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