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

Friday, 26 October 2007

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.

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.


Olga said...

The link you put in to discussion is disgusting. I understand by blooging to the world we are exposed to any types of comments, but I hope to never read about mine.

With my first I gained 11 kg, and with second - 38 lbs. With first I was back to my weight within 6 months without doing much special (it was back home, I wasn't into excercising then). With second I was still (actually, worse - 50 lbs) overweight for a couple of months. I saw my picture 3 weeks after a baby was born, and got scared. That lead to addiction to the gym, and it took me hard work to get pre-pregnancy weight (even though same 6 months as first time). If I were to get pregnant again (dreams...Girl, I just fell in love too, but don't think it'll lead anywhere), I'd run and swim and weight lift throughout (I see girls at the gym a lot, just lower the weight). And I'd be looking forward going out with a jogger stroller.
Stay true to yourself. And thanks (again) for giving me hope there is life and love waiting after divorce (which is purely due to loosing love, and yes, I am a believer that two people shouldn't be together if there is no love).

notjustamom said...

I'm really sorry you had to come across such disturbing comments on that forum, the added stress isn't good for anyone, let alone a pregnant woman. Of course not everyone who follows your blog does so maliciously, and it's clear you have many supporters. I think others are just concerned.

I do hope you will keep your blog open, I have gotten involved in your life and pregnancy, and wish you only the best. I would miss it if you made it invitation only!

Good luck with your little bambino. I think having a baby is the greatest experience in a woman's life.

Olga said...

Well, SR had closed in...hope you don't do it, and if you do - include me in your life following. My email is on my blog page.

Anonymous said...

Sea Legs,

Its funny how someone can be so judgemental when they hide their true identity.I too only wish you the best! Happy for you & SR that you've found eachother :)

Meghan said...

Sea Legs,

You are a brave woman to continue posting in light of the linked forum thread and the undoubted blog traffic you are receiving from people on that forum.

I have read a portion of that forum thread, and, I agree with Olga, it's disgusting. I find it disgusting in the sense that, using the guise of internet anonymity (which all of us educated internet users should know isn't at all anonymous), posters have felt free to speak with socially unacceptable language, tone, and intent. Of course, this statement isn't inclusive of everything that's happening over on that thread, as I did read some attempts at constructive criticism and some lamentations about poor behavior.

However, as we've said before, that is just one of the joys and downfalls of the internet, or any other public environment. It is clear to me that you have already realized this, and that you aren't at all bothered by that forum thread. Here is just one more "keep your head up" statement, though, in light of all of that garbage.

It would be so much more productive if those posters came over to your blog (or perhaps stay on that forum if that is more a comfortable place) and engage in a constructive, objective, educated dialogue regarding facts and theories as well as a respectful, open, honest discussion of one's personal experiences and feelings.

With regards to my earlier comment, I would never argue that any developing country is a better place to conceive, bear, birth, and raise a child from a medical access standpoint. As Sea Legs alluded to, here in the Western world, most of us have at least some access to the advanced medical technology that keeps pregnant women healthy, allows us to have safe and successful births, and maintains the health of our birthed babies. For this, I'm eternally grateful. Rather, the point of my earlier comment, and I think at least Sea Legs understood it, was that there are perhaps things to be learned from other cultures about pregnant women and their lifestyles.

Your blog entries clearly show that you are operating through this pregnancy based upon how you physically feel. Earlier in the week, you indicated that you were feeling poorly while running as a pregnant woman due to low blood sugar (due to lack of food). Your body was telling you that it needed more, and you listened, and you fed it. Somewhere else in your blog you indicated that you overheated easily as a pregnant woman while running during the heat of the late summer. Your body was telling you to slow down, and you listened to it, and you stopped running to cool down. You have many times written about how wonderful your body feels when you are out running on a trail. Your body was telling you to run, and you ran, and you listened to it. Our bodies are miraculous devices built with complex, multi-tiered systems of support and protection. Listening to one's body is a very simple, easy-to-follow concept that you seem to be adhering to quite well.

Please feel welcome to visit my blog if you're looking for positive speak about powerful women doing physical things. Continue being a happy, healthy beach ball bellied pregnant woman!