Exercise and Running in Pregnancy: Point-Counterpoint

I have had a lot of fun looking up counterpoints for the feeble arguments that have been brought up on this blog and at the runango forum.

I would like to start off by reminding you that three qualified physicians (Running Doctor, Olga and myself) all believe my exercise and weight gain is perfectly healthy.

And now for the evidence:

Point #1.
Running and 6 months pregnant is fine...not gaining any weight and still looking like you're maybe 3 months pregnant is not.

Couterpoints
-Clearly if my size were appropriate for a 3 month pregnant woman, the midwives would be concerned. However yesterday my pubic bone to fundus measurement was within normal for 29 weeks.

-Though the effective size (ES) of the pregnant mothers who exercised under 30 minutes was greater than that of those who exercised between 30 and 60 minutes, the overall ES of the baby did not differ between the two groups.

ie, even though women who exercise more gain less weight, their babies' weights did not differ.
(Winter, 2002, American Journal of Health Studies).

-A current meta-analysis of randomised trials of vigorous exercise during pregnancy did not find a clinically important effect of exercise on birth weight.

(Bell, R. Journal of Science & Medicine in Sport. 5(1):32-6, 2002 Mar.)

Point #2
I had wanted to keep it [my pregnancy weight gain] to 30 pounds total... ended up with 42 I think...

Counterpoint
-This woman gained MORE than recommended during pregnancy and no one dared give her a hard time, though what she did is KNOWN to be a huge risk for her child. Why isn't everyone jumping in and accusing her of not caring about her child? Because we're a society that condones excess weight gain despite the many health risks. Because poor her, "she couldn't help it", right? Well I think that's a bunch of BS. And here are some of the risks associated with excess weight gain during pregnancy:

- gestational diabetes (and all the related complications)
- hypertension (and all the related complications)
- increased risk of c-section
- child who becomes obese and ends of with diabetes, hypertension, arthritis, heart disease, etc., etc.

Point #3
She really really pisses me off. Seriously, it makes me want to weep for that poor child's life. Also, it makes me feel like crap. I could barely keep my kids in for 6 months and I did no running whatsoever and took it easy and this crazy b!tch runs 80 miles a week and doesn't eat and she'll probably go over her due date.


Counterpoint/Agreement
-Yes, this poster is right. Premature births are most often caused by genetic factors or cervical defects, which are not affected by exercise. Bed rest, for example has never been shown to decrease premature births from cervical incompetence. And exercise itself has never been shown to cause premature births.

Points # 4 & #5
82 miles plus the cross training you did is not moderate. 3 hours is not moderate. 3 hours is more than a healthy non-pregnant elite does in a day!

You're right that they do not talk about any effects on PR's child. But that doesn't mean you can assume it's a healthy behavior like you're doing. You don't know, and you're willing to take a chance on the baby inside of you with something that is an unknown?

Counterpoint #1
-31,000 women in their second trimester were involved in this study. Those who identified their physical activity level as vigorous were, on average, slightly older and more educated, and weighed less than women in the other two categories. However, there were no significant differences in the rates of low birth weight or fetal or neonatal death.

(Rose NC. Obstetrics & Gynecology. 78(6):1078-80, 1991 Dec.)

Counterpoint #2
-There is limited evidence which suggests that exercise is related to shorter labour and is a useful treatment for gestational diabetes. Exercise is also associated with fewer symptoms and discomforts of pregnancy. This relationship is temporal in that exercise earlier in pregnancy is associated with fewer symptoms later in pregnancy. The lack of evidence for any harmful effects of exercise on pregnancy outcome indicates that, for healthy, well-nourished women, exercise during pregnancy is safe and subject to few restrictions. This conclusion is reflected in the revised recommendations of the American College of Obstetricians and Gynecologists.

(Sternfield B. Sports Medicine. 23(1):33-47, 1997 Jan.)


Point #6
I love how she mentions back when were hunters and gatherers and women barely gained weight while pregnant. Yes there is a healthy comparisson for our modern age. How many women died in pregnancy and during childbirth in those days. And how many children died before age 5 if they survived the first few months of life.

Counterpoint
-Please review the reasons for decreased infant and maternal mortality summarized by Atul Gawande, MD below.
By the fifties, owing in part to the tighter standards, and in part to the discovery of penicillin and other antibiotics, the risk of death for a mother had fallen more than ninety per cent, to just one in two thousand.

Around the world, virtually every child born in a hospital had an Apgar score recorded at one minute after birth and at five minutes after birth. It quickly became clear that a baby with a terrible Apgar score at one minute could often be resuscitated—with measures like oxygen and warming—to an excellent score at five minutes. Spinal and then epidural anesthesia were found to produce babies with better scores than general anesthesia. Neonatal intensive-care units sprang into existence. Prenatal ultrasound came into use to detect problems for deliveries in advance. Fetal heart monitors became standard. Over the years, hundreds of adjustments in care were made, resulting in what’s sometimes called “the obstetrics package.” And that package has produced dramatic results. In the United States today, a full-term baby dies in just one out of five hundred childbirths, and a mother dies in one in ten thousand. If the statistics of 1940 had persisted, fifteen thousand mothers would have died last year (instead of fewer than five hundred)—and a hundred and twenty thousand newborns (instead of one-sixth that number).
(Gawande, The Score, Oct. 9th 2006, New Yorker)

http://www.newyorker.com/archive/2006/10/09/061009fa_fact?currentPage=1

And I will end with the following from the American Association of Family Practice: "Numerous case reports can be found of women who ran extensively throughout their pregnancies and who delivered healthy, normal birth weight infants. One example is Sue Olsen, ranked fourth nationally for 24-hour races. She ran a four-hour marathon when she was eight and one-half months pregnant. The following week she partly ran and partly walked a 24-hour race posting 62.9 miles.3 One week later she delivered a healthy infant. Although these reports lack comparison groups and are not generalizable, they lend support to the conclusion that healthy women with normal, uncomplicated pregnancies may exercise with few restrictions without adversely affecting their infants or themselves."

(Khanna, "The Effects of Exercise on Pregnancy" American Family Physician. April 1998.)

I can post a multitude of additional references for any of you who are interested.

CONCLUSION:

The weak and unresearched arguments posted on runango and on this blog recently are doing a disservice to pregnant women who deserve to know that exercise (even vigorous) along with its often-associated lower weight gain are safe and healthy in pregnancy for the mother and the baby.

29 week prenantal visit

Just got back from seeing now our 4th midwife. SR and I like to get multiple opinions and meet all the possible ladies who might perform the delivery.

Thankfully she said everything is going well. I gave her the exact details of my workout prior to the injury and she was not concerned. I told her I had injured my piriformis muscle 1 week ago and that I was sad I couldn't run. She said that finding alternative exercises might be the way to go at this point. She then said that she would refer me to physical therapy, though, in the hope that I can return to running if I feel up to it. And, Yay! I did manage to run 1 mile today, like my goal, and I felt good.

As far as the weight gain is concerned, she said I gained nothing during the first trimester, but that my weight gain in the second and third trimester was exactly on the curve it should be and she had no concerns as far as my weight. As I have discussed on this blog before, weight gain in the second trimester is the most important.

She actually recommended I keep the weight gain to a minimum from this point on since I have a small pelvis and she and I are concerned about cephalo-pelvic disproportion. I actually disagree with that on the grounds that I think the baby will end up the same size regardless of how much I gain.

I have responses ready for many of the comments I have received. It seems a bit ironic that all of this bashing should come when I'm not even running. Anyway, I need to look up all of my sources and then will write an educational post for everyone.

Running Song of the Day: "The Parade" by John Vanderslice

In the Runango Spotlight

Looks like the folks at runango just can't get enough of my blog.
http://www.runango.com/forums/topic_show.pl?tid=66344

And no this blog is not a joke. I am happy that their thread this time concedes, in part, that all of my exercising and 9 lb weight gain may not be unhealthy.

Here's an excerpt:
1. midwives are great and capable.
2. you CAN run while pg.
3. you CAN lose weight while pg, what i mean is lose body fat, while the baby gains....
4. she is seeing someone, she is a dr. her bf is a dr. she is being looked after by people that know her much better than anyone here.

I recommend the naysayers on the thread do some research into exercise in pregnancy before they make any more vapid generalizations.

And please read my post about the 6 month 5k. The woman I met there ran through her entire pregnancy, until the day before delivery, gained 12 lbs and delivered a healthy 7 1/2 lb baby that is now a healthy 12 year old. Shortly after she did that she went to the Olympic trials.

And then take a look at Paula Radcliffe. She ran successfully through her pregnancy and just won the NYC Marathon. She also has a healthy daughter.

If anyone can come up with an example of exercise combined with proper nutrition and low weight gain leading to complications then I will take your comments more seriously.

Recovery day #6, 29 weeks pregnant

I ran 1/2 a mile today. It felt great to be stared at on the treadmill at the Y. Men especially stare at a pregnant woman running like they might at an animal in the zoo. And I'm more than okay with that as long as I can run again.

My goal is to increase my mileage by 1/2 mile a day, barring excruciating pain in the hip. Honestly, I am absolutely desperate to run again. I had a bout of depression this morning before the workout for no particular reason except the lack of endorphins.

I am continuing to bike, elliptical, swim and do yoga. But any of you who are runners out there know there is no substitute for running.

I'm already fearing my blood pressure will be up at the prenatal visit on Friday, despite the lack of appreciable weight gain. I was also planning to refuse the glucose tolerance test for gestational diabetes, just because I fancied myself so healthy. But without the running I'm not so confident.

At least I'm happy with the weight gain: 9lbs in 29 weeks. Honestly, I would not have wanted to gain more.

Okay, can you say control freak?

But bear with me. I think back to when we women were hunter-gatherers and know that's how we should live now. I read the shocking statistic that premature births have increased by 30% in the last 20 years! And what has changed? Our diet, our activity level and our environment. But the details have not been worked out in the medical literature. No studies to date can account for this rise. Everything points to infection, but why are women now more susceptible to these infections??

Anyway, I'm hoping to run a 5k race on Dec. 8th, but we'll see how the hip is.

Only had time for one song while running today and it was a good one:

Running song of the Day: "Floating" by Jape.

No Running, No Problem

I attempted to run on Saturday with SR. Up a steep, windy path in the woods in the cold, feeling okay at first. But by the time I got to the top I was crying in pain from my pelvis. The muscles down there felt like a knotted mess.

Time for a break, we decided as I cried and tried to get my muscles to stop spasming. A longer break than one day.

It was bittersweet that on the way down, an adolescent boy and his father wearing coonskin caps asked "Did you just run up that whole path?"

"Yeah! And I'm six months pregnant."

The young boy was wide-eyed and speechless. I soaked up the good feeling with some sadness, knowing I might not be running for the rest of the pregnancy.

In the meantime, life has been surprisingly great. The key has been finding alternative exercises while the piriformis heals. Sea Legs Girl has become fittingly passionate about swimming. And biking is still a way for me to exercise outside. And whatever else I can find to do at the YMCA without running. And tonight I have yoga, which hopefully will realign my chakras, or at least stretch my piriformis a bit.

Sorry the image is in French (in many ways). But basically, chakras are places in our bodies that correspond to our spiritual and emotional selves. They need to be in balance to avoid physical or psychological injury. No, we didn't learn about them in medical school, so I can't say too much more other than it's a great concept.

We had a really good weekend, despite not running together. We saw my parents on Saturday night. We ate at a restaurant in Madison, WI, near where my parents live that serves all organic, all locally grown food. It's called L'Etoile.

That night SR and I stayed at a Days Inn. Pillow talk lasted for hours.

On the way home, we worked on the languages we're teaching each other. I'm so excited about our move to Scandinavia. I have these grand plans of joining a soccer and a track league and going to the University to get an undergraduate degree in literature, all the while being a doctor and a mom and a wife. In a country with such a nice social system, it should be cheap and possible.

I will end by saying that I can hardly believe how blessed I am to have SR's two wonderful kids in my life. Rather than thinking her life is weird, SR's daughter seems to be embracing the fact that she has so many adults around to love her. Despite being 6 1/2 years old, she is one of my best friends.

Here we are riding in Santa's Sleigh.

Oh, and I'm not giving up on the running song of the day, still hopeful I'll be back at it. Can you blame me for hoping it will just be a few days?

Running Song of the Day: "I was a Daughter" by Basia Bulat (from London, Ontario)

Injury

Those of you who have been following this blog have probably been waiting with great anticipation for my first injury. I'll admit that there does seem to be something a bit loco about running 12 miles a day during the 3rd trimester of pregnancy. I kept thinking that with only a 9lb weight gain, I wouldn't be much more susceptible to injury.


Anyway, it was a beautiful cold Thanksgiving night. SR was still at work, so I ran out to the deserted trails with music and felt myself becoming part of the dark, empty night, when, basically, my hip just started hurting more and more. It's now to the point that I am having trouble walking. The only way I made it home was it was sooo cold that I think the pain was somewhat numbed.


I'm pretty sure it's the piriformis muscle.

So no running today. I'll stick to the bike, the elliptical and swimming. Hopefully I will avoid a big setback and I'll be running again tomorrow. We are again planning to go out of town for the weekend, which hopefully will involve running in a state park, but we'll see.


And now I'm asking for advice: does anyone know anything about pregnancy belts? From what I've been reading, they might make the runs more comfortable. But I don't want to end up with a hideous running accessory that does nothing more than cause chafing.


And for those of you who can run...


Running Song of the Day: I Love Ya by Nik og Jay (my favorite Danish band)

I'm so pregnant

Ankle swelling (or pitting edema as we affectionately call it) has marked a new phase of pregnancy for me. Not only does this swelling make it more difficult to run, but along with it came swelling in other parts of my body. I suppose most notably, the labia, which means impressive camel toe in most of my running pants. While 13 year old boys may enjoy this, I'm not too fond of it on myself. Though it does make sex feel good in a new way.

And then there are these swollen veins below my eyes. I noticed them a couple of days ago and asked SR about them. Immediately he said "Oh, yeah, I had been wondering about those for a while now."

Well that just made me feel great. Obviously they don't look good, otherwise, he would have said a while ago "What beautiful puffy veins you have below your eyes."

Alright, so I'll stop being vain about the veins. But I will just say that I'm glad I didn't worry too much about the lack of weight gain, because now there are about 3 extra pounds of fluid on me. And running has become a more daunting task anyway since it has gotten colder out. (Yes, I'm still running 12 miles a day, plus biking and the rest of the workout). Oh, and I have the worst cold in the world. But I'll come out of the wine cellar now.

We did have a fun night last night. We watched a Nordic Christmas movie with the kids. Then when we went to bed SR and I sat and watched the baby move in my belly. It's almost alien-like how much he moves in there... and how much you can see from the outside. It seems unlikely he will end up being a calm child, but I guess you never know.

Happily, even with the big belly and all the swelling, sex is still great. We are still perfect together.

Oh, those green eyes. I have nothing to complain about. I am pregnant and in love.

Happy Thanksgiving!

Running song of the day: He Keeps Me Alive by Sally Shapiro (okay, she's Swedish, too. Guess it's Swedish music week.)

5k race marks beginning of 3rd trimester

What a great good way to start out the 7th month! I was soooo nervous about running a big race knowing I would be big and slow and, of course, probably have to pee in public again. But SR was so excited about us running the race, and deep down I was, too. This race is one of many things I would not have done without him there to encourage me.

Once we had warmed up and I was standing in line, listening to Sambassadeur on my ipod and talking to people about my "6 Months Pregnant Shirt" the world was an exciting place with nothing to be afraid of.

I started out really fast and felt good. But about 2k into the race, my thighs started to burn like I have never experienced. I thought I might have to walk. Somehow my pride kept me going. And then the pain of the full bladder took over. But the race was wide open with no bushes to hide in along side of the road. I considered peeing my pants. But thought that might be my pregnancy-induced dementia talking again so I snuck off behind a gas station, where I'm sure I was seen peeing by a good 50 runners. It is quite sad to not be able to get through a measly 5k without having to stop and pee. Yes, I did pee immediately before the start. Anyway, the 20 second stop behind a wooden crate rejuvenated my legs, too. I was able to finish strong without agony.

I got right around my projected time with 24:30. That was actually 6th for my age group, which I was happy about in such a big race. A good 2 1/2 to 3 minutes slower than my pre-pregnancy pace, but I'm okay with that.

After I crossed the finish line, my stomach was killing me and I was sure I would puke. I looked up and tons of people were looking at me with concern (I'm sure since they saw the shirt). I collected myself and walked off with a smile to find SR.

On my way off the course, a bunch of people came up to me to congratulate me. One guy asked me if I had seen the recent articles about running in pregnancy in the New York Times. I told him my friends (that's you, readers of this blog) had sent me the articles.

I spotted SR and he eventually said he got 3rd. Which I thought was amazing in such a big race, but he seemed disappointed with his time. I guess he just wouldn't be himself if he didn't always push himself to the limit. He did get some nice socks and and a glass with turkeys on it.

As we were waiting for the awards, many people came up to talk with me, the most notable being a 43 year old woman who had run in the Olympic trials a number of years back. She said she had run all the way through her pregnancy 12 years ago. She ran the day before she went into labor, but said the morning she went into labor she "only" rode her bike. I detected a kindred spirit, or at least possible support for my "crazy" theories about pregnancy and exercise. Anyway, she only gained 12 lbs during her pregnancy and gave birth to a healthy 7 1/2 lb baby, who is now a normal 12 year old girl. She said with clear pride, "I got home from the hospital and put on my old pants and they were too small!!!"

I told her it was great to hear that someone had exercised, not gained much weight and gave birth to a normal baby. She said, "I had a great obstetrician and my husband is an ER doctor, so I wasn't too worried." Then I told her I was a doctor in town as was SR, to which she replied "Why would you worry? You obviously know what you're doing."

Well, who wouldn't worry when the world around us is so overly protective of pregnant women? My dear mother agonizes daily about the bouncing from my running "pushing the baby out early."

And it's not like I don't care. I didn't sleep well the past two nights thinking "I haven't eaten enough fish lately. I hope the baby doesn't come early from that." I've even gotten to thinking that the baby is so used to the exercise now that if I let up something will go wrong. So we all probably have a little voodoo in our beliefs about pregnancy simply because it's something that we care about so much.

And speaking of fish (and something non-voodoo), there was a large study which showed that women on the Faroe Islands and Denmark who eat higher amounts of omega 3 and omega 6 fatty acids have pregnancies that last 5-6 days longer than those who eat less. And there is a dose-response relationship. That may not seem like much, but when you consider that most women do go to term, eating fish appears to have saved a significant number of women from premature birth. But anything in excess is risky: in Iceland, the women who consume the highest amount of fish have the smallest babies. And another study from Denmark showed that the highest consumers of fish oil had no protection from premature birth, but those with moderate consumption had longer gestation on average than those who consumed very little fish oil.

I will need to add more pics once our computer is working again. I'm at the hospital now :).

Running Song of the Day: Normandie by the Shout Out Louds (yet another great Swedish band)

Turn all the words into poetry

What greater freedom is there in life than running in the woods on a beautiful fall day?

Things have been a bit stressful lately with lost sleep and I even took a day off from running. But it is exhilarating to be back at it again. I hope everyone who is reading this has something they love to do, that makes them feel completely free.



Here is a song about a girl who likes to run:

She's a single face in the crowd
And she runs to the sound of her heart
She doesn't know why that she runs
But she runs

And her heart is emptier than light
And her soul is married to the stars
She doesn't know why that she runs
But she runs

Ah, yes. That's Running Girl by the great British band, Ooberman.

So with all the stress, the details of which I won't get into, I did a lot of thinking, especially about our precious son and came up with some rules to live by that perhaps he'll read some day.

Four tips for our son:


1. Whenever you perceive there to be a fault in someone else, look inside yourself and find two.


2. When something unfortunate happens in your life, find something good that can come out of it.


3. It is okay to cry because life is beautiful. In fact, if you don't, you are missing it.


4. You can't change what happens to you, but you can shape your destiny.

So running has been wonderful lately. And I unintentionally lost 3 pounds. It does concern me. But I feel great. And the belly is clearly growing. And I will be lighter for the 5k race on Saturday (oooh, I can feel the concerned comments coming).


SR opened up his blog again, happily. And I wanted to address a concern from Monica who commented on his blog.

When you think about all of the bouncing, jostling and shaking you're doing of a developing fetus, that just can't be good.

I guess I just don't see how bouncing up and down during running could harm a baby. He is surrounded by water and it really must feel like a swaying motion to him, like a cradle or rocking chair. SR and I joke that he will never be seasick. He always seems to nap when I run, so I can't imagine anything other than him being content in there during the runs.

And there's no call for comparing running to smoking, Monica2. Running and exercise in general is healthy during pregnancy, smoking is not for many MANY reasons (increased risk for placental abruption, decreased blood flow to the baby resulting in poor organ development, I could go on, but I think we all know how bad smoking is).

So, it's off on my bike to use the eliptical now, which I have been enjoying lately.

Gosh, I had a good day after waking up to SR whispering in my ear the sweetest words I could imagine. He knows how to make me happy. I love him.

Running song of the day: Between the Lines by Sambassadeur

Something maternity

Just got back from a hot date with SR at the hospital cafeteria. We both had our favorite menu item (the garden burger) and talked for hours about death, religious traditions, antibiotics, etc. And I got lotion rubbed all over my body in the call room, which doesn't happen every day. A perfect date considering the location.

In other news, yes, we did go shopping for maternity clothes. I have been averse to this idea for some time now. There is just something about maternity clothes that says to me I've stopped caring about how I look, and I'm proud of it.


My wonderful aunt sent me $50 to buy, as she wrote, "something maternity." And once SR saw this, he got quite excited about a shopping trip. You see, my aunt as well as my mom and her other sister fully embrace their femininity and have a keen sense of how to do just the right feminine thing at just the right time. Clean, potpourri-scented homes, pants with pleated waistlines, geraniums on the porch and meat loaf on a kitchen table of love are just a few examples. This seemingly genetic sense of womanliness was not passed on to me. And maternity clothes are just another accessory in the life of the perfect woman that I fail to have a desire for.


So as you can probably guess, I wasn't as excited about my new wardrobe as SR was. But finding pants I could wear to work comfortably was a necessity. We started at Macy's where they informed us they didn't have a maternity line. At which point I thought I would have an excuse to just buy large "normal" pants. But they pointed us in the direction of JC Penny's. Certainly not the epicenter of fashion in my mind, but there was no way out now.


While I was busy cringing, SR picked out about 10 pairs of pants and brought them to the dressing room. I will point out that it is virtually impossible to find size small or size 4 maternity pants. So six out of the ten he chose were immediately out. And one of the four left had vertical stripes on it. SR fondly referred to these as "clown pants" but was still hoping I would try them on.


Anyway, we did have a lot of fun. And we found a pair of jeans that I really do like. Here's the pregnoid me in mat-pants:









I just need to find some work pants now. There is apparently a Gap maternity line on-line that isn't too bad.


So we ended up not going out of town at all, being so wrapped up in maternity shopping and wanting curry from the local Thai restaurant. And to end the night, I cut SR's hair for about two hours while we watched Notting Hill (SR's favorite romantic comedy). The next morning we spent 3 hours in bed having sex and admiring each other. Not a bad couple of days off.


And I'm gaining weight faster than planned. But that is okay, though obviously it's making running harder. The pressure on the bladder and bowels is intense. Apparently Paula Radcliffe also ran like a mad woman through pregnancy. She has a diary on-line and there is a nice article I just found about her in the NY Times. Here's a quote:



“As far as I know, no one has ever done what she’s done,” Pivarnik said.
Here is an internationally competitive athlete, at the pinnacle of her career, who continued training during pregnancy at a level most runners who are not pregnant would find daunting. For the first five months, she ran twice a day, 75 minutes in the morning and 30 to 45 minutes in the evening. Then she cut back, running an hour in the morning and riding a stationary bike at night.



Okay, so I'm no Paula Radcliffe, but I'm proud to say they can't get away anymore with saying "no one has ever done what she's done," at least as far as the training goes. Though I'm sure she did run faster than me. Here she is now looking beautiful and happy:

And here's the link to the article:
http://www.nytimes.com/2007/11/03/sports/othersports/03runner.html?_r=1&oref=slogin

And just for fun, I thought for the first time I'd post my stats for the week:

Running: 82 miles
Swimming: 4 miles
Biking: 20 miles
Daily yoga/core workout


Yes! Week 26 begins and I feel great!


Running Song of the Day: A Sorta Fairytale by Tori Amos

P.S. Just realized that two of my readers referred me to the above article after I read it & wrote about it! Thanks Lisa & Coty!