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Pregnancy and Fitness

You may have seen that woman in the Spinning class—as her pregnant belly expands week after week, she raises the handlebars up and continues on. Or you read about the eight-month pregnant woman who completed a marathon. These can be both inspirational and intimidating stories. The truth is that exercise is important during pregnancy. The American College of Obstetricians and Gynecologists recommends exercise for pregnant women at least 30 minutes a day most days of the week. But you don’t have to be an Olympic athlete to enjoy the benefits of exercise.

Pregnant woman have many choices for staying fit during pregnancy, as long as they take some precautions. As with all exercise programs, first check with your doctor or midwife to make sure before you start. He or she may have some advice or suggestions. Your provider may actually advise you against exercise if you have certain risks.

Low impact exercise can have great benefits for pregnant women. Exercise can help relieve back pain, boost your mood, help you sleep and increase your stamina. These are just a few of your choices:

Walking

If you are not a regular exerciser before you get pregnant, you may be more motivated now to keep yourself and your baby healthy. You can start small by simply taking short walks in your neighborhood. Add small spurts of activity throughout your day—take the stairs instead of the elevator, or park your car further from the entrance of the building.

Yoga

If you were already attending a yoga class before you got pregnant, be sure to tell the instructor that you are pregnant. You should generally avoid asanas, or poses, on your back after your first trimester. Be particularly careful with balance poses, as your center of gravity shifts in your second trimester. You should also avoid Bikram, or “hot,” yoga.

St. Luke’s Women’s Center offers prenatal yoga classes specially suited for women at all stages of pregnancy. Click here to see the schedule and get more information.

An integral part of yoga is Pranayama (Prana- Life Force and Ayama- Expanding or lengthening). It is very important, regardless of which pose you are in, to concentrate on your breath. Most of us have a tendency to hold our breaths during a pose because we are trying too hard to be in the pose. You should be able to breathe with ease in any pose. If the breath is restricted, scale back on the pose and start again. Always be mindful of how your body and mind feels in the pose. There should be a quietness in the mind as you are holding the pose.

At the end of the lesson always practice Shavasana (corpse pose) which brings awareness to your body and breath. This pose needs to be modified slightly in pregnancy by tilting your body to one side so that you are not lying flat on your back.

prenatal yoga

Swimming

Swimming is an excellent, low-impact aerobic exercise that works every muscle. You may be concerned about swimming in a chlorinated pool while you’re pregnant. If the pool is managed by a reputable gym, and the chemicals are properly balanced, the risk should be minimal. However, you may also want to consider a saline water pool.

Generally you should listen to your body. If you feel discomfort, simply stop. You will likely need to adjust and modify your exercises throughout your pregnancy, but with good instructors and guidance from your health care provider, you can remain fit and active.

Health Issues for Women in their 40s

Our own Dr. Anna Kogan was featured in SFGate with an article about women in their 40s and the health issues they need to consider.

Menorrhagia, or Heavy Bleeding: What is your body telling you?

If you experience heavy bleeding, you might feel distressed or frightened. Sometimes, though not always, it can be a signal that something is amiss.

Many women do not realize they are experiencing heavy bleeding because it is a normal flow for them. Since heavy periods can lead to fatigue, pelvic pain, and anemia, it is important to consult your provider for support. 

He/she can help determine if there is an underlying cause, and offer guidance about Western and holistic therapies that can support your body’s health.

 

What is heavy bleeding? 

Every woman’s body is different, and there is a wide range of normal when it comes to women’s cycles. An average period lasts about five days,1 with a normal range of two to eight days.2 A typical flow is somewhere between 10 and 35 mL, and averages about 2 tablespoonfuls.  

As hormonal changes occur, a woman’s menstrual periods may vary. Heavy bleeding is quite common in perimenopause (a few years before periods completely stop), and perimenopausal women are most likely to report it.3, 4

In the U.S., between 5 and 10 percent of women report heavy bleeding to their doctors.5 A lot of women do not report it to their physicians either because they think that it is normal or because they are embarrassed. Over 10 million women are diagnosed each year with menorrhagia, the medical term for heavy bleeding.6 Menorrhagia is defined as a menstrual flow of more than 80 mL. That translates to period lasting seven days or more or soaks over 16 pads or tampons.3

  

What to do about abnormal bleeding

If you have concerns about your periods, consult your health care provider for support. He/she can help you determine whether there is an issue, and if so, what you can do. Your provider may run diagnostic tests to help learn more.

The course of action you choose will depend on what the cause is, whether it is affecting the quality of your life, your sexual relationship and your ability to work . Talk with your provider to explore your options.

 

What can cause heavy bleeding?

There are many possible explanations. Since heavy bleeding sometimes signals a serious health issue, it is important to consult your health care practitioner for support.

Some common reasons for heavy bleeding include:

 

Using an IUD for Birth Control

Some women with an IUD experience more painful, longer, or heavier periods. There are other IUDs, which contain and release a small amount of progesterone daily, that reduce the quantity and duration of bleeding, reduce menstrual cramps, and also provide effective contraception.

If you experience unusual bleeding, pain, abnormal discharge, or a fever after an IUD fitting, consult your provider right away.

 

Hormonal Imbalance

Two key hormones, estrogen and progesterone, regulate a woman’s cycle. These hormones cause the lining of the uterus to build up and then, during menstruation, to be sloughed off. If estrogen’s influence is unusually strong, the lining can become too thick. When this happens, bleeding can be very heavy as the thick lining is shed.7

 

A Cycle without Ovulation

You might have a heavy period if you did not ovulate during a cycle. Often, this is accompanied by a very long stretch between periods (more than 40 days).7 This happens to every woman occasionally.2

Your provider can help determine if there is an underlying reason why you missed ovulation, like hormonal imbalance or stress. If you are trying to conceive, your provider can help you to determine how to best support your fertility.

 

Fibroids/polyps

These are non-cancerous growths in the uterus. They are benign, and, on their own, are not generally cause for concern. About 30 percent of women get them by age 35.2 They may cause no symptoms or may be associated with menorrhagia and pelvic pain.2

The exact cause is unknown, but fibroids seem to be regulated by estrogen production. Fibroids tend to grow during pregnancy, and become smaller after menopause.2

Minimally-invasive treatment options are available. Because fibroids can lead to infertility and pregnancy loss, some women choose to have them removed.

 

Malignancy

Rarely, irregular bleeding can be a sign of cancer or pre-cancerous changes in the lining of the uterus. Women who have irregular bleeding after age 35 or 40 may need an endometrial biopsy ( a simple office procedure in which a sample of the endometrium is taken) to rule out cancer.

 

Coagulation

Some women experience irregular or heavy bleeding as a result of their inability to form clots due a variety of coagulation defects.

 

Complications from Pregnancy

Any woman in the reproductive age group who has any irregular bleeding should immediately do a pregnancy test. Urine pregnancy tests are highly reliable. If positive, they should consult their physician to make sure that it is not an ectopic/tubal pregnancy, since this condition can be potentially life-threatening. A very heavy period is a possible sign of miscarriage. If you are pregnant, or think you might be, consult your provider if you experience heavy bleeding.

 

Other Causes

Heavy bleeding may also emerge because of other medical conditions, inherited disorders, and certain medications. In general, these causes are rare.

 

References

  1. Creinin MD, Keverline S, Meyn LA. How regular is regular? An analysis of menstrual cycle regularity. Contraception. 2004 Oct;70(4):289-92.
  2. The Boston Women’s Health Book Collective. Our Bodies, Ourselves. New York, NY: Touchstone; 2005.
  3. Jerilynn C. For Healthcare Providers: Managing Menorrhagia without Surgery. Available at: http://www.cemcor.ubc.ca/help_yourself/articles/managing_menorrhagia. Accessibility verified June 1, 2014.
  4. Warren M. The Need For Proper Diagnosis and Treatment of Menorrhagia. Menopause Management, November/December 2002.
  5. National Women’s Health Resource Center. Survey titled Majority of Women Do Not Seek Treatment for Health Condition Affecting 1 in 5, November 15, 2005.
  6. Centers for Disease Control and Prevention: Office of Women’s Health. Helping Women Understand Bleeding Disorders, Health Matters for Women Newsletter, Summer 2002.
  7. Mayo Clinic. Menorrhagia (heavy menstrual bleeding). Available at: http://www.mayoclinic.org/diseases-conditions/menorrhagia/basics/causes/con-20021959. Accessibility verified May 30, 2014.

Meet & Greet Dates for 2014!

If you aren’t sure where you want to have your baby, come meet our team of certified nurse midwives and obstetricians to learn about their philosophy of  personalized births for you and your family!

Register for one of these dates on our Web site.

March 11, 2014

May 12, 2014

July 8, 2014

September 22, 2014

November 11, 2014

Last Meet and Greet of 2013

We can hardly believe that 2013 is already starting to wind down. This will be our last gathering in 2013—stay tuned for our 2014 schedule. If you are thinking you may have a baby in 2014, please come meet our team. We have some new midwives on our team, too!

November 12, 2013

6 PM

St. Luke’s

3555 Cesar Chavez Street

Griffin Room, 1st floor

Sign up here!

Don’t forget our Meet & Greet next week!

Come meet the midwives and obstetricians that make up the St. Luke’s Women’s Center. Register on the CPMC Web site.

WHEN: Monday, September 16 at 6 PM

WHERE:  St. Luke’s Campus, 3555 Cesar Chavez Street, First Floor (Griffin Room) San Francisco

 

Delaying the Severing of the Umbilical Cord

There was an interesting story in The New York Times recently about a paper analyzing the benefits of delayed umbilical cord severing after birth. This has been standard practice among the midwives at St. Lukes Women’s Center, according to Emily Beck, CNM.

“We allow the cord to pulse out, meaning it has no more pulse in it,” she says. “This allows the baby to receive all of its own blood. Some studies have suggested reduced risk of anemia as benefit. Essentially, we allow nature to take its course.

Of course, if there is any risk of the mother or the baby being compromised they will clamp and cut the cord. “We monitor the situation to ensure the safety of the mother and the baby.”

Meet the midwives!

Come meet our midwives and doctors at our free Meet & Greet event. You will also get a tour.

Tuesday, July 23, 2013

6 PM to 7 PM

3555 Cesar Chavez Street, 1st Floor, Griffin Room

San Francisco, CA

 

Call 415.641.6911 to reserve your space!

Meet our team in July

If you would like to learn more about our midwives and about the unique experience at St. Luke’s, come to our meet and greet!

July 19, 2012
6 pm to 7 pm

Sign up here!

Meet our team!

Meet our team of certified nurse midwives and obstetricians at our next Meet and Greet. Register here or call 415-641-6911 to reserve your space

6 p.m. to 7 p.m.
Griffin Room, 1st floor
3555 Cesar Chavez Street
San Francisco

Tuesday, July 23, 2013

Monday, September 16, 2013

Tuesday, November 12, 2013

 

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