Health Features

Healthy Babies, Healthy Moms

There’s nothing like having a baby to get you into a healthy lifestyle. Taking care of yourself during pregnancy means you’ll be taking care of your baby, too, and there’ s nothing more important than that in the whole world. Just ask any mom!

[fit mommas]
In 2011, a woman 39 weeks pregnant made headlines for going into labor shortly after completing the Chicago Marathon. While most women probably aren’t going to run marathons in their final trimester, there’s no reason why they can’t safely exercise throughout pregnancy.

brave new world
Gone are the days when pregnant women were advised to kick up their feet and relax. Today, physicians say most pregnant women should be physically active. “Exercise has been shown to help on several levels before, during and after pregnancy,” says Dr. Peter Ahlering at Missouri Center for Reproductive Medicine.

According to Dr. Gil Gross, SLUCare obstetrician/gynecologist, sedentary pregnant women are at an increased risk for excessive weight gain, as well as complications like gestational diabetes, high blood pressure and clots. If that’s not enough motivation to get moving, babies born to fit mothers are leaner and less likely to become overweight or develop diabetes as adults.

Regular exercise also is good for mental well-being, providing a healthy stress outlet while hormones are in flux. And women who exercise during pregnancy are better able to tolerate the physical changes of pregnancy and have a higher pain tolerance for labor, Ahlering says.

get with the program
For women who were not physically active before pregnancy, Ahlering recommends starting small. “Generally one should start low with something like 30 minutes of walking daily, then work up to a safe and comfortable level that can be individualized over time.”

Pregnant women are no longer advised to monitor their heart rate during exercise, Gross says. “Nowadays, we tell patients not to focus on maximum heart rate, but rather on how they are feeling. We don’t want a pregnant woman getting to the point of exhaustion or unable to catch her breath. She shouldn’t be unsteady or light-headed, either. These are all signs that she did too much,” he says.

Simply use common sense, Ahlering advises. If in doubt, he recommends asking your health care professional. “Generally, the traditional cardio and weight exercises are fine. Beyond 20 weeks, pregnant women should not exercise while lying flat on their backs. Gross also recommends avoiding high-impact exercises or activities that may put them in harm’s way, like boxing. Exercise that requires stability, like many traditional poses in yoga or Pilates, also can be difficult to do while pregnant and may need to be modified as time goes on.

“Swimming is a great, low-impact exercise, as well as the stationary elliptical machine, treadmill and stationary bike. Regarding weights, I recommend decreasing the weight, but increasing the number of reps,” Gross says.

high risk pregnancies
Talk with your doctor about your physical activity, especially if you have a high risk pregnancy. Even patients on modified or full bed rest can do light exercises to help circulate blood and reduce the risk of a blood clot. “Patients on bed rest arguably benefit the most from a good exercise plan,” Ahlering says. “Good advice is to consult with your doctor and medical staff. Really, I can’t think of any case for whom a plan of exercise cannot be devised, one just has to approach it properly.”

[birthing options]
Experts agree: pregnant women should educate themselves about birthing options. Even if you know what you want, it’s best to have a plan B, and C, in case the unexpected happens.

it’s up to you
From candle-lit water births with a midwife to epidurals and cesareans, women have plenty of choices for their birthing plan. “I want women to know they should be free to exercise their options. The adage is true: If you don’t know your options, you don’t have any,” says midwife Jessica Henman of Birth and Wellness Center in O’Fallon.

easy epidurals
By far the most common medication to ease labor is the epidural. “When we place an epidural, we have interfered in the physiologic process,” says Dr. Teresa Knight of Women’s Health Specialists of St. Louis. “It is not necessarily a good or bad interference, but we now realize that mom can no longer empty her bladder without assistance or move to another position without assistance. And her body is no longer motivated by the pain of labor.”

There are times, particularly when the labor is exceptionally painful or long, when a vaginal birth can be aided, not hindered, by an epidural. “Sometimes with the lack of pain (from the epidural), the pelvic floor will become more relaxed and a vaginal birth becomes possible when otherwise mom was too exhausted or uncomfortable to proceed,” Knight adds.

Many women fear that an epidural will make them more likely to need a cesarean, but that’s not the case, Henman says. “There is no solid evidence that an epidural itself increases the risk of C-section. However, a woman who is unprepared for childbirth is more likely to get an epidural early, and may have other factors such as fear, health issues or an inability to work with the process that lead to C-sections. Even when a woman is healthy and well prepared, she may choose to use an epidural if her labor is more difficult than expected, which may be due to baby’s position or other factors, which themselves increase the risk of C-section,” she says.

Knight says the greatest reason for a cesarean is a large baby. “Women can help reduce their risk of C-section substantially by reducing carbs, sugar and starch in the second and third trimesters. I worry more about a C-section if a woman needs to be induced or if she is laboring without an epidural and not making progress.”

unmedicated birth
“The benefit of an unmedicated birth is that you are allowing the body to proceed through a natural physiologic process. It is incredible and beautiful how our bodies are able to do it all,” Knight says.

Laboring without an epidural also allows for more movement of both mom and baby, helping the birth process progress smoothly, Henman says. “A mother who can stand, walk, squat, etc., is more likely to be able to change the position of a baby in the birth canal, if needed.”

Knight also recommends preparing for labor ahead of time with yoga, meditation and other focusing exercises. “I tell my patients, ‘Labor is like running a marathon, and those preparing ahead of time are more likely to succeed.’ A doula or labor coach is by far the best way to prepare and have support before, during and after labor.”

choose carefully
“There are many factors that determine a birth experience, and ultimately the child will have a part in the decision as to how the labor and birth experience will be,” Knight says. “There is not a right or wrong way to have a baby. It makes me sad to see women criticize each other for their choices.” As far as who will have the best birth experience? “In general it is women who have discussed all options and reasonable possibilities of how their birth may occur, and then they are willing to go with it even if it is not how they envisioned,” she adds.

[alcohol during pregnancy]
One of the most debated prenatal topics is whether it is safe to drink alcohol while pregnant. While there’s clear evidence that heavy alcohol consumption is harmful, what about the occasional drink or glass of wine?

the standard
The U.S. Surgeon General, the Centers for Disease Control and Prevention, and the American Congress of Obstetricians and Gynecologists all advise pregnant women against drinking alcohol. No amount is without risk, says Dr. Eric Strand, director of general obstetrics and gynecology at Washington University. Yet, we all probably know of someone who claims her doctor said it was perfectly safe to enjoy the occasional glass of wine.

According to Dr. Jodie Rai of Women’s Healthcare Consultants, the confusion comes from conflicting research and outdated medical advice. While Rai still advises patients to abstain from alcohol while trying to conceive and throughout pregnancy, she says a review of the literature on occasional alcohol use during pregnancy has not shown a negative impact on mother or baby in the later stages of pregnancy. She adds that since alcohol affects judgment, women could be consuming more than they mean to. “There is evidence to suggest that women who are planning to get pregnant or are in their first trimester may increase their risk of miscarriage by drinking,” she says.

According to Strand, alcohol has the potential to damage the fetus at any time during pregnancy, and all types of alcohol—beer, wine or spirits—are equally harmful. “But the risks are low enough with low-level consumption that we usually reassure patients who had small amounts of alcohol in early pregnancy, before they knew they were pregnant,” he says.

fetal alcohol syndrome
According to the Institute of Medicine, alcohol produces by far the most serious neurobehavioral fetal effects of all substances, including cocaine, heroin and marijuana, and the damage is directly related to the quantity consumed. Yet there is still a common perception that alcohol use is relatively safe. “Fifty percent of women of child-bearing age routinely use alcohol,” notes Strand, “and 15 percent of those would qualify as ‘binge drinkers’ based on their pattern of usage.” Additionally, these numbers dwarf those of pregnancies impacted by other “drugs of abuse,” he says.

Fetal alcohol syndrome (FAS) is the most severe of the alcohol spectrum disorders. It manifests as learning disabilities, hyperactivity, difficulty with attention, speech and language delays, low IQ, and poor reasoning and judgment skills. “The babies may also have heart and kidney problems,” Rai says. An FAS baby has a small head, low birth weight and distinct facial features.

Strand adds that for every child born with FAS, many others are born with mental or behavioral problems that may be the result of lesser alcohol use. “In an adult, the liver is responsible for metabolizing or breaking down the alcohol. The baby’s liver is immature and cannot metabolize the alcohol as well,” he explains.

the new study
Last year, an international team of researchers concluded alcohol during the first trimester and beyond does not appear to raise the risk of premature delivery, low birth weight or size, or maternal complications from high blood pressure. The study was led by Dr. Fergus McCarthy at Cork University Maternity Hospital in Ireland and published in the October 2013 issue of Obstetrics & Gynecology.

The researchers compared birth outcomes among 5,628 women. More than half reported drinking during the first trimester: Nearly 20 percent reported occasional alcohol use, 25 percent low consumption and 15 percent heavy use. The researchers found no significant differences in rates of premature birth, babies with low birth weight or small size, or preeclampsia. The study did not, however, follow child development after birth.