**So, Gina, tell me a bit about your labor and delivery; how it went, which end came out first, etc.  I hear he did a caveman on his way out?:**

Yes, my baby boy basically kicked his way into the world…a full nine weeks earlier than expected.

After some research, and deciding I was potentially bad-ass enough, I had been considering a natural birth (no painkillers… you know, like a crazy person).  I even had a couple books and the number for a doula.

The trouble was, when my water broke on St Patricks day, I had yet to crack open the books or actually *call* the doula.

My St Patty’s day started innocently enough.  Covering Justin’s Bootcamp was business as usual: sucking back some fresh air in Forest Park with some of my favorite people.  There were cavemans and planks, warrior runs and sprints.  Next, a quick (half-calf) coffee followed by an hour of ‘On The Move’ instruction.  On The Move is a group fitness class established through Wash U’s PT program, designed for overweight, obese, and medically complicated participants.  We had some back pain ladies present so our efforts were focused   on building movements around correct posture and core control.

I returned home in time for our house to be inundated by a cluster of close friends gathering to celebrate both St Patrick’s Day and the impending 30th birthday of my loving husband, Andrew.  The group ‘hoofed it’ just under 2 miles from our home in Mapelwood to the Dog Town festivities. Our pace was quicker on the way home, motivated by thick raindrops and a rumbling sky.

Home meant ten take out orders of corned beef and cabbage from Foleys and more partying.  As the evening wore on, the crowd got hungry again, and Andrew innocently wondered up the street for carry out orders at Tiffany’s diner.

I had been sitting lazily at our dining room table, piecing a puzzle together with my neighbor and her 3-year-old when a gush of fluid escaped me…and didn’t seem to want to stop.

What happened next might as well be adapted for a Lifetime TV drama…or maybe a prime time Sitcom.  Inebriated friends spring into action, throwing clean clothes and cameras into a bag, hastily summoning my bewildered husband, and whisking the two of us were away.  We were chauffeured by the only logical sober driver…my 38-weeks-pregnant gal-pal Kelly, who happens to work as a pediatric PT the NICU at Children’s Hospital.

When we arrived at St Mary’s hospital, the doctors (who kept trying to admit Kelly) seemed un-phased  and insisted they could ‘keep me pregnant’.

They also said we weren’t leaving without a baby.

Naturally, I was confused.

They admitted me, told me to get comfortable, and started pumping me full of magnesium.  The goal was to keep me on bed rest at the hospital for (gasp!) four more weeks.

I was horrified by the idea of sitting still for that long, but pre-term delivery to a breeched (feet down, not ideal) baby scared me way worse.

I suppose you could say my ‘labor’ lasted from the time my water broke (around 11pm) on the  17th to 6:16 the following evening.  The magnesium was meant to suppress the contractions. Its probably safe to say now that the drugs did little aside from making me woozy and weak and nauseous.

Les Mills fans, you’ll love this one: over the course of the day,  I developed this strategy of dealing with particularly sharp contractions that included visualizing Body Combat tracks.

Yup.  I would squeeze my eyes shut and silently recite the lyrics to a track, twitching the appropriate muscle groups for each choreographed move.  It distracted me just enough and made the contraction seem more like a strain I was intentionally placing on my body, and somehow more bearable.

Maybe I was *too* cool about the whole thing.   The nurses and I trusted that the drugs were keeping me out of labor and what I was experiencing was just normal discomfort.  What no one realized (until too late) was that the whole day, my baby was working his way into my birth canal, eager to hit the ground running.

At about 5pm, I was finally lulled into a state of drowsiness and ready to finally take a much needed nap.  My husband saw his opportunity to step out for some ‘real food’ and check on our dogs.  The nurse arrived about 45 minutes later, to inform me they were planning to wean down my magnesium.  As she casually asked me about my pain, I experienced another sharp contraction isolated near my pubic bone, as the last few had been.  She was perplexed by my discomfort and I felt like a big weenie because the contractions weren’t even registering much on the monitor.  She suggested it was maybe just my bladder and that I try to urinate.   Sitting up, I experienced that pressure those women talk about on that show, I Didn’t Know I was Pregnant (it’s a real thing, I recommend scoping it out sometime).  At 6pm, I had finally met my match when it came to pain.  The doctor was summoned and the next thing I knew, my bed and I were flying down the hall to the OR.  At that point, my husband was miles away, sitting down to a meal with his sister.

I did a lot of crying and protesting at first.  As the overhead lights flashed past my vision, I remember gripping the bed rail and doing the only thing I could think of… Count out loud.
To Ten.
Over and over.
It’s this thing I do when I’m running sometimes: if I think I can’t make it up a certain hill or keep a certain pace, I start counting to distract myself.
It’s very possible I looked like a complete lunatic, dressed in my hospital gown, reciting numbers, clinging to the bed rail, and whizzing down the hall.

In the end, I got my wish for a natural delivery.  There had been no pain medication during my ‘suppressed’ labor and now there was just no time.

At delivery,  my baby was still sitting upright, but low enough that the doctor was unconvinced that a c-section would be any better than the traditional method.

Do you ever have that dream where you arrive to a class and there’s an exam you didn’t know about?  (or maybe that’s actually happened to you…) *That* was how I felt, multiplied by 1,000. I was totally unprepared.  Mix in the pain and adrenaline and God knows what else and it was like living a nightmare.

When I was instructed to push (by the ‘peanut gallery’ of what seemed like 40 L&D staff gathered around my gurney), I heard a desperate, hysterical version of myself respond with, ‘I don’t know how to push!’

Instructions immediately flew at me from all directions and for a moment, all I could do was cry.

Then something clicked.  A nurse at my left side locked eyes with me and said, ‘take a big breath, I’ll count to ten, and you push until I get to ten.’ Suddenly, this was just another day at Bootcamp.  A ten second isometric.  Shit, I could do that.  I looked right back at her and nodded between sobs, ‘Ok,  I can do that.’

Nine minutes later, I had a son.
My husband missed it by only a few minutes.

3 pounds, 10 ounces
Ready to take on the world.
Colten Thomas LaRose.

**is it possible that your  increased activity levels during pregnancy have anything to do with your preterm labor?

You better believe this was the first question I asked after I was admitted.  In my heart, I knew the answer was ‘no’.  But I was certain that had to have been the running theory buzzing over the rumor mill.  Of all my new mom friends, I was certainly the most active both before and during pregnancy and this was frequently a topic of amazed conversation.

There were actually two physicians standing at my bedside when I posed the question; and they both began vehemently shaking their heads before I even finished expressing my concern.

What I experienced is known as pPROM (preterm premature rupture of the membrane)  The doctors–and now Internet– assured me that this is a rare incident (no more than 3 percent of pregnancies) and the cause is unknown.  It can be correlated with a few things, including smoking and hypertension, but I can sleep easy knowing neither of those things is relevant to my own situation.  There is no evidence to suggest that any form
of physical activities (even sex!) can cause early rupture of the membrane.

**What did you do differently in your training routine to adjust for the pregnancy?

The first trimester, I was *exhausted*.  I could tolerate my morning  workouts, but by the end of the day, I was defeated.  There wasn’t a huge decline in intensity or duration of my workouts (especially with weights)  but I couldn’t handle anything beyond my couch by the time I got home at night.

My running pace fizzled gradually.  I ran a half marathon at week 10 and my time was a full 20 minutes slower than usual.

Because my classes were taking priority, running was eventually casually tossed in the back seat.

By the third trimester, I was running once a week at best and the last run I attempted (a week before delivery) lasted less than a mile before it turned into a pleasant walk.

I started backing up on squat and lunge weights during Body Pump in the second trimester.   That was partially due to the need to last through a second class (and my declining endurance) and partially due to pain.

I have some moderate muscle imbalances and postural faults contributing to occasional low thoracic pain in my ‘normal’ life.  These issues only worsened near the end of my second trimester as my baby started to grow and pooch — throwing me even more off alignment. The ligament laxity we generally associate with pregnancy actually occurs and peaks in the first couple months, but the effects are generally *felt* more in later months due to mechanical changes.

I also never achieved the *really* pregnant stages where I was carrying my baby in a way that would significantly inhibit my posture or potentially caused a lot of pain.  Therefore, it’s difficult to say how things might have continued to decline.  According to my research, most women tend to quit running altogether by the third trimester due to discomfort.

After the first trimester, I began modifying my positioning during certain activities: limiting supine exercises to only a few minutes at a time, or sometimes (with chest press and supine triceps) jacking up the back of the bench into a small incline. This was to prevent blood pressure problems and discomfort.  I also quit prone exercises completely by the end of the first trimester (for obvious reasons…). Planks ended up as my best bet for a good abs/trunk exercise–which is great because they’ve always been my favorite anyways!

How do you feel about current/common recommendations of exercise and pregnancy?

When you go looking for it, or talk to most doctors (at least, this was my personal experience), the current recommendations are that mom can handle just about whatever she feels.; especially in the case of those who were active pre- pregnancy. ‘Listen to your body’ was the advice I got from more than one source…. In regards to both pre- and post- natal activity.

The American Congress of Obstetricians and Gynecologists actually recommends 30 minutes of exercise a day for pregnant women, for as long as they are physically able.

The problem lies with *old* and dated recommendations and philosophies that pregnant women are extremely fragile and exercise should be avoided.  The stigma persists, even though there is plenty of evidence supporting the contrary!

Women who continue running or participation in endurance exercise throughout their pregnancy have been shown to have shorter labor and delivery time with fewer instances of operative delivery and acute fetal stress.   The same study showed no significant difference in incidents of preterm labor between the exercise and non-exercise groups.

More recent studies have shown that not only does maternal exercise improve the strength of a baby’s heart prior to delivery, these benefits last even beyond birth!  Naturally, I am thrilled I gave tiny little Colten a little boost in utero because he really needs the strength now!

To answer your question more specifically, I feel pretty good about current recommendations.  It’s the lingering old stigma and the fact that there still seem to be doctors who hold onto old practices and recommendations that really burns my britches.  It seems like many women are still misled into the belief that exercise can be harmful instead of beneficial in a normal, uncomplicated pregnancy.

*** What do you suggest a woman does if pregnant and worried about exercising?  Or wanting to start?

If mom has already been a a workout champ I say, stick with it sister!  Don’t try to be a hero or expect PRs to come out your ears.  But don’t let other people determine your capabilities.  If you start to feel ‘off’,’ take a break or back it down a notch or two.  Evidence suggests its best to hang somewhere between 50 and 85% of your pre-pregnancy intensity.

Do your thing safely and be cautious to avoid injury — as should always be the case, right?  If you’ve had musculoskeletal pain in certain areas in the past during or after your workout, now might be a good time to get someone to help clean up your mechanics.  The last thing you need during pregnancy is an injury, and falls should not be taken lightly.  Therefore, it might be wise to avoid sticky situations like running on uneven surfaces in the dark or say, cliff diving 🙂

If you’re just getting started with a workout regimen, good for you!  You’re making a great choice for both you and your baby and there should be no greater incentive than the health of your child.  And, the earlier you start, the better.  There is evidence suggesting the starting early with an exercise plan will lessen the discomforts felt in later pregnancy!

Newbies to exercise should always be cautious for a number of reasons, safety being the most important.  Expecting moms, as I already mentioned, are especially prone to injury given their hormone-induced ligament laxity.

Therefore, the smartest thing to do would be finding a knowledgeable, credible trainer or even therapist to guide your body mechanics and overall programming.  Be picky! Ask about credentials. Not all trainers are created equal.  We’re spoiled at The Lab because Justin is so discriminatory when hiring trainers.  This is *not* the case at other gyms.

***When should a mother not exercise?   Or what warning sides should she watch for when exercising?

Of course, there are some legit concerns when expectant mamas are exercising (especially if you’re new to the game or only a casual gym-goer). As I mentioned before, pain (the ‘bad kind’ not the ‘good burn’) should be a warning sign that something is amuck.  Either modify out of pain (reduce weight or clean up mechanics) or discontinue the activity in favor of something more comfortable.

Because blood volume increases during pregnancy, there is a real danger of blood pressure issues and hypoxemia (deceased blood/oxygen) to baby.  Feeling lightheaded or dizzy should be a great cue to tap out and rest.  Modifying positions as I described above becomes important after the first trimester.

Also, remember mama’s body is working overtime to grow that precious little guy or gal.  You’ll need some extra calories; but keep in mind you’re not *actually* ‘eating for two.’  an extra 150 calories is good for the first trimester, 300 after that, and a whopping 500 extra is necessary for nursing moms.

Illness or infections will create big time set-backs during and after pregnancy.  If  feeling sick and run-down, it is certainly better to skip a workout and rest up than to try and power through and suffer more for a longer period.

Obviously, it’s important to first discuss your goals with your OB. High risk pregnancies carry special considerations when it comes to exercise.

The sad truth is that my next pregnancy will likely be considered high risk because of how anxious my little guy was to join us this go-round.  While I have no plans to retire to the couch, I will certainly spend more time scrutinizing my exercise choices and consulting with my doctor the next time I get myself knocked up.

***Some recommendations state that getting your heart rate too high is a concern?

This is *outdated* news which sadly, is still floating around, apparently even in the medical community.  From what I can gather, at some point, someone came up with this arbitrary number (140 beats/minute) and insisted women use it to limit their exercise intensity.

Again: This is now considered to be out-dated advise!

A better idea is to use what we call the ‘talk test’ to determine an appropriate intensity level.  You should be able to carry on a conversation during your workout without an enormous amount of effort.  If you could belt out a show tune in the middle if your run, you’re probably not getting much of a workout, but gossiping about your in-laws should be achievable.

Let me conclude by saying that I am enormously glad that I was able to stay active during my entire pregnancy.  Most moms I see limping in and out of the NICU had serious complications during their pregnancies and/or deliveries, often ending in cesarean sections and an emotional and physical ass-kicking.

My recovery was a breeze. I was back on my feet the morning after my delivery, pacing back and forth from my room to the NICU; home two days later; and back at work (part time) within a week.

I hate to brag (that’s a lie, I love it), but little Colten is *rocking* it in the Neonatal ICU.  He never needed a ventilator, utilized supplemental oxygen for less than a day, and I’ll be damned if he’s not started taking food from a bottle (and boobie!) at 32 weeks.  Ask any neonatal healthcare provider, this is considered a real achievement.  He gets this super-determined look on his face whenever presented with the challenge of eating and I can’t help but wonder if I’ll someday see that same look as he crosses a finish line, or scores a game-winning goal, or hell, completes a complicated piece on the piano.

Colten is a remarkable little man who already seems to know the value of hard work.  As for me, I have discovered a new undeniably  powerful source of motivation:

For more reading…

http://www.aafp.org/afp/1998/0415/p1846.html

Virginia L LaRose, PT, DPT
Physical Therapist
Washington University in St Louis
Human Health and Performance Laboratories
314-608-9890

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