Whether having children is in your 10-year plan or you’ve decided now is the time to start trying, it’s never too early to begin preparing your body for pregnancy. Ensure your body is ready to carry a baby by addressing before pregnancy any pain or problems associated with posture or weakness. Unfortunately, these issues can worsen during pregnancy and cause pain and dysfunction. The good news is a physical therapist can evaluate, diagnose, and treat pre-pregnancy musculoskeletal issues and continue to help you during pregnancy and post-childbirth.

Tips to Help Prepare Your Body for Pregnancy

1. Strengthen your pelvic muscles. To strengthen your muscles, use pelvic floor contractions (commonly referred to as Kegels), which involve gently squeezing the sphincter muscles (rather than the buttocks and thighs). These tightening exercises help prevent leakage when a woman sneezes, coughs, etc, and also can help reduce pelvic pain during pregnancy. However, many women do Kegels incorrectly (perhaps because muscles are too tight and need to be relaxed before strengthening). Physical therapists who specialize in women’s health can instruct women in how to perform these exercises safely and correctly.

2. Prepare for “baby belly” by focusing on your core. Core exercises can help prevent diastasis recti —abdominal muscle separation. As your belly grows, the abdominal muscles that run vertically along either side of the belly button can be forced apart, like a zipper opening. If these abdominal muscles separate from each other too much, the result can be low back pain, pelvic pain, or other injuries as your body tries to compensate for its weaker core. This also can result in the post-pregnancy “pooch” many women find undesirable. But beware, some exercises, such as sit-ups, increase the likelihood of developing diastasis recti.

3. Take a breath! Learning proper breathing and relaxation techniques from your physical therapist will help prepare your body and mind for a healthy pregnancy. It is important to learn to properly exhale before performing any exercise. With proper technique, your core and pelvic floor muscles will contract automatically, and this will lead to optimal stability and injury protection.

4. Begin a regular fitness routine. Exercise will help reduce the amount of cortisol (stress hormone) in your body and will boost your muscle and cardiovascular strength—strength you’ll need to carry that extra baby weight. Once you become pregnant, consider engaging in relatively low-impact activities such as swimming, walking on even surfaces, biking, or using an elliptical machine. Runners should be aware that loosening of their ligaments may make them more susceptible to knee and ankle injuries. Also, when the muscles and ligaments that support a woman’s pelvic organs weaken, the repetitive jarring of running can cause these organs to descend. This is known as pelvic organ prolapse. Physical therapists strongly recommend that, to prevent this condition, women wear undergarments that offer pelvic floor support, or compression shorts that support the pelvic floor both during and after pregnancy.

5. Practice good posture. Poor posture can have a major effect on every part of your body, particularly with regard to pain during pregnancy. A physical therapist can evaluate your posture and suggest muscle-strengthening exercises and lifestyle education (such as not sitting at a desk for long periods, and carrying your grocery bags properly). Establishing healthy posture habits—pre-baby — will better prepare your body for the extra weight of pregnancy and lessen your chances of low back and pelvic pain.

So, in the midst of all the planning and excitement, don’t forget to focus on yourself, the mom-to-be. You have a big job coming up. Take time to prepare your body for the rewarding challenges ahead.

By Beth Kephart

Her voice comes to him like a stream of music, particles of sound from a  world outside his own. He has awakened from a sleep and from a dream he  won’t remember, and feels swaddled by sound — not just the voice, which pleases him, but the decisive beating of his mother’s heart, the  grumble of her intestines, the murmur of her lungs as they balloon and  then deflate. The light is dim inside the womb. Blood gurgles as it  washes by. He feels the weight of his mother’s hand pressing in, toward  his knee, and he presses his knee out toward it, as if to say, Yes, I am here.

Thirty-eight weeks ago he was nothing but one cell. One cell that then divided into  the stuff of tissues, organs, bones, and hormones, each cell finding its place in the growing cluster by heeding the instructions inscribed in  its genes. Some cells sloughed off and others settled in for life –  folding and migrating until, for instance, a miniature tube became his  pumping, robust heart. Now, transparent nails cap the tips of his  fingers and his toes. Billions of neurons are bundled in his brain.  There are creases on the bottoms of his feet, and on the sides of his  head are the fleshy blooms of his ears.

Now that he has a mouth and hand, he sucks his thumb. He squints toward the placenta through the amniotic fluid in which he floats. Attached to the back wall of his mother’s uterus, the placenta utterly encircles him,  anchoring him in with the ropy umbilical cord. The placenta is the only  organ he’ll discard upon his birth. An ingenious collaboration, composed partly of his cells and partly of his mother’s, it has served him these last many months as lungs, liver, kidney, endocrine glands, commissary, and telephone. How has he been getting his oxygen and blood? Through  the placenta. Where has he been sending his waste? Back to the placenta. From where have his glucose, amino acids, water, fats, mineral ions,  and vitamins come? The placenta. By what means has he already initiated  the processes of his own birth? By sending a squirt of hormone to the  placenta, of course.

For indeed the time has come. There’s enough fat on his body now to help  him make the transition to what will be a far cooler, drier environment. Enough neural pathways have been established between his sense organs  and his brain. He has shed his lanugo (the fine hairs that have covered  his body for many weeks) as well as his vernix caseosa (the waxy white  coating that has protectively sheathed his skin during his long  incubation), and then swallowed both; they’ll ooze away from him after  birth, with his first bowel movement. His bloodstream has been fortified with his mother’s immunoglobin proteins. And he’s ingesting the salty,  growth factor-enriched amniotic fluid that he floats in — thereby  helping the maturation of his digestive system.

For weeks now, he has been practicing breathing — exercising the muscle  fibers of his diaphragm, strengthening the nerve connections between his respiratory center and his brain, ensuring that his lungs will have the stuff it takes to expand and ventilate when they finally meet air. And, just to ensure that all systems will indeed be go, he has lately given  himself over to the stuff of sleep, napping as much as 95 percent of the time. He’s been spending much of that naptime in rapid eye movement  (REM) sleep, which has increased his heart rate, fluttered his eyes,  quickened his pulse, sparked the release and receipt of electromagnetic  pulses. This has been integral to the development of his brain –  pushing the mass of bundled nerves, cells, and connections to sort  themselves out in time for life outside the womb.

Now the fetus hears a low-frequency sound — the voice of his father. Soon  thereafter, the voice of his mother wafts in. He feels his body swaying, and senses that his own oxygen level has started to decline, for his  mother is pacing again, exerting herself and, therefore, him. His body  responds as it always does at times like these — channeling the  oxygen-rich blood to his brain and other critical organs, protecting  them above all else.

Upside down and snug in his mother’s womb, the fetus is aware that his  mother’s abdomen is tightening around him. Small, painless contractions  that are a mere precursor of what’s soon to come. “The baby comes when  the baby’s ready” may be folk wisdom, but it is also a fact, and this  fetus — fully developed, with no more space to stretch and grow — is  definitely ready for life outside.

Life On the Outside

A few days ago, his brain’s hypothalamus sent a message to his pituitary  gland. His pituitary, in turn, sent a signal (a small dose of the  chemical adrenocorticotropin, or ACTH) to his adrenal glands, which  subsequently played their part by releasing a stress hormone, called  cortisol, through the umbilical cord to the placenta. There, it has  begun to promote the production of estrogen, suppressing the manufacture of progesterone and, at the same time, releasing enzymes that are  capable of converting progesterone into estrogen. Thus, without raising  the suspicions of his mother, the fetus — as seemingly helpless as he  is — has triggered the processes of his birth.

All throughout her pregnancy, his mother’s abdominal muscles have been held in stasis by the predominance of progesterone over estrogen. Enough  progesterone has kept her body from rejecting the foreign object of her  fetus; the right amount of estrogen, on the other hand, has made mild  contractions possible, keeping the abdominal muscle toned.

Now that contractions are required to bring the pregnancy to a close, the  hormonal ratio must begin to shift in favor of estrogen. The softening  and dilation of the cervix is reliant on estrogen, as is the production  of proteins that encourage contractions. The ability of the mother’s  blood to coagulate during the birthing process depends on estrogen; so  does the production of prostaglandin and oxytocin receptors. Without  these, vaginal childbirth would be impossible, for it’s only after  estrogen makes the mother’s uterus more suspectible to oxytocin — and  oxytocin and prostaglandin then stimulate the contractions of smooth  muscles in the uterine wall — that the whole choreography of labor can  genuinely begin.

To get the contractions moving at some meaningful tempo, what’s needed is a dose of oxytocin, whose production is a collaborative effort: it’s  released by the pituitary glands of both the mother and the fetus. The  release of the oxytocin promotes further hormonal releases from the  adrenal and pituitary glands of the fetus. Mother and child have  officially entered the first stage of labor.

Contractions will start coming every 15 to 20 minutes or so now, each lasting 30 to  60 seconds. For the mother, there’s pressure and pain. For the fetus,  there’s the sensation of being squeezed. He hears voices outside  himself, feels the rock and walk of his mother’s pelvis. As labor  progresses and the cervix starts dilating, contractions come more  forcefully, more quickly, bring more pain to the mother. With his own  head, the fetus helps the process along — stretching his mother’s  cervix until it initiates a new cascade of nerve impulses that travel up the mother’s spine to her pituitary gland, which answers with the  release of more oxytocin. This further stimulates the contractions.  Inside, the fetus feels the squeeze and release of the muscular chamber  that’s housed him these many months.

With every contraction, the uterus shortens and closes, inching the fetus  farther down. With every contraction, the cervix widens. If things  seemed tight before, they’re nothing short of crowded now. The  contractions are coming far more often, and the fetus is dimly aware of  an array of new sounds outside the womb. He hears the groan of his  mother, the soothing voice of his father. Now he is squeezed tightly;  it’s not pain he feels, but pressure. The uterine muscles clamp down on  his head with such persuasion that he begins to release the thyroid  hormones and adrenaline that his body instinctively knows it will need  to adjust to the cooler temperatures in the outside world.

The pressure from the contractions, as well as the rising concentration of  prostaglandins, also protect him from a serious danger: the temptation  to breathe. Breathing before his head is completely free of the birth  canal would mean taking in fluids and risking pneumonia, so the fetus  obeys the blueprint in his genomes that instruct him to wait until the  world can hear him cry. It might sound easy, but his oxygen supply is  getting thin. His umbilical cord, with its many vessels supplying  oxygen-rich blood, is stretching. His mother’s blood vessels are  squeezed. The placenta is starting to tear away from the anchor of her  uterus. But he mustn’t yet breathe.

All of a sudden something breaks. he feels the amniotic fluid trickle, then rush past him. Just below his head, the cervix is at last fully  dilated. He feels his head push through a narrow channel, caught in the  vice of a contraction. With the cervix fully dilated, he can now push  through the birth canal, but it’s not a journey even this world-ready  fetus could make were it not for his own soft skull, which deforms in  the narrow passage. Still, no pain for the fetus. Just pressure.

It seems to go on for an eternity. The umbilical cord is stretched thin.  There’s hardly any oxygen in his blood. The amniotic fluid is being  squeezed from his lungs. His body fights fatigue.

Suddenly, there it is: A cold, bright, shouting light — dry air! Sound turned up to a whole new level. Slippery hands upon his head. A clamp on his  umbilical cord. He wails. Instinctively, he turns 90 degrees in the  birth canal, and trusts the hands in this new world to pull his naked  body free.

The fetus’ holler is that very first breath he’s practiced for. His lungs  draw in the air and its air sacs open. The oxygen relaxes the walls of  his lungs’ blood vessels, causing them to dilate. Whereas in the womb  the fetus’ blood bypassed his own lungs and was shunted off to be  oxygenated by his mother’s, now the shunts close forever, and his blood  begins to find its way into his lungs. There, it is oxygenated, and  rushed into his arteries via his heart.

The world the baby has entered is strange and new. There’s five times more  oxygen available now than there was ever before, and the rush of its  life-giving molecules stimulates his nerve cells. He still has a lot to  master, for his umbilical cord has been cut and his placenta –  surrogate lung, kidney, protectorate — is no longer a part of his life. Now his nutrients must come from milk. Now his kidneys must take charge of balancing his bodily fluids. But before he’s given much of a chance  to grasp the skills he’ll need, he’s given (and isn’t this just like  real life?) an exam — an Apgar test — which assesses his heart rate,  respiratory effort, color, muscle tone, and reflexes. Then he’s carried  beneath the harsh lights, through the dry air, toward a new destination.

A sweet voice he recognizes speaks to him, and a second voice whispers in his ear — his father. Who knows what the proud, encouraging sound  waves mean, but they play like music to his ears. He nuzzles close in  his mother’s arms.

Beth Kephart’s A Slant of Sun: One Child’s Courage was a 1998 National Book Award finalist.

— Jan Tritten

*    Its use facilitates physiologic positions for labor

•     It encourages fetal descent

•     It assists in rotation of the baby in the posterior position

•     It encourages pelvic relaxation

•     It allows for pelvic rocking and body movements

•     It encourages rhythmic movement

•     It helps relieve back pain

•     It can be used with both external and internal electronic fetal monitoring

•     It encourages pelvic mobility

•     It provides perineal support without undue pressure

•     It takes advantage of gravity during and between contractions

•     There is less strain on wrists and hands when in the hands-and-knees position

•     It helps when a back rub or back pressure is needed

•     The ball may enhance rotation and descent in a diffcult birth

•     The ball can be used as support while squatting

•     Its use helps widen the pelvic outlet to its maximum dimension while used during the second stage while squatting

•     It eliminates hard external pressure of a bed, chair or rocker when sitting

•     It allows freedom to shift weight for comfort

•     It helps take the pressure off hemorrhoids

•     It encourages good physiologic resting positions

•     It may speed labor

•     It helps contractions to be less painful and more productive

•     It is benefcial with techniques for failure to progress

•     In shoulder dystocia, it can support the mother who needs to be on hands and knees to facilitate rotation of the posterior shoulder.

by Paulina Perez, RN, BSN, FACCE, CD.  Posted with permission from ICEA.

As the rate of caesarean deliveries steadily rises, so is the ‘trend’ of  pregnant women employing a birth support person – a doula – to prepare for and  help her with the big event of giving birth.

Over the past 10 years, the caesarean section rate in Australia increased from 23.3 per cent in 2000 to a peak of 31.5 per cent in 2009, according to the Australian Institute of Health and Welfare.

If you don’t know what your choices are, you don’t have  any.

Caesarean rates are among the highest in Western  Australia with 33.3 per cent, together with Queensland.

She said the vocation of becoming a doula was quite accidental, and started  when one of her girlfriends, inspired by Gaby’s own positive birth experience,  asked her to be with her when she delivered her son.

“When my girlfriend had her baby, she wanted me to be there and help her  create that atmosphere. I really didn’t know what my role was, didn’t know what  a doula was, I just knew that me being there would help her be calm and focused  within,” she said.

“It wasn’t until five years after I’ve been attending births that someone  said ‘oh, you’re a doula’ and I was so shocked there was a word for it and  [after researching it] I discovered there was a whole movement.

“I was the only doula in Perth at that time as far as I knew.”

Gaby describes a doula as a support person, who gives women in their birthing  experience emotional help.

Contrary to midwives, doulas have no medical role in the birthing suite and  only offer advice when explicitly asked. But she said her real focus is  delivering effective child birth education  before the big event.

She said the vocation of becoming a doula was quite accidental, and started  when one of her girlfriends, inspired by Gaby’s own positive birth experience,  asked her to be with her when she delivered her son.

“When my girlfriend had her baby, she wanted me to be there and help her  create that atmosphere. I really didn’t know what my role was, didn’t know what  a doula was, I just knew that me being there would help her be calm and focused  within,” she said.

“It wasn’t until five years after I’ve been attending births that someone  said ‘oh, you’re a doula’ and I was so shocked there was a word for it and  [after researching it] I discovered there was a whole movement.

“I was the only doula in Perth at that time as far as I knew.”

Gaby describes a doula as a support person, who gives women in their birthing  experience emotional help.

Contrary to midwives, doulas have no medical role in the birthing suite and  only offer advice when explicitly asked. But she said her real focus is  delivering effective child birth education  before the big event.

“I used to be a doula that just turned up for the birth, but I realised after  the first 10 years – which I call my ‘apprentice years’ – that really the focus  and effort is about the work I do prior to the birth.”

The concept of an experienced woman attending birth is not new, she said, and  can be found in various indigenous cultures around the world. She said doulas  used to be called god sibs or montrice.

“Aboriginal women had them forever, known as Charrlies and in Japan they are  called Josanp,” she said.

“It’s not a new thing but has become en vogue because there is such a high intervention rate  and the medical model is so powerful in the hospitals that women’s births have  been seen as a medical procedure and not something that’s a natural  process”.

Around 2004 there was an influx of women asking for birth support, Gaby said,  who is actively involved in training  doulas.

Gaby, who describes herself as “a guardian of natural birth” is very  passionate about helping women have the most natural birthing experience they  can have and take away their fears and apprehensions.

Gaby said she believes what she calls “the cascade of intervention” was a  factor explaining the rising rate of caesarean deliveries in Australia.

“Women need to know that the smallest amount of intervention can snowball. A  lot of women end up with caesareans because they were induced.

A major focus for Gaby is tackling the trend of women electing for caesarean  births, which is also on the rise.

“They miss out on a beautiful experience. It’s the most divine experience a  woman can go through.

She said while most partners are welcoming her into the delivery suite to  take the pressure off and provide a calm and relaxed environment through her  experience, she sometimes faced hostility from medical staff.

“In a lot of the private hospitals here in Perth the midwives really are  hostile to me,” she said.

“They see me as a threat. They even got to a point where you have to sign a  consent form that you won’t speak to your client, or encourage them or give them  advice at any time.”

Gaby found that her skills are gaining acceptance by the medical profession,  and her new book A Labour Of Love II proudly features a foreword  written by Perth’s Professor Fiona Stanley.

With the new book, the sequel to her first birthing guide A Labour Of Love,  Gaby aims to “empower through knowledge to give women the birth they want”.

“If you don’t know what your choices are, you don’t have any,” she said.

“Should you need medical interventions, you can’t feel disappointed if you  have put everything into your mental and physical preparations. People spend  more money on their cot, their prams and their baby car seats etc than what they  do on education. Birth education is invaluable.”

Topics discussed in the new book also include optimal foetal positioning,  mental preparation, and techniques such as imagineering, hypnosis and several  other alternative therapies like acupuncture, acupressure and homeopathy.

Read more: http://www.watoday.com.au/national/health/the-rise-of-the-doula-20130408-2hhg8.html#ixzz2R4JGqdKh

BirthdaySuit Maternity is a fun company that I co- own with my daughter, Kristy. We have fun designing and sewing labor gowns, so mamas will look and feel their best during labor.

” Birth Day Suit Maternity is run by a mother/daughter powerhouse! When Kristy was pregnant with her first baby, she joked that she was concerned her baby would be scared of her when he first saw her from looking “rough” after labor, so with that, she made her own maternity hospital gown. She strutted her stuff throughout the labor and delivery ward halls, loving how the attention she was getting helped distract her from a long 36 hours of labor! When her baby was 3 months old, Kristy and Kathryn decided that this product was a true need for all mommies-to-be, and it became their mission to help dress laboring women across the world! They created their maternity design studio and have been sewing ever since!”

Happy Birthday Audrina!  Your eyes are beautiful!