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. 

Midwifery Model of Care

Often, I am asked about how midiwves care for women differently than other obsterical providers.  And while, it's different midwife to midwife, there is the basic Midwifery Model of Care that I'd like to share as a fundation for why we are different.

Midwives Model of Care™

The Midwives Model of Care™ is based on the fact that pregnancy and birth are normal life events. The Midwives Model of Care includes:

·       monitoring the physical, psychological and social well-being of the mother throughout the childbearing cycle

·       providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support

 

·       minimizing technological interventions and;

·       identifying and referring women who require obstetrical attention

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.

5 Things to think about before choosing an obstetrical provider.

Routine gynecological care can be just what it is. . . routine. But when the time comes to choose whose hands will be the first to caress your little infant child, the choice in provider becomes ever so much more important.  Luckily, in most locations in the United States, women have a choice.
First off, yes intuitive sense or the feeling you get is one of the best ways to size someone up.  There also are some other things to consider.

1) What is your provider/group's cesarean rate? 
The cesarean rate in the United States is 32% (NY Times article) and even higher is some states like New Jersey (38%) and Florida (37%).  The World Health Organization recommends a cesarean section rate of 15% and it's completely acceptable to expect your provider to have a cesarean section rate around 18-20%.  States like Alaska and Utah boast rates of 22%. 

2) What happens when your provider is unavailable, goes on vacation, is sick, or has a special event?
Most providers have a "back-up" physician or midwife that covers their patients and deliveries while they are away.  It is helpful to know who that person would be and to see if you are comfortable with that provider.  Some physicians don't routinely work weekends or certain days of the week like Mondays, so ask.

3) How far away from the hospital, birth center or your home does your provider live?
If your doctor lives 60 minutes away and your last labor was 1 hour, then you may want to consider someone else.

4) How does your provider/group feel about induction?
Induction is something that most women don't think will happen to them, until it does. Induction can increase a woman's likelihood of having a cesarean as well as increase her need for medication interventions. There are several reasons why a woman's labor may be induced: Postdates or 42 weeks; rupture of membranes without labor; convenience or size of the baby. It is helpful to know your providers stance on induction, induction rates and flexibility on induction policies.


5) How many deliveries does your provider do in a month/year?
This can be helpful to know so you can see how available they will be for you when you are in labor. If someone does 30 deliveries a month, practicing solo, they may very well have someone else in labor at the same time as you.