Getting a Cold During Pregnancy: What Medicine Can you Take? (Week 32)

I'm sick, and have been for the past few days. I have had the usual cold symptoms: runny nose, sore throat, and a mild headache from sinus pressure. Luckily I have no fever.

So what does one do when she is pregnant and has a cold or the flu? Is there anything that is safe to take to help alleviate symptoms? Although there is some debate as to what medicine is safe to take, and when it is safe to take it, there are some drugs that have not shown any harmful effects to the baby. Nevertheless, always consult with your doctor before taking any medications.

What You Can't Take

• Ibuprofen (e.g. Advil), or any kind of NSAID (non-steriodal anti-inflammatory drug) can be harmful to the baby during any stage of pregnancy. Generally, anything labelled as an anti-inflammatory should be avoided.
• ASA (e.g. Aspirin). While shown to be relatively safe during the first trimester, it can cause labour complications and should be avoided later in pregnancy.
• Avoid cold remedies that contain alcohol. 
• Avoid the decongestants pseudoephedrine and phenylephrine, which can affect blood flow to the placenta.

What you Can Take

• Acetominophin (e.g. Tylenonl) is perfectly safe to take while pregnant, and will not only offer some pain relief, but also help to bring down a fever.
• Guaifenesin, an expectorant (Hytuss, Mucinex, Naldecon Senior EX, Robitussin)
• Dextromethorphan, a cough suppressant (Benylin Adult, Robitussin Maximum Strength Cough, Scot-Tussin DM, Vicks 44 Cough Relief)
• Guaifenesin plus dextromethorphan (Benylin Expectorant, Robitussin DM, Vicks 44E)
• Cough drops
• Vicks VapoRub

All in all, you can rest assured that it is safe to take over-the-counter cold medications on a short-term basis. These drugs, however, should not be used indiscriminately or for extended periods of time. In addition, use should be confined to only those products that are appropriate for the symptoms.


Non-Medicinal Aids

• Rest, and plenty of it
• Water, and plenty of it
• Lots of clear, decaffeinated liquids, such as teas and broths
• Orange juice or other juices with vitamin C
• Taking your prenatal vitamin, which contains vitamin C to boost your immune system and zinc to help fight off germs. And don't forget to get your vitamins and minerals the natural way — by eating food rich in nutrients. You can find vitamin C aplenty in citrus, strawberries, melon, kiwi, mango, papaya, broccoli, red cabbage, tomatoes, bell peppers, spinach, and a host of other delicious foods. Get your zinc from turkey, beef, pork, cooked oysters, yogurt, wheat germ, oatmeal, and eggs.
• Eating fresh garlic — known to have virus-fighting compounds (if you can actually get it down), or using anti-viral spices such as cardamom, cinnamon, and cloves in your cooking
• Humidifiers to keep the air around you moist (consider a warm mist humidifier)
• Saltwater gargles to relieve sore throat pain (try one teaspoon of salt in eight ounces of warm water to get the fastest relief)
• Steam inhalation or nasal lavage to relieve nasal congestion or sinus headaches (for lavage, dissolve a quarter teaspoon of salt and a tiny pinch of baking soda into eight ounces of lukewarm water, and use a nasal aspirator to irrigate — or clean — out your nasal passages)
• Saline sprays to moisten your nasal passages (but make sure not to use the medicated sprays)

Rib and Chest Pain During Pregnancy (Week 30)

A week ago I started getting pain in my chest whenever I laid down to sleep either on my side or my back. I ended up having to sleep in my recliner upright for a few days for the pain to go away. Thank goodness I had an airplane neck pillow and a extremely comfy chair to get me through that time. The pain in my chest started just a few minutes after laying down, and radiated from my sternum (chest bone) and through my rib muscles on each side of it. The pain would make breathing more difficult, and the only thing that I could do to alleviate the pain the next day would be to have my partner stretch my chest muscles a few times throughout the day.

Although I have had this pain before I was pregnant, it would be rare. I would wake up in the morning with a stiffness in my chest, but shortly after getting out of bed and moving around the pain would subside.

Topical Pain Relief Creams a "No-Go"
A visit to the pharmacy for some topical muscle relief cream proved fruitless. I'm not allowed to take any anti-inflammatories, whether orally or topically, while pregnant. Not good. Fearing the worst--that the pain would last for the remaining two months of my pregnancy--I did some research online to see what was going on: why was the pain so severe, and why was it so consistent? The results I found were unsatisfying.

Is it Heartburn?
If you Google "chest pain during pregnancy" or "sternum pain during pregnancy", the results overwhelmingly tell you that what you have is heartburn. That's' baloney, I say. Here's what the symptoms are for heartburn:

• A burning sensation in the chest
• A burning feeling in the throat
• Feeling of food "sticking" in the middle of the chest or throat
• Sour or bitter taste in the mouth
• Difficulty swallowing

I know what heartburn feels like. It has visited me sporadically throughout my pregnancy. It's not fun, but it's not the kind of pain I was feeling. So what is it, then?

No One Really Knows What Causes It

The sobering truth is, there's no clearcut explanation for why this happens to pregnant women. There is a condition, known as Costochondritis, which is an inflammation of the cartilage that connects a rib to the breastbone (sternum). It causes sharp pain where your ribs and breastbone join....Hmmm, okay, this sounds a lot more like what I've been going through. My sternum and the muscles on either side of it are sore to the touch. Having said this, I'm not into self-diagnosis, so I'm also not about to jump to the conclusion that this is what I have.

Pain in the ribs and sternum is not uncommon to pregnant women. As the baby grows, the uterus expands and can put pressure on your ribs. The Intercostal muscles, which are located between ribs, can become strained. Rib pain can make movements and even breathing painful. During pregnancy, it may be difficult to find a position which isn't painful, which seems to complicate the situation. 

Okay, so the question remains: what can I do about the pain?

How to Ease Rib and Chest Pain During Pregnancy

Pain Medication. Before taking any medication, confirm that it is okay to do so with your doctor. Tylenol is generally considered safe during pregnancy, and more severe rib pain may take a stronger pain medicine. Many different types of pain medication can be prescribed during pregnancy for rib pain, but your doctor will need to decide which medicine is best for your pregnancy. 

Open up the chest. Sit upright in a comfortable chair and place a small pillow in the small of your back creating an arch. This will take some of the pressure off your rib pain and make it easier to breathe again. You will know when you find the angle that works best for you, some pregnant women need more of an arch than others.

Stretch the chest. Follow this link to find instructions on how to do an assisted chest stretch. Being pregnant, it is easier if you are seated in a chair. Your partner will have to raise his or her knee to place it between your shoulder blades. This stretch was my lifesaver--it immediately reduced the pain to almost nothing, and by the end of the day I'd have no pain at all.

Use ice to reduce inflammation. Place a bag of ice or a chilled gel pack on your ribs where the most pain is. If you have rib pain on both sides, place ice over each. It is generally considered best to have a thin layer of cloth between ice and skin, so you may be most comfortable by placing your ice pack right over your clothing. 

Raise your arms above your head. While seated, either with the ice packs or without, raise your arms above your head. I have a high back recliner, and I can grab the back of the seat with my hands to prevent my arms from getting tired. It's a great way to take the pressure of my uterus off my lower ribs. Hold this position as long as is comfortable, and repeat as needed.

Work that Pelvic Floor (week 28)

Crunches don't really seem to be happening for me any more. I'm at the seven-month mark, and my belly is  big enough now that it gets in the way. I have a hard enough time getting off the couch once I sit down. I have quickly learned that either I sit down on the edge, or I sit in a firm chair.

On top of which, I've realized that my inability to lift the weights I used to lift before I was pregnant is a direct result of the loss of strength in my core. One of the principles I learned early on as a personal trainer was that a strong core helps you lift heavier weights, which in turn makes for stronger arms and legs.  In some cases it takes the scenario "you don't know what you got until you lose it" to make you realize how true that really is.

The loss of strength in my core is directly a result of the stretching of my rectus abdominus over my uterus. In its stretched-out state, it simply can't contract with the same strength it had before. So, how do you strengthen a core that just doesn't work the same way it used to? You need change your focus to the deeper muscles in your core and pelvis. And you can forget about looking for that familiar "burn" when you do an intense ab routine; instead, you need to visualize the muscles that are working and focus on contracting them to their maximum ability.

What to Work On

Pelvic Floor: This includes the group of muscles that support and help control the action of the vagina, the uterus, the bladder, the urethra, and the rectum. Contracting the pelvic floor muscles prevents the flow of urine when you are peeing, and causes the vagina to tighten. Giving birth puts a lot of stress on these muscles, and can weaken and damage them. This can result in stress incontinence (a.k.a. "mommy bladder") and decreased satisfaction during intercourse. Stress incontinence means that you might leak small amounts of urine while coughing, sneezing, laughing or exercising. 

Strong pelvic floor muscles can support the extra weight of pregnancy and help you push during the second stage of labour. When done regularly, these exercises can help to prevent stress incontinence and improve your healing time after birth. Another bonus of the exercises is that women with strengthened pelvic floor muscles are more likely to be orgasmic and have a more satisfying sex life.

Transverse abdominus: it's a muscle I've talked about in my earlier blog entitled How to Train Your Abs During Pregnancy. For those of you who don't know, your transverse abdominus is a muscle that runs underneath the more visible rectus abdominus (the muscle that shows when people have 6-pack abs), and acts as your stomach girdle.

How to Work on Your Pelvic Floor
I'm sure you've heard of the term "kegels", but you may not be aware of how to do them. First of all, they're the easiest exercise to do because you can do them pretty much any time, anywhere. You can be lying down, sitting in the car driving, or standing in line at the bank.

Finding them: First of all, you need to figure out how to contract your pelvic floor muscles. The easiest way to do this is to try and stop the flow of urine while you're peeing. If you succeed, you've got the basic move.

Perfecting your technique: Once you've identified your pelvic floor muscles, empty your bladder and sit or lie down. Contract your pelvic floor muscles, hold the contraction for five seconds, then relax for five seconds. Try it four or five times in a row. Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions.

Repeat 3 times a day: Aim for 3 sets of 10 per day.

How to Work Your Core
Pelvic Tilts: They can be done lying on the floor or standing with the back to a wall. The standing version is a bit more difficult, but it is a good option for women who are not comfortable on their backs.


1. Lie on your back with the knees bent and the soles of the feet on the floor (or you can stand with your back against a wall). This is your neutral position, with the natural curve of the lumbar spine causing the low back to be slightly elevated.

2. On an exhale, gently squeeze your glutes (butt muscles) and pull your hip bone towards your lower ribs. Your butt will not actually leave the floor, but you will feel your low back press into the floor (or wall).  You are essentially taking the curve out of the low back.

3. After a few seconds, inhale and return to your neutral position.

4. Repeat this movement 5 to 10 times.

Click here for an animated version of this exercise.


Tail Wagging

Starting Position: Kneel on a mat and assume the "all-four's" position. Keep your head in a neutral position by looking down at the floor.

Action: Keeping your shoulders still, move your right hip toward your right shoulder as far as you can. Slowly return to the starting position then move your left hip toward your left shoulder as far as you can

Bird Dog
There's no sense in re-inventing the wheel. Here's a great link on how to do the bird dog exercise.

Mental Health and Pregnancy (Week 26)

I've been feeling great during these past few weeks of my pregnancy. My belly is ever expanding, and I've gained a total of 20lbs so far. Even though my thighs slightly rub together now when I walk (gack!), the doctor says I'm right where I need to be in terms of weight gain.

My baby is healthy and active (he kicked my Obstetrician's Doppler microphone 3 times during my last visit), which I guess isn't a surprise given how active mommy tries to be. I've been keeping active with a combination of swimming twice a week, walking twice a week, and doing various 20-minute exercise videos to work on muscle maintenance.

My mood has also been pretty good. Although I alternate days between feeling tired and energetic, overall my spirits are pretty high. I'm very glad for that. Not everyone is so lucky. It is just as easy to feel depressed and anxious as it is to feel happy and joyous when you're pregnant. I am ever aware of the possibility that I may get depressive symptoms during and/or after my pregnancy.

The Link Between Mental and Physical Health
Mental health has always been a prevalent issue in my life for two reasons: a) depression and anxiety runs in my family, and b) I have a BA in Psychology, which increases my awareness and sensitivity to the topic. One of the reasons I maintain such an active lifestyle is because I'm convinced it is one of the reasons I am in such a good mood to begin with. When I don't exercise for a while, I get lethargic and generally feel "blah".

There is a large body of research on the link between mental health and exercise. Put simply, when depressed and anxious people exercise over a set period of time, many feel better. Furthermore, if they maintain an active lifestyle, they are less likely to relapse.

Other research has shown that women who exercise during pregnancy are less likely to develop Postpartum Depression. This is great news, particularly for those mothers who want to avoid taking anti-depressants during and after pregnancy.

My quick and dirty advice to those of you who are not pregnant but one day plan to be: start exercising before you become pregnant, and maintain an active lifestyle throughout your pregnancy. If you are pregnant now, it's never too late to start exercising and begin reaping the rewards.

How to Recognize Symptoms of Depression
Depression can spring up on any one of us at any point in our lives. It can be particularly distressing when you have a baby, and you feel that you should be feeling happy and motivated to take care of this new life, but you feel the opposite instead. An estimated 14 to 23 percent of moms-to-be experience clinical depression, and about 40 percent have some symptoms. That's a lot of sad pregnant women.

Symptoms of depression include: feeling sad for several weeks; loss of interest in activities you normally enjoy; feelings of guilt or hopelessness; and/or difficulty concentrating. If you recognize any of these symptoms in yourself, talk to your doctor or midwife.

How to Recognize Symptoms of Anxiety
Pregnancy is listed as a significant stressful life event. t is normal to be somewhat preoccupied with "doing all the right things" to ensure your unborn child has the best chance for a normal development. However, for some women this preoccupation can get blown out of proportion to the point that it affects how they live their lives.

Earlier this year, one of my clients was on her fourth pregnancy, and was well-aware that her anxiety levels increased during pregnancy. During our exercise sessions, she would get nervous about how high her heart rate felt to her when she did anything aerobic. Even though her doctor told her she was fine, and we used a heart rate monitor to make sure her heart rate wasn't elevated to a dangerous level, it was hard for her to not feel a sense of panic over it. The biggest thing that helped her control her anxiety was simply her awareness of what it was caused by, and that her feelings were not rational.

If you are suffering from anxiety that is persistent, intrusive or out-of-proportion; irritability; inability to sleep because of your fears; waking up with a racing heart; or have difficulty concentrating, talk to your doctor or midwife.

Pre-Natal Fitness Exercise Videos...Cheap and Cheerful Fitness! (Week 24)

I just hit my sixth month this week, and I have to say, I really have no complaints. Since my tummy now protrudes further than my chest, my hip pain is still gone, I'm sleeping well (apparently, not for long), and my energy is moderate to high (thanks to the iron supplements), I'm feeling pretty darn good. I am still training clients, walking, hiking, swimming, and now have added prenatal workout videos to my repertoire. I've also done a bit more reading on how to work on concerns about diastasis rectii (see my Sept 7th, 2010 entry on how to train your abs for pregnancy).

Why Exercise Videos Instead of the Gym?
As a personal trainer, it makes a lot of sense that I should visit the gym and train using a prenatal fitness program. So why am I not going? It's simply the psychology of it: when I go to the gym, I go there to work hard. It's what I've been doing for years. The problem is, I shouldn't be working hard now. It has taken me months to come to terms with the changes my body has undergone, and that I can't train the way I used to. Looking back, I'm pretty sure that the hip pain I had a month ago was because I pushed my body a bit too hard.

By following exercise videos, I am relinquishing control over the intensity and duration of my workouts to someone else. Frankly, it's a nice feeling. Heck, if that woman on the screen says I only need to do 15 reps of squats with no weights, then I will!

Exercise videos for pregnancy also introduced new exercises to me, and made my workouts more interesting. When you exercise for any length of time, it's important to keep things interesting so that you keep doing them.

Training Abs to Reduce Diastasis
When you are further along in your pregnancy, it becomes a good idea to use a device to support your abs while you do crunches. Whether it be a belly band, a tummy splint, or a towel, a device that wraps around your tummy while you perform a crunch will decrease the lateral force on your rectus abdominus. The least expensive tool is the towel. (see picture)

Although the woman above is clearly not pregnant, this is how you would use it to do crunches. You can increase the intensity of the crunch by lying on a stability ball. Whenever you do a crunch, make sure to pull in your belly button to engage your transverse abdominus. This will also reduce the lateral force on your tummy.

Great Pregnancy Exercise: Swimming (Week 21)

I am pleased to say I am feeling less breathless and dizzy since my post last week. For one, I doubled my iron dosage, which has helped elevate my daily energy as well as my capacity to climb stairs. I also have started to take it easier in general: I walk, climb stairs, and do everything a bit more slowly than I used to. But what I'm most pleased about is that I've gotten back into the pool and have started a swimming regimen again. This is after  finding a new bathing suit that fit me.

How I Found a Swimsuit in the Fall
Given that it is the fall season and swimsuits in general are harder to come by, I found it difficult to find a maternity store that sold bathing suits. There is a specialty bra and swimsuit shop in Toronto called Melmira that not only offers a great selection of maternity bras, but also maternity swimsuits. Although I did go there to buy two maternity bras a few months ago, they cost me $250. Given the high prices of their bras, I assumed their swimsuits would likewise be expensive.

So instead I paid a visit to Bikini Village, who doesn't sell maternity swimsuits at all. I asked the clerk if there was any way I could find a regular suit that would fit my new body, and she said "of course!". I tried on two swimsuits before deciding on a simple Roots one-piece that was a few sizes larger than what I normally wear. Easy peasy!

Why I Love Swimming Right Now
Although walking is also great exercise when you're pregnant, when I walk for an extended period of time, I tend to feel pressure from the weight of the baby  in my lower abdomen, which is a bit uncomfortable. When I swim, I feel completely comfortable moving around in the water. In fact, it's a easier to move slowly while I'm swimming because I'm so buoyant now!

The Benefits of Swimming During Pregnancy
Swimming is great exercise because it uses both large muscle groups (arms and legs). It is both low-impact (reducing the risk of injury) and it is a great aerobic workout. In general aerobic exercise

• improves circulation
• increases muscle tone and strength
• allows you to sleep better at night
• improves your energy
• helps you cool down from the emotionality caused by pregnancy hormones

Swimming Tips

• If you are new to exercise, check with your doctor or midwife before starting any exercise 
• Drink plenty of water to stay hydrated (swimming in a pool of water doesn't count!)
• If you're in your first trimester
• Try to swim for at least 30 minutes daily (if you have the energy). 
• Swimming first thing in the morning may counteract nausea and energize you for the rest of the day
• If you're in your second trimester
• You don't have to change anything that you were doing in your first trimester--except you might need a new swimsuit
• If you're in your third trimester
• The breast stroke is particularly beneficial in the third trimester, because it lengthens the chest muscles and shortens the back muscles, two areas that typically become misaligned as your body changes during pregnancy

Breathless and Dizzy...and Not in a Good Way (Week 21)

Being a (self-acclaimed) superfit mom, I went into this pregnancy pretty confident that I would be able to maintain a level of fitness that I could be proud of. Of course, life has a funny way of cutting me down to size once-in-a-while--even though I'm short enough as it is.

My Near-Faint Experience

Late last week I experienced something I had never felt before. I was walking with a client around their neighbourhood for our weekly one-hour walk, at our usual moderate pace, when I started to feel out of breath. At first I thought it was funny because a walk like that never used to make me feel like I had just done a 30-second sprint. "Ah, the joys of pregnancy," I thought. Soon enough, it became apparent that my heavy breathing was not subsiding, and I was starting to feel dizzy. I began to feel faint. To my minor embarrassment, I quickly reached a point where if I didn't sit down, I was going to collapse. My poor client, who had no idea what was going on with me, was understandably concerned. I was having a hard time breathing, and my heartbeat was pounding in my ears. Without having much choice, I sat down on the curb to try and recover. It took all of 30 seconds to feel normal again. Without skipping a beat, I got back up and we completed our walk. I had no idea what to make of what had happened, and what was worse was that I couldn't explain it to my client. 

The very next day, I walked home from the cinema with my partner--it's all of a 10 minute walk. We reached our building and headed up the four flights of stairs to our apartment. By the time I had reached the hallway, a huge wave of dizziness came over me. I was breathless yet again, and my heart was going a hundred miles a minute. I needed my partner to help me through the apartment door. I was starting to see stars, and I realized I was close to passing out. After collapsing on the couch, I panted for another 30 seconds, during which time my breathing and heart rate quickly subsided. It was at this point I decided that I should figure out what the heck was going on with me. Thankfully I could easily find out what the problem was--and that it was nothing serious. 

Pregnancy and Breathlessness

In pregnancy, your ribcage widens to allow for an increase in lung capacity. This works to offset the problem that the growing uterus plays in constricting your breathing. As your uterus expands, it pushes up into your diaphragm, making it harder to pull in your usual-sized breaths of air. Moreover, with all those pregnancy hormones that cause your muscles and ligaments to relax, your diaphragm is on a mini vacation, not working as hard to pull air into your lungs. 

To make things worse, the increasing progesterone in your body makes you more sensitive to the carbon dioxide your muscles produce as a waste product when you move. The resulting breathlessness is caused by your body trying to get rid of the carbon dioxide and replace it with oxygen as quickly as it can.  

Breathlessness can also be caused by low blood iron levels, which I am prone to.

Pregnancy and Dizziness

By now, if you've been following my blogs, you've learned that there's a lot of hormone-induced relaxing going on in the body. One of the other parts of the body that are relaxing as your pregnancy progresses are your blood vessels. They are widening to help increase blood flow to your baby. This causes your blood pressure to be lower than usual, which can reduce the blood flow to your brain, temporarily causing dizziness.

Dizziness is also caused by low blood sugar levels that may occur as your body adapts to changes in your metabolism. Women who are anemic or who have varicose veins may be more susceptible to dizziness than others (not only do I have low blood iron levels, I also have varicose veins, which explains the severity of my symptoms).

When you Need to Worry About Breathlessness and Dizziness 

There are not always benign explanations for why you may feel breathless and dizzy during pregnancy. You should contact your health care provider immediately if your dizziness is accompanied by vaginal bleeding and/or pain in your abdomen. This could be a sign of an ectopic pregnancy, a low-lying placenta, or placental abruption.

You should also contact your health care provider immediately if you have persistent dizziness or dizziness accompanied by blurred vision, headaches, or palpitations; this may be a symptom of severe anemia or some other illness that could have a negative effect on your pregnancy.

If you are feeling breathless and you get the feeling that your heart beat is racing, irregular or missing a beat, or if you feel chest pain--especially if it starts when you exert yourself--or if you have difficulty breathing when you're lying down or at night, see your doctor.

Pain in the Hip! (Week 20)

So, remember that article I wrote not-too-long ago about how the back and pelvis slowly may go out of whack as your pregnancy progresses? Well, it couldn't have been more aptly timed. For the past few weeks I have been experiencing pain in my lower back and hip. It first started pretty mildly, and would only hurt if I moved a certain way, like turning or bending over. It was a sharp stabbing pain that would go away whenever I stopped the particular movement I was doing.

As the weeks progressed, I maintained my toned-down exercise regimen that I've implemented since getting into my second trimester. However, the pain became more frequent and more movements became difficult to do. My clients would notice me limping about and would offer to help me do the normal tasks I would do while training them. Hmmm, not cool. It's one thing thing to endure some discomfort, it's another to let it affect my job. On top of which, it became increasingly difficult to exercise.

Katrina Kulhay to the Rescue
Fortunately, one of my clients referred me to a Toronto Chiropractor that specializes in pregnancy, Katrina Kulhay. I met her for the first time today. She is a positive, energetic woman who sincerely got excited over the news that I was pregnant, and began spouting words of advice on nutrition and exercise. Aside from telling me a lot of what I already know, she also told me to tone down the impact of the exercise I've been doing (which is something an active person hates to hear). This is because as my pregnancy progresses, the levels of relaxin (the joint-loosening hormone) will increase to a point where too much impact could cause my joints to slip around "like a banana". Eeesh.

When it came to the treatment, she obviously knew what she was doing. She was quick, efficient, and actually took the time to explain what she was doing to me as she was doing it. Since that single treatment this morning, I have progressively felt better throughout the day. In fact, as I write this, I am fully mobile again and almost completely pain-free.

Changing my Exercise Routine
Dr. Kulhay advised me to perform special exercises to help strengthen my pelvic floor. This will prevent future pain, as well as make it easier to push out my baby during delivery. These exercises included kegels, supine pelvic tilts, and assisted squats.

Assisted squats can be done with two chairs on either side of you. Holding the back of each chair in each hand, slowly lower yourself down into a squat position. Return to standing. While you complete the movement, use your hands to help slow you down as you lower your body, and help push you up as you raise your body.

Kegels and supine pelvic tilts can be done every day. Do 3 sets of 15-20 reps. For squats, do 3 sets of 15-20 reps every other day.

As far as working my abs and upper body, she said I could continue as I had been before. If you are suffering from lower back pain and discomfort like I am, I would recommend performing upper body exercises that are seated or lying down, so as to not stress your back.

The Scoop on Taking Iron and Folic Acid During Pregnancy (Week 19)

**CAUTION**Don't take any vitamins supplements for pregnancy without first consulting with your doctor. Too much of anything isn't good for you or your baby.


I am now well along in my pregnancy, and I have a lot to show for it. I think the breasts have decided to stay the size they are now, which is quite the relief. I shouldn't have to worry about them getting any bigger until I begin nursing, when they're expected to grown again (yikes!). What's even better is that now the tummy has caught up to my chest, so now I actually look pregnant.


There Goes the Iron
Even though my energy has improved significantly since my first trimester, I've started to notice that I'm now getting the midday slump I used to get before I became pregnant, and before I was taking iron supplements. Several months before I became pregnant, my naturopath determined that I had really low blood iron levels. That was why I would feel tired a lot, even though I was pretty active (actually, being active meant I needed even more iron than I was getting from my diet). My naturopath put me on a highly absorbable form of iron, called Glycinate, which in about a month gave me a new lease on life. I finally had energy to get me through the whole day.


Unfortunately, during my first trimester I couldn't really take any supplements because the smell of them would make me nauseous. Now it has caught up with me, and I can feel myself getting tired the way I used to when I was iron deficient. I'm groggy in the morning, tired by about 3PM, and exhausted after eating dinner. This is because at this point in my pregnancy I need double the amount of iron I used to take. The thing about taking iron supplements is that iron stores take a while to build up in your body, so taking them won't appear to make a difference at first. I've been taking them for about a week now, and am hoping to see some improvements in the next few weeks.


Taking in enough iron is so important, especially during pregnancy.Combine the increased blood volume during pregnancy, increased needs of the fetus to grow blood cells, and blood loss that occur during delivery, and you have a strong case to make sure you're getting enough iron. 


Folic Acid
As soon as I became pregnant, my family doctor put me on folic acid supplements. She told me that it is especially important to the development of my embryo in the first trimester, when the neural tube is developing. The neural tube is the precursor to my baby's spine and brain.


In fact, many sources recommend you take folic acid if you are planning on getting pregnant. The reason for this is that it helps to synthesize and repair DNA, and it is especially important during periods of rapid cell division and growth (which is what happens during pregnancy). On top of that, folic acid works hand-in-hand with iron to produce healthy red blood cells for you and your baby. 


Finding Iron and Folic Acid in Your Food
I always tell my clients to try to get as many nutrients as they can from the foods they eat. That's because not only do these foods usually include multiple nutrients, but they are much easier for your body to absorb than in pill form. 


The best sources of iron come from animal sources such as eggs (particularly the yolk), lean red meat, and liver. Good plant-based sources include beans, spinach, and fortified breads, cereals, and oatmeal.


The best sources of folic acid come from similar sources for iron: liver, leafy vegetables such as spinach, asparagus, turnip greens, beans, sunflower seeds, and fortified grain products.

Pregnancy is a Pain in the Neck! (Week 17)

It's funny how many things you eventually realize other people neglected to tell you about the painful changes that happen in your body during pregnancy. Neck and back pain, lower abdominal aches, pain in your pelvis, and sciatica. Not exactly the things you'd find listed in a sales brochure (if there was one) of the fantastic adventure of pregnancy.

Although some things are harder to control than others, there are things you can do to minimize the pains of pregnancy.

Neck and Shoulder Pain

Recently I've been getting headaches and pain in my neck and shoulders. At first I thought it might be the way I was sleeping, since I've taken to sleeping with a body pillow between my knees and arms (which is supposed to help me sleep on my side since sleeping on my stomach and back are out of the picture now that I'm into my second trimester). But now I've realized what the problem really is: my ever-growing breasts. Okay, so not everyone may be sympathizing with me right about now, but let me tell you, when you increase by 3 cup sizes in the span of 4 months, it takes a toll on your body. While not everyone experiences such a dramatic increase in breast size, for those that are carrying around a few extra pounds up above, it can put tremendous strain on your shoulder and neck muscles.

This is where I've had to bite the bullet and realize I'm going to be spending a lot of money on bras during my pregnancy. No more can I go to my local chain lingerie shop, try on a few bras, and come out with something pretty and supportive. Nope, now I am about to book a fitting with a specialty bra shop to find something that transfers the increased weight from my shoulders to my back. I will look for bras with wider, padded straps, a thick back strap, and possibly even a criss-cross  strap in the back to distribute the weight across my back. That should help ease the pain.

A good massage from your partner definitely doesn't hurt, either. I get one as often as I can from mine. :-)

Lower Back Pain

Your back and abs work together to support your torso, and keeping both of them strong helps prevent backache when you're not pregnant. Unfortunately (as I mentioned in my previous blog), your abs are stretching continuously as your baby grows inside of you. This means that they really can't work to support your core like they used to. On top of that, the growing weight throughout the front of your body pulls your back forward out of its normal alignment, so your posture and the curvature of your spine also changes. Then, as if that wasn't enough, your ligaments and muscles are loosening to allow your pelvis to widen to ease the passage of your baby during delivery.

Your best bets for minimizing your discomfort are to avoid activities that may be jarring to your spine like running and jumping; be sure to squat from your knees when you're bending or lifting, avoid sitting or standing in one position for long periods of time; pay attention to your posture; and tuck a pillow between your knees when you're sleeping on your side. Also, you can add exercises to strengthen your lower back, glutes, and hamstrings. Check out this great back exercise routine for pregnancy.

Lower Abdominal Aches and Pelvic Pain

Sorry ladies, but these are two sources of pain that you can't really improve. These issues are related to the  loosening of the ligaments and muscles of your pelvis that I mentioned above. You will find that you may feel the pain right below your growing belly, or even lower in your hips. (For me, I started experiencing lower abdominal pain in my 14th week. Let me tell you, it was pretty disconcerting when I didn't initially know what the pain was caused by.)

Your pelvis is made up of 3 bones that are attached by ligaments. Under normal circumstances, the ligaments holding the bones together are strong enough that they act as a single bone. However, as the weight of your midsection increases during pregnancy, it puts more pressure on your pelvic bones, causing the ligaments holding them together to stretch. This can be pretty uncomfortable, and may, in extreme cases, make it hard to move around.

The only thing you can really do in cases like this is to really take it easy. Rest often, take stairs slowly, and avoid heavy lifting and pushing.

Sciatica

The sciatic nerve is a long nerve that runs from the lower back to the back of the legs and feet. Typically this nerve allows feeling in the muscles of the legs and feet. During pregnancy, as the pressure increases on your back from the growing weight of your tummy, the sciatic nerve can become inflamed. 

Typically the symptoms of sciatica in pregnancy include the following:

• Pins and needles in the lower back or leg, and possibly the affected foot.
• Shooting or burning in the leg, buttock or lower back.
• Pain in the lower back or back of the pelvis that may extend into the foot.
• Numbness in the leg or feet.

For some, sciatica can be extremely painful. If you think you have sciatica, see your doctor. You can find relief from pain through physiotherapy, 

strengthening the pelvic floor, abdominal and back muscles (see the link above), chiropractic therapy, acupuncture, and massage.

How to Train Your Abs During Pregnancy (16 Weeks)

Disclaimer
Consult your physician or obstetrician before you try any of the exercises I recommend below.


Abs, what abs? I don't see no stinking abs...anymore. Actually, I never used to be one of those women who was blessed with the ability to have 6 pack abs that other people could actually see, no matter how much I trained them. The only way I would have been able to show them off would have been to diet to the point of emaciation, which I was never prepared to do. Besides, I think other people like me better when I'm not irritable because I starved myself of carbohydrates for prolonged periods of time.


In spite of the lack of what was visible, I had really strong abs before I became pregnant. And shortly after I became pregnant, I still had strong abs. I trained them in the same way I had trained them pre-pregnancy, using many variations of crunches with equipment like the stability ball and bosu. These were intermediate-advanced types of exercises.


Over time, my belly has stretched as my baby grows inside me. Now, as I approach my fourth month, the advanced ab exercises have gone out the window, replaced by the good-old-regular crunch. Not that I planned it that way, but crunches have become enough of a challenge for my abs that I don't need to do all the fancy-dancy stuff I used to. This goes to show how important it is for you to listen to your body, especially as it changes during pregnancy.


The Benefits of Training your Abs During Pregnancy

Keeping your abs strong during pregnancy can help prevent the common occurrence of back pain as your growing belly puts more stress on your lower back. Strong abs also will help you push during delivery, as well as help to speed your recovery. 

The Not-So-Nice News: Diastasis Recti
"Diastasis what?" Yes ladies, there's something weird and wonderful that happens to your abs as your belly expands into the later months of pregnancy: they separate. This is known as Diastasis Recti, and while most women go though pregnancy without experiencing dramatic changes to their abs, about 45% of women get some degree of ab separation during pregnancy. 


Let me explain what actually happens. The muscle you are looking at when you see someone with a 6-pack on their tummies is called the Rectus Abdominus. This muscles is made up of two sections, one that runs from your ribs down past the left of your belly button, and one on that runs down the right side (see pic below). In the middle holding both sides together is a strip of tissue called the fascia. As your belly expands during pregnancy, this fascia stretches. The bigger you get, the more the fascia will stretch. This creates the appearance that your abs are separating. This is a painless condition, and it tends to happen to women who are overweight, have short torsos, or who've had multiple pregnancies.

I can't tell you how unimpressed I was to learn about the possibility of this happening to me. Although I am not overweight, nor have I had multiple pregnancies (yet), I have a short torso. I won't post any of the pics I saw of post-partum bellies showing separated abs, but suffice it to say it wasn't pretty. Yes, this is purely in an issue of vanity: Diastasis Recti is not a dangerous condition and will not cause you any pain. 

The best way I like to handle a problem is to see if I can do something about it. So I researched ways to minimize the chances that this could happen to me. I'm pleased to report, I found some light at the end of the tunnel.

Prevention and Treatment of Diastasis Recti

While there's no real way to completely prevent your abs from separating during pregnancy, there are ways you can reduce your chances of it happening. First, it's best to start out in good shape: having strong abs and a healthy weight is the first step.

Next, you need to change how you train your abs when you are pregnant and after you give birth. Most ab exercises you did before pregnancy like crunches and oblique crunches (your obliques are the muscles located to the sides of your rectus abdominus; also known as "love handles") focus on our external ab muscles (the ones directly below your skin). You need to change your focus to your inner ab muscle, the Transverse Abdominus (see pic below). Your Transverse Abodominus is your natural stomach girdle; it's the muscle that pulls in your bellybutton whenever you tighten your abs.

Ab Exercises to Do During Pregnancy
Until you reach your 2nd trimester, there's no need to stop doing crunches. In your second trimester onwards, you need to modify these exercises. I'm not going to re-invent the wheel here. There are plenty of great resources online that explain the kinds of ab exercises you can do while you're pregnant. Here are the ones that I liked:


http://www.abs-exercise-advice.com/pregnancy-abdominal-exercise.html
http://www.progressiveparent.com/Pregnancy_postnatal_exercise/pregnancy-exercise-abs.htm

What your Cravings Tell You When you're Pregnant (15 weeks)

Cravings are hard enough to deal with when you're not pregnant, let alone when your hormones are raging and you are starting to realize that your body's not your own anymore. My cravings have changed over time since I became pregnant. In the first couple of months, I would crave a very specific food dish--like pad thai or fried eggs on toast. The next day the same dish would make me feel nauseous at the thought of eating it. I'm also a chocolate lover, and would eat a piece of dark chocolate every day before I was pregnant. Now, chocolate doesn't interest me in the least. In fact, NO sweets interest me anymore. Brownies, cookies, and other baked goods just have no power over me right now.

"Hah!" you think, "leave to the fitness expert to not want to eat junk when she's pregnant"...Not so fast! My cravings for salty foods are at an all-time-high. And when I first became pregnant, I wanted nothing but breads, pasta, and cheese. Not exactly nutrient-rich, low-calorie foods.

Nowadays, in the start of my second trimester, I have found that something bizarre but pleasant has happened to my cravings: I crave veggies and fruits. In fact, just today I ate green beans with my meal--and I actually liked them! When I used to read about other women who said they craved healthy foods during their pregnancy, I scoffed: there's no way that would happen to me. It goes to show, you really have no idea how your body will change during pregnancy.

So what is it that causes pregnancy cravings?
The first and best answer to this question is that our bodies crave what they need. "Yeah right," you think, "I didn't need to eat that whole box of macaroni and cheese dinner." Well, you probably didn't need to eat that much, but your hormones are telling you something when you crave fatty, calorie-dense foods. Your hormones (who will become your worst best friends over the next long while), are helping your body grow your baby. One of the side-effects, of course, is that they tell your body that it needs more calories. Your hormones aren't necessarily great at specifying how many extra calories your body needs, and that's why you may feel like you tend to overeat. In fact, compulsive eating is quite normal during pregnancy.

So why is it that I now crave veggies and fruits? True to form, my body is now telling me that it needs vitamins and nutrients to help my baby grow and develop properly. I'm not a vegetarian, but for those of you who are, you may find yourselves craving red meat, which is because your body is producing a lot of extra blood and it needs the extra iron.

How to Deal with Cravings During Pregnancy
Given that your body is asking for the things it needs via your cravings, it follows that if you are craving something specific while you are pregnant, you should eat it. I don't recommend overindulging, but eat enough to keep the cravings at bay. I know, it's hard when your arm seems to move of its own accord to the third piece of chocolate cake, but take a break from eating for 15 minutes or so to give yourself some time to digest the food. That way, your body has time to tell your brain "hey, I'm good now. I got what I wanted".

3 months down, 18 lbs to gain

Starting Weight: 102 lbs
Weight today: 109 lbs
Week: 14


For the fit mom-to-be, the prospect of weight gain during pregnancy can be quite the mental hurdle to overcome. How do you come to terms with years of working on your body to keep strong and fit, only to watch it seemingly disappear in a matter of months? Insecurities abound, especially for me, where, being under the scrutiny of my clients, I must appear the epitome of "the healthy pregnancy". At this stage in my pregnancy, even my Lululemons have gotten tight--just today a client pointed out that I was "muffin topping". Ai carumba!


How vain of me, huh? To think that the worst thing happening to me right now is that I am gaining weight and am not fitting into my clothes. I obviously can't control this, as my weight gain thus far is nothing more than the sign of a healthy pregnancy. So what are the facts about weight gain during pregnancy? How do I make sure I gain the right amount of weight?


The Facts About Weight Gain During Pregnancy
1) The phrase "eating for two" is a misnomer. Your baby is pretty small in relation to you throughout your pregnancy. At 3 months, it's only the size of your closed fist. So you don't really need to consume much more calories than you did before pregnancy. 100-300 calories per day extra is all you need. That's the equivalent of an extra slice of multigrain toast, an extra 3oz of salmon, or 1 avocado.


2) Most of your weight gain isn't fat. In fact, in the 20-35 lbs of weight you'll gain over the course of your pregancy, only 20% of it will be fat.

Baby	8 pounds
Placenta	2-3 pounds
Amniotic fluid	2-3 pounds
Breast tissue	2-3 pounds
Blood supply	4 pounds
Fat stores for delivery and breastfeeding	5-9 pounds
Uterus increase	2-5 pounds
Total	25 to 35 pound

3) Expect to gain 1 lb per week after the first trimester. You can gain anywhere from 2-5lbs during the first trimester, after which point you should gain about 1lb per week. (That would put me right in the normal range!)


4) Exercise: do what you can. During my first trimester, the last thing I wanted to do was exercise. I was tired in a way I had never felt before. My whole body just felt heavy. Going up the usual 4 flights of stairs to my apartment was tiring...This, from a woman who has trained for and run a marathon! 


One thing I've learned being involved in health and fitness for so long, is that you have to listen to your body.  You might not be able to push yourself like you did before you were pregnant. Your body's energy is being directed towards growing your baby, and your hormones are very much out of your control. Do what you can when you can, but be mindful to try and do something at least 3 times a week: go for 45 minute walk, take the stairs, do a light weightlifting workout. 


Keep yourself in good habits, because by the 2nd trimester it gets easier, and you can increase your intensity again. Even at this point, though, you may still find your heart beating in your chest after doing a brief stint of more intense cardio. It's okay, your blood volume is ever increasing and your heart has to manage a larger blood supply.