Exercise during and after Pregnancy

Part of the midwifery model of care is that you have an obligation to do all you can to prepare yourself for delivering your baby.  Keeping your body fit is a big part of that. 

I try to exercise almost every single day (except Sundays), but when I'm pregnant I'm especially diligent about it. I have to be.  I have varicose veins BAD on both legs and when I don't exercise, those veins hurt and throb.  Doing some sort of cardio workout is essential every day to get my blood moving. And it makes a WORLD of a difference in managing my veins. (I'll do a whole post on my lovely veins later- I know, you can't wait!)

Now, when I say "workout" you may be envisioning me running, going to the gym, or pumping iron in my garage for an hour.  Umm...no. I don't do any of that.  I refer you to the picture at the top of this post.  That's a little more my speed, especially when I'm pregnant.

And that's fine. As long as I'm doing something, I feel great and my body feels great.  I don't have to kill myself to get that great feeling or to get results. I know a lot of people of all ages who run- they run for fun, they run marathons, they just love it.  I am not one of those people. I hate running. With a passion. I used to like going to the gym, but with so much going on in my life (read: 4 kids), it's a headache to try to figure out how to get myself there. Plus it can be expensive.  And I'm cheap. And lazy.  When my hubby gets home from work, the last thing I want to do is run out to the gym.  I want to be home, I want to to chat, I want to curl up with him and read a book or watch some Jimmy Fallon. We have a bowflex in our garage and try as I might, I can never consistently stick with it.  It's just too boring. And in the winter it's cold out there, and in the summer it's hot.  You get the point- I need to be doing something I like or it doesn't happen at all.  

So what works for me? A few things, actually:

Dance workout. For years I've had a playlist (that I change or update periodically) of music that I dance to. To add a little more intensity, I'll use a step-stool and some light hand weights for some of the songs, but mostly it's just me getting my groove on.  And I work up a sweat. And I love it! The great thing about this workout is that the intensity is flexible- I can really work hard and dance for awhile, or I can keep it shorter and do less intense songs.  But I always have fun, and that's why this workout has stuck  for years and years, pregnant or not. There's actually a few websites out there that list songs according to beats (of your heart) per minute. Just google "running songs".  But make sure you put on songs you like, or you won't be motivated to move!

Walking.  I love to walk around my neighborhood. We have lots of hills, and that makes it even better. A good, fast-paced, hour walk is one of my favorite workouts ever.  It clears my mind and rejuvenates me. Once, I passed two teenage girls that totally started snickering at me and my power-walking. And I just thought, oh, just wait, ladies.  Give yourself 15 years and you'll be right here with me!

Swimming. I'm not doing this right now, because it's still cold, but lap swimming is awesome, especially for us preggers. I swam competitively for years, and it's just a great whole-body workout that tones and gives you cardio at the same time.  Not to mention puts great all-over pressure on my varicose veins at the same time.

This next one is going to make me sound like an old lady.  But I love Walk Away the Pounds with Leslie Sansone.  There's a gazillion different ones, but the link shows you to the only one I have. I did it this morning. Sometime I'll try some of her other ones. This is one I only do  when I'm pregnant, or in those first few postpartum weeks.  It's a great workout to get you moving when, well, you can't seem to do a whole lot.  I grow out of this workout when I'm fully back in shape, but when I'm pregnant and/or postpartum, it's just what the doctor ordered.

Fit2B.us is a great online pilates/yoga studio. And it's super cheap (and modest!).  All their workouts are tummy-safe (plus there's lots of diastasis-awareness material on the website) and they have a whole section for new moms and pregnant ladies.  Eventually, I will grow out of this website too, but it's perfect for me right now.  Not just because I'm pregnant, but because I'm new to this whole pilates/yoga stuff. I actually started this a few months before I became pregnant.  Whenever I do a pilates workout on this site, I always follow up with a few back exercises.  Lower-back stuff is crucial, crucial, crucial.  Your tummy muscles need your lower back to be strong, and I've found that unless I'm taking care to do specific back exercises, my lower back can hurt after I have my baby.

For post-baby time, I like the book Baby to Bikini.  If you're one wanting a step-by-step, week-by-week program for getting back into shape after you have your baby, this one is a good place to start.  It gives you a plan for the first 6 months.  Simple but effective. I've never followed it for the whole 6 months, but it has given me a good understanding of what exercises are safe after baby, and what ones should wait.  Not to mention a whole slew of exercises to pick and choose from.

So that's it.  Nothing magical or too hard.  Even when I'm fully back in shape, I still don't run or go to the gym.  Because I hate those things.  Dancing & walking are my mainstays, then everything else changes according to what I feel like doing and what my goals are. Currently, I'm getting more interested in pursuing pilates and yoga and want to make that a bigger part of my overall workout plan, even more so after I have my baby.  I like hiking and biking, too, so sometimes those play into my schedule. Or I'll try out a workout video from the library or from youtube (youtube can be hard, though- I have 4 girls and do NOT allow skanky workout videos playing in my home.  So most youtube workout videos don't make the cut around here). Change it up and keep it fun and interesting. And don't be fooled into thinking you have be killing yourself or doing something you hate to benefit your body.  Nothing could be further from the truth.

A few postpartum words: find out what a diastasis is and how to check your tummy for it and heal it.  This is muy importante.  Do NOT do sit-ups, crunches or anything of the like until you get your tummy healed.  There's a lot out there now about diastasis, so go do some research.  Second, plan on splinting for at least a few weeks.  You can buy a splint (Fit2B.us has a few links to different ones) or just use a stretchy piece of long fabic (I've done this and it works great. I'm cheap, remember?).  When a woman has a baby, she should be handed a bunch of diastasis-awareness material along with all those free formula samples. Remember, there's  no reason why you can't look amazing after you have a baby! 

So go kill it, ladies!

Appointment #2

Yay! Heard my baby's heartbeat today! And just, for good measure, I recorded it. Excuse my belly.

That's a hand-held doppler she's using.  And it's my midwife's assistant, Tiffany, who is finding the heartbeat.  Baby was super cooperative- Tiffany found the heartbeat right away- so I rewarded him or her with a grilled Italian from Capriotti's. For the baby, of course.   Next up is my ultrasound in a few weeks! Whoo-oo! How does that work, you ask? My midwife, Sherry, refers me to an imaging center and the imaging center calls me and sets up an appointment.  My insurance will cover the cost of the ultrasound.  It was fun, too, to chat more with my midwife and get to know her better.  She's super cool, and we're definitely forming a friendship. 

I love getting my half-way-there ultrasound.  It's so exciting to see your baby and a) see that's it's growing alright and b) find out the gender.  We have four girls, so statistically, we're headed for another girl.  After you have three of one gender, it's not 50/50 anymore.  You're actually more likely to keep having the SAME gender. Wierd, huh?  So in about three weeks we'll find out if that's holding true for us or if we'll break the mold.  We're excited either way.  Although, if we end up with another girl I am SO calling my hubby Tevye (as in Fiddler on the Roof) or Mr. Bennet (as in Pride & Prejudice).  There are so many great Fiddler soundbites already rolling around my head....

A 31% C-section rate? What the heck, people?

So recently a friend shared this article about having a C-section on the source of all essential knowledge, Facebook. Never having had a C-section, I was fascinated and totally freaked out.  

Ok, so you just read it right? I realize this is just one lady's experience- definitely not the final word in how C-sections are.  As with any birth experience, it's a varied as we are as individuals.  

Before I go on, let's set the record straight:  C-sections save lives.  Of babies. Of moms.  There are so many birth scenarios that have turned out happy because of C-sections.  And I am grateful that should something go awry, this option if available to me to save my life or my baby's life. I know many women who had no other option; some knew they'd have to have a C-section from the get-go, while some had C-sections as a last-minute emergency.  And, thankfully, I get to have those wonderful people (and their cute kiddos) in my life.  C-sections are nothing short of a wonderful modern miracle! 

That said, a 31% C-section rate in this country is nothing short of embarrassing. (And to think it was less than 5% in the early 1970s!!)  Only 5.2% of planned homebirths end in a C-section at the hospital. Hate to say it OB/GYN's, but midwives are kicking your trash here. Really, we're supposed to believe that almost 1 in 3 births is an essential C-section? Let's take a look at a few facts:

• The WHO (World Health Organization) says that no country is justified in having a rate over 10-15%
   
• Rates above 15% have been shown to do more harm than good (Althabe and Belizan 2006)
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• Countries with the lowest rates, like Nigeria (1.8%) and Ethiopia (1.0%), are typically poorer third world countries without the facilities or medical sophistication to do C-sections for any other reason than a last ditch effort to save lives.  C-sections done in these countries also are much riskier to the mother and baby
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• Other industrialized nations have rates similar to the U.S's.  Almost all European nations have rates in the teens and twenties (Italy is the highest in Europe, at 38%, Finland near the lowest at 16%).  South America and several Asian nations have rates higher than the U.S. (Holy Cow, Brazil! You're at 45%!) This C-section epidemic isn't unique to our nation.

  (These figures are from a 2010 study by the WHO, see the whole thing here- scroll to the bottom to see the tables). 

So, what's going on?  This article outlines a few reasons for the crazy rates. (And this isn't some hippy article, by the way. It's intended to be read by health care professionals and patients alike. Check it out for yourself.) In summary, it says:

• Low priority of enhancing women's own abilities to give birth: "Care that supports physiologic labor, such as providing the midwifery model of care, doula care providing continuous support during labor, and using hands-to-belly movements to turn a breech baby reduces the likelihood of a cesarean section" Side note- I've heard a lot of wonderful things about CNM's (certified nurse midwives- they usually work under an OB/GYN) that deliver in hospitals that have embraced this midwifery model of care, to the benefit of their patients. Many are supportive of the presence of doula's, the desire for a natural birth- and even water births in some cases.
• Side effects of common labor interventions: "Current research suggests that some labor interventions make a c-section more likely" (i.e. labor induction for a first-time mom)
• Refusal to offer the informed choice of vaginal birth: "...many women with a previous cesarean would have liked the option of a VBAC, but did not have it because health professionals and/or hospitals were unwilling (Declercq et al. 2013)"  Side note- according to the Mayo Clinic, 75% of VBACs are successful. Them good odds, ladies.
• Casual attitudes about surgery and variation in professional practice style: "Our society is more tolerant than ever of surgical procedures, even when not medically needed."
• Limited awareness of harms that are more likely with cesarean section: "Cesarean section is a major surgical procedure that increases the likelihood of many types of harm for mothers and babies in comparison with vaginal birth."
• Incentives to practice in a manner that is efficient for providers: "Many health professionals are feeling squeezed by tightened payments for services and increasing practice expenses. The flat "global fee" method of paying for childbirth does not provide any extra pay for providers who patiently support a longer vaginal birth. Some payment schedules pay more for cesarean than vaginal birth. Even when payment is similar for both, a planned cesarean section is an especially efficient way for professionals to organize their hospital work, office work and personal life. Average hospital payments are much greater for cesarean than vaginal birth, and may offer hospitals greater scope for profit."  

 So that last reason- for profit- really irks me. What the heck, medical professionals? That feels a little like a betrayal.  Whatever happened doing what's in the best interest of your patients, not your vacation schedule? You're going to subject a patient to a whole slew of new risks because you want to speed up their delivery and get a fatter paycheck? Not cool, people, not cool.

Again, I recognize that C-sections save lives.  Lots of lives. But only in about 5-10% of cases. Heck, for all I know this pregnancy might end in a C-section. And that's okay. If that happens, I will feel that I am in that 5-10%. And at least I won't be wondering if I was just taking 'too long', and my doctor had a hot date to get to.