Pre Natal Worries & Complaints

 FIRST TRIMESTER WORRIES:

• Will exercise cause problems such as miscarriages, developmental defects, ectopic pregnancies (a baby growing outside of the womb) and abnormal development of the placenta to occur more often?

Miscarriage - actually occurs very frequently (15-20% of women are affected).
Clapp 1989a., 1994a - study showed that there was no change in the incidence of miscarriages in women who continues regular aerobics or running during early pregnancy, as compared to women who didn't exercise. The rate of miscarriages for both the exercisers and non exercisers remained between 16-17% for 6 years.
Cohen et al, 1989 - this was a retrospective  questionnaire study that looked at women who ran in early pregnancy. Again they found no evidence of an increased risk of a miscarriage occurring.
In summary, though as many of 15-20% of the general population miscarry,
all the evidence indicates that exercising does not increase this risk.

Congenital malformations - these problems are much more rare and include things such as heart defects, deafness and brain damage.
Clapp 1994a - in this study the rate of malformations was the same for the exercising and non-exercising groups; 2-3%, which is the same as for the general population. This finding would support the idea that pregnant woman are more than capable of dissipating heat. This means that concerns about thermal stress leading to malformations during the first 3 months are probably unfounded. However, caution should still be employed.

Ectopic pregnancy - the incidence of ectopic pregnancy is actually rising in the population at large. Although there are factors known to increase the frequency of ectopic pregnancy (smoking, pelvic inflammation and sexual practices), exercise does not appear to have any effect. (Clapp 1994a).

Placental problems - this group of problems includes placenta previa (the placenta implants too low in the womb), placental abruption (the placenta breaks away from the wall of the womb before the baby is born) and poor placental growth. Once again while factors such as smoking are implicated in increasing the frequency of such problems, exercise has not been found to have any effect.

SECOND & THIRD TRIMESTER WORRIES
Will exercising restrict the growth of the baby?
Will it lead to premature labour?

Premature labour - many people believe that jerky movements and bouncing (such as those experienced during running) will cause the membranes to burst (waters to break) before the baby is due. Full term is at 40 weeks of pregnancy and it is only births that occur before 37 weeks that can cause problems.
Klebanoff, Shiona, and Carey 1990; Luke et al. 1995; Rabkin et al. 1990 - these three studies all clearly showed that exercise during pregnancy did not increase the incidence of premature labour.
Clapp 1994a - this study also demonstrated that exercising did not increase the rate of premature births. An additional discovery was that women who continue to exercise regularly through their pregnancies actually deliver 5-7 days earlier than their non exercising counterparts. A definite bonus if you are in the final days of pregnancy!

 Fetal growth - this concern stems from the fact that blood is diverted away from the placenta during exercise and glucose levels fall. This led people to conclude that the baby would not get enough nutrients and its growth would be compromised.
Klebanoff, Shiona, and Carey 1990; Luke et al. 1995; Rabkin et al. 1990 - the same studies as cited above also showed that there was no increase in the incidence of smaller than average babies in women who exercised during pregnancy.
Clapp 1994a - in addition to supporting the conclusions of the above studies, this one showed that babies born to exercising women had less fat on their bodies. This observation held true when the same babies were followed up at five years of age and interestingly the children of women who exercised during pregnancy scored much higher on tests of general intelligence and oral language skills. (Clapp 1996b)

 Placental growth  - worries about placental growth are similar to those of fetal growth. The concern is that exercise could stop the placenta from functioning properly.
Clapp and Rizk 1992; Jackson et al. 1995 - both studies concluded that exercising in fact increases the rate at which the placenta grows and ultimately improves its functional capacity (ability to supply the fetus with nutrients and dispose effectively of waste products).

Common pre-natal complaints:

Exhaustion
Many women feel exhausted during early pregnancy. This is perfectly normal and hardly surprising when you think of the changes the body is going through.
Advice: Take regular naps without feeling guilty! Accept any help that is offered and try to reduce your daily load. The problem should lessen as you enter the second trimester  if it doesn't it is worth getting your blood tested to make sure you are not suffering from anaemia.

Weak bladder
Many women complain of an increased need to urinate. This is caused by an increase in urine production by the kidneys coupled with the pressure of the expanding uterus pushing on the bladder.
Advice: The problem may get better after 12 weeks as the uterus normally rises at this point. Make sure that you continue to drink plenty of water even though you might be tempted to avoid it! If the problem seems to be getting worse or you experience pain when passing water it is worth getting checked to see if you have cystitis (a bladder infection that is more common during pregnancy and is easily cured.)

 Constipation
Changes in bowel habits are common in pregnancy and most women notice that they are more constipated.
Advice: Increase the amount of water that you are drinking (aim for around 2 litres per day). Try adding more bulk to your diet e.g. bran, prunes, apricots and whole grain cereals. Try drinking peppermint tea as this is known to help with digestion. Many doctors suggest a mild laxative such as Milk of Magnesia or prune juice if you are having problems  do not use a stronger laxative unless your doctor approves it.

 Indigestion
This is one of the most common complaints of pregnancy and may become more severe as the pregnancy progresses. Pregnancy increases the frequency of heartburn as there is decreased intestinal motility and the uterus compresses the stomach.. It can also be related to changes in eating habits that often accompany pregnancy.
Advice: Eat frequent small meals and keep a record of what you are eating to see if a pattern between eating certain foods and indigestion occurs. Avoid positions such as bending or lying down after eating. A mild antacid can be helpful.

 Cravings
Probably the most widely talked about symptom of pregnancy (especially among husbands and partners!). We are not sure what causes them but it seems that the increased hormone levels of pregnancy interfere with a woman's saliva, altering her sense of taste.
Advice: Don't worry - a little of what you fancy wont do any harm (as long as they are not inedible substances!).

 Morning sickness
Morning sickness affects around 70% of pregnant women and can actually occur at any time of the day or night. The problem is normally at its worst around 8-12 weeks and finishes by week 16.
The sickness is normally more of an inconvenience than a serious health issue. There is however a medical condition called hyperemesis gravidarum (pregnancy-induced nausea and vomiting), which causes severe vomiting and can result in a depletion of nutrients. In such cases the woman should be treated in hospital with intravenous fluids and anti-sickness medications.
Advice: Eat small amounts at frequent intervals and avoid food with unpleasant or strong smells. Ginger is known to be an effective natural remedy for nausea. Try drinking ginger tea, nibbling on ginger biscuits or sucking a piece of crystallised ginger stem. If you find that the vomiting becomes frequent or violent visit your GP for advice.

 Lower abdominal or pelvic discomfort
Women who continue to run or do high-impact aerobics during pregnancy may experience lower abdominal discomfort or feel pressure in the pelvic region. It seems that this discomfort may be due to excessive mobility in that area (due to the presence of hormones such as relaxin).
Advice: The problem is often solved by wearing a maternity lower abdominal support belt.

 Feeling dizzy
Dizziness is common in the first 3 months, especially if a woman rises too quickly or has to stand for a long time.
Advice: Make sure that you eat and drink regularly (at least every 4 hours) to keep your blood sugar levels stable. Try to avoid standing up too quickly and standing still for too long.

Sore breasts
This is also common and is similar to how a woman feels just before her period. Later in pregnancy as the milk ducts develop, the breasts may become swollen and blue veins can be seen.
 Advice: Gentle massage by you or your partner may ease the discomfort. A good maternity bra will help and will also limit stretch-marks and sagging.

Feeling down
Post-natal depression is well documented but you don't hear much about pre-natal blues. Feeling blue whilst pregnant is not uncommon and may be due to a number of reasons such as anxiety about the birth and concerns about physical changes to the body.
Advice: Try not to worry and remember that you are not alone. Many women feel guilty about being down in the dumps when everyone is telling them how happy they should be.
If the feelings persist after the first 3 months then it is worth talking to your GP  antenatal depression is not a condition to be taken lightly.

POST-NATAL WORRIES:
Does exercising whilst breast feeding change the taste, quantity or quality of the mother's milk?
Does exercising whilst breast feeding slow the growth of the infant?
Is it safe to diet whilst breast feeding?

 Milk production - a common concern is that exercising will diminish the quantity of milk produced and that it will contain more lactic acid (a bi-product of exercise) making it unpalatable to the newborn.
Dewey et al. 1994 - this studies looked at the effect of running on breast milk production. It concluded that frequent, moderate-to-high intensity running during lactation did not impair either the quality or quantity of breast milk. One problem with the study however was that it did not measure lactic acid levels in the milk and this remained a cause for concern.
Quinn and Carey 1997 - this study looked specifically at lactate levels in the milk of exercising mothers. They concluded that, unless the intensity of the exercise was extremely high (above the aerobic threshold), there was little change in lactate levels of the maternal blood.

We can therefore conclude that exercise at a moderate-to-high intensity does not affect the quality or quantity of breast milk, but that periods of intense anaerobic exercise (e.g. interval training) can occasionally alter the taste of the milk.

 Weight loss - this a major concern for many women who want to get back into shape as quickly as possible. As yet no study has been done to examine the combined effect of dieting and exercising whilst breast feeding so we still don't have all the information.
Strode, Dewey, and Lonnerdal 1986 - this study looked at healthy, non-exercising women who were breastfeeding and on a calorie restricted diet. They found that as long as the mother kept her intake at 1,500kilocalories or more per day, there was no decrease in milk production or milk quality. This was not true however for women who ate less than 1,500 calories.
The conclusion; be sensible! As long as the infant continues to suckle and gain weight normally it's ok to exercise, diet and breastfeed but weight loss should be kept to 1lb or less per week. Women who wish to follow this approach should consult their care provider and monitor the baby's growth carefully.

Infant growth - breast-fed babies gain less weight than bottle-fed infants, although the only difference between them is that the breast-fed babies are leaner than those who are bottle-fed. This difference is important when looking at whether exercise affects the infant's growth as we must compare like with like.
Dewey et al. 1994 - this aforementioned study also looked at the question of infant growth in breast-feeding mothers who exercised. They found no evidence to suggest that the growth of these infants was in anyway impaired.
Clapp 1996a, 1996b - once again no differences were found between the infants of breast-feeding mothers who exercised and those who didn't. The study concluded that exercising through pregnancy and during lactation did not alter weight, length, head circumference, or fat mass at one year of age, and , at age five, the only difference was that the children were leaner.

POST-NATAL PROBLEMS

Caesarean births
A caesarean birth involves major abdominal surgery and will leave the woman feeling extremely sore and bruised. It is common to have a lot of vaginal bleeding as blood may have pooled in the pelvic area during the operation. We recommend that our clients begin gentle exercise as soon as possible after the birth to prevent blood clots forming in the legs. Please ask us for our 'Hospital Exercise Pack'.

Episiotomy
An episiotomy is an incision made into the area of skin between the vagina and the anus (the perineum) in order to deliver the baby. Such a procedure may be needed if the baby is showing signs of distress during a prolonged labour. The area may will be sore, especially around the stitches for some time after the birth.
Advice: Try to keep pressure off the area. Relax in a warm, salty bath.

Haemorrhoids
Haemorrhoids are a common post-natal complaint as the strain of the birth can cause blood vessels in the anal area to rupture.
Advice: Try not to strain during bowel movements. Eat a diet that is high in fibre. Try an over the counter haemorrhoid cream such as Preparation H.

After pains
Pains similar to those of labour can occur for some days after the birth as the uterus shrinks back to its pre-pregnancy size.
Advice: Try to relax and take a mild analgesic such as paracetamol to relieve the pain.

Diastasis recti
This is a painless condition where the two sides of the rectus abdominis separate down the middle. The core exercises in the Fit2Be pre-natal programmes are modified to account for this condition. Women should check for this condition 3 to 4 days after giving birth as we made need to modify their programme if the two sides of the muscle are not coming back together. To check for diastasis recti the you should lie on your back on the floor with your knees bent. Lift your head and bring your chin to your chest. At the same time get feel with your fingertips just above and below your tummy button, into the soft vertical gap between the muscles. If the separation is greater than one inch (about 2 fingers width), separation has occurred. If you do discover that you have diastasis recti then we can help you with specific exercises such as pelvic cross tilts which can be done at home before commencing on the Fit2Be post-natal programme.

Fluid retention
Although you will have lost a lot of fluid at birth, you may still feel bloated and as though you are carrying a lot of extra weight. Fortunately fluid retention is a short lived problem and will begin to reduce over the following weeks.
Advice: Avoid processed foods as they contain a lot of salt and this will increase water retention. Try to avoid drinking a lot of alcohol and caffeine as they both have a dehydrating effect. Book in for a relaxing massage (you've definitely earnt it!) and ask your therapist to concentrate on your lymphatic system to promote drainage.

Tiredness
A feeling of overwhelming tiredness is universal amongst new mothers. There is nothing that can prepare you for the affects of labour and caring for a new baby.
Advice: Don't panic it wont last forever. Accept any help that is offered and DON'T FEEL GUILTY. Practice relaxation and breathing exercises - examples are taught in Fit2Be classes but please ask us if you would like further information or contacts.

Breast pain
As the milk comes in around day three post-delivery, you will probably experience some discomfort and swelling. You may also become aware of a dragging sensation which is due to the milk flow and the stimulation of your baby starting to feed.
Advice: Take a mild analgestic such as paracetamol if your breasts are causing you discomfort. If the pain gets considerably worse or you notice excess swelling of a colour change, you could have Mastitis. Mastitis is a painful inflammation of the breasts common after childbirth. It can be treated using antibiotics and you should consult your doctor if you are worried about your symptoms.

The following excerpt on Mastitus was provide by The Breastfeeding Network.

Mastitis (© 1999 The Breastfeeding Network)

Mastitis means inflammation of the breast. The first sign of mastitis is a red, swollen usually painful area on the breast. The redness and swelling is not necessarily a sign of infection. Bacteria are not always present, and antibiotics ma not be needed if self-help measures are started promptly. You may get mastitis when milk leaks into breast tissue from a blocked duct. The body reacts in the same way as it does to an infection - by increasing blood supply. This produces the inflammation (swelling) and redness.

Advice: These self-help measures may also help to clear blocked ducts and engorgement
Keep on breastfeeding - you may feel ill and discouraged but continuing to breastfeed is the quickest way to get better - and won't hurt your baby.
Feed your baby more frequently or express milk (so that your breast is kept as well drained as possible) until you feel better.
Check that you baby is well positioned at your breast… if you are in doubt about his please contact one of our doulas at info@fit2be.com subject line: Doulas
Feed from the side, which is sore first to drain it as thoroughly as possible.
Soften your breast, by expressing a little milk or running warm water over it, so that the baby finds it easier to feed well.
Use a wide toothed comb to stroke gently over the red area and towards the nipple to help the milk flow, or massage gently.
If the situation does not improve contact your doctor for further options.
Note: Antibiotics can make the baby produce loose, runny nappies and become irritable and restless, but the baby will not be harmed and will get better when you finish the antibiotics. Antibiotics kill natural bacteria in the body as well as those causing illness. This may allow thrush (candida) to flourish. Eating live yoghurt or taking Acidophilus capsules may help to restore the balance.

Breast sagging
Many women worry about the change in elasticity of their breasts after birth and breastfeeding. Advice: Don't worry things will start to settle down. There are exercises that can be done to counteract the downward slide! These exercises are included in all Fit2Be postnatal programmes but please ask us if you would like additional advice.

Headaches
Headaches are common after delivery and some women experience them for several weeks after the birth.
Advice: Head massage can be effective in combating headaches - book in with a practitioner or gently massage your own head paying particular attention to the temples.Aromatherapy can also help. Apply lavender or peppermint oil (blended with massage oil - 1 drop of lavender to 1 teaspoon of massage oil) to your temples. Keep drinking lots of water. Dehydration is a major cause of headaches and can easily occur when breastfeeding. Breathing and relaxation exercises can also help as headaches can be caused by stress and anxiety.

Stretch marks
Stretch marks occur when the skin's deeper layers (collagen and elastin) are stretched by weight gain. Advice: There is no miracle cure but they will fade with time. Try applying lavender oil daily to improve the appearance of any marks that remain.

REFERENCES:
Cohen, G.C., J.C., Prior, Y. Vigna, and S.M. Pride. 1989. Intense exercise during the first two trimesters of unapparent pregnancy. The physician and Sportsmedicine 17:87-94.
Clapp, J.F. 1989a. The effects of maternal exercise on early pregnancy outcome. American Journal of Obstetrics and Gynecology 161: 1453-1457
Clapp, J.F., k.H. Rizk. 1992. Effect of recreational exercise on mid-trimester placental growth. American Journal of Obstetrics and Gynecology 167: 1518-1521
Clapp, J.F. 1994a. A clinical approach to exercise during pregnancy. Clinics in Sports Medicine 13: 443-457
Clapp J.F. 1996a. Exercise during pregnancy. In Perspectives in Exercise Science and Sports Medicine. Vol 9, Exercise and the female - A lifespan approach, ed. O. Bar-Or, D. Lamb, and P Clarkson, 413-451
1996b The morphometric and neurodevelopmental outcome at five years of age of the offspring of women who continued to exercise throughout pregnancy. Journal of Paediatrics 129: 856-863.
Dewey, K.G., C.A. Lovelady, L.A. Nommsen-Rivers, M.A. McCrory, and B. Lonnerdal 1994. A randomised study of the effects of aerobic exercise by lactating women on breast-milk volume and composition. New England Journal of Medicine 330: 449-453
Jackson , M.A., P. Gott, S.J. Lye, J.W. Knox Ritchie, and J.F. Clapp. 1995. The effect of maternal aerobic exercise on human placental development :Placental volumetric composition and surface areas. Placenta 16: 179-191
Klebanoff M.A., P.H. Shiona, and J.C. Carey 1990. The effect of physical activity during pregnancy on pre-term delivery and birth weight. American Journal of Obstetrics and Gynecology 163: 1450-1456
Luke, B.M. Mamelle, L. Keith, F. Munox, J. Minogue, E.Papiernik, and T.R.B. Johnson. 1995. The association between occupational factors and pre-term birth: A United States Study. American Journal of Obstetrics and Gynecology. 173: 849-862.
Quinn, T.J., and G.B. Carey. 1997. Is breast milk composition in lactating women altered by exercise intensity or diet? Medicine and Science in Sports and Exercise 29:S4
Rabkin, C.S., H.R. Anderson, J.M. Bland, O.G. Brooke, G. Chamberlain, and J.L. Peacock. 1990. Maternal activity and birth weight. A prospective population based study. American Journal of Epidemiology 131: 522-531
Strode, M.A., K.G. Dewey, and B. Lonnerdal. 1986. Effects of short-term caloric restriction on lactational performance of well-nourished women. Acta Paediatricia Scandinavia 75: 222-229