Message from an eating disorder counselor

I have been reading your blog and a licensed counselor who treats women with eating disorders (and a competitive athlete), i have been really concerned about your eating/exercise habits during your pregnancy. remind yourself that there are others of us out there who are having difficulty getting pregnant and to see someone who was so lucky not take care of themselves is VERY hard to observe.

Thanks for the concern Allison. I have been doing my best to be the healthiest I can be during pregnancy!


Initially my fear was gaining too much weight. Anyway, with all of the exercising (shown in many, MANY studies to be healthy for mom and baby), that's not what's happened.

I gained the pound back from yesterday and more. It was probably just dehydration from skipping dinner.


My body is still in control... I have been waking up nearly every night hungry (despite going to bed full) and go eat something. So last night I preemptively ate more and that seemed to work.

And I do have to wonder why so many of my readers are so concerned when I've received nothing but positive feedback from my healthcare providers and reassurance that the baby and I are healthy. I have the impression from them that I'm doing perfectly as far as exercise and weight are concerned (and I've seen 3 different midwives).

All that aside, I wish you success getting pregnant! I have never been so happy in my life and I know very well how fortunate I am. I still see this pregnancy as a miracle after not having a period for six years! I actually got my period back after eating fish nightly for a couple weeks. Could be a coincidence (since I fell in love around the same time), but I do wonder if this shouldn't be recommended to athletic women who don't get their period.

Happy Halloween, everyone!

P.S. Olga, I've been eating papaya like a crazy lady, but my urine hasn't turned red yet... what gives? :)

Email from Sea Legs Mom

Yes, got an email from my mom today that made me feel more than slightly guilty. She is concerned because I told her the midwife I am seeing advised me to gain 1lb a week from now on:



I can certainly see that you are at a crossroads and will have to make some changes. I was not at all the perfect expectant mother, I should have exercised MORE. But, I always put you first, and made sure that you had an abundance of nutrition. - Sea Legs Mom



This made me feel terrible. What started out as what I perceived to be a healthy challenge (not gaining much weight), has turned into a source of concern for everyone around me, myself included.



So I ate quite a bit the last 5 days. And didn't weigh myself, thinking the weight would just come on naturally. But I was almost a whole pound lighter today when I finally stepped on the scale.



Never in my life did I dream I would have this problem. Usually weight is so easy for me to put on. But with my busy schedule and the terrible heart burn (and, yes, a crazy lingering fear of gaining weight), I guess I just can't do it.



Honestly, I have no fear that the weight will come, though. Things have just been a bit crazy lately with our work schedules. And SR and I have hardly seen each other. I actually had to skip dinner last night so we could go to bed together early before his 4:30 wake-up time.



He is over sleeping at the hospital right now. I miss him.

Thursday night and Friday we are going to a nearby state park. I can't wait.

I will leave you with a quote I heard yesterday on NPR (from a wise woman with a beautiful, androgynous voice):

There is nothing more than a human story. - Maya Angelou

Running song of the day: Gabriel by Najoua Belyzel

24 week prenatal visit

Hi everyone. Yeah, I guess there are a lot of you now! I just wanted to give a quick update from the prenatal visit. According to the midwife, all is going well. I even specifically asked her about weight gain. She said I had done well in gaining 2 pounds since the last visit 5 weeks ago and that I was "right on track to gain the right amount." She even commented that I must be a runner since I look so fit. Anyway, she mentioned that she herself would like to lose weight. So no concerns from her point of view. I actually think SR and I were more concerned about the only 7lb weight gain so far. She reassured us that the weight would come on more rapidly in the later months.

And she recommended papaya for my heart burn, which I had never heard of before. Coincidentally I had been eating just that the past 3 days and had felt much better as far as the heart burn was concerned.

Oh, and I adamantly told her that our little boy was not going to be circumcised. There is no medical reason for it. And, to put it bluntly, there is more sexual lubrication that way (no, I didn't say that out loud). She said she was so happy we had made that decision, and made it obvious that she was opposed to male circumcision.

An interesting day. And some challenging patients at work.

I just want to make one comment to possibly clear up some confusion about me and the blog: I am, at 126 lbs and 5'5", certainly not anorexic. Nor would I ever want to be. I've never wanted more than to be healthy and strong and fit. It would be hard to take me seriously as a physician if I had an eating disorder.
I'll leave it at that and go on posting as normal on the blog. Thanks for asking me not to close it. I feel terrible that SR's is no longer open to the public since we really enjoy blogging and communicating with people this way.

I want to respond to all of your comments individually, but I've just got to get to bed now. It's going to be sad tonight sleeping without SR. But we did just get to have great call room sex, so I'll be alright.

Pregnancy and Western Culture

Wow. Thanks to everyone for your responses. And I'm feeling so good today after sleeping 9 hours and having amazing sex before going to bed. I can't say I have ever felt so healthy and womanly in my life.

And I've found a fun forum that talks about SR's blog and mine quite a bit. Here is the link to it, if any of you are interested. http://www.runango.com/forums/topic_show.pl?tid=62300

It is really fun to see people talking about the blogs, whether or not they agree with everything/anything. As Meghan said:

I... appreciate the fact that you are willing to challenge the status quo, and you aren't bashful about it.

And I hope you will realize (if you have not already) that the reason I challenge the status quo is for the health of the baby, myself, and hopefully other mothers some day.

Meghan, I want to thank you for your thought-provoking comments. You have really energized me and have given me many things to talk about.

I sometimes wonder if the highly cautionary angle our culture takes towards pregnant women is a remnant of the Victorian Era philosophies that pedestalized women as helpless creatures and that birthed sexism in our culture in earnest. - Meghan

When I learned that women who have an incompetent cervix (risk for early labor due to cervical dilation) were told to go on bed-rest and have their cervix's sutured shut (cerclage), I didn't think too much of it until I did research into the subject for a med school clerkship. Neither of these practices are based on data. In fact both of these practices have been shown to be equal to doing nothing in terms of outcome for the baby. It scares me to think of what is done to patients in our society just because of tradition and not knowing what else to do.

And you do have to wonder about the traditions of western culture in general. Should we really believe in the traditions of a culture that values hour-long commutes in big cars, guns and an Applebee's over sex, physical activity and outdoor life?

H.D. Thoreau had it right when he went to live on Walden Pond. He just forgot about the sex part.

My point is, exercising all day long, in the beautiful outdoors surrounding us, gaining little weight, and (of course) being in love, do make me feel so healthy and alive. I truly feel bad for mothers who are afraid of being active during pregnancy and hope our way of thinking changes. Of course, the weight gain thing is what gets me into trouble with my readers.

Meghan also brought up "African subsistence cultures". And what I can add to this is that the people of hunter-gatherer societies have by far the healthiest appearing cholesterol profiles. This is because they are active all day, walking and running long distances for food. And surely they are healthier for it. But, it is also true, that the real advances in neonatal survival come from nutrition, the availability of c-sections and antibiotics. So the western world does better in terms of neonatal outcomes. But the ideal would be to combine both of these.

As far as heavy work done by Guatemalan women, I did spend some time working at a free clinic/ER in rural Guatemala, and I will just point out that their activity is not cardiovascular. And there is a very high rate of diabetes in their culture as well as malnutrition, and I am certain it is worse than it used to be say many hundreds of years ago, due to the redistribution of food and crops on the planet. And neonatal survival is nowhere near as good as that in the developed world. I did quite a bit of research on this when I was there. I don't necessarily think their culture should be used as a model for healthy maternal-fetal outcomes. Though certainly they are less sedentary (and less protective of their "delicate" women), and our culture could without question benefit from that.

Now, as far as weight gain in pregnancy is concerned, 1. Weight gain of less than 0.27 kg/wk was associated with increased odds of spontaneous preterm birth in all racial or ethnic subgroups.
(Stotland, Obstetrics & Gynecology. 108(6):1448-55, 2006 Dec.)

2. Weight gain less than 8kg increased the risk for a small for gestational age baby and weight gain more than 14 kg increased the risk for a large for gestational age baby and hypertension.
(Tsukamoto, European Journal of Obstetrics, Gynecology, & Reproductive Biology. 133(1):53-9, 2007 Jul)

3. The risk of cesarean section did not differ between weight gain of the 25- to 34-pounds and 16- to 24-pounds. There was an increased risk with a weight gain of more than 34 pounds, though.Lower than recommended weight gain in the second trimester only (sorry I don't have the exact numbers) was associated with lower birth weight and shorter length of gestation. (Sekiya, Gynecologic & Obstetric Investigation. 63(1):45-8, 2007)

The thing that these studies didn't address was whether or not the women who gained less had troubled pregnancies from the beginning (I did know a friend who never felt hungry when pregnant and there were problems with the baby all along). They also don't address the nutritional status of the women who gained less.

So, I looked into it a bit more.

4. A small study from London, Ontario (a town one of my readers knows quite well) with women who exercised AND gained less than recommended during pregnancy showed there was no increased risk of adverse outcomes. They were very careful in this study to make sure that all expectant mothers had adequate or above recommended nutrient intake.
(Giroux, Applied Physiology, Nutrition, & Metabolism = Physiologie Appliquee, Nutrition et Metabolisme. 31(5):483-9, 2006 Oct.)

This was just a pilot study, though, so perhaps we will learn more soon.

And a few more studies, just to show you what I found. I tried to just include studies of women who started at a normal BMI (such as myself and I'm sure many of my readers)

5. The weight of the women who had excessive weight gain in pregnancy was significantly greater at each time-point of follow-up after delivery than the weight of those who gained within or below recommendations.
(Amorim, Obesity. 15(5):1278-86, 2007 May.)

6. There is no correlation between weight gain and risk of still birth. They looked at 48 women who had had a still-birth twin pregnancy and matched them with 96 mothers who did not have a still-birth with their twin pregnancy. There was no difference in the amount of weight the mothers gained.
(Rydhstroem, Gynecologic & Obstetric Investigation. 42(1):8-12, 1996)

So, what would I recommend to patients? Well, the gain of 16-24 pounds has been shown to be safe (as has around 20 lbs [.27 kg/day]), with weight gain in the second trimester being most important. And so it is what I would tell patients. In my (perhaps crazy) mind, I think that if you exercise AND eat well that you can get away with gaining quite a bit less (as the London, Ontario study is starting to show), but as this study is quite small right now, I can't recommend this to patients... yet.

Thanks again for all of the comments and well-wishes after the fall! The little one is kicking as I write, so I don't think the fall had any adverse effects on him. We've got a prenatal appointment this afternoon. I'll let you know if we learn anything interesting.

Running song of the Day: Sideways by Let's Go Sailing

P.S. Just wanted to add that I'm still at a total of 7lb weight gain as of 24 weeks. Yes, I know it's less than it should be.

running accident

Had quite a scare today... went out for a run in the beautiful fall sun, feeling good after eating a really tasty big breakfast. I was coming down a hill in the woods at a pretty good clip, listening to some music when I tripped over a root and landed right on the belly. My elbow only broke the fall a little. I would be lying if I said it didn't hurt, but that's not why I started to cry. I was so scared. I layed there just waiting to feel the baby move, tears coming down my face. And I felt nothing, just my own pulse. There was nothing worse I could imagine than something happening to the baby. I prayed and cried. I didn't want to get up, but knew I should get to the OB department at the hospital to make sure everything was okay. I was a good 6 miles from home, but I ran back fast (for a pregnant lady). I waited for about 10 minutes to be seen by a nurse, all the while waiting for a sign from little C, but there was nothing. She took my blood pressure (which was low) and seemed to be eternally postponing the doppler. I just wanted to hear his heart. Then I was laying there waiting for the doppler to be brought in when I felt him kick. Oh, thank god! And she put the doppler on my belly and there was his heartbeat, perhaps the most beautiful sound I have ever heard.

They actually wanted to admit me for observation, but I refused. I have been feeling him kicking quite a bit since then and no cramping. I actually discussed the incident with a colleague and he agreed that it was almost certain everything was okay. SR agreed, too, that it didn't really seem necessary for me to stay.

Anyway, I am a happy mother-to-be again. And I will have to be more careful around that root.

And I just wanted to address a comment I got, too, about a previous blog post:

Sea Legs Girl said:
"The fear is probably a bit irrational, but in my mind, most moms are fat and out of shape. Ever since I was a little kid, I just associated pregnancy with becoming fat."

Michelle said: Way to insult and alienate every mother in the world. Just because YOU have a psychological issue, that doesn't mean it's OK to lump every women who has ever birthed a child as being fat, out-of-shape.

Certainly what I said wasn't meant to be alienating. #1, I am being honest: I don't want to get fat (and I think that is pretty normal), #2, Acknowledging the fact that many of mothers are overweight is telling the truth and is not alienating. I'm not saying anything about anyone's character. It is like saying, lots of women who smoke get lung cancer. I don't want lung cancer, so I'm not going to smoke. Obesity is also a disease (which I see repeatedly every day) and I don't want to become overweight, so I will watch what I eat and watch my weight gain during pregnancy.

That being said, I did a lot of looking at research today and was surprised to find a correlation between low weight gain during pregnancy and low birth weight as well as pre-term delivery. But I've got lots more info about that. I just wanted to get everyone interested in reading the next post.

For now, suffice it to say that I just ate a chocolate chip cookie that was the size of my head.

Running Song of the Day: Gotta Have You by the Weepies

When obsessions start to hurt you

After the house guests had all gone, there was a small amount of fallout created by my recent insanity. I think SR and I have both been a bit overworked and under-rested. And my refusal to exercise less and eat more finally crossed the line into craziness in SR's mind.

We found this really cool old house converted into an Indian restaurant in the Twin Cities during our weekend away and we were sitting waiting for our roti and curry when he says:

Do you think perhaps you have become a bit more obsessive lately?

And I then knew that my fight to be the thin pregnant woman in perfect shape was no longer a fun game to him, but something that was getting in the way of our happiness.

And, in truth, it has become near impossible to slow or stop the weight gain. Half way through my runs I am getting so low on blood sugar that I feel close to fainting. Then I finally make it home and immediately get on my bike. Anyway, my body is saying no to exercising on little food. And despite all of my attempts, I continue to gain weight.

So a compromise needs to be reached. Exercise is one of the healthiest things we can do for ourselves and our growing babies. And I am still sure that our bodies send us signals to gain way more weight than we need to or than is healthy. So the trick is finding that healthy middle ground.

SR then stated Most women have obsessions during pregnancy, but usually they involved things like buying baby clothes and preparing the baby's room.

And this is true, but I don't believe spending money nesting in this way is productive. How many outfits does a baby need? And what is wrong with a simple bedroom? And of course the answer to these questions is obvious. But there has also got to be something comforting in a pregnant woman acting "normally."

But in my mind, the best thing I can do for the baby now is to stay healthy and happy. And to value the precious relationship SR and I have.

One of the so many things I love about SR is that he is not afraid to confront me when I am being crazy.

Anyway, the dinner was soooo tasty. And the next day we went running in a beautiful hilly state park with the fall colors in full splendor. And with no one around I could pee every 5 to 10 minutes. And I was a happy pregnant woman again, with less stress and a full stomach :).

A pillar of salt

Life is never boring around here. And almost never includes enough sleep. Last night I got home late from work and SR and I had a long conversation about religion. I tend to see the positives of pretty much any organized religion (involvement in the community, spiritual inquiry, empathy) and SR thinks those aspects of religion are ruined by wars, closed-mindedness and exclusionary thinking. Of course there are extremes in anything people have strong emotional feelings about, that is our human nature. We actually mostly agree, it's just we emphasize different aspects of religion. Anyway, it was soooo late at the end of our talk and SR has to get up way before the sun to see patients in the ICU. But we stayed up longer anyway, because we are still so in love. And need to touch each other. I kept thinking last night about when we were in a nearby state for a weekend back in the spring. I'd never felt a feeling of connection so strongly with another person. All we did was run and talk and make love and sense our closeness. It seemed as if we could at any moment burst into flames and become ashes rising together in the atmosphere without bodies or reasons or thoughts. Just love for each other. And that is religion and that is spiritual. And if it's not, then nothing is.

I used to need organized religion so much. It felt so right to me to share beliefs with people. Lately, I have been thinking of the REM song a lot, "Losing your religion" (a great love song) and though I feel less of a compulsion to go to church, my religion is anything but lost.

Anyway, life has been really good the last couple of days. SR and I went running and I beat my time record for running the 12 mile route I've been doing for the past 2 months. And no pain! It was a beautiful day.

And we got to have wonderful call room sex the night before that. It is still so thrilling and beautiful.

In other news, a week ago, SR's ex-wife's partner's water broke at 29 weeks. They, of course, were quite stunned and scared. She was admitted to the hospital where SR and I work. SR and I went to visit them. Anyway, I ended up doing a lot of explaining to them about what it means to have your water break, why the baby doesn't "go dry", what the treatments are and how well they work. For whatever reason, a doctor had not been around to see them yet at that point. I guess SR's ex said to him 2 days ago "I really like SL Girl. She did such a good job explaining things to us in the hospital. I see now why you are perfect for each other."

I must say that made my day. I guess I can be kind of an awkward person in real life, especially around the ex. But I'm glad she was able to see a better side of me.

So the ex's partner had the baby yesterday at just under 30 weeks. The little 3lb girl was intubated initially, but is now extubated and in the NICU. We're all hoping for the best and honestly the prognosis is good.

I can feel the question already: Was she a runner, too? No, she wasn't. The water breaking prematurely is associated with infection and, interestingly, the western diet. Women's water breaking prematurely happens a lot more frequently now than it did say 30 or 40 years ago. And the details of that need to be more fully worked out, but I won't get into that anymore here.

Well, time for the run now. I've had a number of people tell me in the last week how healthy I look, so that is quite reassuring to me... and hopefully to those of you who are worried about my weight and exercise. And, by the way, I do appreciate the concern.

Running Song of the day: See the Sun by Dido

Race Pictures

Here are some pictures, finally, from the half-marathon. Things have been hectic here with working every day in addition to the daily run, bike, swim and core workout (I don't know how long I can keep this up!). But it's sure keeping me from putting on weight. Yes, I do have obsessive-compulsive traits.

Anyway, above is a pre-race shot outside of our cream-colored duplex. The race had an early start, so we biked there in the dark.

Here are two post-race pictures displaying the sweaty shirt. The number is kind of hiding the pregnant belly.

And finally, my favorite shot, which you may have already seen if you read SR's blog (runningdoctor.blogspot.com).