The Perfect Pregnancy Plan

Excuse the alliteration, but for some reason this post deserves it.

In the future, much as there is discussion about an optimal training plan, women will talk about the optimal pregnancy plan: to lose weight and get into the shape of their lives.

But let's back up. Why isn't it like that now? (and why do you feel that just because I suggest it, I'm perverse??) Well, Heather said it best in her comments: our way of looking at pregnancy is "anitquated". In the 19th century, life was different in the sense that only the upper class had the "luxury" of a pregnancy of rest and lots of weight gain. I imagine that (as is true today) pregnancy outcomes were greatly influenced by socio-economic class and thus these women did at least appear to have healthier pregnancies.

During the 20th century, women gradually looked at physical activity and leanness as desirable. But the rules about pregnancy weight gain and being sedentary remained. Thus women saw their physical condition and weight as something they had to "sacrifice" for the health of the baby. Women now typically get out of shape and overweight due to pregnancy. And most never get back to their pre-pregnancy weight or physical condition. And that's why you find my suggestion "perverse" - because it should be a time of sacrifice. (But while sacrifices for a good reason are noble, sacrificies without reason are simply self-gratifying).

And women don't always make "sacrifices" if they don't find them convenient. Some women go on drinking large amounts of alcohol while pregnant and we have learned from them that babies don't do well when drowned in alcohol. The would have done well making a "sacrifice". Other women went against conventional wisdom and ran multiple marathons, crossed the English Chanel swimming or won biking or running races while pregnant. The reason these women did this is perhaps not difficult for my readers to understand: exercise is healthy when not pregnant - it hardly makes sense that it wouldn't be while pregnant. The body of evidence showing it's health and safety grows and grows: these women have healthy kids.

And not only do they have healthy kids, they have healthier kids. They don't get overweight and they score better on tests of motor and verbal development.

The new "sacrifice" will thus be - I am giving up my unhealthy sendentary lifestyle and my extra pounds during this pregnancy. Pregnancy is wonderful for many, many reasons - among which is a golden opportunity to get into the shape of your life.

Let's consider the example of Stefanie Shocke. She just had a beautiful 7lb 9oz little girl. How much weight would you wager she gained? Answer: 9-10 lbs. (Bet that wasn't your guess unless you have been reading her blog). Even more impressive is the fact that she set a very fast PR in both the marathon (3:31 at 22 weeks) and half marathon (1:35 at 18 weeks) distances midway through her pregnancy! SHE exemplifies the Perfect Pregnancy Plan.

If you are reading this and thinking "everyone already agrees with you, SLG, so just shut it already!", then you have been spending too much time reading my blog. (No, not too much time, just time :)).

Here are the recommendations from the ACOG castle (that's the American College of Obstetrics and Gynecology, of course):

pregnant women should be encouraged to engage in regular, moderate intensity physical activity

(am I the only one who reads this and wonders - if intense is dangerous, then is moderate a little dangerous?)

And here's a quote from Running Times Nov. 2010.

As the research suggests, in most cases, runners are encouraged to run through much of pregnancy, but not to set any big training goals. While more than 30 minutes may be safe, this is not the time to hog mileage. Smart training will ward off stress fractures and sprains, as well as keep the baby healthy. Like a monster hill at mile 25 of a marathon, knowing what to expect can make all the difference.

I remember clearly reading this the first time and thinking "what the hell does that mean?" - basically the whole paragraph is a confusing mess. But "not the time to hog mileage" - why does there always have to be a guilt trip - and for no reason??? Sometimes all of this bullshit makes me throw up in my mouth. This whole "take it easy, don't do too much" comes from no scientific evidence and is simply ANTIQUATED. I applaud people who set new training goals, run farther and faster than ever. Heck, I ran way more miles a day during my very own first pregnancy than I had ever run before - why is it exactly that the working hypothesis is this is dangerous?

Because all of our working hypotheses stem from (another Heather quote I love) "you must rest during pregnancy, you poor delicate reproductive blob"


And here in Denmark, it is no different: - no high intensity exercise, - no long-distance running, - nothing more intense than you did before you became pregnant. Says the Danish Ministry of Health.

Not only is the above not supported by research, but it is confusing. Again what is "high intensity" - running up a hill? running a 100 miler?

I have imagined many possible scenarios in which a study could be done which would clear up this confusion. But these studies are really hard to do - I get tired just thinking of all of the confounders. The truth is more and more women will find they become more physically active than they were before pregnancy and more will participate in sports at an intense level. And this is how or views of exercise in pregnancy will change. You may not agree with me - but your kids will!

And since I'm prophesying - the weight gain recommendations will also continue to come down or widen. They were just lowered in 2009 after the recommendation of the Institutes of Medicine and now women who are normal weight should gain between 25-35 lbs. Some women can "get away" with gaining this much - and it certainly must be genetic. But many, many women who eat healthy, listen to their bodies and exercise find they gain significantly less than is currently recommended. And they are more likely to return quickly to their pre-pregnancy weight.

As I have discussed before, the current recommendations are based on one study, where women who gained less in the second trimester had babies that did worse. But the study is flawed from the outset because babies who have an illness or condition to begin with often don't grow correctly and thus these mothers ALSO gain less - making it appear as though the mother's weight gain was the problem when the baby had the problem from the beginning. Anyway, I am certain the weight gain guidelines will also widen to include much lower weight gains as being healthy. One day.

Now I am tired of writing.

I will simply mention that I had a beautiful 3 hour run in the hilly woods around Næstved - and have to admit this was the running song of the day (since I may have listened to it 8 times): Go Do by Jónsi. (Thanks for the rec again Steve Q. I have decided you are allowed to make a running music library for me to save me some time :).)

Edit: Okay, I rarely add something to my posts as an afterthought, but I really need to make one thing clear (thought it would just be assumed, but it's actually not that obvious) - there is no "perfect plan" for every pregnant woman, just like there is no "perfect plan" for everyone who wants to run fast. There are only perfect plans for every individual. Stefanie's pregnancy was simply one example of a plan. And if you're more for the high mileage preganncy, then I guess you'd be following more of my sort of plan. The LAST thing I wanted to do was make people scared or guilty because they feel they're not doing enough.