Tuesday, August 2, 2016

The drawbacks of being fit and pregnant

While this second pregnancy has been virtually nothing like the first, the common thread has been my effort to be active and healthy throughout the process. With my first pregnancy, I was able to run/jog until the very end, but I did not lift nearly as heavy or as frequently as I have with this pregnancy (which forced me to stop running around 30 weeks due to discomfort not advisement to avoid it). I have enjoyed the 50-60 minute cycle classes at my gym at least two days/week and various cardio machines on other days as tolerated, but I have felt my best and most energetic on days that I lift weights during this pregnancy. Some of this is due to increased confidence in knowing what I am doing is both safe and beneficial (I felt more guilty/uncertain with the first pregnancy- running felt better and safer at the time), but overall I am happy to have found something that helped minimize my back pain and maintain some semblance of muscle mass throughout the duration of this pregnancy. 

8/1/2016: 37 weeks, 27lbs gained
So let's get down to business- if you follow me on social media, you've seen my incessant posts about the importance of being healthy before, during, and after pregnancy. Why the hell would I write a blog post suggesting fit pregnancies have drawbacks? This is my way of paying it forward for all you active women who are pregnant or want to get pregnant and who may also be working toward various fitness goals or want to pursue them postpartum. There are some issues which may arise during and/or after your pregnancy which A- are not talked about much and/or B- are not heavily referenced in the literature because being fit and pregnant means you are an outlier. Norms and standards by which doctors base their care are based on these norms and outcomes compared to them- by being fit during pregnancy, you may likely fall outside of some of these norms, and you should be prepared for some "bumps" along the pregnancy road (HA.HA.HA.). Here are a few of my "heads up" warnings if you, like me, want to be healthy and fit at all stages of pregnancy:

1- Start pelvic floor PT. Like, now. 
 If you are a runner or some type of endurance athlete, but especially a runner, heed this advice! Many moms experience stress urinary incontinence (SUI) after any form of delivery, not just difficult vaginal deliveries like my first, but the degree to which you may experience this depends largely on how well you cared for the muscles of your pelvic floor at all stages of the pregnancy. What does this mean? In short- you will pee yourself. You may just pee yourself when sprinting or doing high-intensity plyometric exercises- congrats to you if this is your degree of incontinence. Some of us, myself included, pee in those instances as well as when we cough, sneeze, laugh, or change position (sitting-to-standing, for example). Yeah, it really sucks. It's embarassing, it's frustrating as hell, and you feel like a prisoner in your own body because you can't get through a day without carrying multiple pads or changes of underwear, even planning the outfits you wear based on who you will be with and what you will be doing, to salvage your dignity. 
   You may be thinking- I do Kegels, I do lots of core work, I have it covered. Are you sure? How can you be sure? I was certain that doing core stability exercises like Pilates and certain yoga poses facilitated strengthening the pelvic floor as well. HELL TO THE NO my friends. These are very different exercises entirely, and you can actually do pelvic floor exercises while doing yoga or Pilates, but they are not the same! Rather than reading a two-dimensional description of how to do these exercises, I HIGHLY encourage you to talk with your OBGYN or PCP and get a referral for pelvic floor PT or a women's health PT for consultation if you even experience a light amount of incontinence. I am a strong proponent of now saying that while incontinence may be common among female mother athletes, this does not make it acceptable for your quality of life. You should not have to tolerate peeing yourself to any degree. 
          For me, my degree of SUI was interfering with my quality of life to the extent that I was, for the first time in my life, truly depressed. I can see this in hindsight, the pinnacle of my SUI complications came in first trimester of this (second) pregnancy. I had a cold that seemed to last the entire duration of the trimester, so not only was I exhausted and nauseous from the pregnancy, but every time I did anything other than sit quietly, I would leak. I eventually stopped running despite my physical ability to do so, I was just too embarrassed to continue to try. Black spandex pants only get you so far when you have no control of the flow of your urine. I finally mentioned it to one of the OB docs in the practice I visit (not my "regular" OB) and she recommended a series of anti-depressant medications safe for pregnancy. That was my breaking point, and I decided to seek a second opinion. I finally reached out to my regular OB and described my symptoms, he was the one to suggest that I go to pelvic floor PT while pregnant and ask about being fitted for a pessary (Google it). Truly, this little donut-shaped device saved my sanity until I was too uncomfortable to run around 30 weeks. We will resume PFPT after I delivery and explore the timeline for the sling surgery to permanently fix the damage "down there", but I can't say it enough- don't tolerate leakage if it makes you uncomfortable. There are treatment options for you. Better yet, start PFPT before you realize you need it! 

2- Don't freak out if you are told you are "measuring small". 

36 weeks
First, I would like credit a few of my mama friends who helped support me when I was told this same info on multiple occasions with this pregnancy. I won't share your names, but you know who you are. Thank you :):) I started getting the "you're measuring small" feedback around 34 weeks when most women start to change shape somewhat drastically and quickly. Even with my first pregnancy, I gained 12lbs in the last month and while much of it was due to a growing baby boy, some of it was also due to decreased activity levels (and I didn't have a toddler to chase, so I could nap and rest more!). At the first mention, I didn't panic. The doc at that particular visit even advised me to not panic, but that I should have changed measurements by the next appointment.  So, next appointment rolls around- no change in fundal length or my bodyweight. By the next appointment, at this point 36 weeks, I had not gained any weight from 34 weeks and fundal length was considered 5cm below gestational age. In other words, the norms suggested I should be around 34-36cm in fundal length, and I'm assuming based on the numbers that I was measuring 31cm. My doc at this appointment, who is my usual doc and I do trust very much, advised that it was medically necessary to be referred for an ultrasound to check my fluid levels and to ensure the baby's development was normal to this point. He did mention that it was likely due to my fitness and activity levels that I was measuring small, nevertheless I needed to follow through this time as he would order it per medical necessity. Commence freak out. 

Turns out, thankfully, baby girl is healthy and growing and "average" for this point in pregnancy. Also turns out this was a blessing in disguise as we learned she had flipped from head-down presentation to breech... ugh. I will be sure to document my recovery-from-c-section journey in many blog posts to come, but at least we know now we are likely headed for surgical removal of our daughter. I digress. 

At my 37-week appointment yesterday, I had a long conversation with my OB about our options with breech presentation. He reiterated several times that because I am "so small", the likelihood that she will flip or that a procedure known as ECV would be likely unsuccessful, I'm fairly limited in options. Who knew? We have crappy luck of the draw that she decided to flip and will likely stay that way because, in so many words, my strong abdominal muscles have created a tight cage around the placenta and there's little room for her to change position at this point. 

Chances are you won't encounter these crappy odds, and I certainly don't regret doing core work and strength training throughout this pregnancy despite the ironic likelihood that we will have to slice through my abs to remove the baby. 

3- People can be just as nasty about gaining too little weight (in their opinion) as gaining too much. 

You know, I hope there are people out there who make a point of showing such disdain for women who smoke and drink and do other ellicit and recreational drugs while pregnant as they do for women who eat healthy and stay active. Holy crap. I don't know what it is about pregnancy that suggests to strangers hey sure, if you have the audacity to touch my protruding belly, you sure as hell are allowed to make a comment about the size of said protrusion. Um, what? This phenomenon is incredibly frustrating for someone who tries to teach empathy in healthcare settings for a living, you know, we don't judge obese people just because they're obese, right? Yes, I am lifting what you consider to be heavy weights in the effort to slowly drain the oxygen from my placenta. You are exactly right. Oh, that's not what you meant by your comment? Well what outcome would you have that I offer to you when you ask such an insensitive question. WHAT IS WRONG WITH PEOPLE?! "Are you sure that's safe?" No, actually, I'm not sure. You should ask that man eating a double bacon cheeseburger and supersize soft drink with a Rx for an insulin pump if what he's doing is safe, then you can get back to me. 

If you plan to exercise while pregnant, heaven forbid you are/were an athlete before becoming pregnant, be prepared for some truly idiotic comments. As a teacher, it is true: there are no dumb questions. There are, however, plenty of dumb people in this world, and I recommend you prepare yourself for some of the craziest and most personal questions you will ever receive in your lifetime as when you are trying to be both healthy and pregnant. 

1 comment:

  1. Great post. I just saw a UroGyn yesterday to learn about my options. I'm starting with PFPT exercises. I'm hoping to avoid surgery.