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expecting
fitness
by: Birgitta (Gallo) Lauren

how to modify and enjoy your exercise program throughout your pregnancy with Sheryl Ross M.D.

ISBN: 1-58063-064-2 Published by St. Martin's Press
Foreword By Jane Seymour

Preface

Foreward By Raul Aorta MD
The Pregnancy/Exercise Connection
Cardiovascular System

Your Changing Biomechanics.

FOREWORD BY JANE SEYMOUR
       The first time I met Birgitta, it was at the request of my doctor, Sheryl Ross, MD I was three and a half months pregnant with twins, and Sheryl told me that I needed to exercise to counteract the effects that this pregnancy would have on my body. My show, Dr. Quinn, Medicine Woman, was on hiatus, so it was a good time to start an exercise program. This pregnancy at this stage in my life was very different from my previous pregnancies, which I also exercised through. Back then I was pregnant with only one child and I did floor exercises at Jane Fonda's Workout Center. Now, with twins, I was a "high risk" pregnancy, and I wasn't sure what I would be able to do.

       Birgitta assessed me and conferred with Dr. Ross about everything we were to do. We started out with some light toning exercises that she gradually made more difficult. In the beginning we would alternate indoor workouts with pool workouts. We did a lot of squats, outer thigh exercises, abdominals, upper body movements on the Pilates machine, breathing exercises, and those eternal Kegels. She would throw in Kegels everywhere, at the bottom of a squat, in the middle of a stomach contraction, and even during stretching. Working in the pool was a lot of fun. Birgitta had all kinds of pool toys that we used for resistance. Sometimes my time was so constrained that Birgitta had to come to the set to work me out. It must have been quite a sight-me exercising in a big crinoline dress, hat and all.

       She always encouraged me to work to my capacity, but also to listen to my body and slow down and rest when I needed to. She kept it fun and varied and modified the workout according to my advancing condition. Toward the end I was put on bed-rest just to be on the safe side. I was supposed to remain in bed for most of the day, but about the only time that I did was during our workouts. Birgitta somehow managed to modify and redesign my whole workout to be done in bed. Being pregnant with twins became a gruesome experience, but she kept my spirits and strengths up. It was always about staying strong and healthy, never about vanity-and I'm proud to say, I never waddled once.

        Exercising during a pregnancy is like a metaphor for life. It can be difficult, at times when you feel like giving up, when you're aching and tired and overwhelmed. But you keep going. Finally, when those boys were born, the purpose was clear. I did it for them as much as for me, but postpartum it was all for me. Three days later, Birgitta came to the hospital handing me a sheet of three "little" exercises to do until I saw her in two weeks. I got no break at all. I was back in shape in no time. With a Golden Globe nomination, it was a good thing. Hollywood can be very cruel, especially at awards-we have to look fabulous.

       We continued working out, gradually making me stronger, and by the time my boys were six months old, I felt and was back to normal.

        As you read on, you'll be impressed with Birgitta's dedicated and thorough research and incredible knowledge on pre- and postnatal fitness. This book is full of useful information that you won't find anywhere else.
Thank you Birgitta.

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PREFACE
       We are living in very exciting times. Gone are the days of submissively accepting the idea that pregnancy is a disease that requires total confinement and inactivity, and the fear that the pregnant body can't be trusted. The outmoded Western belief that a pregnant woman should be sedentary is cultural and not based on physiological need. New studies show that exercise and pregnancy actually complement each other to be "feto-protective." There is actually more that a pregnant woman can do than can't do, but if you haven't exercised before you will need to begin slowly.
I designed this book to be as comprehensive as possible, covering everything you need to know to enjoy a healthy pregnancy, including exercise and nutritional guidelines, information on the changes the pregnant body goes through, answers to many pregnancy-related questions, and much more. Although some of this information has been published, a lot has never before been made available to the public. It is all based on the latest research from medical journals (primarily the groundbreaking work of Drs. Raul Artal and James F. Clapp III) and institutions including the American College of Obstetricians and Gynecologists and the American College of Sports Medicine, as well as my years of personal experience working with pregnant moms. You may find some sections to be a bit technical, but it's not necessary for you to study and learn every detail. Even if you just skim through some of the medical chapters, you will still gain an understanding of the whys, hows, dos, and don'ts of pre- and postnatal fitness.

       Birgitta Gallo's (now Lauren) Expecting Fitness is the first book to offer recommendations on how to modify specific sports and fitness activities during pregnancy. It covers practically every sport and fitness activity, with instructions on how to adapt each one. There are some activities that should be avoided altogether during pregnancy, but you'll be surprised how much you can do, with some modifications. In addition to teaching you to adapt your current activities, I'll also lead you through exercises to tone, stretch, and strengthen every part of your body.
You should consult your OB/GYN prior to beginning any fitness program or participating in any sport or activity. You know your body best, however, and if you feel your doctor's guidelines are too restrictive, you should consider getting a second opinion. Unfortunately, there are some doctors out there who don't keep up with the latest scientific data on exercise and pregnancy, and some who cling to outmoded fitness recommendations. Make sure you choose a doctor you feel comfortable with. For advice on how to find the right doctor, I recommend the book Doctor Shopping: How to Choose the Right Doctor for You and Your Family by Hal Apiar.
       The benefits of exercise during pregnancy are tremendous. These benefits include increased energy levels, reduced pregnancy discomfort, fewer delivery complications, decreased labor time, and speedier recovery time. Exercise will give you better control of your pregnant body, because a strong and fit body can better support the growth and changes in a pregnant woman. Exercising when pregnant also helps your circulation, relieves tension, and helps with balance and coordination. You will gain less weight and regain your pre-pregnancy shape sooner. Most importantly, recent research has proven my personal theory to be correct-your baby will derive substantial health benefits.

       Realizing that your pregnant body is beautiful, strong, and healthy will do wonders for your self-esteem, confidence, and emotional well-being. With an educated and positive outlook on the changes of pregnancy, you will move and enjoy your body much more. With a better understanding of your pregnant body, knowing how to minimize discomfort and prevent complications, your mind will be more at ease throughout your pregnancy and as you anticipate motherhood.
Being able to motivate and inspire women to confidently go through their pregnancies strong, fit, and healthy, and to educate them about their pregnant bodies is extremely fulfilling and exciting. Part of my goal in writing this book was to answer your questions about prenatal fitness, so that you can confidently exercise your right to a healthy pregnancy by staying as fit and strong as you can. Just by picking up this book you are demonstrating an interest in giving your baby the best possible start in life. Being pregnant is definitely not the time to stop moving-stay active and enjoy the nine months of quiet before the storm.
Also look for Jane Seymour's upcoming book on having twins, to be
released in the spring of 2001.
E-mail me with any questions at birgitta@expectingfitness.com or look for my newsletter at www.expecting-fitness.com.


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FOREWORD BY RAUL ARTAL MD
       It is well recognized that 40 percent of all medical conditions in our urbanized society are behavior related, that is, they arise because of sedentary lifestyle and poor nutritional habits that result in obesity, cardiovascular disease, diabetes, and hypertension.

      Pregnancy provides a unique opportunity for behavioral modification. The increased awareness for well-being in pregnancy provides a strong impetus for lifestyle changes. Pregnancy-acquired lifestyle changes ultimately impact on the well-being of the entire family. It is laudable that prominent individuals in the entertainment industry such as Jane Seymour have taken upon themselves to promote a healthy lifestyle for the public at large. These initiatives have a significant influence on behavior modification.
Today's women are better informed and usually assume the key role in issues that relate to family health. Most of the women in today's society combine a career with pregnancy and motherhood and wish to remain physically active. We as health-care providers should promote these trends.
Contrary to the beliefs and practices of previous generations, we should change the perception that pregnancy is a state of confinement. It is not! Women can and should continue to derive health benefits from an active lifestyle during their pregnancy.

       The immediate benefits of exercise and fitness in pregnancy include the ability to better cope with the rapid anatomical changes of pregnancy: to maintain better posture, ambulate more easily, experience less back pain, and maintain a better overall psychological outlook. Fit women also appear to cope better with labor and delivery.

       Throughout history, attitudes toward pregnancy and fitness have changed dramatically, although misconceptions and misinformation persist to this day. To the Victorian lady, pregnancy was a state of confinement and it was considered unseemly for pregnant women to engage in active recreational or social activities. It was even inappropriate to be seen outside her family setting.
The same attitude toward pregnant women persisted in the beginning of the century in the United States. In 1913, a handbook for pregnant women advised:

Walking is the best kind of exercise. Most women who are pregnant find that a two to three mile walk daily is all they enjoy, and very few are inclined to indulge in six miles, which is generally accepted as the upper limit. Very few outdoor sports can be unconditionally recommended to the prospective mother. Because athletic exercise is either too violent or else jolts the body a great deal, it is especially dangerous in the early months of pregnancy. All kinds of violent exertion should be avoided-a rule which at once excludes sweeping, scrubbing, laundry work, lifting anything that is heavy, and going up and down stairs hurriedly or frequently. The use of a sewing machine is also emphatically forbidden.


These attitudes have gradually and slowly changed. By 1949, the U.S. Children's Bureau recommended:

A moderate amount of exercise is good for anyone, and this is particularly true for pregnant women. Unless you have been ill or unless there is some complication, you can continue your housework, gardening, daily walks ... and even swim occasionally.

Grantly Dich-Read, a South African obstetrician practicing in London, emphasized knowledge, relaxation, and some specific prenatal exercises to reduce the need for pain medication in labor. A Russian physician named Velvovsky developed a psychoprophylaxis regimen for "painless" childbirth, which was introduced to the West in the 1950s by Dr. Fernand Lamaze and brought to the United States by one of his patients, Marjorie Karmel.

       Most childbirth preparation classes thereafter focused on relaxation techniques intended to ease the perception of pain and minimize the administration of pain medication. Some called this technique natural labor, a term that was utilized earlier in the century to describe home deliveries. At that time, hospital deliveries were associated with a high incidence of maternal mortality, primarily due to infections. The hospital environment was considered dangerous, unnatural, and a last resort.
Realities and perceptions have changed. Modern hospitals and facilities are certainly the safest locations for labor and deliveries; prospective mothers are educated, inquisitive, in control of their bodies, eager to stay fit and derive health benefits from a healthy lifestyle. In the past ten years, significant research has demonstrated that exercise during pregnancy is not only safe, it is also desirable.
Safe guidelines for exercise in pregnancy have been developed and published by the American College of Obstetricians and Gynecologists. Pregnant women are well-advised to participate in programs that incorporate these guidelines; however, it's always wise to also consult your obstetrician.
Birgitta Gallo has authored with Dr. Sheryl Ross this very practical book on fitness and pregnancy. This book is an excellent, balanced source of information that should find its way to each pregnant woman who desires to remain active in pregnancy!
-Raul Artal, MD
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THE PREGNANCY/EXERCISE CONNECTION Pregnancy is a nine-month physical and emotional roller-coaster adventure to motherhood. There is so much information on pregnancy, but do we really understand it? Myths and unsubstantiated theories are perpetually thrown at us. New books come out all the time without updating their information or researching all of the new medical studies on the subject, many of which have been published in just the last five years. Many books dispense facts about pregnancy but leave out the all-important why.
This chapter begins by detailing the benefits of prenatal exercise and dispelling the myths that had earlier generations of women afraid to leave their rocking chairs during pregnancy. Next, it describes the basics of the pregnancy/exercise connection, helping you to understand why exercise is not just okay but important during a pregnancy, benefiting both mother and child, and how and why pregnancy will affect the way you can exercise.


why you need to exercise
Let's begin with the reasons why you should exercise during all stages of your pregnancy. Most of these will be discussed in greater detail elsewhere in this book, but I wanted to start off by listing the many benefits-to you and your baby-of a good pre- and postnatal fitness program:

PRENATAL BENEFITS
• improves your fertility
• reduces the unpleasant effects of the biomechanical changes in
your body
• eliminates or reduces pregnancy-related discomforts
• prevents and treats pregnancy-induced diabetes
• improves calcium absorption, preventing hypertension,
preeclampsia, and future osteoporosis
• relieves tension, stress, and possible depression
• increases your general strength, improving your ability to carry
your larger belly
• reduces the strain on your upper back
• reduces the strain and pressure on your lower back and sciatic nerve
• prevents "round shoulders" and improper posture
• increases energy, particularly in the last trimester
• improves your immunity
• less excess weight gain
• a better looking pregnant body
• increases your self-esteem and improves your self-image
• gives you a sense of achievement
• gives you a more positive outlook on your pregnancy and
motherhood
• strengthens, tones, and gives you better control of your pelvic floor
muscles during labor
• improves your endurance, fitness level, and muscle control, for
a faster, easier, and less painful labor
• prevents or reduces the risk of labor complications
• reduces your chance of needing a C-section
• reduces the chance of birth defects
• increases the chance of delivering a child with higher Apgar
scores (tests taken at one and five minutes after birth-low scores
usually indicate a problem with the baby's health)

POSTPARTUM BENEFITS
• minimizes stretch marks
• minimizes postpartum blues or depression
• minimizes present and future incontinence (urinary leaking) and organ prolapse problems
• allows faster recovery from pregnancy and labor
• helps you get back into shape easier, faster, and more safely
• reduces back strain from carrying and nursing your newborn
• increases energy and allows you to keep up with your baby
• gives you time for yourself
• reduces birth defects and need for medical intervention
• child is born healthier, leaner and calmer
• minimizes your child's chances of having a weight problem
• improves your child's neurological, mental, and physical development


myths
Now, let's get some of those pesky myths out of the way. There have been so many misconceptions about what pregnant women should or should not be allowed to do. There have been even bigger misconceptions about the entire concept of "prenatal exercise;" perpetuated by both the fitness industry and the medical community, mainly due to the lack of knowledge on how exercise can and should be modified during pregnancy. Many of these myths grew out of fear or ignorance, and they have been disproved by modern medical research.
Following is a list of things regular exercise during pregnancy was thought to cause:
• miscarriage
• hormonal imbalance
• overstressing of the joints, increasing risk of injury
• redirecting blood flow away from the fetus to the muscles, reducing oxygen and nutrient supply for the fetus
• overheating the fetus in the womb
• uterine bleeding
• displacement or rupture of the placenta (the placenta moving to cover the opening of the cervix, preventing the baby from coming out during labor)
sessions to fifteen minutes and keeping your heart rate under 140 bpm (beats per minute). When you're pregnant, your resting heart rate increases by about ten to twenty bpm, so just walking around could bring it up that high. Most prenatal fitness research done in the past was performed on animals. Not surprisingly, scientists have discovered that those findings often do not quite correlate to human pregnancies.
       Recent research, performed over the last ten to fifteen years, has proven that exercise is not just okay for a healthy pregnant woman, it is actually beneficial, and not just to the mother but to the baby as well. We can thank two American gynecologists-Raul Artal, MD, and James F. Clapp III, MD, for most of this research. Dr. Clapp, professor of the Department of Obstetrics and Gynecology at Metro Health and Medical Center in Cleveland, states, "Pregnancy is a normal physiological state, not a disease, and the benefits of exercise appear to be substantial for both the woman and the pregnancy."
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CARDIOVASCULAR SYSTEM
When you exercise, the primary targets for your blood to flow to are your muscles. Pregnancy itself increases your blood volume by 40 to 45 percent-it increases the amount of red cells that carry oxygen, and allows blood vessels to carry more blood at once. Exercise increases your blood volume another 10 percent. Put all of this together, and you have an abundance of blood, ensuring that there is always plenty to go around, protecting the fetus and serving the needs of your other organs. With more hemoglobin in the blood transporting oxygen during exercise, the fetus draws more blood and oxygen than usual through the placenta, and more blood is being pumped with each beat of the mother's heart. A sufficient oxygen supply to the fetus is thus ensured.

       This safety mechanism might have something to do with the fact that pregnancy improves your metabolism to compensate for your weight gain. Therefore, you won't need as much oxygen to do the same amount of exercise. This faster metabolism, combined with extra blood and increased oxygen intake, gives pregnancy a "training effect," making you more fit.

       With all this extra blood, your body may at times have trouble moving it around. If you lie on your back or sit in the same position for a long time, the circulation slows down, and blood pools in your legs, preventing it from returning to the heart or flowing to the fetus. This makes you tired and dizzy. This is called "supine hypotension," and is another safety mechanism of the pregnant body. If this happens when you are in a standing position and the blood doesn't get back to the heart, your blood pressure falls and you need to lay down to enable the blood to rapidly return to the heart-so you faint and fall. Amazing how it all works-who knew fainting could, in a way, be "good for you."

        Exercising and moving your body will keep your blood circulating properly. When exercising, keep your legs moving as much as you can. If you are doing certain seated, standing, or lying exercises, make sure to walk around a little between sets, to prevent blood pooling in your legs. It is probably this blood pooling that accentuates varicose veins, which is why exercise helps to alleviate them. Sitting for a long time can also add to pressure in the pelvis, so you're not going to be comfortable in any position for very long. In order to keep your blood circulating efficiently, it is almost as if pregnancy makes your body say, "Get up and move."
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YOUR CHANGING BIOMECHANICS
The mechanical workings of your body (how your joints move and which muscles are doing what work during a movement), are definitely affected by both your pregnancy and any physical training you may do.
       The physical changes that you will experience from pregnancy increased size, weight, changing shape and center of gravity, swelling tissues, and softer joints-affect the way you walk and perform everyday tasks. You are carrying more weight around, on top of softer, less stable joints, which makes you more susceptible to injuries, sprains, and lower back pain. Exercise, when done properly, strengthens your body, reducing this risk of injury and strain.

       After the fifth month, your hips won't move as well and your range of motion will be restricted. A simple movement such as getting up from a chair becomes not so simple. Leg strengthening exercises for the outer and front thighs (quadriceps), and front lower legs (tibia), will help, and thereby reduce the risk of injury to your knees. Pressing yourself up with the help of your arms will also alleviate the strain on your legs, which means that you should strengthen your arms and upper body, too. It's hard to imagine that just getting out of a chair could get so complicated, but when you are pregnant and your body doesn't move as well, you have to become more aware of your posture, body position, situation, and surroundings. You need to come up with ways to reduce the stress on your body. Instead of sitting on a low chair or sofa, try sitting on a higher chair or bar stool.

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