Healthy Expectations—Part Two: Fit and Tranquil Trimesters

Stress is a fact of life. However, too much stress during pregnancy, like poor nutrition, can have a detrimental effect not only on the mother, but on her unborn child as well.

Pregnancy adds another layer of stress on its own: worries about the health of the baby, abilities to cope with parenthood, and the drastic changes to body and lifestyle. It is crucial to manage stress during pregnancy, as research continues to reveal dangerous effects such as compromised immune system, elevated heart rate and blood pressure, poor eating habits and insufficient sleep – none of which are good for mom or baby. Furthermore, high levels of stress have been linked to an increased risk of premature delivery or low birth weight. A 2008 Harvard Medical School study indicated that women who experience too much stress during pregnancy are more likely to have babies with immune-related problems such as allergies and asthma.

Taking steps to manage stress levels will help avoid unhealthy consequences. One effective strategy to relieve stress during pregnancy is massage. It soothes and relaxes the nervous system by releasing endorphins and helps alleviate the physical discomforts associated with pregnancy: muscle spasms, inflammation (especially in the hands and feet), and joint pain.

According to Nicole Meltzer, RMT, CHt, who specializes in fertility issues and prenatal care, each trimester has its challenges and massage can address most of them. “In the first trimester, fatigue and nausea are the biggest complaints. Pregnancy massage tends to have a relaxation focus during the first three months – helping the body to rest and focus its energy on baby-building. In the second trimester the focus is on preparing the body for delivery. Mom’s hips are moving, ribs are expanding, and there may already be some swelling in the joints. All of these discomforts of a rapidly changing body can be addressed. Third trimester treatment becomes more aggressive in the preparation for childbirth. All aches and pains and swelling are attended to.”

Meltzer’s prenatal massage clients agree that massage was very effective in dealing with many pregnancy-related issues. “Prenatal massage was a tremendous help in aiding my body in adjusting to all the physically taxing changes that occur in pregnancy (such as carpal tunnel syndrome, sore back, circulation challenges, etc.),” said one client. Another recent mom believes “that coming for a massage every week while pregnant was a godsend.” She adds, “My muscles were in great shape so it helped me tremendously with my delivery. It made it quick and easier. I was also able to get back into shape faster, again due to the great benefits that massage offered to me … I could not have gotten through my pregnancy if it was not for [Nicole’s] magic hands.”

And while all registered massage therapists in Ontario are trained in the basics of pregnancy massage, Meltzer recommends pregnant women be treated by an RMT with specialized training in prenatal care. It is “particularly important if the pregnant client has any medical conditions, pregnancy-related or not.”

Practising cleansing breathing techniques can also reduce stress and anxiety during pregnancy by keeping your mind and body calm. Renowned yoga and meditation teacher, Swami Saradananda says, “slow-paced breathing can be one of the best ways to prepare for an efficient labour. The more you are able to stay relaxed during childbirth, the less pain you will feel and the more energy you will have to help you push out your baby.” In her book, The Power of Breath, Saradananda provides guidelines for slow-paced breathing (or ‘breathing for new life’):

1. Breathing slowly and deeply, start to listen to the sound of your breath flowing in and out. Try counting your breath – “In 2, 3, 4, 5. Out 2, 3, 4, 5,” – counting up to whichever number feels most comfortable.

2. Now focus your attention on your exhalations. Create a mental link between the words “release tension” and “focus” and your outward-moving cleansing breath. Direct this thought and your breath into various parts of your body, starting with those that feel tense or restricted.

3. To energize your breathing, continue practising this slow-paced breathing, but visualize your breath as a continuous cycle. Picture energy entering your body as you breathe in, and tension leaving as you breathe out.

4. As you continue to inhale and exhale, mentally repeat phrases such as, “Energy in, pain out,” or “My breath, mind and body are calm.” Alternatively, you may wish to mentally repeat rhythmic phrases on your in-and-out-breaths, such as “Healthy baby” or “Be calm, stay calm,” splitting the phrases between your in breaths and out breaths.

Learning to meditate can also calm anxieties. Studies have shown that meditation can reduce stress, relieve pain, lower both blood pressure and heart rate, and improve quality of sleep.

Another tool to consider is hypnosis – a very relaxed state where the therapist is able to work directly with the sub-conscious mind. Meltzer, a certified hypnotherapist, says, “tremendous healing takes place in this state, making it very effective at alleviating the stresses of fear, anxiety and doubt. Hypnosis can also be used during labour and delivery for pain management, providing a calmer and quicker birth.”

A study in China at the College of Nursing at Kaosiung Medical University in 2008 showed music to be effective with stress management.

KEEPING FIT DURING PREGNANCY

Exercise is another important tool for managing stress when pregnant, but it also helps reduce backaches, constipation, bloating, and swelling, may help prevent or treat gestational diabetes, increases energy, improves your mood, improves your posture, promotes muscle tone, strength and endurance, helps you sleep better, and improves your ability to cope with the pain of labour.

Some body changes during pregnancy will necessitate adjustments to your fitness program. The hormones produced during this time cause the ligaments to relax. This makes joints more mobile and at risk of injury. The extra weight in the front of your body shifts your centre of gravity, placing stress on joints and muscles, especially those in the pelvis and lower back. This can cause back pain and instability – placing you at higher risk of loss of balance and falling. The extra weight also means your body is working harder than before you were pregnant, putting added stress on your heart and lungs.

Exercising safely should be your priority when you are pregnant. Consult with your health care provider before you begin or continue to exercise. Choose a pregnancy-friendly program and avoid the risk of blunt abdominal trauma and loss of balance (such as contact sports, downhill skiing, horse-back riding and gymnastics). You should adapt or avoid exercises that require you to be in a supine position after the fourth month of pregnancy, as the weight of the baby on your uterus compresses a major vein, which can affect the amount of oxygen travelling back to your heart, and to the baby. Avoid exercising in extreme weather conditions, and never exercise to the point of exhaustion. Pay attention to signs such as lightheadedness, spotting or fluid leakage. Listen to your body, it will provide signals if you are overdoing it.

The Canadian Academy of Sports Medicine offers the following exercise parameters for pregnant women. If you exercised before you became pregnant, you can continue with your regular activities by following the PARmed-X for pregnancy (an assessment tool to help determine the appropriate and safe parameters for medical screening and exercise prescription). If you did not exercise regularly prior to pregnancy, it is recommended you don’t start an exercise program until the second trimester. The suggested frequency is three times per week, progressing to a maximum of four to five times per week. If you are a beginner, the sessions should last about 15 minutes. As your pregnancy progresses, the sessions can increase to a maximum of 30 minutes (even if you exercised for a longer period before pregnancy).

It is important not to over-exert your already hard-working body. Heart rate is less reliable in pregnancy for determining  exercise intensity, so the modified heart rate target zones, as outlined in the PARmed-X, should be used when measuring your exercise intensity.

Borg’s 15-point Rating of Perceived Exertion (RPE) scale and the “talk test” are recommended as alternate methods of quantifying exercise intensity. A target range of 12 to 14 is suggested in pregnancy. The “talk test” is if you are exercising at a safe intensity and can carry on a verbal conversation at the same time. (Note: You may also want to consult the Society of Obstetricians and Gynecologists of Canada’s 2003 guidelines: “Exercise in Pregnancy and the Postpartum Period”).

In addition to strength training (you may want to switch to body resistance only, instead of weights during the third trimester) and gentle stretching, your fitness regimen can involve a number of safe, less strenuous, but continuous aerobic activities such as brisk walking, swimming and stationary cycling. Body/mind exercise modalities such as yoga and pilates are also excellent ways to stay fit during pregnancy, and also to remain calm and focused.

Emma Cunningham, Stott Pilates certified instructor, says, “Pilates helps balance the small supporting muscles around a joint, which is great for maintaining stability despite the hormones that loosen your muscles and ligaments in preparation for birth. Also, the focus on the pelvic floor muscles in pilates can shorten labour time and intensity, as well as stop pregnancy side-effects, like incontinence.” Certain yoga poses and dynamic moves in Pilates contribute to improved balance and spatial orientation, as well. Yoga and pilates also play a positive role in counteracting the effects of pregnancy posture – swayed lower back, rounded upper back, tight hamstrings and loose abdominal muscles. The poses help women maintain the strength and integrity of the core group of muscles.

YOGA FOR PREGNANCY

Monica Voss, a yoga teacher at Toronto’s Esther Myers Yoga studio who offers a weekly prenatal yoga class and workshops for couples on labour preparation, says the goal of her prenatal classes is to help women focus on their pregnant selves. She feels most women she teaches are so busy working that they have no time to just feel the sensations of having a baby. Voss says her prenatal class can provide a safe and positive setting where pregnant women can come and “drop inside themselves and explore what it is to be pregnant.”

In terms of safety, she believes students should listen to and trust their own bodies. If they have done a pose before they were pregnant, they can continue doing so as long as they feel safe and comfortable. For example, she says gentle twists and inversion poses are fine as long as mindful adjustments are made (such as reducing holding times). Nevertheless, ensure that your workout is specifically geared toward pregnancy so you can avoid or adapt positions.

Voss particularly likes the Cat and Child yoga poses for pregnant women. The Cat pose is a great stretch for the spine and strengthens the upper body. It is also a useful pose as a bridge to labour as it can be used as a birthing position.

The Child’s pose can normalize blood circulation and provide a gentle stretch for the hips, thighs and ankles, and help to reduce stress and fatigue. Cunningham feels the Swimming Prep is an excellent Pilates exercise to help pregnant women maintain stability, while the Side Plank is a wonderful way to keep the abs toned and offer support for the belly.

Here are step-by-step instructions for each of the above:

Cat Pose

• Begin with your hands on the ground at shoulder width, elbows and shoulders in line with the hands and your knees on the ground hip distance apart and directly under the hips. Your spine should be neutral with eyes gazing towards the floor slightly in front of the fingertips.

• On an inhalation, drop your belly toward the floor while lifting your sit bones and your chest towards the ceiling. Gaze either directly in front of you or towards the ceiling. Slide the shoulder blades down and back away from the ears.

• On an exhalation, begin to round your spine towards the ceiling, engaging your abdominal muscles, pulling the belly towards the spine and tucking your head and chin towards the chest. Avoid pushing the chin to meet the chest.

Child’s Pose

• Kneel on the floor sitting on your heels with your big toes touching and knees hip distance apart.

• On an exhale, drop your torso down between your upper legs. Work to keep your hips and pelvis grounded towards the floor and lengthen your back body from pelvis to the back of your neck.

• Rest your hands on the floor parallel to your upper body, with your palms facing up. Release your shoulders toward the floor, widening the shoulder blades across your back. Rest in this pose breathing deeply.

Swimming Prep (modified for pregnancy by having you on your hands and knees, rather than on your stomach).

• Think about tightening up your abs around your baby without changing your spine’s position.

• Reach one arm and the opposite leg away from each other. Don’t let your lower back collapse – keep thinking about drawing the baby in and up using only your abdominals.

• Try not to let your weight shift to one side (3 to 5 reps each side). 

Side Plank

• Lie on your side, propped up on one arm, with your elbow directly underneath your shoulder.

• Bring your hips into line with your shoulders. Take a deep breath, and as you exhale, lift your hips off the mat, balancing on your forearm and your knees (or your feet if you’re really feeling strong).

• Hold it for as long as you can, and then lower yourself back down with control. Make sure you start on your weaker side first, as you have to hold the same position on the other side for the same amount of time.

ENDNOTE

Pregnancy, with all its physical changes, challenges, and emotional ups and downs, will change your life forever. If you make smart, healthy choices in regards to fitness and nutrition, and manage your stress levels, you and your baby will stay nine months (and hopefully well beyond) strong physically, mentally and emotionally. And a healthy, happy mother and child is a beautiful blessing indeed.

References

• Nicole Meltzer, RMT, CHt is co-founder of Balanced Body Mind Spirit in Richmond Hill. Through her specialization in fertility issues and prenatal care, she helps parents conceive and achieve balance while on their journey into parenthood. Nicole offers pre/postnatal and pediatric Massage Therapy, Hypnotherapy for children, fertility and childbirth, Reflexology and Reiki.  She teaches a variety of classes including, Hypnosis for Childbirth, Tools for the Birthing Partner, Focused on Fertility, and Infant Massage.   www.balancedbodymindspirit.com

• Monica Voss, who began her yoga studies in 1978, teaches a variety of weekly classes in Toronto, including prenatal. She offers workshops, retreats and teacher training in Canada, the U.S., Great Britain, Mexico, the Caribbean and Costa Rica. She co-owns and directs Esther Myers Yoga Studio with Tama Soble. www.estheryoga.ca

• Emma Cunningham is a STOTT PILATES Certified Instructor. She owns Pilates Core, which operates out of The Performance Health Centre in Liberty Village, Toronto. She is also working towards a pre- and post-natal certification from Baby & Me Fitness. www.pilatescore.net

• Bridson, Karen, Nine Months Strong, Lifeline Press, Washington, DC, 2004

• Harms, Roger W. (ed.), Mayo Clinic – Guide to a Healthy Pregnancy, Harper Collins Publishers, Inc., New York, NY, 2004

• Canadian Academy of Sports Medicine, Exercise and Pregnancy Discussion Paper, www.casm-acms.org

• The Society of Obstetricians and Gynecologists of Canada’s, Exercise in Pregnancy and the Postpartum Period, www.sogc.org

• American Pregnancy Association, Exercise Guidelines During Pregnancy, www.americanpregnancy.org

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