New Fit 4 Two classes starting next week!

It’s that time of year again: new schools for both my kids (one in high school, one in kindergarten, OMG), and new classes for me to teach.  Next week I’m running two free trials for Fit 4 TwoStroller Fitness on Monday morning and Prenatal Fitness on Tuesday evening.  I love doing the free trials because they’re an opportunity to welcome new folks, show them what Fit 4 Two is all about and hopefully give them some take-home ideas for how to maintain or improve their fitness levels, and also to say “thank you” to repeat customers by giving them a little freebie before the new session begins in earnest.

This session is going to be a lot of fun.  We’ve had a beautiful August, and I’m really hoping the weather stays nice enough to keep Stroller Fitness outside!  In the event it doesn’t, however, we will use the gym at the community centre and do an indoor version of this mobile workout.  With any luck, we may be able to take parts of Prenatal Fitness outside, too, since it’s still light outside well into the evening.  I’m still working with some of the moms and babies who took my prenatal classes last fall.  Now I’m looking forward to seeing some new faces, and being even a small part of such an important time in women’s lives.  One of my favourite things to do as a fitness instructor is the relaxation segment that concludes every Prenatal Fitness class, where we take a few minutes to just be mindful of how we each feel at that moment, to focus without judgment on the transformations taking place in each of the women’s bodies, and to experiencing each moment fully without worrying about what came before or what we have to do next.  I like it because, let’s face it, we can all use some relaxation at the end of a long day, and because there is no better preparation for labour and birth than learning to accept and respect your body for what it is, what it can do, and what it needs in the moment.

In addition to Stroller and Prenatal Fitness, I’m also adding a new class format to the schedule this year, Tummies 4 Mommies, which I’m pretty excited about.  It’s a progressive series of classes that focus specifically on postpartum core rehabilitation. Participants will learn techniques for engaging and strengthening their core muscles from the inside out, and they’ll get handouts to take home so they can practice their technique on their own time (or not).  So many people spend so much time doing a million crunches to no avail (and actually with a potentially negative impact if they experienced diastasis recti during pregnancy or if they haven’t first strengthened their deeper core muscles):  I’m looking forward to working in a very focused way with women to help them activate the muscle groups that are really going to give them an integrated, effective approach to building a stable core, and help protect them from some of the problems that result from weak muscles in this area (can anyone say urinary incontinence? boo…). Core classes are also fun because they offer lots of opportunities to interact with the babies during the workout.  The babies are adorable, plus this takes the pressure off the moms to try and fit their exercise in between moments of fussiness as they can continue to snuggle, play or even nurse throughout a lot of the movements!  If you want to learn more about core conditioning during and after pregnancy, check out this month’s edition of Fit 4 Two’s newsletter, and remember that there are franchises operating all over western Canada, so there are lots of opportunties to join these classes. 🙂

In defense of heroism

How many times have you heard something along the lines of, “There is no medal for having a natural birth,” or “Don’t be a hero—have an epidural/scheduled c-section/other intervention of choice”?

Well, it occurred to me yesterday as I was on the return leg of my after-work run, that one reason I loved giving birth to my first child with no pain medications was that when all was said and done, I did feel like a hero. Not because giving birth unmedicated made me superior to other women: not in the slightest. This is not about relative judgments. Rather, I felt like I’d just beaten my own personal best—I did something that, going in, I wasn’t at all sure I could do, and that turned out to be much harder work than I’d ever imagined.  (They don’t call it “labour” for nothing, let me tell you.)  The feeling I had after giving birth was something like the feeling I get when I run faster or further, when I lift heavier weights or increase my endurance so I can do more reps: stronger and more powerful than I’d ever been before.

And, yes, heroic. I know that millions of women give birth unmedicated all over the world. It’s utterly common. But it’s still a big deal for each and every individual woman, just like each and every baby is a big deal for an individual family, despite the fact that there are 7 billion of us crawling around all over this little planet.

I’d argue that every birth is heroic. Every woman who gives of her body in that way, who grows and births a child, is doing something fundamentally heroic and worth honouring. At our last ICAN meeting, we talked about the idea of “cesarean courage.” Pushing your body to its limits, bringing your child into the world safely with only your own labour (in both senses) to thank is an amazing, empowering experience. And putting your body on the table—telling a doctor who you may not ever have even met before, yes, cut me open, bring my baby into this world, whatever you have to do to me in the process is collateral damage—may feel anything but empowering at the time, but is actually an incredible testament to a woman’s strength in a time of crisis, and to her willingness to do whatever it takes to save someone else’s life. I’m not sure there’s a better definition of heroism than that.

There are many different ways to feel empowered by birth. This Empowered Birth Week, I’m thinking of all the women I know who have shared their birth experiences, and shown their incredible strength as they birth naturally, as they birth after induction, as they consent to life-saving interventions, as they fight back against a system that causes needless problems during their births, as they stand up to their own fears to birth their babies safely, as they birth their babies and then watch them struggle in the NICU, as they birth their babies in the comfort of their own homes, as they give birth in custody, as they birth babies for other families, as they birth in as many different circumstances as there are different women. None of them will get medals (although my mother did get me a really beautiful engraved watch after Clea was born), but all of them, each and every one, embodies a unique kind of power that deserves both celebration and respect.

Are women stupid?

It strikes me how often choices around birth—especially women’s choices (as opposed to choices made by doctors, midwives and other professionals)—are reduced and simplified, boiled down to the overall message that women are stupid and can’t be trusted.   

I remember distinctly during my second pregnancy when I’d tell people I was planning a homebirth being met with horrified gasps, and comments along the lines of, “Aren’t you scared?  What if something goes wrong?!”  Aside from the obvious responses (anything unknown is always a little bit scary, and something could go wrong at any moment of any day—it’s more likely I’ll get hit by a car crossing the street than have a catastrophic homebirth), I often found myself wondering if the people asking the questions actually thought I was stupid.  I got to the point where I would just retort, facetiously, “Oh, wow, I hadn’t thought of that because I don’t care at all about my health or my baby’s safety.  I’m just having a homebirth because I don’t know any better.  Plus, all the cool the kids are doing it.”  I’m not very nice when I’m pregnant.

There isn’t a lot of room in conversations about birth for the women who are actually having the babies and the reasons why we do what we do.  Our voices get drowned out amidst so much politics and ideology, and we’re left looking like idiots who really can’t manage our own lives.   For example, I read a comment in an article earlier this week about women being birth copycats:  a celebrity gives birth in this or that way, stupid sheep women follow suit.  So easy.

Spare me.

Yes, celebrities are influential.  To wit:  I became a vegetarian when I was 12 because of Howard Jones, and I joined Amnesty International in grade 8 because there was a membership table at the U2 concert I went to that year.  I bought white jazz shoes because Duran Duran wore them in several of their videos, and I still favour black clothing because of The Smiths.

But I did not plan a homebirth when I was 34 because of Ricki Lake or Cindy Crawford.  Nor did I have a c-section because of Britney Spears or Gwen Stefani (even though I do like the latter’s music, and appreciate how easy she has made it for me to teach my children to spell “bananas”). 

Celebrities can do a lot to normalize certain birth choices, and sometimes they launch advocacy campaigns of their own.  Widely publicized elective inductions and c-sections can make those procedures look like no big deal and help to strengthen a culture that encourages non-medically-indicated intervention in birth.  Similarly, Ricki Lake’s The Business of Being Born has encouraged critical thought about the birth industry to come into the mainstream, instigating conversations about things like homebirth that might otherwise never have taken place. But none of this automatically translates into women deciding to do x or y with their bodies during birth.  Taking such a reductionist approach really misses the mark. 

It seems to me, and some research appears to support this, that the notion that women make birth choices based simply on celebrity behaviour—or because it’s ‘what’s cool’ on MDC or Babycenter or among their circle of friends—is patently absurd.  It’s an assumption that allows a convenient side-stepping of the problems with the whole notion of choice in childbirth. 

There are multiple reasons why women make particular birth choices, and—libertarians be warned—those choices are rarely autonomous. More often than not, they (we) are ‘choosing’ the least problematic of the limited options available, with partial or flawed evidence plus heaps of personal constraints informing/directing the decision.  Reducing decision-making to one variable is the surest way to silence birthing women and to cut off any meaningful discussion about how to support women—how to change what is currently in North America a very, very flawed system—so that all of us can give birth in the scenario that is most comfortable, most safe, and leads to the best possible outcomes.

The painful point is:  none of us can make really good choices in a system that condescends to women as a group, and holds our integrity in contempt.

Rather than judge women for their choices, it might be more fruitful to question the professionals who control access to the bulk of the information (most women don’t have privileges at academic libraries and wouldn’t be able to read the professional journals, even if they had the time or inclination to do so), who interpret the scientific data for non-scientific audiences, and who market various forms of birth with motives that have little to do with women’s best interests.  It might be useful to bust open the false doctor-v.-midwife/vaginal-v.-surgical/home-v.-hospital dichotomies, and remember that real women’s bodies are the battlegrounds for what often come down to professional, ideological, and corporate wars.

It’s hard to make confident choices when you are doing so in the midst of a firefight.  I had a doctor literally throw my chart at me when I told her I was choosing midwifery rather than physician care for my second pregnancy.  I have been castigated for accepting interventions that supposedly led to my c-section, and accused of false consciousness for having felt empowered by my first birth because it was induced and thus not natural.  I’ve seen the same things and more happen to dozens of other women, often by professionals, but also by other mothers, many of whom react from a place of anger  or frustration with a system that may have mistreated them and/or betrayed their trust.  All of this is unacceptable.

Each one of us makes the best choices we can with the information we have available.  Information is rarely perfect or complete and knowledge is always partial, and sometimes choices made with the best of intentions turn out to be the wrong ones.  Rather than assuming that pregnant women are idiots, why not assume that they—more than anyone else—want to have their babies safely, in a setting that is appropriate for them and their families?  Why not admit that the system in which we give birth is adversarial?  What would happen if we didn’t blame women for being stupid or vapid, and instead looked at the reasons why they’re putting their trust in Ricki Lake instead of their midwife or OB?

An epidural is not the only way to protect your pelvic floor

There has been a lot of discussion this week about press coverage given to a new study suggesting that epidurals may prevent trauma to the pelvic floor during delivery. Basically, the idea is that an epidural relaxes the muscles such that they don’t tear. I don’t know whether or not that is true. I haven’t read the study itself, only representations of the story in various places. I know that Amy Romano at Science and Sensibility is sceptical, and I think she is a pretty trustworthy source of information. It has been interesting to follow the discussion between her and the study’s authors in the comments section of her blog. (And ire-provoking to see the known ideologue Dr. Amy Tuteur’s $.02 popped in there, too—but I digress…) Whether or not the study’s conclusions have merit, the coverage of the study, particularly in the Globe and Mail, has been quite atrocious.

I’ve said it before and I’ll say it again: I don’t think there’s anything inherently wrong with epidurals. They have an appropriate time and place, and the only person who can really say for certain whether or not an epidural is indicated is the woman with the baby descending through her pelvis. I’ll trust her to be the judge of how she wants to manage those sensations. So, this is not an anti-epidural rant. Hell, I was practically desperate for one with my first baby—got to the hospital in transition and begged for one. I was too far gone, at 8 cm, to qualify—and in retrospect I’m glad that was the case, as it was a very cool experience to give birth without drugs—but at the time, if someone had tried to suggest that I was wrong to ask, I’m sure I would have wrung his or her neck with my own bare hands. That said, there are definitely risks involved with an epidural, just as there are risks with any invasive medical procedure. Risks v. benefits. That’s the name of the game.

So, there may be benefits to epidurals that we didn’t know about before. That’s awesome. It’s always good to learn new ways of preventing women from lasting harm to their bodies. Women want good options when it comes to health care. But a) this study isn’t saying epidurals prevent tears—it’s saying epidurals may play a role in preventing some kinds of pelvic floor damage; and b) the uncritical coverage of this study has not explained that there are also many other steps women can take to safeguard the health of their pelvic floors. The point is: there is nowhere near enough data to say that epidurals are necessarily the best approach, and they certainly aren’t the only one, either.

What else can women do? There are the often-cited birthing strategies that include not giving birth on one’s back, but instead choosing a position that is more in synch with physiological processes occurring and can benefit from gravity; avoiding fundal pressure; and pushing spontaneously, rather than following directions for pushing. But there are other things women can do as well, before they get to the moment when they are actually in labour—a moment when they may or may not want/be able to think about those strategies.

Women who perform simple pelvic floor exercises during pregnancy and after delivery can greatly reduce their chance of pelvic floor trauma and the speed of postpartum healing. The stronger the pelvic floor, the more flexible; the more flexible, the more likely those muscles will get up and out of the way and not tear while a baby passes through. A strong pelvic floor can also prevent/reduce the significance of other common pregnancy- and birth-related concerns, such as hemorrhoids, prolapse, and urinary incontinence. And as a bonus, contracting the pelvic floor automatically gets the transverse abdominus to co-contract, helping to tone the abdominal muscles. These are seriously awesome exercises that can be done anywhere, at any time of day, with no special equipment.

 So, what do you do? Basically, you want to do a modified Kegel, which can then be performed in various series, at various speeds, and in various patterns. If you’ve never done a Kegel before, the idea is to draw the muscles of the pelvic floor (PF) up and into the body, as if you’re stopping yourself from going pee. Draw them in, breathe, hold for a few counts, breathe, relax. Once you get the hang of that, you can move on to combine PF work with other core strengthening exercises such as curls (unless you have diastasis recti), superwoman, and cat-cow. You can do them sitting on a chair or an exercise ball, standing, lying on your side, on your hands and knees, in child’s pose—there are many positions that work, all of which have a slightly different benefit.

The bottom line (pardon the pun) is: strengthen your pelvic floor. Pregnant or not, this is a good thing to do. But if you’re pregnant or contemplating giving birth at some point, strengthening your pelvic floor is a noninvasive, key step in minimizing the risk of tearing and other significant trauma to the perineal region.

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