Managing Your Energy Levels During Pregnancy (Week 36)

I'm in the home stretch now. Four more weeks (roughly) to go, and my excitement/anticipation is growing. That's not the only thing that's growing: as of three days ago, I measured 42 3/4" around my middle. This is the point in the pregnancy that I'm saying to myself, "Really? Can my belly get any bigger?" Of course the answer is "yes", but it's pretty disconcerting nonetheless.

Energy Fluctuations
One thing that I've noticed throughout my pregnancy is that my energy levels have fluctuated quite dramatically on a week-by-week and even day-by-day basis. I was told to expect that my energy levels would suffer in the first trimester, pick up in the 2nd trimester, and then drop off again in the 3rd. Although I did have a marked improvement in energy in the 2nd trimester, I've found that in this last stretch there has been a lot more variability. Sometimes I have good days, and sometimes I have bad days.

Sure, I've put on about 1/3 of my pre-pregnancy weight, which is a lot of work to haul that much extra weight around. But that doesn't explain why some days are easier than others. It all boils down to fluctuating hormone levels and the physical adaptations to pregnancy that my body has to endure. Although at this point I've become used to the feeling of not having as much control over my body as I once did, I've found ways to optimize my energy levels.

How to Boost Your Energy During Pregnancy

• Exercise. It's no surprise that I recommend exercising as a way to boost your energy, however this advice comes with a caveat: pick a day when you're feeling more energetic to get in some activity. Forcing yourself to exercise when your energy is low will more than likely make you feel more tired, not less (this is advice runs counter to what you would do if you weren't pregnant: exercise can often boost your energy when you're feeling low). Also, at this point, just getting off the couch can be enough to be considered exercise. Walk, stretch, do yoga, swim, or do a prenatal exercise class or video.
• Rest when you need to. There will be days when you just don't feel like moving at all. Get over it and just accept it. I had to. Resting when your body tells you to will make you feel better. So get as much sleep as you can. Take naps, or just put your feet up and relax in a comfortable position. As it is, many women don't sleep as well in their last trimester as it gets more uncomfortable to be in a much larger body. And if this wasn't convincing enough, just remember that soon enough your time will no longer be your own, and your opportunities to rest will be dictated by someone else. Enjoy it while you can.
• Eat well and drink plenty of water. Eat foods rich in iron and protein. Choose foods such as red meat, poultry, seafood, leafy green vegetables, whole-grain cereal and pasta, beans, nuts, and seeds. Bright-colored veggies and fruits are packed with nutrients--some of which can help increase energy. The jury's still out on whether or not caffeine is okay to have during pregnancy, so play it safe and stay away from it. Besides, having caffeine too close to bedtime just increases your chances that you won't get a good night's sleep, and caffeine in general makes you dehydrated. Dehydration can decrease your energy levels, so drink for two. If you're urine comes out a pale yellow, you're drinking enough water.
• Manage your stress levels. Being pregnant can be stressful in and of itself. There's a lot of learning and a lot of planning to be done before your little one arrives. So take some time and meditate, pamper yourself, laugh, and spend as much time as you can with loved ones--especially your partner. Again, all of these things will be harder to do once the baby arrives, anyways.

So many moms have told me to enjoy my time being pregnant, and although it's not always easy, life is always better when you count your blessings instead of your aches and pains.

On Breastfeeding and Birth Plans (Week 35)

Why I Chose to Breastfeed
It was quite early into my pregnancy that I decided that I would breastfeed my baby. I had two reasons for choosing this: a) vanity, and b) miserliness. First, breastfeeding will help me to lose weight more quickly than if I formula feed. Believe it or not, you need to take in more calories when you're breastfeeding (up to 500 calories per day) than when you're pregnant (200-300 calories per day). That's because when you're breastfeeding, a lot of calories you take in are diverted to creating breast milk for the baby. Also, breastfeeding encourages your uterus to contract to its original size more quickly than if you don't. That satisfies my vanity quite nicely.

As far as miserliness is concerned, that is more obvious: breastfeeding is a lot cheaper than buying formula, which can cost up to $250 a month.

My Visit to a Breastfeeding Clinic
Today I made a visit to a breastfeeding clinic to learn all I could about how to breastfeed. Hearing the stories of the pain and frustration experienced by other moms I know during their first few weeks of trying to breastfeed, I wanted to make sure I was aware of all my options.

I learned a lot, to say the least. At the clinic I got the chance to see some patients breastfeed their babies, and learned what to watch for in terms of signs of a good latch. I was also lectured on the ins and outs of  sore nipples, skin-to-skin contact, breast engorgement, and even how to tie a baby wrap around my body so that I can carry my baby hands-free (a great way to do chores, run errands, or simply go for a walk with the baby).

One thing they also made me aware of was how having a birth plan can help me stay in control of what happens to me at the hospital while I'm in labour, as well as what happens to me and my baby after delivery.

The Quick and Dirty of Creating a Birth Plan
The first question I asked myself was, "how do I know what I want to happen during my labour and delivery if I've never done it before?" The lactation specialist recommended that I seek out a doula to educate me about the process about labour and delivery, as well as coach me during the actual process. Again, being cheap, I had decided a while ago not to use the services of a midwife or a doula, so this didn't interest me too much.

So, I did what I always do: I did my own research. What I found was that I have a lot of choices that I can make at the hospital so that I am not confined to their regular procedures. The birth plan is also helpful to your partner to understand what it is that you want to happen. This is particularly useful because he or she can be your advocate when you are in the throes of childbirth, and not feeling very communicative. I am also going to talk to my obstetrician about my birth plan so that he can make further recommendations.

In general, some things for you to consider include:

• Hospital vs. home birth
• Vaginal vs. cesarean delivery
• Types of interventions you would like (or not like) to happen; e.g. pitocin, amniotomy, episiotomy
• Who you want to have around you; e.g. your partner, family, etc.
• The kinds of pain relief methods you'd like to employ; e.g. breathing techniques, massage, epidural
• You may want the option to walk around, drink and eat during labour
• The position in which you'd like to give labour--as opposed to the traditional "on your back" hospital position
• How you would like your baby fed: breastfeeding vs. bottle feeding

After writing my birth plan I feel a lot more confident about going into my last stage of pregnancy than I did before. I highly recommend empowering yourself by learning as much as you can, either through clinics, hospital workshops,hiring a midwife or doula, or simply do as much reading as you can.

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.