lighter but overall growth was not compromised.
* Placentas of exercising mothers are larger, more efficient, and healthier-looking.
* Infants born to exercising mothers were more alert postpartum and needed less consolation from others.

(All of these results are taken from Dr. Clapp's studies as reported in Exercising Through Your Pregnancy. See this fabulous book for even more amazing benefits.)

It blows my mind.

Imagine how huge the risk reductions would be if you exercised through pregnancy AND had a doula. Whoah. We can do so much to avoid the pitfalls of pregnancy and birth. It gives me so much joy and hope to know that I am not at the mercy of chance. I have a great deal of power over my circumstances when it comes to pregnancy and birth. It is a wonderful thing to be able to choose to pro-actively reduce risks and bring so much benefit to myself and my babies. I love it!

Re-post: Tips for avoiding tearing and episiotomies

Things have been quiet in my corner of the blogosphere despite my having one or two posts in the works in my head.  I just haven't had a block of time to get them on "paper."  In the meantime, I thought I'd re-post and oldie but goodie from the early days of my blog since some of my newer readers might not have seen it and might find it helpful.  (Stay tuned for a post about waterbirth next.)

Giving birth for the first time was one of the most empowering experiences of my life. My water broke, my contractions started, everything progressed smoothly, and, less than six hours later, my baby girl was born. It was an ideal birth experience, except for one thing. That one thing made my next few weeks of recovery extremely painful. I tore. I really tore....

Read the rest of this post over at my new website!

No medals here

Wow. Huge thanks to Jill (The Unnecesarean) for sharing this fabulous post by Arwyn: "Just like athletics: exploring a childbirth analogy." Jill described it as her "favorite breakdown of the childbirth-athletics analogy," and I have to agree that it is definitely my new favorite as well.

Arwyn eloquently discusses how our culture is quick and eager to praise, admire, and encourage those engaged in athletic feats--marathons, sporting events, and even local 5Ks, but when a woman attempts natural childbirth (a likewise challenging physical feat), she is lucky if she finds one or two supporters to cheer her on. Instead, far too often, it is those on the sidelines who should be her loudest cheerleaders who tell her she "can't do it."

I am personally saddened and disheartened when I (frequently) hear women tell me that it is their husbands who say, "You're definitely not tough enough for a natural birth," or who "can't bear to see her in pain," and thus push her toward an epidural. Would they also suggest that she's not tough enough for a marathon, if that was her goal, or stop her in the last grueling miles of the race and say, "You need to stop... I can't stand seeing you in so much pain"? I certainly hope they wouldn't. All this stuff has brought to mind this post from last June--"Nobody thinks you're a hero."

Here are a couple of teasers from Arwyn's post:

Everyone has heard of and no one doubts the existence of “runner’s high”, so why do we start plugging our ears and rolling our eyes and flapping our tongues when we speak of “birthing high”? Just as in athletics, in the absence of intolerable pain and unnecessary interferences (the latter of which is all too often responsible for the former), birthing has the potential to produce the most delicious chemical cocktail which feels good. (Divine even: I certainly felt like a birthing goddess afterward.) Even discounting that, or in its absence, there is potential for pride and a sense of accomplishment: something we value so much in athletics, yet scoff at in childbirth, where our effort benefits both us and another. We deny women that pride in accomplishment (for which support of athletics is so vital to girls’ sense of self and women’s equality), that boost in self-esteem and feeling of competency, right when we need it most: at the start of parenting, one of the most demanding journeys a person can undertake. . . .

But the current cultural construction of birth must change: not by moving backward to a time when women had no options in childbirth, and were expected — even encouraged — to suffer, and in which there were no medical interventions for when they were truly needed; but forward, to a time when our bodies are valued, our spirits are supported, and the work of birth is seen as hard, yes, and even sometimes painful, but within reach of most of us, and oh so worth it: just like athletics.

And some pics, for fun...

My dad (in the blue hat) finishing the Boston Marathon as a 50th birthday gift to himself, with his friend, and my (now deceased) brother, Steven, running the last 5 miles with him (behind my dad)...Me and my husband with his Boston Marathon finisher's medal (April '08)...My husband helping me run my first 10K, the longest race I've ever run...And then again, helping me through one of the most difficult (and best) experiences of my life (with my doula as another cheerleader)...So much better than a medal...

Sunshine on my shoulders...

...makes me happy!

And even more now that I read about a study conducted by Boston University School of Medicine researchers. It appears that vitamin D can prevent cesarean births! I've fallen in love with vitamin D over the last few years as I've learned more and more about all the ways the "sunshine vitamin" improves our health and well-being, so when I saw this new study's findings, I couldn't believe it! ANOTHER reason to love vitamin D?! Are you kidding me?!

In a news release about the study, Dr. Michael Holick, director of the General Clinical Research Center, a professor of medicine, physiology and biophysics, and an assistant professor of medicine, explains, "In our analysis, pregnant women who were vitamin D-deficient at the time of delivery had almost four time the odds of Caesarean birth than women who were not deficient" (US News and World Report, "Vitamin D Deficit in Pregnancy Tied to Caesarean Risk").

Apparently vitamin D deficiency is tied with decreased muscle performance and strength, so it makes sense that women with low levels would struggle through the taxing muscle-endurance feat of childbirth.

These findings have made me ecstatic, but they've also got me pondering. For so long I've believed that the birth process is perfectly designed... that nearly all complications arise from medical interference in the process. But this study has shed some light (no pun intended) on a percentage of those complicated births. I guess I can't blame the medical establishment for everything... dang it! ;-) The truth is that multiple factors are always involved.

Even so, I still believe that even most vitamin D-deficient women can give birth normally. Chances are it will just take their bodies longer. And that's where the medical establishment steps in. 'Cause they're not typically very patient with those long labors, so interventions are introduced (pitocin, epidurals, instrumental or surgical deliveries). Women with muscle weakness aren't guaranteed a cesarean birth, but their weak muscles will stack the odds against them... at least in the hospital.

All the more reason I'm glad I live in the Valley of the Sun... where even the winters are sunny and pleasant. And all the more reason to get out into that gorgeous weather and exercise. 'Cause anything I can do to strengthen my body is going to improve my odds of a smooth and problem-free delivery!

More good news about exercise

The studies keep rolling in... prenatal exercise is so worth it! The New York Times reported Monday about a small Brazilian study showing that regular prenatal exercise significantly reduced the need for pain medication during labor--"only 27 percent of the exercisers, compared with 65 percent of the controls, requested pain medication during labor"(click here for the full article). Here's the study's abstract.

Speaking of exercise... I'm supposed to be running a 5K this Saturday morning. And my Thanksgiving holiday vacation really threw off my exercise routine... yikes. Gotta get back on the ball!

Let's get movin'

I just read some great news. Though it only confirmed what I already knew. Check it out!

"Moderate physical activity during pregnancy does not contribute to low birth weight, premature birth or miscarriage and may actually reduce the risk of complications, according to a Michigan State University professor who contributed to the U.S. government's first-ever guidelines on physical activity" ("Guidelines urge physical activity during pregnancy," Physorg.com).

I should say that, although I was dead set on exercising through this pregnancy, I've been woefully inactive for the past month or two (or has it been three?). But this little news flash may be just the boost I need to get back out there and run again. Maybe I'll even go tomorrow?

Wanna improve your odds?

I mentioned back in April that I had been skimming the book Exercising Through Your Pregnancy, by James F. Clapp M.D. I was really impressed at that time with the amazing benefits of exercising through pregnancy. But I didn't read the book in-depth. I decided earlier this week that I wanted to take a closer look. Now that I've read several of the chapters and examined the data thoroughly, I am telling you... it absolutely blows me away! Look past the cheesy/dated cover picture, my friends, and read this book! Or, if nothing else, keep reading this blogpost.

There are risks inherent in pregnancy and childbirth, but we can do things to minimize those risks. We all know that good nutrition is essential for pregnant women. Poor nutrition often leads to pre-term and low-birthweight infants as well as pre-eclampsia in mothers. Eating well is one of the absolute best things you can do for your unborn child's physical and neurological growth. But now I'm convinced that exercise may be just as important.

I won't go into all the benefits of prenatal exercise here. I'd just like to focus on one set of benefits in particular--the effects of exercise on the course of labor. You might remember my very early post about the benefits of doulas. Having a doula assist your labor and delivery reduces many chidbirth risks significantly. Prenatal exercise has even more pronounced benefits!

Women who continue exercising regularly through the end of their pregnancies (three times a week for at least 20 minutes at a moderately hard to hard level of exertion) demonstrated the following reduced risks during the birth process...

* 35% decrease in the need for pain relief
* 75% decrease in the incidence of maternal exhaustion
* 50% decrease in the need to artificially rupture membranes
* 50% decrease in the need to induce or augment labor with pitocin
* 50% decrease in the need to intervene because of abnormalities in the fetal heart rate
* 55% decrease in the need for episiotomy
* 75% decrease in the need for operative intervention (forceps or cesarean section)

In addition, check these out...

* More than 65% of the exercising women delivered in less than four hours.
* 72% delivered before their due date (but fewer of them delivered before 37 weeks--preterm--than the control group). The exercising women delivered, on average, 5-7 days earlier than active women who did not exercise regularly.
* Significant reduction in the incidence of umbilical cord entanglement.
* Much lower incidence of fetus passing meconium from distress.
* Umbilical cord blood samples indicated that babies of exercising moms remained relatively stress-free with plenty of oxygen. They seemed to tolerate the stresses of labor and delivery better than the control group.
* The exercising mothers' infants were, on average, 14 oz lighter but overall growth was not compromised.
* Placentas of exercising mothers are larger, more efficient, and healthier-looking.
* Infants born to exercising mothers were more alert postpartum and needed less consolation from others.

(All of these results are taken from Dr. Clapp's studies as reported in Exercising Through Your Pregnancy. See this fabulous book for even more amazing benefits.)

It blows my mind.

Imagine how huge the risk reductions would be if you exercised through pregnancy AND had a doula. Whoah. We can do so much to avoid the pitfalls of pregnancy and birth! It gives me so much joy and hope to know that I am not at the mercy of chance. I have a great deal of power over my circumstances when it comes to pregnancy and birth. It is a wonderful thing to be able to choose to pro-actively reduce risks and bring so much benefit to myself and my babies. I love it!

Some Birth Research Headlines

Courtesy of the Lamaze Institute for Normal Birth Research Summaries:

Prenatal Diagnosis of Suspected Fetal Macrosomia Increases Risks of Cesarean Section and Maternal Morbidity without Improving Newborn Outcomes

Sadeh-Mestechkin, D., Walfisch, A., Shachar, R., Shoham-Vardi, I., Vardi, H., & Hallak, M. (2008). Suspected macrosomia? Better not tell. Archives of Gynecology and Obstetrics, doi: 10.1007/s00404-008-0566-y.

"An initial suspicion that the baby is large may instill fear in the pregnant woman which may impede both her confidence in her body and her labor progress. Slow labor progress reinforces the suspicion that the baby is big and more aggressive management ensues. This management often hinders the woman's ability to move freely and assume the positions that may help her baby negotiate through her pelvis, further slowing progress and reinforcing the perceived need for surgical intervention. Based on this study and previous evidence, women should strongly consider refusing tests late in pregnancy intended to estimate fetal weight.

"The estimate itself may be bad for her health because the care provider's expectation that the baby will be macrosomic appears to increase both unnecessary medical intervention and the morbidity that may accompany it" (exerpt from the Lamaze Research Summary).

Women Having Spontaneous Vaginal Birth Without Episiotomy Least Likely to Experience Postpartum Pain

Declercq, E., Cunningham, D. K., Johnson, C., & Sakala, C. (2008). Mothers' reports of postpartum pain associated with vaginal and cesarean deliveries: Results of a national survey. Birth, 35(1), 16-24.

"One argument made for elective cesarean surgery is that it avoids the pain of labor. Its proponents also allege that surgery occurring before labor offers advantages over intrapartum surgery. This study, however, finds that women having cesarean surgery are more likely to experience pain that interferes with routine activities and to experience long-term pain than women birthing vaginally and that timing of the surgery makes no difference.

"Women considering elective surgery to avoid labor pain should be advised that while labor pain can be controlled, cesarean surgery substantially increases their risk of experiencing many months of pain postpartum or pain that affects their quality of life. Instrumental vaginal delivery likewise increases the probability of experiencing perineal pain in both the short and long term compared with spontaneous vaginal birth" (exerpt from the Lamaze Research Summary).

Prenatal Yoga May Result in Less Labor Pain, Shorter Labor

Chuntharapat, S., Petpichetchian, W., & Hatthakit, U. (2008). Yoga during pregnancy: Effects on maternal comfort, labor pain and birth outcomes. Complementary Therapies in Clinical Practice, 14(2), 105-115.

"This study provides evidence that regular yoga practice in the last 10-12 weeks of pregnancy improves maternal comfort in labor and may facilitate labor progress. The researchers offer several theories for these effects. First, yoga involves synchronization of breathing awareness and muscle relaxation which decrease tension and the perception of pain. Second, yoga movements, breathing, and chanting may increase circulating endorphins and serotonin, "raising the threshold of mind-body relationship to pain" (p. 112). Third, practicing yoga postures over time alters pain pathways through the parasympathetic nervous system, decreasing one's need to actively respond to unpleasant physical sensations.

"Prenatal strategies that help women prepare emotionally and physically for labor may help reduce pain and suffering and optimize wellbeing in childbirth by providing coping skills and increasing self-confidence and a sense of mastery. More research is needed to confirm the findings of this study. However, yoga's many health benefits and the lack of evidence that yoga is harmful in pregnancy or birth provide justification for encouraging interested women to incorporate yoga into their preparations for childbirth" (exerpt from the Lamaze Research Summary).

Enduring a mile (or a centimeter)

My husband ran the Boston Marathon last Monday, and I was so inspired by it that I decided I want to run it as well. So, yesterday, my husband and I decided to see how fast I could run a mile. We ran a warm-up mile at a medium-effort pace, and then I threw myself like crazy into the 2nd mile. It was misery. It was horrid. It was an intense mental tug-of-war between "I can do this! Keep going!" and "What was I thinking?! I have to stop!" But somehow I kept going.

This really does have something to do with birth, I promise... just hang with me. After finishing my run yesterday, I thought a lot about the experience. I speculated that it was probably like a mini-marathon--a condensed version of the marathon experience. And I also recognized that the same things that helped me to navigate the journey of childbirth also helped me to get through that mile (and would probably help me get through a marathon as well). Here's a play-by-play:

1) In the beginning, chatting works wonders. The first part of that mile, I kept telling my husband to "Talk to me!" When he was talking to me, running felt easier. The conversation was a welcome distraction--especially when it was about topics completely unrelated to what we were doing. The same was true in childbirth. Talking was extremely helpful through the early intense contractions (around 4 centimeters).

2) Eventually, chatting is not possible. Somewhere in the middle of my mile, a switch flipped. Suddenly I reached a point where I didn't want/need dialogue. I didn't want to talk. I couldn't formulate sentences or contemplate options. All I could think about was my own body and enduring to the end. Distraction was no longer helpful. Instead all words had to be pure fuel--encouragement, positive energy. I pulled into myself, but I could hear my husband's occasional words of encouragement: "You're doing awesome! You can do it!" Those simple statements carried me on. This was eerily similar to the way I felt as I navigated "transition" (7 to 10 centimeters dilation) giving birth to my daughters. The same things that helped me get through transition were the things that pulled me through that mile--minimal distractions and LOTS of quiet, gentle encouragement.

3) What you say to yourself matters most of all. In the midst of my misery, when I felt like I couldn't possibly push myself any harder or faster, I found my mantra: "The faster I run, the sooner I'm done." As soon as I spoke it out loud, I felt an instant surge of energy and was able to leap ahead, lengthening my stride and picking up speed for several yards. Whoah. So cool. The words you speak to yourself have so much power--for good or bad. Make those words only positive and you will find power within yourself to do anything--be it finish a mile or reach 10 centimeters in labor.

4) There's nothing more motivating than the finish. When my husband said, "I can see the finish!" I felt instantly encouraged, "You can?!" Thank the heavens!! Once the finish was in sight, I knew I could make it the rest of the way even though my strength was spent. This is much the way I felt when I had reached full dilation in labor and was ready to push--pushing was like seeing the finish line. Somehow the pain seemed less intense because I knew I was so close to the end.

Maybe all of this is self-evident, but I had fun drawing parallels between the experiences. It was fascinating to me, and helpful to recognize that I have done hard things in the past and found the strength to endure. I have given birth twice without pain relief. If I can do that, I can run a marathon. And, if you've ever done something difficult and intense like running a marathon (or even a mile), you can definitely get through childbirth. And, I guess, the ultimate point is... if you can find enough strength within yourself, you can do anything. Anything.

More evidence that prenatal exercise is a big win-win

Yahoo! News reports the findings of a recent study on maternal exercise. Dr. Linda E. May, one of the researchers involved with the study, explains:

"When the mom exercises during pregnancy, the unborn baby gets the same type of training effect that you would see in an adult - so you see the lower heart rate and also improved heart rate variability, which is evidence of improvements in the nervous system of the heart."

"Maternal exercise may be the earliest intervention to improve the heart of children and possibly the best."

Click HERE to check it out!

"Running for Two"

I just finished reading this great blogpost over at "Running for Two." Lisa is chronicling her first pregnancy as a runner and is nearing the finish. She draws a great analogy between the role of a "pacer" in an endurance race and a labor coach. Check it out!

Also, I've been skimming a book from the library--Exercising Through Your Pregnancy, by James F. Clapp. Based on the research presented by Clapp in this book, I'm totally convinced that exercising (safely) through pregnancy is one of the best things you can do for your unborn child (and yourself). I am definitely looking forward to exercising through my next pregnancy. Here are some of the benefits Clapp discusses:

* Limited weight gain
* Less physical discomfort
* More energy
* Easier, shorter, less complicated labor
* Newborns who "readily self-quiet" and "need less consolation from others"
* Some evidence that the children of women who exercise throughout pregnancy have heightened intelligence and oral language skills (as measured at 5 years of age).

Good stuff, eh? Have you had experience with any of these benefits of exercise in pregnancy? Please share!

P.S. It can be tricky to find active wear to accommodate a growing belly, but Fit Maternity will have you covered. Be sure to check out the support belts!

Tips for avoiding tearing and episiotomies

Giving birth for the first time was one of the most empowering experiences of my life. My water broke, my contractions started, everything progressed smoothly, and, less than six hours later, my baby girl was born. It was an ideal birth experience, except for one thing. That one thing made my next few weeks of recovery extremely painful. I tore. I really tore.

Despite the painful recovery, this was actually the lesser of two evils for me. Though some caregivers continue to cut episiotomies in as many as 80% of their patients, medical research does not support routine episiotomies. Studies from as far back as the 80s made it clear that routine episiotomies have no benefits and carry real risks. One of the most detrimental risks is that episiotomies can lead to further tearing, sometimes extending into the anus. These fourth degree anal tears almost never occur without an episiotomy. In addition, a spontaneous tear may only reach into the surface layers of skin, while an episiotomy cuts into far more layers. Episiotomies are rarely warranted and should be reserved for those unusual emergency cases. Ultimately, even without all the evidence, I just didn't want someone cutting me. I knew, going into my first birth experience, that if I had to choose between them, I would choose to tear. And, tear I did.

The best case scenario, obviously, is neither. The best outcome is a happy, healthy baby and an intact perineum. So how does a woman improve her chances of keeping her perineum intact?

1. Choose a midwife, or a doctor whose practice is evidence-based. The typical midwife's philosophy of birth is one of non-intervention. Most midwives tend to avoid episiotomy and are aware of the best positions and techniques to avoid tearing. I saw a group of certified nurse-midwives with my second daughter's birth, and was relieved to hear, at my first appointment, that 70% of their patients end up with intact perineums. I had only a very minor tear--what my midwife described as a "skid mark"--and my recovery was vastly superior to the first. If you choose to use a doctor, be sure that he/she practices evidence-based medicine, is aware of the research against episiotomy, and understands your desire to remain intact.

2. Exercise regularly. We all know exercise is beneficial to our health, but it's also beneficial to your perineal tissues. Women who are physically active are less likely to end up with episiotomies and are more likely to retain strong pelvic floor muscles post-partum. General exercise is great, but doing exercises specialized for the pelvic floor--"Kegels"--will not only strengthen those muscles, but also increase your awareness of how those muscles function so you can learn how to fully relax them for birth.

3. Have a doula present for your birth. A doula is a trained labor support professional. Research has shown that a doula's presence reduces a laboring woman's risk of requiring pain medications by 36% and forceps deliveries by 57%. Epidurals and forceps deliveries are both associated with increased incidence of tearing and episiotomies, so a doula is handy to have around when you're trying to stay intact. Doulas are the most highly rated providers of labor support and work wonders in improving women's birth experiences, so it won't just be your perineum that thanks you.

4. Deliver in an upright, hands-and-knees, or side-lying position. Research clearly indicates that the worst possible position for delivering a baby is the very position most hospitals direct women to take--on the back, legs stretched out wide, feet in stirrups. The best positions for avoiding perineal trauma are unconventional in most U.S. hospitals, but the evidence is clear. If you want to maximize your chances of staying intact, don't let hospital conventions hold you back. Be sure your caregivers know of your intention to deliver as you choose--upright, on your hands and knees, or on your side. Fortunately, the best positions for avoiding perineal trauma are also the ideal positions for a smoother, easier delivery, so you won't be sorry about breaking with convention.

5. Use "spontaneous" pushing rather than the conventional Valsalva method. Most women in U.S. hospitals are encouraged to take a deep breath, hold it for ten seconds and bear down--the Valsalva maneuver. Breaking with convention in this case is also beneficial for your perineum. Women who push spontaneously are more likely to avoid tearing. Spontaneous pushing typically involves shorter periods of pushing and more breathing in and out which promotes relaxation of the perineal tissues. A woman following her body's instincts and impulses will deliver her baby far more easily, efficiently, and painlessly than one who is being coached to disregard her body's guidance.

Episiotomies should be rare, and tearing isn't inevitable. Women who arm themselves with information and support can travel through birth uplifted, empowered, and intact. I, for one, intend to do just that the next time around.