Exercising Safely in Pregnancy

Women are encouraged to continue and maintain an active lifestyle during pregnancy in the absence of medical or obstetrical complications.  Women in good health should engage in regular moderate intensity physical activity during a normal, uncomplicated pregnancy.  Before starting an exercise program discuss your level of risk with your prenatal provider to assess your appropriate level/frequency of activity. For low risk, healthy women the CDC (Center for Disease Control and Prevention) recommends at least 150 minutes a week of moderate intensity activity.  For women who have not exercised regularly before pregnancy, it is best to gradually increase up to 30 minutes a day. 

Women should include a mix of aerobic, such as brisk walking, dancing, swimming, rowing or stationary cycling and resistive exercises, such as yoga, stretching, light weight lifting or Pilates most days of the week.  A simple way to assess level of exercise intensity is the “talk test”, you should be able to carry on a normal conversation while performing moderate intensity exercise.  It is also important to maintain proper hydration during exercise, always have water readily available.  After the first trimester, also be mindful of your posture and avoid lying completely flat on your back, instead slightly elevate your head and upper back.  Contact sports or activities with a high risk of falling are not appropriate physical activity during pregnancy due to the risk of trauma.

In addition to helping maintain or improve your cardiovascular health, studies show that regular moderate intensity exercise during pregnancy can actual improve pregnancy outcomes.  Regular exercise has been shown to decrease women’s risk of developing preeclampsia, a potentially dangerous disease of pregnancy causing high blood pressure, edema, protein in the urine and possible seizures.  Women who are active throughout their pregnancy also tend to have decreased need for pain medicine during labor and decreased length of labor.  Obese women who engage in regular physical activity have a decreased risk of developing gestational diabetes.  Women who do develop gestational diabetes during pregnancy and exercise regularly are shown to have improved glycemic control, decreasing the need for insulin management.  Exercising regularly throughout your pregnancy can help boost your energy, improve your mood and decrease your risk of developing complications.  Now that spring has arrived, it is the perfect time to get outside and start moving for you and your baby’s health.

Cesarean Section Rates

A recent article on November 3rd in the Chicago Tribune discussed cesarean section rates published for some Chicago hospitals.  Swedish Covenant Hospital has one of the lower rates in Chicago at 25%.  This rate represents all providers who deliver babies at Swedish Covenant including obstetricians, family practice physicians and nurse-midwives.  Many individual providers track their individual practice’s cesarean rate, which might differ from the total hospital rate. 

For the nurse-midwifery group at Swedish Covenant Hospital, our current cesarean section rate for 2009 is 15% and has been between 12-16% over the last decade.   Our statistics for the last 3 years are posted @  www.swedishcovenant.org/midwives.

Healthy people 2010 from the U.S. Department of Health and Human Services suggest a target cesarean section rate of 15%.  The American College of Obstetricians and Gynecologists suggest a benchmark for a first time cesarean section rate of 15.5% and repeat cesarean section rate of 37%.  According to the CDC (Centers for Disease Control and Prevention) the U.S. total cesarean section rate is 31%.  Many people are wondering, what does all this mean and what are the benefits to a lower cesarean section rate.

Women who have a cesarean birth have longer hospital stays and infant bonding interruption post partum which can lead to difficulties with breastfeeding.  There are also increased rates of the following: hemorrhage, deep vein thrombosis, pulmonary embolism, increased infectious morbidity and placenta abnormalities in subsequent pregnancies.  There are definitely instances when a cesarean section is necessary for the life of the mother or fetus, but current research does not support a 31% need.

There are consequences to multiple cesarean sections including placenta previa, placenta accreta, hysterectomy and bowel/bladder injury.  Placenta previa and accreta can be life threatening for mom and baby and rates of occurrence go up with number of cesarean sections.  A recent study in OB/GYN reviewed over 30,000 patients and found that women with a history of one prior cesarean section had a 3% chance of placenta previa.  After 3 prior cesarean sections the rate reached 40%.

VBAC (vaginal birth after cesarean) rates in the U.S. have fallen since the 1990s, which contributes to the current rising cesarean section rate.  VBAC is considered safe if performed in a hospital with continuous fetal monitoring, 24 hour obstetrician and anesthesiologist coverage available to perform a cesarean section urgently if needed.  Two recent U.S.  studies reviewing over 25,000 VBAC attempts reported a 75% success rate.  If a woman has had a vaginal birth followed by a cesarean section, research shows that for subsequent pregnancies a VBAC attempt is safer than a repeat cesarean section.  Currently many providers will not offer their patients a VBAC and will recommend a repeat cesarean section regardless of whether risks factors are present.

For women who are looking for a provider to partner with during their pregnancy considering the hospital’s cesarean rate is important, but also ask your individual provider what their rate of cesarean section is.  Also discuss childbirth options and philosophy on childbirth with your provider.  Educating yourself about pregnancy, labor and childbirth will empower you and your family to participate in decision-making which will leave you feeling more satisfied with your birth experience. 

 

 

Let’s Help Our Community

Swedish Covenant Hospital is assisting the North Park Friendship Center in collecting can goods for families in need.  The North Park Friendship Center is a non-profit organization that provides services to those in need in the neighborhood.  With the support of individuals, churches, institutions, businesses, grantors and foundations the North Park Friendship Center provides food, clothing and job training to families, children, adults and seniors in the community.  You can help by posting a comment to this blog and in return Swedish Covenant Hospital will donate one canned good to the North Park Friendship Center.  Let’s work together to help improve the quality of life for everyone in our neighborhood, your shared comment will provide a canned good for someone in need.

Pregnancy and H1N1 Virus

I have had many patients ask me about pregnancy and H1N1(Swine) flu since the outbreak.  According to the CDC (Centers For Disease Control and Prevention) severe illnesses have been reported in pregnant women during this outbreak.  Currently there is not a vaccine available, but CDC is hopeful there will be a vaccine available in mid October, with pregnant women being one of the specific populations in need of the vaccination.  There is not currently a recommendation to delay becoming pregnant during the flu season, but there are some general recommendations to reduce risk of exposure for pregnant women and those considering pregnancy.  Some steps to take to avoid exposure include: frequent hand washing, minimizing contact with sick individuals, avoid crowded areas in communities with a known outbreak, making sure ill persons cover their mouth when coughing, and ill persons should stay at home.  If you are pregnant and suffering with respiratory influenza-like symptoms, such as cough, rhinorrhea and sore throat with a fever notify your provider.  Early treatment with antiviral medications is recommended for pregnant women while awaiting test results.  To keep your immune system strong and better able to fight illnesses, eat a healthy well balanced diet, rich in fruit and vegetables, exercise regularly and get enough rest.

Your Health Before Pregnancy

Health care providers discuss health during pregnancy with their patients, but not as much attention is giving to the state of you health before pregnancy.  Before conception, the better a woman’s health is increases your chances of having a healthy pregnancy and a healthy baby.  So what exactly does being in good health mean? 

Having a healthy body mass index (BMI) prior to pregnancy has many benefits.  BMI is a way to assess healthy weight for your height.  Being underweight during pregnancy may lead to smaller babies who have problems during labor and delivery and being overweight increases your chances of having high blood pressure or diabetes during pregnancy.  You can find out your current and ideal BMI at http://www.cdc.gov/healthyweight/assessing/bmi/

You can reach a healthy BMI by following a healthy diet full of real foods such as fruits, vegetables, low fat dairy, low fat meats and whole grains.  Exercising for 20-30 minutes most days of the week is also important to maintaining  a healthy weight and should be continued throughout pregnancy.  Staying fit throughout your pregnancy has been shown to decrease length of labor and women’s need for pain medicine during labor. 

If you are planning pregnancy you also want to change certain lifestyle behaviors.  When trying to conceive  avoid excessive alcohol, smoking, recreational drugs and some over the counter or prescription medications that are not known to be safe during pregnancy.   Avoid hot tubs and saunas, very high body temperatures can be harmful during the early development of the baby.  Avoid consuming raw or undercooked meat also.   

It is important to take a multivitamin with 400 micrograms of folic acid daily.  If taking before pregnancy and during, it can help prevent serious birth defects of the spine and brain (neural tube defects).  If you have had a baby with a neural tube defect, talk to your provider about an increased dose of folic acid.

Track your menstrual cycles, knowing the first day of your last menstrual period is important to accurately date your pregnancy.  Once you have missed your menstrual period notify your provider, prenatal care should be started in the first trimester.  Scheduling a preconception visit before getting pregnant is good and allows time to ask your provider questions, share your medical history and any concerns you may have. 

Before a woman is pregnant is the best time to assess her health.  The better health you are in before you are pregnant increases your chances of a healthy pregnancy and baby.

Welcome

Hi everyone, welcome to my blog, as a Certified Nurse Midwife I would like to use this blog to share women’s health information. I would love to hear back from all of you, comments and questions are welcome. For my first entry I would like to share a little general information about myself and the Swedish Covenant Hospital Nurse-Midwifery Group. I became interested in nurse-midwifery in college after learning about midwives in a women’s studies class and the idea of empowering women to participate in their health really resonated with me. After many years of studying I became a Certified Nurse-Midwife (CNM) in 2002 and joined this group in 2005. CNMs are Advance Practice Nurses with a master’s degree in science specializing in nurse-midwifery and are board certified by the American College of Nurse Midwives. We believe pregnancy and birth is a natural part of a woman’s life cycle and encourage women to participate in decision’s regarding their health and care. We embrace a holistic approach and provide gentle and safe care to women of all ages, before, during and after pregnancy based on current scientific research and the art of midwifery. I plan to post information a few times a month, so please comment and ask questions. I’m looking forward to blogging with all of you, Sherri Ruerup, MS, CNM


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