Photo from Mount Royal, Frisco, Colorado.

"That is happiness; to be disolved into something complete and great. When it comes to one, it comes as naturally as sleep." - Willa Cather

Tuesday, 7 December 2010

A tempered OUC half marathon - or why running fast while pregnant might be dangerous

It's a bit overwhelming to write a race report and a Disney vacation report. So I've decided to talk about the race in this post and then take on Disney next.

Saturday, which now seems like ages ago, was an ideal day for a race. A cloudless sky with temperatures that would later reach the 60's. I had snuck out of Disney World's confines: a magical place for kids, but a nightmare for anyone attempting to go on a run (think half mile sidewalks that end abruptly and don't begin again). I spoke French with the Haitian cab driver for the half an hour drive to downtown Orlando (there is no shortage of Haitian immigrants in Florida these days - it is hard not to be saddened by this). It was still dark when we arrived at 6:30 for the 7 am start.

(I should add that SR was at the ASH [American Society for Hematology] conference outside of Orlando and didn't want to miss any of it for the race - it was hard not to be a little down about that).

There were nearly 3000 runners signed up (officially 2309 finishers: 1156 women, 1153 men) The line was too long for the port-o-potty, so I enjoyed a pee by the shore of Lake Eola, in the heart of the pretty downtown. There was a tiny sliver moon: my new favorite moon phase.

It was time to line up and I really didn't have a strategy at all. I was actually a little scared. I knew I could near a PR if I really pushed it, or get in the low 1:30's (It's a perfectly flat course with relatively few turns). But I was hesitant to run fast for two reasons (for those joining the blog now, I'm 6 weeks pregnant today):

1. When I look back on my miscarriage 4 months ago, I can't forget the day I was running a tempo run and got severe pain in my left pelvis, which corresponded approximately with the time the fetus might have died. Considering my pregnancy tests were always weakly positive, there was likely something wrong from the beginning (the urge to blame oneself is so strong!)...

2. I finally read James Clapp's book: "Exercising Through your Pregnancy". He is a cheerleader for exercising, especially running, pregnantinas (excuse my neologism for pregnant women) and reinforced what always made sense to me biologically and evolutionarily: exercising while pregnant is not dangerous; it is healthy. BUT there was this one study he did that bothered me. He actually showed there were signs of decreased blood flow to the baby while the mother ran. This exact fact makes for a bigger placenta and a more resilient baby in many ways - over time. But this also pointed out to me that if a mother is exercising at max pulse for a considerable amount of time, that blood flow may, at some point, be inadequate. Cigarettes, alcohol and hypercoaguable disorders, all proven causes of miscarriage, negatively impact bloodflow to the baby. It is hard to believe that something so natural and healthy as exercise could be harmful - but at an intense enough level, if the bloodflow is decreased enough, theoretically it could. Deep down, I doubt this is true, but I certainly wish there were more research on the subject...

So I lined up with the 8 min/mile group. And I actually ran the first few miles slower than this because I had a weird pain in my pelvis (on the left, as always). I thought about stopping, but it was such a beautiful day and I felt so good otherwise. Eventually the pain migrated up to a side-stitch. I was relieved. I began running at about 7:45 pace. My goal at that point was to finish under 1:44. I felt so in control and energetic. It was a beautiful route (if you like road running) half on pavement, half on cobblestones and with no shortage of palm trees. There were cheering crowds everywhere, sporadic music playing and announcers attempting jokes at various points. The more I ran, the more struggling young people I passed. I felt so old and wise! Starting out slowly sure is fun. I picked up the pace even more for the last couple of miles and came in at 1:43:30, 90th female, 7:54 pace. I think this pregnancy may teach me how to run a race as a training run. It was fun and I wasn't even sore the next day.

The first female came in in 1:14:07 and was 4th overall! Damn! Her name is Erin Nehus Vergara and she's from Indiana and was attempting to qualify for the Olympic trials. Sad thing is I don't even know if she did - though I imagine she did.

Above is the scene after the race. Perhaps the woman in the pink compression stockings catches your eye. I did beat her, but who's keeping track? ;)

Same old race outfit as always, this time with an Orlando flowerbed backdrop.

Lake Eola in downtown Orlando and right next to the race start. This is the exact spot I had peed right before the race.

I didn't even listen to my iPod during the race, so no running song today - sorry!


Danni said...

It makes sense intuitively that exercising hard enough that you're anaerobic would be bad for the baby. But my intuition is informed by nothing. Nice job on the race!!!

Julie said...

Congrats on a great race! Only in my dreams could I ever run a half marathon that fast. : P You're awesome! It looked like a gorgeous day too.

Ewa said...

From evolutionary perspective it makes no sense for exercise to be harmful.
Love your picture. You are glowing, but of course you have good reasons.
Be happy and relaxed if possible. That may have as big and impact on your fetus than your occasional high heart rate, which I believe is positive.

Stefanie Schocke said...

Great job!!!! Love the picture of you after the race.

Now I'm off to read that part of Clapp's book! I missed that study somewhere...intrigued now.

The Chapples said...

What's funny is that you're exactly two days ahead of me pregancy-wise (I'll be 6 weeks Thursday - but haven't announced it to the world, so SHHH!) and I've already slowed to >8:30 pace for every run. Despite us being relatively even as runners (you're a little bit faster), my pace slowing isn't a choice. I just can't push it any faster without feeling dizzy or my heart beating all weird. I had the same thing happen the last go-round as well so I am guessing I am in for a lot of slow running for the next nine months. Congrats to you on the baby and the race. I am definitely in the "race-free" pregnancy camp and like it that way (so nice to have an excuse to not push it...I'd rather just run for the fun of it and race when I can actually "race" :P)so I can't relate to wanting fast times while knocked up but I won't give you hard time about it ;). I'll be interested to read about your pregnancy since I'm right there with you.

mmmonyka said...

Lorax has turned out alright, right? And if I remember correctly, you were not exactly taking it easy in that time:)

Great run! (It makes me want to do a HM)
It is soooo cool that more woman finished than men!

Marathon Princess said...

Congrats on a great race! I am by no means an expert, but running and "racing" through my pregnancy was the best thing I did for my running overall. I just couldn't push myself like I normally do and was okay with it since I had a good reason. It taught me to listen to my body and have fun while I raced. I never felt better after races then I did when I was pregnanct. I am trying very hard to keep this mentally now, but it isn't as easy.

cherelli said...

Nice work SLG - and smart too - certainly at the intuitive level after last pregnancy - looks like a beautiful day!! Like Chapples referred to, it's great that you are feeling so energetic too, sounds like every woman is so different - and you're one of the lucky ones!! have a great week :)

Stefanie Schocke said...

I can't find the it in Clapp's book? Maybe I didn't look hard enough. Can you post the page numbers? Too late for me now anyways.. :) (meaning now that I'm almost 31 weeks). But I'm so curious now!

Steph said...

I took your approach to pregnancy the first time -- I ran through week 33 and after that did regular 6-mile brisk walks on the treadmill. At 35 weeks, my doc noticed that the baby had stopped growing -- not getting good blood flow through the placenta -- and I had an underweight baby via unexpected c-section. She spent her first two weeks of life in a warming box in the NICU. My doc (after consulting with the other OBs in his office) thinks that my level of exercise could very well have contributed to the problem and recommended no running this pregnancy. I've asked for a couple of other opinions through my family (my brother is a physician and works with some OBs) and also a friend who is an OBGYN. They all had the same recommendation -- I should sit it out for nine months. It's only nine months and there will be plenty of years to get back into running later on. My brother said that one of his OBGYNs made a really good point -- distance running while pregnant MIGHT not be bad for the baby, but it definitely can't be GOOD for the baby, so why would you take that risk? That one sunk in, and although I'm dying for a run, I'm trying to be content with treadmeill walks for the benefit of my kiddo. Tyring to concentrate on scheduling some come-back marathons. I've read enough of your blog to know that you probably won't agree with me, but just wanted to chime in given the topic of this and previous posts.

Brianne said...

Funny you should mention your left side bothering you for two pregnancies - I seem to suffer chronic right side issues. In the first pregnancy it was on the right side that I had round ligament pain(prevented me from running because I worried it might be serious), hip pain during labor, and the side of the c-section incision that didn't close properly. In the second pregnancy it's again where I had round ligament pain(trusted it wasn't serious this time and ran through it for 9 months), middle of the night side stitches, and the side to which my vbac's daughter was turned when she came out, face up:) And then that's the side that ached immensely for three days following birth, especially during contractions. Weird. Maybe some people just have "a side."

sea legs girl said...

Well, I am really, really affected by all of these comments and want to some of them one by one, but first I have a general comment. All evidence that has come out so far about running in pregnancy shows it is both healthy for the mom and the baby. And distance running is no exception. And I truly believe that if you feel good and comfortable while exercising there is no risk - and if something goes wrong it is WRONG to blame the exercise (okay, that one was specifically to Steph, whose comment really touched me and I hope your little one is doing better!). There is, in my mind, this one area of uncertainty, and that is exercising at max pulse for an extended period. And even THAT is probably safe - but it was simply a concern of mine I wanted to point out.

sea legs girl said...

Stephanie - it is in the chapter on benefits for the baby. I am at work still, but can get you the page when I get home. Hope I didn't scare you!!! Clapp certainly wasn't scared. He overall deduced that the fluctuations in bloodflow were very beneficial for the baby.

sea legs girl said...

The Chappels - honestly as I was writing this post I wondered to myself if you were pregnant. How exciting we get to be in it together! On my training runs I have also slowed down A LOT. And maybe one of the reasons I found excuses for not running fast was because I deep down didn't feel well enough to really push it. It seems like every day now I feel more limited than the day before - but that is a good thing. In my miscarriage pregnancy, I bascially had no symptoms of being pregnant.

sea legs girl said...

Steph - I just have to address your comment again. I really feel for you because I can imagine what my reaction would be if someone told me my baby had not had adequate blood flow. Man. I really hope she is doing well now. I do not fault your OB-GYN or brother, but I do not agree with them. Over all of human history, women have run while pregnant. And Clapp does a very good job showing studies demonstrating myriads benefits to the baby and to pregnancy outcomes if a mom exercises. He is a particularly big fan of running. Again, I think exercising at max pulse is a potential area for risk - but distance running at elevated pulse, but not anaeroblic levels, I have a lot of difficulty believing could be dangerous. I do not know the whole story, but my sense is that there was a problem with the blood flow from the beginning AND that exercising may have exacerbated it or alternately may actually have given your daughter the reserve to survive. Over time, exercise improves blood flow to the baby.

I would be happy to discuss my thoughts with your brother OR OB-GYN so they or you don't go around thinking I am some exercise freak "doctor".

Bottom line - what you did in your last pregnancy was NOT wrong. You have no reason to feel guilty. And you may have helped your daughter. Giving you guidelines on your current pregnany, I agree, is difficult. Have you been "worked up" for possible health problems that could have contributed to the blood flow issue? Autoimmune diseases? Vasculitis? Hypercoaguable disorders?

Steph said...

Sea Legs Gril,

Thanks for your thoughtful response. FYI, my daughter is doing fine now -- it was just a stressful beginning.

I guess the distinction that I should have emphasized with respect to the information I have received is the distinction between moderate exercise and distance running. All of the OBs I have consulted either directly or indirectly thrugh my brother (5 now, because I have been hoping for a different answer) have definitely agreed that regular exercise IS healthy good for the baby, but recommended against any kind of distance running. They all said that putting the added depletion on my body over a longer period of time, even if I feel comfortable, could not be good for the baby (even if it does not harm the baby).

I admit that I haven't read any studies that specifically discuss distance running (which I would define as running 30 or so miles a week during pregnancy). I would be interested to know if there have been any with statistical significance. The difference between the distance running and the moderate exercise is where the OBs seem to be drawing the line, and so I wonder if there is backup for that other than through their own personal experience.

To my knowledge, I had all of the standard tests and screenings during my first pregnancy and there were no other issues. My doctor admitted, however, that the baby's growth issue could be due to 100 different things. Given my past experience though, and because the OBs have seen LOADS more pregnancies than I have, I'm going to follow their advice and behave myself this time around. Unfortunately, their advice for me this time is NO running (altough I was still encouraged to do plenty of treadmill walks). I guess my thinking now is that if there's even a chance that the problem was due to a bad decision on my part, I'm not going to risk it again. Instead, I'll eagerly looking forward to my first post-partum race.

Steph said...

Thanks for your thoughtful response. FYI, my daughter is doing fine now -- it was just a stressful beginning.

I guess the distinction that I should have made regarding the information I have collected is the difference between distance running and moderate exercise. All of the OBs that I have consulted, either directly or indirectly through my brother (5 now because I keep hoping for a different answer) have agreed that moderate exercise during pregnancy is healthy and is indeed good for the baby. With distance running, however, they have all said that the prolonged depletion of my body, even if I feel perfectly comfortable, cannot be good for the baby (even if might not do any harm).

I guess my point is that all of the OBs that I have talked to seem to draw a line between moderate exercise and distance running. I admit that I have not read any studies on the effects of distance running during pregnancy (which I would define as about 30 miles a week or so), but I would definitely be interested to know if there are any of statistical significance.

To my knowledge, I had all of the standard tests and screenings during my first pregnancy with no other issues. My doctor did admit, however, that the problem could have been caused by 100 different things. I guess that since the OBs have seen loads more pregnancies than I have, and because of my first experience, I'm inclined to behave myself, try not to second guess them and follow their unanimous advice. Unfortunately, for me this means NO running during this pregnancy (lots of walking is still encouraged). If there is any chance that our problems the first time around were due to a bad decision on my part, I guess I'm not willing to risk the same outcome again if there is any chance that I can avoid it. Even if that means sitting on the sidelines and impatiently looking forward to my first post-partum race.

sea legs girl said...

First, Stephanie, it's on pg. 110 in Clapp's book. Where he says "Namely, the trigger for the increase in the baby's heart rate was probably a fall in uterine blood flow..."

Steph - glad she's doing well now. It's really sad that I don't know of any studies looking at women who did what you described as distance running. I wish there was at least something out there to base recommendations on for those who like to run A LOT. As of now, there is no evidence for or against. There is only the evolutionary argument that is for it. And the fact that some exercise is clearly better than none.

Stefanie Schocke said...

I obviously didn't look in that chapter! Thanks for the page number. I'm not worried, just intrigued. :)

olga said...

There was some published article in Ultrarunning magazine saying it's ok to keep up the distance while pregnant, but preferably lower the intensity, and do look under your feet.
The family photo at the pool is warm and fuzzy. You look quite happy, but I bet you wished all of them were at the finish line for you:)
Yup, recharge. Can't believe you said that:) Who are you and what did you do to SLG? (Larry's question to me today).

sea legs girl said...

Ha ha Olga. Yeah I don't know if you DID something to me, but your posts do speak to me :). That sounds like a very interesting article. Though I'm sitting here thinking: have they seen research I haven't? Otherwise we're all just extrapolating/guessing. It's still almost enough to make me buy an online subscription just to read and a find out if someone knows more. ALMOST enough.

Brianne, boy are you right about that side thing. My left side was hurting me so much today I almost thought I might have an ectopic pregancy, but then my uterus probably wouldn't be so big already!

sea legs girl said...

Steph - SR just pointed out to me that I may have misinterpreted what you meant by "distance running". I guess I thought you meant like, over 50-60 miles a week. But if you meant something more moderate, than there are plenty of studies showing health benefits of that for mother and fetus. Studies on running high weekly mileage are lacking, though. There are many anecdoctal reports showing it's safe, but not more than that.

Fast Bastard said...

This is a comment to Steph:

First of all, I hope everything goes well with this pregnancy.

Since Sea Legs started this blog, I have worried that someone would say what you said. Or, actually, say what she thought you said. She thought you had followed her advice and had a bad outcome. As I read your story, you just exercised as you did, and later found her blog.

I sometimes worry that her blog might end up as a lightning rod for people with your story. Like you said, there could be 100 different reasons for what happened to you. There are many women (relatively few, but many in absolute numbers) with bad outcomes and many who run, so there will be many with a combination of the two.

I think you have to see this from your OB-GYN's standpoint. She probably knows it's not the running - and has told you so. But imagine if she told you that you could run again and you get another bad outcome. You can always get some "expert" to tell a jury that running is dangerous in pregnancy, so your OB has to worry about that a potential suit.

Lawsuits are a constant worry for OBs.

In fact, imagine the fifth OB telling you to go ahead with running. If anything happened, the first four would happily stand up in court and talk about how they advised you not to run.

All OB-GYNs are ultra-conservative in their advice for the above reason. And that's perfectly understandable.

If you had followed a special diet, or done anything else out of the ordinary, during the first pregnancy, you would have been told to drop that activity completely.

Personally, I think strenuous exercise should be avoided in pregnancy, but only because it hasn't been studied well enough. From my specialty, I know little about babies, but a lot about blood flow. I can't imagine, physiologically, that you could harm a baby by having a very high heart rate for a long time. In fact, I can think of very few organs, healthy or diseased, that one could harm this way.

One study has shown that high-impact sports (martial arts, soccer, horseback riding) lead to an increased rate of miscarriages. Olga, I wonder if one could claim that very technical running falls under that category, because of the risk of falls? But few women do this anyway.

I would also avoid lifting weights so heavy that you have to do it against a closed glottis (ie. while holding your breath), as this raises the blood pressure dramatically. But how many pregnant women do that, anyway?

Good luck with this pregnancy!

olga said...

SLG, don't buy the online version of the mag - no study, just a few pregnant women as an experiment of one (each). BTW, the question was from Larry to me - about me, it's just funny that I thought the same question about you - to you:) People change, or at least go through stages. It's allowed. I was recommended to watch Eat, Pray, Love (I am choosing to read a book instead) about going in phases and learning balance.
FB, while I haven't run during pregnancies (I just wasn't running yet), I backpacked with 50lbs pack in the Adirondack mountains up to 7 months, and carried a 4.5 yo on my neck at times to add on (he was tired, and my ex was against giving in). So, take it with a grain og salt, but I do think the most dangerous thing is falling (no matter trails or roads, and what sport), even though lots of science says the baby is rather cozy in a bunch of fluid. Still. That'd be my fear. And the fact that I simply wouln't be able to go "hard" due to high diaphragm and heavy breathing, and being uncomfortable moving an elephant around who is attached smack in the middle of my body. So, what do I know.
I was saying at times that I wish I decide to have a baby again just so I can have a "running/gym" pregnancy with little weight gain and then run with a baby jogger (cute and great workout). But then I look at my teen (and adult) kids - and say the hells with more kids. They are only adorable until 11:)

Katie said...

Great race! I read Clapp's book too. He is super supportive of running pregnant, but he also advises caution to those who are competitive. He writes that we should be closely monitored, which was why I ultimately didn't really race while pregnant. I did run a few races with my mom which turned out to be great fun. Not that I think other ladies shouldn't race while pregnant, but I have self control issues when it comes to racing...

Katie said...

So I was just reading the comments, and wanted to add something for Steph's sake. It really stinks that your doctor would suggest that your running may have caused your baby's issue (because there's no real evidence to support such a statement). And I realize that I'm only a single sample point, but I ran through both my pregnancies with good baby results both times. This last pregnancy I ran 36-57 miles a week and wound up averaging 47 miles a week. I also ran 7 miles the day I went into labor.

Steph said...

To FB,

I am an attorney and so I do understand the possibility for “defensive medicine.” I also have a very good relationship with my physician, however, and honestly believe that his advice is motivated first by my well-being and that of my baby. Also, at least one of the other OBs I discussed this with is a personal friend, and so definitely not motivated by the potential threat of a lawsuit. She had the same advice.

That being said, I guess my thought is that, when the life of my kid is at stake, don't I want conservative advice? Haven't these physicians seen hundreds more pregnancies than any of us and wouldn't that give them instincts and insight about the situation that I don't have? Don't I want them to weigh the potential costs and benefits (i.e., the potential benefits of running for me and my baby versus potential costs) and then give me the results of that cost-benefit analysis in the context of their years of knowledge and experience?

Because I have been a distance runner for years (marathons and ultras), I'm not used to sitting out and have really been struggling with these questions over the past few weeks while admittedly pouting a little and feeling fatter by the hour. At the end of the day, however, when there is no real statistical evidence to show that these OBs are wrong (and I can’t bring myself to dismiss medical advice on the mere assumption that it might be derived from the threat of litigation), I can’t bring myself to ignore their advice simply because I want don’t want to interrupt my routine and worry about losing the weight later. I ask myself, do I really want to run because I know that it’s good for the baby, or do I want to run because it makes me feel better? When you line up all of the factors and consider them together, it appears that to ignore the medical advice would be a terribly selfish thing to do. Sure, things might turn out just fine, but then they also might not, and given the stakes . . . .

And so here I sit getting bigger by the day . . . . uggh.