Exercise in Pregnancy

MYTHS vs FACTS

There is a lot of confusion about exercising in pregnancy and even some providers counsel patients incorrectly. Many women get their information from magazines or friends as opposed to their provider.  Here are is what ACOG (American College of Obstetricians and Gynecologist) and the US Department of Health and Human Services say about Exercising in Pregnancy.

Myth #1 Pregnant women should not excede a heart rate over 140 beats per minute.

FALSE: This restriction was removed from ACOGs guidelines in 1994.

Myth #2 If I wasn't exercising before I got pregnant, I shouldn't begin to exercise now.

FALSE: Healthy pregnant women should begin or continue easy to moderate activity for 150 minutes per week (approx 20 minutes everyday or 35-40 minutes 4 x a week).  This is when a woman should consult with her provider to determine if she is healthy enough for exercise.

Myth #3 Even though I vigorously exercise regularily, I should cut back in pregnancy.

FALSE: Women who exercised vigorously can still continue to exercise vigorously.  Some restrictions may need to be made on the type of activity. See a previous post on Activities in pregnancy.

The Dos & Don'ts of Pregnancy

The internet abounds with Dos and Don'ts of Pregnancy. This list was complied with the advice of experts. Always check with your provider regarding activities in pregnancy.

Activities to Avoid in Pregnancy

X-Rays and CT Scans - unless absolutely medically necessary.
Sonograms and MRI's are the imaging technique of choice in pregnancy.

Amusement Park Rides

Downhill Skiing or Snowboarding

Scuba Diving

Surfing or Intense Water Sports

Waterskiing

High Intensity Contact Sports: hockey, water polo, football, rugby

Gymnastics

Flying after the 35^th Week (earlier in some cases)

Extreme Sports: mountain biking, hang-gliding, rock climbing, kayaking, sky diving, etc

Horseback Riding

Saunas, Steam Rooms, and Hot Tubs

Extreme dieting in Pregnancy

Gardening without Gloves

Changing Cat Litter

Retinols or Retin-A creams

Botox sorry :(

Activities that are Safe in Pregnancy

Jogging and Running*

Swimming*

Low Impact Aerobics*
Snorkeling

Body Waxing

Intercourse - at any point in an uncomplicated pregnancy unless membranes are ruptured

Dental and Eye Exams - inform your provider you are pregnant

Manicures and Pedicures

Massages

Vacations at High Altitudes

Attending a Rock Concert

Prenatal Yoga & Pilates

Acupuncture, Chiropractics & Alternative Medicine Techniques - most are safe, inform the provider you are pregnant 

*It is always advisable to discuss your daily activities or planned activities during your pregnancy with your heath care provider. 

Tip Tuesday: Learning How to Relax

Relaxation is actually something that many people must learn. There are several ways to learn how to relax: meditation, guided imagery, even dance and moment classes can all teach relaxation. Relaxation is about learning how to control your mind and body. Some relaxations exercises involve tensing and relaxing of each muscle group in a coordinated series. Some ways to relax include breathing or rhythmic movements. Others can even involve hypnosis.  Practice relaxing so that you are very comfortable with your ability to relax yourself.  If you find it difficult, consider taking a yoga class, talking to a health care providers, or reading material on relaxation to get some technique tips.

Tip Tuesday: Write it Down

As you think about your birthing experience, write it down. Visualize how you see the labor and delivery experience progressing and your own reaction to what happens. Keep in mind, while the timing of labor can be unpredictable, a lot of what happens once labor starts can be steady, calm and reassuring.  Write down where you will be, who will be with you and different birthing scenarios as well as a the perfect dream scenario.  While we can't always "plan" for birth, we can "try on" different scenarios.

5 Tips to Tackle Pregnancy Fatigue

1. Get more sleep. Pregnant women battle fatigue from early on in the pregnancy. It's important to listen to your body and get adequate rest when possible. Even going to bed 10-15 earlier or waking up 10-15 minutes later can make a big difference.

2. Exercise. As impossible as it seems, exercise is an excellent way to fight fatigue.  Even as little as 15 minutes a day of aerobic exercise can help to decrease fatigue.

3. Healthy Foods. Foods can act like medicine. Unprocessed, healthy foods can improve stamina and decrease tiredness.

4. Fluids. Staying hydrated and drinking plenty of fluids can increase energy.

5. Take vitamins. B complex vitamins boost energy if consumed daily. Also continuing to take a prenatal vitamin or other vitamins that are prescribed can help fight fatigue related to anemia or a vitamin deficency.

Hydrate Naturally

Pregnant women go though several physiological changes during pregnancy. As a result of these changes, they can dehydrate quickly, especially in the summer. Dehydration can happen rapidly in women at any gestation. It can even happen to women who are generally well hydrated and have great diets. A lot of pregnant women will drink water to hydrate, which is great, but if a woman feels dizzy, weak, or is having several bouts of braxton hicks contractions, she may need to drink something containing electrotypes. While Gatorade, Poweraid and Vitamin water offer a great sources of electrolytes, they can also have excess sugars or artificial sugars. Here are some great, natural alternatives to helping women stay hydrated in pregnancy.


Coconut Water: The water found in the center of a coconut is rich in electrolytes and low in sugar. Some like to drink it mixed with other fruit juices likes pineapple or orange.

Mangosteen juice: This fruit comes from Southeast Asia and is very high in antioxidants like xanthones.  It is a popular drink as part of alternative cancer therapies and also has been shown to inhibit the growth of bacteria. It's low in calories and sugars.   

Noni Juice: Also low in calories and a bit bitter is high in antioxidants. It comes form the South and North Pacific Islands of Polynesia and Indonesia. It's also been said to boost immunity.

Goji Juice and Acai- Similar to mangosteen, Goji and Acai. They are high in antioxidants and low in sugar. Goji comes from the Himilayas. Since it does not contain carbohydrates, it is low in sugar. It also has chlorophyll that aids the body in cellular production and helps fight anemia.   

Aloe vera - Aloe vera is a long healing ago healing plant that was used for all kinds of treatments. It is great for soothing the digestive tract and aiding in heartburn and indigestion or irritable bowels. It also has cancer fighting and diabetes fighting properties. It is aslo great for the skin, hair, and nails.

 So drink up, gals and hydrate naturally!

Pregnancy Power Salad

Jicama Pomegranate Salad

When I'm pregnant I can't get enough salad, especially in the summer. So I've complied a few of my favorite pregnancy super foods to make a super yummy pregnancy power salad.

• 1 small head of romaine cut with a knife
• 2 cups of raw spinach
• 10-14 walnuts loosely crushed
• 1 jicama, peeled and julienne
• 1/2 cup of pomegranate seeds
• 2 hard boiled egg whites chopped

** You can also add avocado, chunks of corn or mandarin oranges


Lime vinaigrette

• 1/4 cup fresh lime juice
• 1/4 cup apple cider or red wine vinegar
• 1/2 teaspoon salt
• 1 tablespoon honey or agave
• 3 tablespoons olive oil, avocado oil, walnut oil, or brown rice oil

Place the chopped romaine and spinach in a bowl and drizzle the dressing to taste. Cover with jicama, walnuts, pomegranate seeds and egg whites and enjoy.

Fetal Kick Counts

After the 28th week or the third trimester, a woman may become increasing aware of the baby kicking in the womb.  Before this, some women don't even feel the baby moving until the 20th week and it can be different with each pregnancy.  In general, I usually counsel a woman that she should  be aware of the movements regularly throughout the day,  paying attention that she perceives a grouping of movements in the morning, afternoon and evening. Babies can be active at different times of the day and usually by the 28th week,  a woman will gain a sense of what a normal amount of movement is for her baby.  Counting can be very helpful if she perceives a change in the frequency or a decrease in fetal movements.  Fetal movements are a great predictor of fetal well being and fetal kick counts is a way to quantify fetal movements.  Other reasons to do fetal kick counts are if a woman's provider instructs her to do so, she has a medical indication in which they are recommended, it's something she enjoys, or she feels a sense of calm and reassurance by doing so.

How to do fetal kick counts:

• It is best to count while sitting or resting.
• The woman should place her hands on her belly and time how long it takes her to perceive 10 kicks.
• Without being distracted, a woman should perceive 10 kicks in 1-2 hours.
• If after 30 minutes of waiting, a woman does not perceive movement, she should walk, change positions, drink something cold or have something sweet to eat.
• If there is any concern regarding the amount, frequency or quality of fetal movements, a woman should contact her provider for counseling. 
• The proper way to do fetal kick counts should always be reviewed with an obstetrical health care provider.**

• There are apps for smartphones and mobile devices that can be helpful  
• Baby Kick Counter and Wiggle Wrecorde

• Or check out this link for a handy chart.

The Birth Plan

It's true, there is a common belief among labor & delivery nurses and obstetricians that birth plans lead to the BIG ROOM, aka the operating room. While this stereotype is entirely unfair (as many stereotypes are), in their defense, I think it may be that a few women who "birth plan" sort of ruined it for the rest, by zealously typing up binders full of planning and structuring for their exact, idyllic birth.

The birth plan, theoretically makes sense. Planning in any situation usually makes that situation less stressful and more enjoyable. That's the funny thing about the birth plan - you can't! And birth often is more than idyllic without adhering to a plan.

The best way to "birth plan."

1) Prepare. Prepare for the unexpected. Labor will most likely begin at an unexpected moment. Pack ahead of time and have plans for different scenarios with work, transportation, and childcare (if needed). Tour the facility where you plan to give birth.
2) Communicate. Talk to your partner and your provider about what your preferences are for the birth. Ask your provider about what you expect and any protocols at the facility where you will give birth. A lot of your preferences may be what your provider already practices like skin to skin and not performing episotomies.
3) Trust. Trust your body and your ability to birth. Trust your provider to have your interests at heart. Trust your provider to take your preferences and make them happen whenever possible.
4) Be flexible. Plan to go with the flow
5) Relax and enjoy. As much as possible, try to relax and enjoy the birthing process.

Filling out a birth plan or a list of preferences can be a good way to go over your preferences with your provider.  In the birth setting, it can prevent you from having to constantly repeat yourself.   Keep it brief and relevant.

Headaches in Pregnancy

Headaches in pregnancy are common and can happen at any stage. They do tend to be more common in the first trimester, up to 20 weeks. Here is a great overview of headaches in pregnancy.

HEADACHES 

What causes them?

Hormonal changes

Nasal congestion

Allergies

Hunger (low blood sugar)

Fatigue

Lack of sleep

Food triggers

Eyestrain

Tension

Stress & anxiety

Caffeine withdrawal

TMJ or Jaw tension

What to do about them?

Avoid triggers such as MSG and artificial sweeteners

Teas, coffee, wine and nuts have tannic acid which trigger headaches

Aged cheeses and added nitrites to meats can be triggers

Stay hydrated with lemon water

Talk a warm shower

Place a hot compress on the temples or over the eyes

Take a warm bath

Exercise to increase circulation

Drink a caffeinated beverage 

For congestion try inhaling steam or a warm compress over the sinuses

For tension, anxiety or stress get a massage

Wear a mouth guard at night

Consider acupuncture or acupressure

  The vitamin supplement magnesium has been associated with lower headaches in pregnancy*

Tylenol, as recommended on the bottle, is safe for most pregnancies*

Links

American Pregnancy Association

Mayo Clinic

*You should always discuss your pregnancy symptoms with your provider at each visit, including headaches.  Any severe headache, blurry vision, or floaters should be reported to your provider right away. Always consult your provider before taking any medications, supplements, or herbs in pregnancy.

Midwives as a Status Symbol

New York Times Article Click Here

Midwives as a Status Symbol

Are we really the next pooch in a prada or a Buggaboo stroller?

The NewYork consumer has changed, but so have we; and, so has New York herself.  Nowadays, most of us have higher education degrees and are delivering in the hospital as well as the home. It wasn't until 1992 that we were legally prescribing medication in New York and 2010 that we were able to legally practice independently.  New York trusts us, while we have the outcomes and education to support why she should.  In addition, we happily provide care for the "hippy-dippy spiritual birth," but we also provide what many women want: simple and supported, natural hospital birth.

Natural Hospital Birth

At the risk of being a groupie, I just have to mention how excited I am by Cynthia Gabriel's book Natural Hospital Birth, The Best of Both Worlds.
In America, we are so unindated with compromise and moderation.  We have business class, crossover SUVs, and 2% milk, but when it comes to birth we have been black and white for a long time,  Cynthia's book, however,  is an anthem to the 50 Shades of Grey natural hospital birth allows us.

I'm elated that this middle of the road option is also being applied to the birthing room.  I mean, where would America be without the middle class? Women no longer have to choose between the two extremes of home birth or overly defensive hospital birth, armed only with a birth plan and a semi-supportive, annoyed practioner.  We are seeing all types of women, providers, and births in the hosptial setting. It's darn well about time!

Amazon link to the book

The Importance of Kegels

Kegels - Never to be Underestimated

I feel I can never stress enough the importance of doing Kegels.   After a recent gal pal date, over coffee, I realized "do your kegels" is the "monthly self-breast exam" and "practice safe sex" women's health motto for this new decade. 

We, as women, do Kegels to prevent complications that arise with the pelvic floor from age, regardless of whether or not we had children.  These complications can include urinary incontinence, urinary urgency, pain during intercourse, pelvic organ prolapse, and uterine or cervical prolapse.

Ok, but what are Kegels?  The Kegel muscles are the group of muscles that make up the pelvic floor. Kegel exercise are the subsequent exercise that strengthen these muscles.

How do I do Kegels? The best way for women to do Kegel exercises is to imagine they are trying to pick up a marble with their vagina.   Another way to know a woman is doing them correctly is to try to stop the flow of urine. They can be done in any position (sitting, standing, lying).  They should be done in 3-5 times a day for 10 reps each set.  Pilates exercises are known for consistently engaging the Kegel muscles.  Most women need 3-4 weeks before they will begin to see improvement.

Benefits in Pregnancy. Kegels can also be beneficial in pregnancy and labor and delivery, as a strong pelvic floor offers the pregnant woman more support during pregnancy and more strength in delivery. 

Some resources:

 The Mayo Clinic Guide to Kegels a step-by-step guide to exercising the pelvic floor.

Kegelmasters - Like lifting weights for the pelvic floor. Products that provide resistance and increased strength training.

Light Bladder Leakage - information about light bladder leakage and it's link to menopause.

8 Foods Pregnant Women Should Eat

Almonds: These nuts are less allergenic than their cousins the peanuts, cashews & macadamia nut.  They are  high in folic acid, fiber & B vitamins have a low glycemic index. They are high in vitamin E, which can help with vascular health. Their fat content make them a great snack, which helps you to feel satisfied. Try a 20-30 almonds as a snack.

Chia Seeds: A What? Exactly. This is becoming a more popular food in healthy eating circles.  Chia seeds are the ultimate vegetarian source of omega-3 fatty acids, important for brain and eye development. They have 5000mg per ounce.  They are high in fiber and contain a moderate amount of protein (4g in 1oz). In addition, they contain minerals like potassium, phosphorus, calcium and manganese.

Cherries:  These berries are often overlooked as a superfood. They are the right color to give that rich antioxidant boost and are high in fiber and vitamin C.  They also have natural melatonin which can  aid with insomnia in pregnancy.

Chickpeas: An overlooked legume.  These beans are a great source of protein and also are high in folate.  They can have 15g of protein per cup. They also are a great source of minerals like selenium and zinc.  So eat up that hummus.

Eggs: One egg has every single essential amnio acid we need.  It's one of the very few dietary sources of vitamin D and also contains vitamins A, B6, B12, E, chlorine, iron, calcium and folic acid.  One egg has approximately 12g of protein.  Need I say more?

Flaxseeds: Known primarily as a great vegetarian source of omega-3, flax actually have less omega-3 than the chia seed, but many other wonderful properties. Flax has ligands which help balance hormones and can help stabilize mood swings in pregnancy.

Mushrooms:  Especially types like Shiitake are a great low calorie highly satisfying food. They are  high in several minerals such as: selenium, copper and potassium. They can be helpful in reducing inflammation in pregnancy

Yogurt:  There is just no getting around how wonderful yogurt is.  All natural, no sugar added, live culture yogurt is high in lactobacillius which quells yeast (a common complaint in pregnancy). Many types of yogurt are high in protein as well as calcium. The list of medicinal benefits is vast: decreased muscle cramps, promotes skeletal growth, decreases inflammation, aids in digestion, improves skin, decreases nausea.

Let them eat fish! Just not BIG ones.

Mercury is found naturally in our environment. Most commonly as a liquid or a gas. We are exposed to it through the dental work in our mouths, the food we eat, mainly fish, and until recently, vaccines. While the body is capable of eliminating mercury from the body, it should only be consumed in tiny amounts.

But we love fish and maybe aren't so crazy about the saturated fats in pork, beef, and chicken.  Fish are a great source of omega 3s, the B vitamins and protein which are so essential to the developing brain of a fetus.  So to aid with the confusion, I've added a link below which clearly charts what is suitable for a mother-to-be.

Here is a great resource from the American Pregnancy Association about types and amounts of fish suitable for pregnancy. 

Click here.  

Seems fish isn't such a catch 22 after all.

Food Avoidances in Pregnancy

Deli Meats: luncheon meats (including deli meats such as ham, turkey, salami and bologna) unless they are reheated until steaming hot. They can be contaminated with listeria.

Smoked Meats - Refrigerated, smoked seafood often labeled as lox, nova style, kippered, or jerkey along with pate may also contain listeria. Canned meats or shelf-safe meats are ok. Some smoked meats may also contain nitrates or nitrites.

Unpasteurized milk or cheeses: Brie, Camembert, Roquefort, Feta, Gorgonzola and Mexican style cheeses that include queso blanco and queso fresco can be unpasteurized. Check the labels. Again, listeria and other bacteria are the concern. If it says it is pasteurized, it is ok. Unpasteurized milk is very hard to come by in most states, mainly found on farms.  Unpasteurized is overall not recommened in prengnacy, however this milk can be safe and even good for you if you are sure if is free from contamination from bacteria and know the source.

Fish with high levels of mercury: A sample of these types of fish include: shark, swordfish, king mackerel, and tilefish. See a complete list here.

Nitrates - While controversial, some providers recommend avoiding or limiting nitrates to a few times a month.  Specifically, nitrates found in hot dogs, cured meats like bacon and ham, or smoked meats. Check labels.


Raw Eggs: Homemade caesar dressings, mayonnaise, cookie dough, homemade ice cream or custards, and Hollandaise sauces may be made with raw eggs.

Caffeine most studies show that caffeine intake in moderation is OK. As a general rule, caffeine should be limited to fewer than 300 mg per day during pregnancy. Depending on the strength, an 8-12 oz cup of coffee has roughly 150 mg of caffeine. 

Alcohol There is NO amount of alcohol that is known to be safe during pregnancy, and therefore alcohol should be avoided during pregnancy.

Smoking Should be completely avoided in pregnancy as well as exposure to second-hand smoke.

Over the Counter Drugs Tylenol is safe to take in pregnancy, as recommended on the bottle. Any other medication should be discussed with your heath care provider.

*All dietary changes, restrictions and conditions should be discussed with your health care provider.