How to Get Healthy and Stay Healthy During Pregnancy

 

maternity-pictures-1_carmenhibbinsEach woman arrives at a new pregnancy from a different starting point. One woman may have planned for months to get pregnant, taking vitamins, eating healthy, and exercising. Another might be classified as medically obese and is worried about how that will affect her pregnancy—should she lose weight or focus only on eating healthy? While yet another may have, not intending or wanting a pregnancy at the time, been drinking heavily or using illicit drugs. Of course, most women are somewhere in the middle. Ultimately it’s most important that a woman work at getting as healthy as possible, so that she and the baby have the best outcomes.

So how does a woman who is already pregnant get healthy and stay healthy? And what are the risks if she isn’t healthy?

Lets look at the central tenets of a healthy pregnancy:

Good nutrition

Eating right helps to build a strong and healthy baby, and it helps the pregnant mom as well. A healthy diet can help to prevent high blood pressure, preeclampsia, gestational diabetes, and premature labor. A healthy diet can help to ensure against the baby growing too big, which could lead to a difficult birth.

Earlier this past year, we outlined a healthy diet for pregnancy. Be sure to eat plenty of protein and whole grains, and focus on color and variety in your fruits and vegetables during pregnancy. Good sources of protein include meats (limit seafood because of the high mercury content in many sources of seafood), dairy, eggs, nuts, beans, and seeds. And the less processed and milled the grains, the better. Drink plenty of water and salt to taste. Eat small, nutritious meals often. And, most of all, limit sweets and high-sugar-content food and drink.

A good prenatal vitamin is important for a healthy pregnancy as well. Prenatal vitamins are specially formulated for a pregnant woman’s needs. In particular, the pregnant woman needs at least 400 mcg of folate (higher if a BMI over 30) and Vitamin D. Folate in the first trimester helps the baby’s developing nervous system and strengthens the mom’s immune system. Vitamin D also helps with the mom’s immune system and helps the baby to develop strong bones and teeth before and after the birth. Vitamin D can be continued postpartum and can help to decrease the risk of postpartum blues.

What if a woman has a high BMI when she finds out she’s pregnant? There is no evidence that dieting to lose weight is good for mom or baby. In that case, she should focus on the healthy pregnancy diet, balancing the pregnancy needs for quality protein, whole grains, and plenty of fruit and vegetables. Many women who struggle with weight before pregnancy discover that eating healthy for the pregnancy helps them to maintain a healthier weight during and after the pregnancy. Most moms-to-be who have a higher BMI at the start of pregnancy can expect to enjoy a healthy pregnancy.

Exercise

Exercise helps the pregnant woman prepare for birth by strengthening and toning her body. It can also help to manage weight, and, combined with a healthy diet, can lower the risk of giving birth to a large baby. The adage is that if a woman already has a regular exercise practice, she can continue the practice. But, if the mom is new to exercise, low-impact exercise with a gradual endurance plan is just as beneficial.

The shift in the woman’s center of gravity and increase in joint laxity can make exercise more challenging. Water sports, such as swimming or low-impact water aerobics, can help support the pregnant woman’s body. Mild exercise in general can help the woman meet the greater oxygen demand that pregnancy creates. However, too aerobic of an activity can decrease her oxygen consumption and lower her overall oxygen volume. Ultimately, exercise can make pregnancy more comfortable and shorten the woman’s labor, and even reduce the need for interventions.

Exercise can also:

  • Reduce back aches
  • Reduce constipation, bloating, and swelling
  • Boost energy levels
  • Help with mood
  • Help with sleep
  • Prevent excess weight gain
  • Promote strength and endurance, which in turn helps the mother in childbirth

If the pregnant woman hasn’t exercised in awhile, but would like to add an exercise routine during pregnancy, she should start slowly, beginning with five minutes and building her endurance by five minute increments until she reaches a thirty minute practice.

What exercise should be avoided during pregnancy? Some forms of exercise are not advisable, such as:

  • Exercise that forces you to lie flat on your back after the 1st trimester
  • Scuba diving, which puts the baby at risk of decompression sickness
  • Water skiing, surfing, and diving, which cause you to hit water with a great deal of force
  • Contact sports such as ice hockey, basketball, volleyball, or soccer
  • High altitude exercise (less oxygen for you and the baby—and risk of altitude sickness, which causes headache and nausea)
  • Any activity that could cause direct trauma to the abdomen, like kickboxing
  • Hot Yoga or Pilates
  • Sports with a high risk of falling, such as downhill skiing, gymnastics, or horseback riding at fast speeds

A regular exercise practice during pregnancy can lead to an exercise practice postpartum, which can help the new mom shed weight and regain muscle tone and strength for her non-pregnant body. Exercise should be avoided for the first month while the woman establishes breastfeeding and recovers from the birth.

Education

In addition to prenatal counseling with a maternity care provider, there are several ways a pregnant woman can educate herself about pregnancy and childbirth:

Childbirth education (CE) classes

CE classes can help the pregnant woman stay focused on pregnancy-specific issues, such as nutrition, lifestyle practices, and preparation for childbirth. Some options for childbirth education classes include: Hypnobirthing, Birthing From Within, Bradley, Lamaze, Birthworks, Centering Pregnancy, Sacred Pregnancy, and others. Local doulas and midwives often have extensive lists of local childbirth education providers, and some midwives offer childbirth classes at birth centers and in their communities.

Books

Books are a powerful way for the pregnant woman to prepare for birth and to learn coping mechanisms for the changing nature of pregnancy. Some favorites include: Spiritual Midwifery, Ina May’s Guide to Childbirth, Diary of a Midwife, Birth Without Violence, Birth with Confidence, and Homebirth Cesarean. There are also literary memoirs about pregnancy and birth, and pregnancy loss that can be powerful and impactful narratives, depending on a mother’s perspective and needs.

Documentaries

Documentaries about pregnancy and childbirth often include interviews with experts, snapshots of individual women’s labors, and commentary on an overall maternity care system. Documentaries, if appropriate, can help children understand an upcoming birth and help pregnant women (and couples) make decisions about what they most want from the birth experience. Some of the better documentaries include The Business of Being Born, Orgasmic Birth, The Face of Birth, Birth Into Being: The Russian Waterbirth Experience, and Pregnant in America. Check out this TED talk by Ina May Gaskin, the international childbirth luminary midwife.

Support

Rhea Dempsey writes about the “circles of influence” that surround the pregnant woman—from friends and family to the wider culture. These circles ultimately impact the woman’s pregnancy and birth experiences.

The people with whom the pregnant woman surrounds herself make a big difference in how healthy, physically and emotionally, the woman will be during pregnancy. The following are important questions to ask:

  • Is the pregnant woman’s home a safe place?
  • Does she have emotional support?
  • Is she more concerned with the anxieties and fears of her mother, her sister, her husband, her friend, than her own?
  • Is the pregnant woman able to decide how and where she wants to birth based solely on her needs and wants?
  • Is her maternity care provider supportive of her wishes?
  • Can she ask questions without fear of belittlement or of her fears being minimized?
  • Does she have access to healthy food and clean water?

A healthy pregnancy hinges on physical elements such as a safe place to live, the opportunity to exercise, access to healthy food and clean water, and good prenatal care, but it also hinges on emotional health, and support is central to a pregnant woman’s emotional health. Support often means more listening than talking, and support means something different for every woman. And, ultimately, after pregnancy, the birth is most about the woman and her baby, not the people who surround her. Sometimes the best support is the most minimal support, support that allows the woman to decide how she wants to birth and who she wants to support her during the birth.

Getting healthy during pregnancy will mean something different for each woman. For instance, a woman who struggles with alcohol and drugs may need to first focus on addiction recovery. After she is clean and sober, she can move on to good prenatal care and nutrition, as well as creating a circle of support that is healthy and best for her and the baby. For a woman who doesn’t have good nutritional habits, getting healthy may mean focusing solely on nutrition and exercise. And for a woman who lives in an unsafe home, getting to safety may be the first step toward a healthy pregnancy.

Focusing on the main tenets of a healthy pregnancy will help a woman get healthy and stay healthy throughout pregnancy, with great benefits to both mother and baby.

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What it Means to Have a Powerful Birth Experience

IMG_2894When a woman first discovers she’s pregnant, the birth can seem distant, an event that happens at the very end of pregnancy. There are nine months to get through first. She knows the birth will be something big, but it’s still a somewhat abstract idea—and maybe even a little scary. She can prepare by taking childbirth education classes or by asking her maternity care provider questions, but the real truth is that every birth is unique—and unpredictable.

Juliana Fehr, author and midwife, often teaches mothers and care providers about the three Ps of childbirth: passenger, pelvis, and powers. The first, passenger, refers to the baby: its position, its size, its vital signs, its presentation. The pelvis refers to the passage through which the baby travels—the mother’s pelvic type and the birth canal, including the cervix. And, finally, powers, refers to the condition of the uterus, such as uterine contractions and other physical indications of active labor. Looking at birth from a systems perspective, it’s clear just how variable each birth experience can really be.

After giving birth many women speak of the power of the birth process or of feeling empowered and more confident after learning just what their bodies are capable of accomplishing. Natural birth advocates often discuss unnecessary interventions as potential disrupters of a powerful birth experience. Unnecessary interventions, like an epidural, can interfere with a woman’s ability to feel and accurately discuss her contractions and some interventions can interfere with beneficial hormones that are released in a natural birth. Unnecessary interventions can invite more complications and more interventions—a cascade effect.

But what if something goes wrong with the three Ps of labor? What if the baby is in distress or has a difficult presentation? What if the passageway is obstructed in some way, or the powers are working not with, but against mom or baby? What if intervention is necessary? Can a mother still feel empowered/powerful/confident? What does having a powerful birth experience really mean?

The Oxford English dictionary defines empowerment as the process of becoming stronger and more confident, especially in controlling one’s life and claiming one’s rights.

It’s easy to see why a woman’s birth experience can both empower and, potentially, disempower her. Some women who go through a disappointing or complicated birth report the birth experience as traumatic. Researchers are only just now recognizing postpartum PTSD as its own classification. Previously women experiencing postpartum PTSD were misdiagnosed with postpartum depression, an equally serious condition requiring treatment. But, like soldiers returning from war with PTSD, women who are traumatized by their birth experiences, experience flashbacks, triggers, and live in a perpetual fight-or-flight state. In 2015, the Atlantic Magazine ran a story on postpartum PTSD, pointing out that up to 17% of new mothers might experience some form of postpartum PTSD. A woman’s birth experience is something she never forgets.

Women can prepare themselves for birth by carefully examining their expectations. The more fixed the expectations, the more room for disappointment, and in rare cases, even trauma. For instance, if a woman is fixed in her desire to birth in her home, but ends up with a complication that requires a transfer, she may have a hard time accepting that she delivered the baby in a hospital with obstetrical assistance. Or, conversely, if a woman is determined to have a hospital birth with an epidural and an obstetrician to catch the baby, but the labor moves too fast to make it to the hospital, she may not achieve either.

There is a beautiful communication between the baby and woman’s body during labor. Most often that communication informs the labor and moves it along smoothly. And sometimes the communication can highlight when something is wrong. For instance, intense back pain in early labor might mean the baby is posterior; persistent back pain when pushing might mean the cord is pulled tight and the placenta is pulling too early from the uterine wall with each push. The most important preparation a woman can make is to remain open to the wisdom of her body, of the baby, and of her trained birth attendants.

A conscious fluidity on the part of the woman in labor can help her to relax and more easily ride the contractions, and it benefits the mother when something unexpected happens.

Flexibility on the part of the family and birth attendants is also important. If a birth moves too fast to make it into a birth tub filled and waiting with warm water, the birth partner and the birth team may need to scrap the idea of a water birth and simply follow the mother wherever she needs to go with the labor. Or the nurse who likes the orderliness and predictability of an epidural and continuous monitoring should remain flexible to the approach each mom most needs and wants for her birth.

Power in birth can take many forms. For some it may mean accomplishing that natural birth, but for many others it may mean something entirely different. The operative words in the Oxford English Dictionary’s definition are “controlling one’s life and claiming one’s rights.” A cesarean birth can be just as powerful as a natural birth. If the woman feels in control of the decision and that her rights and her baby’s rights are equally respected, her birth will be powerful. A slippery slope occurs when birth attendants (midwives, nurses, physicians) don’t fully involve the woman in decisions or when the woman feels coerced or forced to consent to an intervention or change in plans. Another slippery slope occurs when one intervention is recommended, but the woman is not fully briefed on the other interventions that will likely be necessary because of the first intervention (like an induction.) Many hospitals have adjusted rules and regulations so that even if the mother delivers her child by cesarean, the father can be there or the baby can be placed on the mother’s chest immediately after delivery. The mother and her birth team can effectively communicate with the medical personnel to be sure that the mother’s needs are met.

Childbirth is a big event in a woman’s life. It marks the beginning of motherhood and it has far-reaching effects on the mother-baby bond and the woman’s self-confidence. Whether a cesarean birth, a medicated birth, or a natural birth in the hospital, the birth center, or in the home, can all be powerful. And if a mother has experienced a traumatic birth, she can find power in overcoming the trauma. She can recognize the power in her body’s ability to communicate just how painful the birth really was for her. She can find power in, as the Oxford English Dictionary defines in empowerment, the process of becoming stronger and more confident through even the most negative of experiences.

Looking back at the definition of empowerment, it’s clear that when a woman experiences RESPECT, a powerful birth experience will happen, regardless of the mechanics or final outcomes. With respect, a woman can face any birth experience and find power in her ability to embrace the way in which she becomes a mother. Respect, however esoteric the idea may be in the realm of physiological labor, is by far the most important ingredient to a powerful birth experience. Respect is what each laboring woman deserves. It’s with respect that her birth will feel powerful, allowing her to feel confident as she moves into her new role as mother to her new baby.