stretching
Walking Gets Mama into Shape After Bed Rest
July 5th, 2010I was really excited to see several new mamas out walking with their babies in the sunshine this morning. Walking is an excellent way for mama to lose the pre-pregnancy weight and spend time with her baby. Additionally it is an exceptional way for a former mama on bed rest to regain her lower body muscle strength,endurance and her pre-pregnancy physique.
After as little as two weeks of inactivity, a mama on bed rest can lose substantial muscle strength and endurance. Judith Maloni, Ph.d, notes in her publication, Astronauts and Pregnancy Bed Rest: What NASA is teaching us about inactivity,
“Many mamas who deliver after being on prescribed bed rest report that they have difficulty standing up, get dizzy when they first stand up and they have hip and leg pain.”
Many Mamas are unable to support themselves while standing, let alone themselves and their babies immediately post partum! The longer that a mama had been on prescribed bed rest, the longer-and perhaps harder-it is for her to regain her pre-pregnancy strength, endurance and her pre-pregnancy physique.
Most obstetricians advise new mamas not to engage in vigorous physical activity before 6 weeks post partum. While this is sage advice as it applies to engaging is structured aerobic activity, heavy lifting or strenuous activity, it does not apply to walking. In fact, new mamas should take a short walks daily-beginning almost immediately. At first, this may simply be walking down to the nursery to see their newborns. Once they are home, it may be walking around the house, around the yard or around the block. The sooner mama can begin re-engaging her muscles and reactivating the dormant connections between her brain and her limbs, the sooner she can begin the reconditioning process.But let’s not get ahead of ourselves here. I want to keep this post purely on walking and the early post partum mama.
So there I was, walking my 9 laps around the park in my husband’s home town (a mile=3 loops around the park path and I walk 3 miles), watching the mamas walking with their baby strollers and several important tips came to mind that insprired this post.
- Start with a good pair of athletic shoes. It is very likely that you will need to buy a new pair of athletic shoes after you have your baby. Your feet probably swelled or spread to accommodate the added weight of your pregnancy. For some women, myself included, their feet are now a full size larger (or more) as a result of their pregnancies. Even if you are able to wear the same gym shoes you wore while pregnant, you’ll probably notice that they have stretched and/or worn in such a way that they no longer provide adequate support to your feet now. For example, I “waddled” when I was pregnant and to be able to support my weight, I walked on the outside of my feet. Once I delivered and my weight shifted back to a more even, central distribution, my old shoes actually caused pain in my calves when I wore them to walk. If you can afford to do so, get new athletic shoes.
- Wear a good supportive bra. It’s summertime and while tank tops are appealing, be sure to wear a good, supportive bra when you walk. “But walking is low impact,” you may be thinking. True enough, but if you are nursing, you may have noticed that your breasts are not only heavier but also more sensitive than normal. The mere feeling of cloth against your nipples or extra movement of the breast tissue may be very uncomfortable right now. Make sure to wear a bra that keeps you cool and “wicks” moisture away from your breast as well as one that helps minimize movement.
- Wear an abdominal support if necessary.I had cesarean sections with each of my children and my belly was very tender post partum-especially after the birth of my son, my second c-section. I wore a support garment after both pregnancies to help relieve pressure on my belly. There are several good one on the market and Special Addition Maternity and Nursing Boutique has several great support garments-I bought mine there and you can order online and get sizing support during normal business hours.
- Get a good walking stroller. If you can, get a stroller that is designed for walking. These strollers will have larger wheels and the wheels often pivot so that they are easy to turn and maneuver. Today I saw a Graco stroller that had handles that were similar to those that competitive bikes have so that mama can either grip them with her hands or rest her forearms on them. Additionally, many strollers allow you to adjust the handles so that your arms rest comfortably at your sides, not too high and not too low. Very ergonomic!!InStep, BabyTrend and other jogging strollers are great brands to start with. Also, check sporting goods stores as they often stock jogging strollers.
- Once you have the right equipment, you need to walk with the correct posture. Be sure to stand up straight behind the stroller, not hunched over the handles. New mamas often have rounded shoulders from the weight of their pregnancies, nursing and constantly bending forward to care for their babies. Likewise, mama should not be bent at the waist with arms extended in front of her pushing the stroller as if she is hoisting a huge bolder up a hill like Sisyphus. This stance will lead to arm, shoulder, neck and back pain. It’s important that new mamas stand up straight behind the strollers as they walk to minimize pain or injury.
Once mama has these few essential pieces of equipment and posture pointers, she is ready to begin an initial walking program and the journey back to her “pre-pregnancy” self. Our next blog post will address some specific training techniques mamas can use to enhance their walking program.
Still on bed rest yet want to maintain muscle strength and tone? Order Bedrest Fitness, the first DVD fitness program modified specifically for mamas on bed rest.
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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.
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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