Pregnancy is an adventure -- a time to nurture oneself and begin nesting as well as a time of excitement and change. It is also an opportunity to indulge a little. Hey you are going to gain weight anyway! But, pregnancy can also come hand in hand with a few unwelcome side effects. Here are a few tips to help you recognize and avoid some of the less desirable, but not uncommon, aspects of pregnancy.
Problem 1: Low Back Pain: Probably the most typical complaint of women during pregnancy.
Contributing Factors: Ligaments are more lax (loose) during pregnancy, which can contribute to instability and also increase the stress to the spine and its supporting muscles. An increase and redistribution of body weight, as well as the resultant change in center of gravity, also create more stress to the lower back.
Solutions: Prevent low back pain with attentiveness to posture -- stand erectly. Bend and lift with care and with attentiveness to form -- bending from your hips and knees rather than your back. Sleep on your side and, consider positioning a pillow between your knees or try cuddling up to a body pillow, resting your top arm and leg forward on the pillow. If you experience low back symptoms, ask your doctor about a lumbo-sacral belt to provide additional support and avoid activities that reproduce symptoms. Tone your abs and work toward a more neutral spine with a basic program that includes (posterior) pelvic tilts while seated on a ball or on all fours. Consult with a physical therapist if your pain is debilitating; there are treatments and other exercises that can help!
After The Big Day: Use good body mechanics: When lifting the baby from the crib, first move him close to where you are standing to avoid lifting while reaching forward. To lift a toddler from the floor, kneel or squat and lift from your legs or, if you have pain, have your child climb onto a sofa and lift him up from that higher position. Switch off from one hip to the other when carrying a baby for a longer period and opt for one of the great carriers on the market if you will be holding the baby for an extended time (better yet, use a stroller). To rise from bed, when lying on your back, roll to your side and push from your forearm and hands to reach a sitting position to avoid rising using an old-fashioned sit-up motion. Most importantly, get back on track with your fitness program once you've received your OB's OK.
Problem 2: Abdominal Diastasis: Not every pregnant woman winds up with this problem and it is essentially impossible to prevent.
Contributing Factors: The abdominal diastasis is simply a separation of the right and left sides of the front abdominal muscles (rectus abdominus) from their central attachment. Most apt to occur during the third trimester, the separation is a result of weakened connective tissue (from hormonal changes) coupled with the enlarged uterus pushing against the abdominal wall. This separation can be felt as you do a partial crunch, lifting your head and shoulders while you palpate the midline of your abs.
Solutions: In most cases the diastasis will resolve over time after the baby is born. However, avoid progressing your core program without supervision if you have this problem -- working the abs too aggressively and without bracing them may worsen the condition.
After The Big Day: Brace your abdominal muscles with your hands, pushing both sides toward the center if you have to cough. This will keep the sides of the muscle from pulling apart while it contracts. With the exception of pelvic floor (Kegel) and basic abdominal bracing exercises -- such as pelvic tilts done either seated on a ball, on all fours or on your back with knees bent. Most guidelines suggest waiting six weeks after a vaginal birth to begin or gradually resume an exercise program. If you've given birth by C-section, exercise with even greater caution. In either case, proceed only if you have your physician's approval. Avoid crunches at the outset, opting instead for other effective lumbar (lower spine) stabilization exercises that recruit the abdominal muscles. Consult a physical therapist or resource on pregnancy and exercise for specific instructions.
Problem 3: Fatigue: Most women experience fatigue, especially during the first trimester.
Contributing Factors: Your body is undergoing significant hormone adjustments and the added weight and demands of pregnancy increase the stresses on your system.
Solutions: Don't fight it, sleep! And it may seem counterintuitive, but consider beginning a low-level aerobic exercise program; walking, swimming or riding on a stationary bike may help you to sleep better as well as enhance your general level of energy. As long as you don't push your limits, there's no time like the present.
After The Big Day: Once the baby is born sleep may really be at a premium. Try to rest when the baby naps and listen to your body. You are also burning a lot of energy/calories, particularly if you are nursing. The weight will come off if you eat sensibly -- avoid going overboard counting calories -- be sure to eat a sufficient amount and eat healthy foods to address your own nutritional needs.
Problems 4 & 5: Gestational Diabetes & Excessive Weight Gain: (http://www.diabetes.org/diabetes-basics/gestational/)> Besides making good food choices to take in the extra calories you now require, exercise is the only other way in which we may be able to lessen the risk of developing high blood sugar during pregnancy. To moderate weight gain so as not to exceed your doctor's recommendations, I also pass along the advice of my wonderful obstetrician, the late Dr. Thomas Steadman, who put his arm around me when I'd gained 7 pounds in my sixth month. He said "Abby, when you sit down at the table for dinner, talk more!"
Problem 6: General Fitness Concerns: Exercise is a mood-elevator and there are so many ancillary health benefits of being fit. The general guideline is that if you've already been doing it, you can continue to do it -- that goes for weight training, some sports and sex. However, there are a few notable exceptions. Follow these rules from The American Congress of Obstetricians and Gynecologists:
• Avoid exercises on your back after the first trimester. You can continue to work your abdominals in safer ways, like marching while seated upright on a ball, rather than doing crunches or the like.
• Lighten up! Pregnancy is not a time to set personal bests. Go easier on yourself.
• Don't worry too much about your heart rate, but monitor your rate of perceived exertion (RPE). If you feel like an activity is too strenuous, it is. STOP! If you experience labored breathing, light-headedness, dizziness, or other atypical symptoms, stop and consult your physician immediately.
• Work to strengthen your pelvic floor muscles (the famous Kegel exercises). This could be beneficial during labor and delivery but will also likely aid in recovery.
• Avoid high impact or jarring activities that might stress your (now) looser joints. Examples they give include contact sports and downhill skiing. I add horseback riding to that list. Scuba diving is also discouraged because of the pressurized environment.
• Avoid sports and activities that challenge your balance. The front-heavy distribution of your weight as pregnancy progresses will likely make balance more of an issue. This could increase your risk of falling.
• Listen to your body -- even if you are doing an activity you've been doing all along, if it begins to feel awkward or uncomfortable, stop.
Enjoy your pregnancy and all that will follow!
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Follow Abby Sims on Twitter: www.twitter.com/@abcsims
Loren Fishman, MD: Alternative Therapies for Back Pain
http://www.youtube.com/watch?v=9cdSxWvF06g
http://www.youtube.com/watch?v=zkTlpSCmJyY
Women with a gap of more than 2.5 finger-widths can also manually splint the mid line closed as shown here:
http://www.youtube.com/watch?v=juMlSPiZHTw
http://www.youtube.com/watch?v=bxbsq808lxE
To protect the mid line, use the "log roll" technique when getting out of bed, or when rising from the floor. "Log roll" demonstration:
http://www.youtube.com/watch?v=Xoe8PaYvRRc
Additionally, pregnant and postpartum women with diastasis should not perform any exercises that lift/roll/flex the upper spine off the floor or against the force of gravity and should avoid twisting movements of the spine, as these types of movement can make the condition worse. No crunches, sit-ups, oblique curls, roll-ups/roll downs, most Pilates mat work and yoga moves like boat pose and triangle pose, etc.