gestational diabetes
Mamas on Bedrest: Congratulations Cora and Welcome Ravi!
July 24th, 2011
After 11 weeks on bed rest (8 of which were strict) and 30 hours of labor Cora Jeyadame gave birth to her son Ravi Ixtel Jeyadame at 39 weeks and 3 days on July 16, 2011. Cora is my parent’s next door neighbor. I met her while I was home visiting for the summer.
For Cora, the road to motherhood was not an easy one. Cora has a long history of Polycystic Ovarian Syndrome (PCO) and seldom ovulated. When she and her partner Suriya married last August, she immediately started taking Lupron in order to stimulate ovulation. While on her honeymoon, she and Suriya prayed to the Mexican fertility goddess Ixtel so Cora would ovulate and promised that if she became pregnant on her first attempt she would name her child after the goddess. Cora ovulated for the first time the day after praying to this goddess and became pregnant on her first insemination in October.
Unfortunately, Cora’s joy was short-lived. She had significant morning sickness through her first trimester. She developed Gestational Diabetes and low blood pressure complicated by fainting during her second trimester. Additionally, an abnormal heart beat was detected and she had to wear a holter monitor for a month. At 26 weeks she began experiencing preterm labor. However, because of her heart problems, her obstetrician was very cautious using drugs to halt labor. At 28 weeks she was placed on modified bed rest which meant that Cora, a first grade teacher, reduced her work schedule to 3 days a week. When the episodes of preterm labor intensified, she went on full bed rest at 32 weeks.
“The decision to go on bedrest was really hard,” Cora says. “My OB left the decision totally up to me and as a teacher, it was really hard for me to leave the classroom. But the thought of having my baby early was frightening. I knew all of the problems that he could have and that terrified me. So I opted to do all that I could and went on bed rest.”
“Bedrest is so much more difficult than I could have ever anticipated” Cora adds. “I was very lonely and although I thought I would stay at home and finish the nursery, read books and prepare, I found that I wasn’t physically able to do anything to prepare. My attention span was really short so I found that I didn’t want to read and spent much of my time watching reality TV shows. My saving grace was the Bedrest forum on BabyCenter.com. Having those other women on bed rest to correspond with really kept me sane.”
Cora was really lucky because she had a lot of help and support.” My partner Suriya is extremely supportive and my parents live close by so my mother came by often and ran errands and did the grocery shopping.” Cora and Suriya already had a housekeeper and dog walker and hired a helper to do other jobs around the house such as tend their garden.
“It’s impossible to do this without support. I never would have made it without all these people”. (Cora also had a labor doula.)
At approximately 35 weeks, Cora developed Pubic Symphysis diastasis. While it is common for the pubic bone to begin to relax in preparation for labor and delivery, in some women, the relaxation becomes a more pronounced, painful separation. Because she was so uncomfortable, Cora was prescribed oxycodone for the pain and crutches for her limited ambulation.
In the end, Cora had to be induced at 39 weeks and 1 day. Ravi was born after 30 hrs of labor at 7lbs 6 oz and 19 inches long, a perfectly healthy baby boy.
“I loved being pregnant,” says Cora. “I loved that feeling of having life inside of me.”
Admittedly, Cora didn’t like all the complications and probably won’t have any other pregnancies. But she is very glad to have had this incredible experience.
Mamas on Bedrest: Dr. Linda Burke-Galloway Reviews Updated Recommendations for Exercise During Pregnancy
June 28th, 2011
The post below was written by one of my idols and mentors, Dr. Linda Burke-Galloway. Dr. Burke-Galloway is an OB/GYN who practiced for years providing care to high risk pregnant women. She is now a nationally recognized patient advocate, a legal expert in cases involving high risk obstetrics and Medical Malpractice and is the author of The Smart Mother’s Guide to a Better Pregnancy. In this post from her blog, she reviews ACOG’s Guidelines for exercise during pregnancy.
Exercise while pregnant has always been a controversial issue. The days of of “eating for two” to justify inappropriate eating habits is passé. Nine years ago, The American Congress of Obstetrician-Gynecologists published guidelines regarding exercise and pregnancy. Essentially they recommended 30 minutes or more of moderate exercise each day for pregnant women in the absence of medical or obstetrical complications. The Center for Disease Control’s (CDC) recommendations for an “active lifestyle” does not exclude pregnancy.
In the June 2011 issue of Obstetrics and Gynecology, Gerald Zavorsky, Ph.D and Lawrence D. Longo, MD, wrote an excellent article on exercise and pregnancy. They recommend exercise intensity that increases the heart rate to at least 60% of its maximum capacity during pregnancy to reduce the risk of gestational diabetes. Other recommendations for pregnant women are as follows:
• Pregnant women aged 18 to 45 may do 8 to 10 muscular strength exercises for one to two sessions per week on nonconsecutive days. One aerobic training session can be replaced by a muscle strengthening session in the weight room or at home
• Use lighter weights and more repetitions. If you usually perform leg presses with 35 lb for 8 to 12 repetitions, try 20lb for 15 to 20 reps.
• Avoid walking lunges because they may rise the risk of injury to connective tissue in the pelvic area
• Be careful with free weights because they may involve the risk of hitting the abdomen. Use resistance bands instead that offer different amounts of resistance and varied ways o do weight training and should pose minimal risk to the abdomen
• Try not to lift while flat on your back. In the second and third trimesters, lying on your back may cause the uterus to compress a major vein that could limit oxygen received by the fetus
• Zavorsky and Longo recommend that you listen to your body. If you feel muscle strain or excessive fatigue, modify the moves and reduce the frequency of the workouts. “Pregnancy is not the time to perform heavy weight lifting.” Instead, they should do muscle strengthening exercises according to the prescribed guidelines because it will burn calories and increase the resting metabolic rate.”
As always, please consult your physician or healthcare provider prior to starting an exercise program and remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
While Dr. Burke-Galloway’s post is directed towards women having uncomplicated pregnancies, once again I want to reiterate that Mamas on Bedrest need to ”exercise” as well.
OB’s and Midwives emphasize the benefits of weight management, maintenance of cardiovascular endurance, maintenance of muscle strength and tone as well as a decrease in the overall aches and pains of pregnancy as the main reasons women should engage in regular prenatal exercise. Secondarily, they emphasize exercise as a way to ward off Gestational Diabetes and possibly Gestational Hypertension which may lead to pre-eclampsia. All of these benefits of prenatal exercise are even more important to mamas on bed rest, women who are at increased risk of these complications (if the don’t already have them!).
Very few OB’s recommend specific exercises for women on bed rest. For that specific reason I developed Bedrest Fitness. It is a simple yet effective set of exercises that women can do while in bed. I also want to add that women on bed rest should regularly stretch, I recommend hourly, to maintain circulation and to decrease the risk of developing bed sores as well as blood clots in the legs.
As Dr. Burke-Galloway stresses, always check with your health care provider before starting any sort of prenatal exercise program. If ysou have questions about exercise while on bed rest, send an e-mail to info@mamasonbedrest.com. And for those interested in more structured and supervised exercise for women on bed rest, join us this fall for online Bedrest Fitness Classes! Details and registration will be available soon!
LIsten to the Mamas on Bedrest Podcast Interview with Dr. Linda Burke-Galloway Here.
Mamas on Bedrest: Lifestyle Counseling May Improve Some Pregnancy Outcomes
June 2nd, 2011
Lifestyle Counseling May Improve Some Pregnancy Outcomes is the title of a Medscape continuing education module that I just completed. I am a staunch advocate of lots of support and education during pregnancy, so to see my belief somewhat validated was heartening to say the least.
In this particular study, Finnish researchers sought to determine if antenatal counseling of pregnant women at risk for developing Gestational Diabetes Mellitus (GDM) in mamas, reduce the birth weights in newborns born to mothers at risk for GDM and effect ( avoid adverse) outcomes. 2271 Finnish women were enrolled in the study and screened with oral glucose tolerance tests between 8 and 12 weeks gestation. Women in the intervention group received individual intensified counseling regarding physical activity, diet, and weight gain at 5 antenatal visits.
The researchers found that intense counseling regarding diet, exercise and weight gain was effective in controlling birthweight of the newborns, but did not have an effect on whether or not a mother developed GDM. The authors concluded,
“Results from ongoing clinical trials may strengthen the evidence on the effectiveness of lifestyle modifications on maternal and fetal hyperglycemia and its consequences,” the study authors conclude. “The findings of our study emphasize counseling on the topics of physical activity, diet, and weight gain in maternity care especially for women at risk for GDM in order to prevent LGA newborns possibly causing problems in delivery, and both the mother’s and the child’s later weight development.”
So while the authors did not reach their desired endpoint, lowering the incidence of gestational diabetes in women at risk, they did learn that counseling could in fact reduce the incidence of Large for Gestational Age infants and hence potentially reduce incidence of problems during delivery for both mother and baby.
Many researchers may read this study and conclude, “since there was no effect on incidence of GDM, then there is really no need to emphasize diet, exercise and weight management” during pregnancy. And it is with this attitude that I disagree. It has been my experience that women who are given no guidelines regarding their diets, how to exercise safely during pregnancy and counseled about appropriate weight gain during pregnancy do fare better and have fewer complications. I don’t have specific numbers so I cannot say that the results are statistically significant, but I have seen these results anecdotally. I prefer to educate pregnant women about their pregnancies and what they can do to make their pregnancies a little easier; to ease the nausea, pain and/or aches associated with pregnancy, to sleep better and to prepare as best possible for potential complications.
Many may argue that there is little evidence that counseling or coaching has any effect on a high risk pregnant woman, her pregnancy or her baby and that I am potentially coming between a pregnant woman and her health care provider. However, the women that I have had the opportunity to work with have been pleased and thankful to have someone with whom they can reach out to at all hours (via e-mail) and pose even those “silly questions”. They appreciate having someone who can point them to resources for more information and for many of the services that they may need.
If it takes a village to raise a child, I believe it takes that same village to support the mama who is going to give birth to that child. It’s in everyone’s best interest to ensure that pregnant women have all of the health care , support and resources that they need to have successful, uncomplicated (as much as possible) pregnancies and healthy babies. We are all working towards the same goal, so let’s all work together to make it happen.
If you are pregnant, particularly if you are on bed rest and want to know what you can do to positively effect your situation, schedule a Complimentary 30 Minute Bedrest Breakthrough Session. It’s free and accessed by e-mailing info@mamasonbedrest.com.
The full Finnish study is available at icine.
