prenatal exercise
What Exercises Can I Do With an Incompetent Cervix?
July 1st, 2010I recently received an-e-mail from a mama who had just gone on bedrest with an incompetent cervix at 30 weeks.”What exercises, if any, can I do with an incompetent cervix,” she asked?
An incompetet cervix is one of the more common reasons pregnant mamas are prescribed bed rest. While the rates of incompetent cervix are thought to be low, no one is exactly sure how many women are affected by incompetent cervices during pregnancy. An incompetent cervix can manifest in one of three ways:
- Opening of the cervical os more than 2.5 cm during the second trimester
- Thinning and shortening of the cervix (effacing) in the second trimester or early third trimester
- Thinning or opening (funneling) of the cervical opening closest to the baby
The treatment for incompetent cervix is cerclage (surgically placing a stitch through the cerix to hold it closed), bed rest, or a combination of the two.
Being prescribed bed rest puts a mama at risk for blood clots in the legs, muscle atophy and overall loss of strength and cardiovascular conditioning. Most women who are prescribed bed rest should also be prescribed-or at least advised about-exercises that they can do to maintain muscle strentgth and tone as well as to reduce the physical effects if prolonged inactivity. However, it has been my experience that many women prescribed bed rest receive little or no instruction on what they can do to exercise their bodies while on bed rest. This is due in part because many obstetricians don’t know what types of exercises are safe for women on prescribed bed rest. A lucky few mamas will have a consultation or two with physical therapists. But the vast majority of mamas who go on prescribed bed rest will receive no exercise instruction. For this reason I produced Bedrest Fitness when I was pregnant during my second pregnancy.Bedrest Fitness is a set of modified prenatal exercises designed specifically for pregnant women on prescribed bed rest.
A mama with an incompetent cervix should avoid any movements or exercises that put pressure on the cervix and many women will be instructed to remain recumbant in bed or on the sofa. But if you think about it, that leaves your arms and legs free to move. Mamas on bed rest with an incompetent cervix should perform a variety of arm and leg exercises daily to maintain steady bloodflow and adequate circulation back to the heart-especially from the legs. Leg exercises should include:
- Leg Ab/Adduction exercises
- Passive double knee raises (provided Mama can do them using an exercise band or towel to draw her knees up and not engage her abdominal muscles. If mama feels any pressure in her lower abdomen, these should be avoided!)
- Point/flex of toes to exercise the calf muscles
- Ankle circles
Upper body exercises should include (using a towel or exercise band):
- Modified flies
- Shoulder extensions with arms extended forward and to the sides
- Upright rows
- Bicep curls
- Triceps extensions (if allowed to sit up)
On Bedrest Fitness I included Cat/Cow stretches. Women with incompetent cervices can
actually do these stretches, but in my experience they often are unable to gauge how much pressure they are putting on their cervices. So unless a physical therapist or fitness professional is present, I don’t recommend that mamas with incompetent cervices perform these exercises.The same is true of the modified crunches.
Bed rest can have a profoundly negative (albeit temporary) effect on a mama’s overall physical condition. Depending on how long she was on bed rest prior to delivery and the restrictions she’d been given, a new mama can find herself unable to hold herself upright or to even hold her newborn. But if she engages in a few very simple but targeted exercises while on bed rest, mama will find that she will be less deconditioned after delivery and recover more quickly.
If you or someone you know has been prescribed bed rest during pregnancy, order a copy of Bedrest Fitness. Even if Mama can’t do all of the exercises, she will preserve muscle strength and tone in the areas she does exercise. Mama can also download a free set of lower body exercises, stretches and Kegels when she signs up for the Mamas on Bedrest e-mail list.
Kegels: Essential Exercises for Mamas on Bed Rest
February 16th, 2010
Most women have heard of Kegels and at one time or another have been advised to perform Kegel exercises. But in my experience as a woman’s health professional, I find that many women have no idea what muscles are involved in Kegel exercises and as a result have no idea how to perform one properly. So I offer here a short review.
Kegels are essential exercises for all women, but especially for pregnant women on prescribed bed rest. Mamas on bed rest, with their prolonged inactivity and growing uteri are at increased risk of weakened pelvic floor muscles which will be further stretched and potentially weakened if they vaginally deliver their babies. The results can be urinary incontinence (involuntary loss of urine with coughing, laughing, sneezing), organ prolapse (bladder, uterine or rectal prolapse (bulging or protrusion of the bladder, uterus or rectum through their respective openings to the outside), or decreased sexual sensation due to the lax musculature. But I don’t want to get ahead of myself here. Let me start with the basics and work forward.
Dr. Arnold Kegel developed “Kegel” exercises to help women strengthen the pelvic floor muscles following pregnancy.
Dr. Kegel noted that women frequently became incontinent following pregnancy and found that if they could strengthen the pubococcygeus “PC” muscle (the muscle that is suspended along the pelvic floor like a hammock and holding all of the pelvic organs in place), they could often improve or reverse urinary incontinence as well as bladder, uterine or rectal prolapse. He started teaching his patients how to contract the PC muscle and Kegels were born
So how is a Kegel done? First, you have to be sure that you are working the proper muscles. If you are squeezing and releasing your buttocks, you are probably not working your pelvic floor muscles-at least not effectively. You can be sure you are working the pelvic floor muscles:
- By stopping the flow of urine while urinating. While this is a good way to get to know the pelvic floor muscles and what they feel like when contracted, do not stop the flow of urine ROUTINELY as a way to strengthen the pelvic floor muscles. This practice will actually weaken the muscles and cause or worsen urinary incontinence.
- You can look at your perineum and watch as you contract the muscles. If you are performing the exercises correctly, you will see the anus “wink” the perineum move up and down and the clitoris “nod” (thanks to Desiree Andrews of Prepforbirth.com for these great visuals!). This is a great way to see and learn which muscles are working. You can place a mirror on the floor and squat over it to see the muscles or hold a mirror between your legs. However, if you’re pregnant, it may be hard to hold the mirror between your legs and see and this is really hard of you are on bed rest. But for non-pregnant women, this is a good way to start learning how to Kegel.
- You can feel for muscle contractions by placing a finger or two into your vagina and then contracting the pelvic floor muscles around your fingers. Again, once you know which muscles to contract, you can effectively perform Kegels.
- There are devices that one can use to help stimulate the PC muscles. Physical therapists often use such devices when teaching clients how to do Kegels. Additionally, one can buy such devices and learn to Kegel using the devices.
Now once you get the basic muscle contractions down, you can then move on to some “advanced” Kegeling.
Squeeze, Hold, Release : This is just as it states. Squeeze your PC muscle, hold for a few seconds and release.
Elevators: This is an increasing contraction and likened to making floor stops while on an elevator. You begin by lightly contracting your pelvic PC muscle. After about 2-4 seconds, increase the contraction further pulling up the PC muscle. Hold for another 2-4 seconds and then tighten the contraction again. Hold for 2-4 seconds and then release. A variation is to gradually release the contractions holding for 2-4 seconds as the “elevator goes down.”
Quick Bursts: These are just what they say, quick contractions. You quickly contract the PC muscle, say 10 times. Rest for a brief moment and then repeat the series. This should be done several times over the course of about 5 minutes.
Some people recommend that women “Kegel” approximately 20o times a day-performing a variety of contractions. If you Kegel regularly, say 3-4 times a day performing 10 or more Kegels at a time, you will strengthen the PC muscle. But as the saying goes, the more you work a muscle, the stronger it becomes. So if you want to keep your PC muscle strong and have a strong pelvic floor, Kegel often, several times a day and in various situations so that you not only develop pelvic floor muscle strength, but also muscle control which can help prevent incontinence and enhance sexual pleasure.
Note: Second image courtesy of www.menstruation.com.au
Gestational Diabetes: A Particular Problem for Mamas on Bed Rest
January 29th, 2010
Gestational Diabetes (GD) can be particularly problematic for mamas on prescribed bed rest. Previously a common indication for bed rest, with all of the medical advances and therapies most pregnant women who develop GD are easily managed as out patients. Unfortunately, women who are prescribed bed rest for another medical condition are at increased risk for developing GD as a result of inactivity and weight gain. Women who develop GD are at increased risk of developing Type II diabetes later in life as well as Metabolic Syndrome.*
Gestational Diabetes is defined as impaired (improper) glucose metabolism during pregnancy. Some women become insulin resistant, meaning that the insulin their bodies produce does not properly carry glucose from the bloodstream into the body’s cells as it should. Sometimes GD develops because a woman has gained too much weight, a common cause of insulin resistance. Other times the increased hormones of pregnancy interfere with glucose metabolism. Finally, a woman with a genetic predisposition to diabetes may manifest her first symptoms during her pregnancy. This woman is at increased risk of developing Type II diabetes later in her life.
Testing for gestational diabetes is typically done between 20 and 28 weeks of pregnancy. The normal ranges of blood glucose are:
- 70-95 mg/dL Before breakfast (fasting)
- 70-140 mg/dL 1 hour after eating a meal
- 70-120 mg/dL 2 hours after eating a meal
Women who have blood sugars that fall above these ranges during testing will be diagnosed with GD. It is essential that women diagnosed with Gestational Diabetes are treated aggressively and that they achieve and maintain tight blood sugar control. Blood sugar control is essential to ensure the health of both mother and baby. When blood sugars are not controlled during pregnancy, Some unfortunate complications can result such as:
- High blood pressure in the mother caused by preeclampsia
- Excessive birth weight (exceeding 9 pounds, 14 ounces)or Macrosomia
- C-section delivery
- Hypoglycemia (low blood sugar) in the baby at birth
- Jaundice (yellow skin) in the baby at birth
- Respiratory distress syndrome (breathing difficulties) in the baby at birth
- Low blood calcium levels in the baby at birth
- Red blood cell disorders in the baby at birth
- In very rare cases, stillbirth of the baby at 28+ of pregnancy
- In very rare cases, death of the baby in infancy
- Increased risk for type 2 diabetes in both mother and baby later in life
Treatment of Gestational Diabetes is actually quite simple. From many women, adherence to a “diabetic diet”, a regular exercise regimen and regular blood sugar testing are all that is needed. However, for many other women, blood sugar cannot be adequately regulated and controlled with diet and exercise alone, so they are prescribed oral medications or Insulin injections.
Unfortunately most pregnant women on prescribed bed aren’t able to exercise enough reduce insulin resistance with diet and exercise alone. However it is still very important, perhaps even more so, that they follow the dietary instructions from their OB or a nutritionist and that they stretch and do some muscle strengthening and toning while in bed. If women on bed rest are diagnosed with gestational diabetes, they should request a referral to a physical therapist or exercise specialist** so that they can learn safe exercises that they can do while on bed rest.
It may seem unfair to be diagnosed with gestational diabetes while on bed rest for another condition. Try not to become too discouraged. Gestational Diabetes is easily managed and with careful adherence to your obstetrician’s directions, you and your baby can be just fine.
**Bedrest Fitness is a set of simple yet effective modified prenatal exercises that a pregnant woman on prescribed bed rest can do from her bed with her obstetrician’s approval. Order Bedrest Fitness here.
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