Author: Rachel Tinius

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Weekly Tips

Prioritizing Recovery

Your body has just been through a big transformation with pregnancy and delivery. Help to nourish your body by prioritizing recovery, especially during these next few weeks.

Sleep

While sleep may sound impossible right now, even short power naps can help add up to boost your body’s ability to recover. If you’re having trouble falling asleep, try these tips:

– Make the bedroom dark with blackout curtains or a sleep mask

– Reduce the temp. Studies have shown the ideal temperature for achieving deep sleep is 65-69 degrees. Check with your pediatrician for safe sleep tips for baby if room sharing.

– Limit screen time. Reduce your screen time before attempting to sleep and add in blue light blockers or reduce the blue light through your phone’s settings during dark hours

Ask for help

You don’t have to try to do everything on your own. If friends and family ask if there’s anything they can do, give them tasks to help you around the house. A postpartum doula may also be a great investment to help you during these first few weeks.

Nourish your body with food

Nutrition can play an integral part in postpartum recovery. Try to increase your intake of foods high in omega-3 fatty acids, iron, zinc, and fiber.

Activity

While early postpartum isn’t the time to start back to your regular exercise program, these are some activities you can prioritize during early postpartum.

Breathing

  • Breathing is the foundation to your postpartum recovery and strength building process.

Kegels

  • Not just a squeeze, a kegel is a contraction of the pelvic floor muscles that includes both a squeeze as if trying to stop the flow of urine and a lift, as if trying to lift something sitting at the vaginal opening up and inside the vagina like a vacuum cleaner. It is equally important that you can fully relax these muscles after you squeeze them. We recommend seeing a Pelvic Health Physical Therapist to perform a comprehensive assessment and assist you in proper performance, as we know that 50% of women perform kegels incorrectly when only given verbal directions. Pelvic Health Physical Therapist can also assist with any neck, back, abdominal, hip, or pelvic pain you may be having. Pelvic Health Physical Therapists are a critical part of the post-partum care team. (Optimizing Postpartum Care | ACOG). In some states you can see a Pelvic Health Physical Therapist without a referral from your physician. Other states require a prescription referral from your physician. 

Mobility Work

  • It feels good to move your joints after spending so much time sitting to hold and feed baby, especially after 9 months of growing that baby. Focus on shoulder and hip mobility with movements such as wall angels, hip-hinging, rocking in quadruped, and shin box flows.

Walk

  • Start out with short trips around the block and gradually build distance and time. Feeling symptomatic when walking? Sometimes changing to walking on a slight incline can help your body get into a better position.

Mental Health Monitoring

  • Self-monitor for any signs of postpartum depression
  • You can take this simple survey to screen yourself (edinburghscale.pdf (ucsf.edu) . If you score 13 or higher OR if you answered anything but NEVER on question 10, you really need to consult your doctor!

Casey Thomas-Hardesty, MS, NTP and Jenny LaCross, PT, DPT, PhD(c), WCS, ATC, CLT-LANA

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Weekly Tips

Constipation

Constipation is a common complaint during pregnancy likely due to changing hormone levels, diet changes, increased pressure from your growing baby, and a change in activity levels. If you are suffering from constipation, try these tips to get your bowels moving.  

Hydrate

Make sure you’re getting an adequate intake of water throughout the day. Pay attention to your body and drink when you are thirsty. Tea, coffee, and soft drinks are not a replacement for water. Hydration is like the three little pigs: you do not want too drink too little, which can contribute to swelling, constipation, and other symptoms, or too much, which can overload your bladder and lead to increased frequency of urinating. You want to find the sweet spot of “just right” which can be accomplished by paying attention to your body. This may mean you need to “check in” a few times a day to ask yourself if you are feeling thirsty.

Fiber

Foods high in fiber such as apples, avocados, and brussels sprouts can help. Aim for 28g of protein per day during pregnancy. You can also consider adding flax seed or psyllium husk to your yogurt, smoothies, or oatmeal for added fiber (start with 1 teaspoon per day and increase to 2 tablespoons depending on tolerance).

Activity

Move your body to help reduce constipation. Go for a walk, try a yoga or mobility flow, or lift weights to get in your recommended exercise intake plus help your bowels become more regular. There are also several specific exercises that can help. These include hip swings, hook-lying trunk rotation, and quadruped rocking.

Positioning

Using a stool or squatty potty to get the knees above your hips can help your bowels move more freely while on the toilet. Working with a PFPT to learn how to fully relax your pelvic floor may also be beneficial.

Food Sensitivities

Some foods may be contributing to your constipation during pregnancy. If you’ve tried all of the tips above and still experience constipation, ask your OBGYN, midwife, or pelvic floor physical therapist for a referral to a prenatal Registered Dietitian that can help you work through your diet.

Self or Partner Abdominal Massage

This massage designed specifically for constipation is sometimes called the “I Love You” massage because you are tracing the letters “I” “L” and “U” over your belly. While you are not actually pushing stool through your intestines, this massage technique helps to move the tissues around your organs to help things move more easily through the system. It is normal and safe to hear your tummy talking back to you with gurgles while performing the massage but if you do not hear or feel gurgles that is ok too! This is usually performed for 10 minutes and performance is recommended just before bed or as soon as you wake up in the morning.

Watch video below on abdominal massage:

https://vimeo.com/forerunnerbg/download/686023078/48b5dd6d05

Habit Training

The best time to have a bowel movement is in the morning about 30 minutes after waking due to gastrocolic reflex. Waking up and drinking a water beverage (i.e. warm water), moving (i.e. walking around the house), and eating (specifically the mechanical action of chewing) all augment the gastrocolic reflex. Another good time to try and have a bowel movement is 30 minutes after a meal. You can go in the bathroom and sit on toilet for no longer than 5 minutes. This can “train” the bowels. This can be even more effective postpartum. 

Toileting Mechanics

When on the toilet, pull pants and underwear down to ankles to allow legs to relax out to the side

When you bear down, instead of holding your breath, blow out through your mouth as if blowing through a straw. You can also make a sound like “SSSSHHHH” “HHAAAAA” “GGGRRRR”. You can also hum or sing. The goal is to be breathing as you push to protect your pelvic floor. 

As you bear down, imagine “belly big belly hard”, trying to make your belly big like a basketball. 

If nothing is happening, you can rock side to side, front and back on the toilet. You can also make circles with you pelvis and trunk clockwise and counterclockwise.

References:

Jewell D, Young G. Interventions for treating constipation in pregnancy. Cochrane Database of Systematic Reviews 2001, Issue 2. Art. No.: CD001142. DOI: 10.1002/14651858.CD001142. Accessed 29 January 2022.

Rungsiprakarn P, Laopaiboon M, Sangkomkamhang US, Lumbiganon P, Pratt JJ. Interventions for treating constipation in pregnancy. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD011448. DOI: 10.1002/14651858.CD011448.pub2. Accessed 29 January 2022.

Casey Thomas-Hardesty, MS, NTP & Jenny LaCross,PT, DPT, PhD(c), WCS, ATC, CLT-LANA

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Weekly Tips

Nutrition for 2nd Trimester

Welcome to the 2nd trimester. Now that you (hopefully) have your appetite back, you may feel more comfortable incorporating meats and vegetables back into your diet. Below are some tips and ideas to help you through these next several weeks.

Salads

While leafy greens may have been a turnoff during the first trimester, many people find them appealing once again during the remainder of their pregnancy. Don’t just opt for plain lettuce though. Here are some salad toppers that can help you increase your nutrient intake:

– salmon, diced chicken, or hard boiled eggs

– nuts and seeds like pumpkin seeds, slivered almonds, or walnuts

– fruits and vegetables like apples, carrots, and broccoli

– don’t forget the dressing and healthy fats

Easy Meals

Similar to snack plates, putting together quick and easy meals can be a great option for weekday meals.

– tuna salad (look for skipjack or brands with low mercury), whole wheat crackers, apples, and carrots

– breakfast for dinner – scrambled eggs with veggies, whole grain toast with butter, and a side of berries

– sheet pan dinners – one pan dinners help make cooking and cleanup easy. Try mixing vegetables like baby potatoes, carrots, and zucchini on a sheet pan. Toss with olive oil and your preferred spice blend, add in chicken thighs, and cook until chicken reaches an internal temperature of 165 degrees Fahrenheit.

Note: For food storage safety guidelines, click here.

Casey Thomas-Hardesty, MS, NTP

Two Peas Wellness

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Weekly Tips

Nutrition for 1st Trimester

Food aversions and fatigue can make obtaining adequate nutrition difficult in your first trimester. Below are some quick and easy ideas to help you make a balanced plate during the first 12 weeks of pregnancy.

Snack plates

You don’t have to have a traditionally prepared meal to hit all of the macronutrient categories. Try mixing together a snack plate that includes protein, healthy fats, and carbohydrates for a well-rounded meal.

– whole grain crackers, snap peas, baby carrots, sliced apples, nut butter or hummus

– avocado toast and two hardboiled eggs

Smoothies

Smoothies make great options for breakfast when nausea may be higher. Make sure you’re including protein to help keep you full longer. Greek yogurt and nut butters are good protein sources to add to your smoothie. A plant or whey based protein powder is another good option. Just make sure to check the ingredients. Ideally, protein powders would be third party tested, have no caffeine or artificial sweeteners, and have minimal quality ingredients.

One of my favorite smoothies combines

– 1 cup almond milk (or your milk of choice)

– 2 handfuls spinach

– 1-2 scoops protein powder

– 1 Tbsp almond butter

– 1 tsp unsweetened cocoa powder

– ¾ cup frozen blueberries

– ice to reach desired consistency

Textures

Play around with food textures. A steak may not sound appealing right now but ground beef is ok. Similarly, scrambled eggs may be a turn off but hard boiled eggs are a go. Feel free to experiment to see what works for you during these first 12 weeks.

Note: For food storage safety guidelines, click here.

Casey Thomas-Hardesty, MS, NTP

Two Peas Wellness

© WKU {2022} All rights reserved.

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Weekly Tips

Vaccines for your Baby

Vaccines, also known as immunizations, are important for your baby. Vaccines will help your baby avoid future infections and diseases by building immunity. As part of routine childhood healthcare, you will take your baby to a health care provider for vaccines at select time points in your baby’s lifetime.

You may have heard other parents express worries about the safety of vaccines. Fears about the safety of vaccines are completely understandable, however, the biggest fears about vaccines are not based on facts and evidence. 

Here are some facts about vaccines that should help you feel more confident in your decision to follow health care provider and national health guidelines about vaccines for your baby:

Fact #1 – Vaccination is the safest way to protect against certain diseases.

Vaccines produce an immune response similar to what is produced by the natural infection. It does not produce the risks of death or disability caused by certain diseases.

Fact #2 – Combined vaccines are safe and beneficial.

Giving vaccines at the same time adds no harmful effect on a child’s immune system. It lessens discomfort for the child. It also saves time and money. Children are exposed to more of an immune response from a common cold than they are from combined vaccines.

Fact #3 – It is always best to get vaccinated. This is true, even when you think the risk of infection is low, because if we stop vaccinations, deadly diseases will return.

Deadly diseases that seem to have been removed can come back when vaccination rates drop. By making sure each person gets vaccinated, we can decrease the presence of vaccine-preventable diseases. We all have a duty to do what we can to stop the spread of diseases. Even with better hygiene, clean living, and access to safe water, infections still spread. When people are not vaccinated, infectious diseases that have become rare can quickly rise again.

Fact #4 – There is no past or present link between vaccines and developmental disorders or disabilities.

There is no scientific proof to linking vaccination to developmental disorders or disabilities. The most common reaction to a vaccine is slight redness or a soreness that goes away in a few days without any complications. You may have heard that the measles, mumps, and rubella (MMR) vaccine or other vaccines cause developmental disorders, like autism. This rumor started with a single study in 1998 that was quickly found to have false data. The study was removed by the journal that published it and the researcher was stripped of his medical license.

Fact #5 – A vaccine causing disease would be extremely unlikely.

Most vaccines are made from inactivated parts of a virus or bacteria. It is not possible to get the disease from the vaccine. Some vaccines can cause mild symptoms like those of the disease they protect against. But, a common mistake is that these symptoms signal infection. If there are symptoms, it is the body’s appropriate immune response to the vaccine, not the disease.

Here is a link to the CDC’s website about vaccines for children: https://www.cdc.gov/vaccines/parents/index.html

References:

F Bustreo. Embrace the facts about vaccines, not the myths. World Health Organization. https://www.who.int/news-room/commentaries/detail/embrace-the-facts-about-vaccines-not-the-myths 

T Pongdee. Vaccines: The myths and the facts. American Academy of Allergy Asthma & Immunology. https://www.aaaai.org/conditions-and-treatments/library/allergy-library/vaccine-myth-fact 

Public Health. Vaccine myths debunked. https://www.publichealth.org/public-awareness/understanding-vaccines/vaccine-myths-debunked/ 

Authors: Kimberly B. Fortner MD, Oluwafemifola Onaade MPH, Bandon Hays MD, Samantha F. Ehrlich PhD, Jill M. Maples PhD

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Weekly Tips

Proper Body Mechanics & Ergonomics

Proper body mechanics refers to the application of body movement in a way that achieves maximum efficiency and reduces the risk of physical stress or injury.  Ergonomics is about creating a workspace that promotes efficiency and comfort. Together, proper body mechanics and ergonomics are the keys to preventing overuse and strain with baby care.

Think about how many times you lift your baby each day—lifting improperly puts a strain on your back and can cause injury. Using the followings techniques for lifting and incorporating ergonomic techniques for your changing table and other baby equipment will keep you pain and injury-free.

Start practicing these techniques before your baby is born. Learning how to lift your baby correctly from the start will help make proper lifting techniques a habit.

  • Slow down and think about how you are going to lift properly.
  • Put less stress on your back when lifting your baby and baby equipment by bending the knees, hinging at the hips, and keeping the back straight. Minimize bending from the waist or hips,
  • When lifting from the floor squat or kneel in front of your baby to lift.
  • Bring your baby as close to your body as possible before lifting. Avoid holding your baby out in front of your body, as that puts a strain on your back.
  • Gently exhale through pursed lips or a relaxed mouth and contract the abdominal and pelvic floor muscles as you lift
  • When carrying the baby and the carrier, focus on using good lifting mechanics.
  • Avoid the one-arm “grab and lift”—always use both arms to lift and hold.
  • When lifting your baby from the crib, position the baby as close as possible to your side of the crib by gently sliding your baby towards you.
  • Before lifting your baby from the crib, take a big breath and as you exhale, tighten your abdominal muscles and pelvic floor as you slowly lift.
  • Breast feeding position: bring baby to breast with pillows and supports instead of bringing breast to baby. Support your body with pillows, blankets, and or towels as needed as well to optimize your comfort and decrease neck and back strain.

Creating an Ergonomic Workstation

  • Adjust baby changing table to a height that allows an upright position and prevents you from having to bend forward.
  • Tables should be positioned so that their tops are just below the level of the elbow.
  • Store your baby supplies such that you don’t have to reach overhead,  or bend and twist to get to them. If possible, set up the changing table against a wall and install shelving above the table within easy reach.
  • Before you buy, make sure that baby cribs, carriers, and a changing table are easily adjustable to fit the person using them.

https://orthoinfo.aaos.org/en/staying-healthy/preventing-back-pain-tips-for-new-moms/

http://www.working-well.org/articles/pdf/parenting.pdf

Catherine Cram, MS & Jenny LaCross, PT, DPT, PhD(c), WCS, ATC, CLT-LANA

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Weekly Tips

How to Safely Maintain Core Strength During Pregnancy

Among the many physical changes of pregnancy is an ever-expanding tummy.  As your abdomen grows, the muscles that provide support for your core need to remain strong and require a shift in the type of exercises required to build strength. 

Pregnancy-induced changes cause the connective tissue that joins the two sides of the rectus abdominis muscles “six-pack muscles” (they span vertically from your ribs to pelvis) to thin and widen, separating the recti muscles’ two sides. This thinning and widening of the two recti muscles’ distance is called a “diastasis recti.”

The development of a diastasis recti is extremely common during pregnancy, especially third trimester, and postpartum. It is not pathologic unless it interferes with activities and quality of life. The incidence and degree of separation can be increased by:

  • Rapid changes in weight
  • Obesity
  • Genetics
  • Age
  • Multiple pregnancies
  • Poor body mechanics

It’s important to be aware of the tension put on the diastasis recti to help avoid increasing tension and further separation. It is important to be mindful of movements that may increase midline tension.

What to avoid:

  • *Sit up type exercises (puts a lot of pressure on your midline with the loaded spinal bending). However, after delivery or in the 4th trimester, consult with a pelvic health physical therapist for exercise recommendations on how to optimize rectus abdominus function, which will likely include curling up types of activities.
  • *NOTE: This type of curling exercise can be very helpful when performed correctly at the appropriate time. If you have questions, consult with a pelvic health physical therapist.
  • Poor body mechanics (twisting when lifting, raising up from a supine position without support).
  • lifting heavy objects if that is not part of your normal pre-pregnancy exercise routine.
  • Bearing down while holding your breathe when lifting or toileting.

Improving abdominal support with proper exercises can help prevent musculoskeletal discomfort and speed postpartum abdominal recovery. As your pregnancy progresses, you won’t be able to strengthen core muscles with this movement effectively.

Instead, focus on exercises that target the transverse abdominis muscle, a corset-like band of muscle that is crucial for maintaining good belly support.

Best abdominal exercise for pregnancy:

  • Isometric contractions of the transverse abdominis in a variety of positions (sitting, standing, on hands and knees, side lying)
  • Supine and modified supine (after the first trimester) leg slides and knee raises and extensions. NOTE: this does not apply to everyone. If you are a weight lifter or avid exerciser, then these may be way too easy and not load your tissues enough. This is more for women who are inactive or minimally active leading into pregnancy.
  • Working functionally to provide abdominal support with movement by making a habit of tightening the lower tummy and holding as you lift, bend, and move. Make sure to match the amount you’re tightening with the difficulty of the task. You do not need to tighten as much when lifting a kleenex. You should tighten more if lifting a heavy grocery bag. Think about the muscle as a “dimmer switch” with the ability to span a range of tightness as opposed to an “on/off” switch. 
  • Use your breathing to enhance your ab exercises by blowing out as if trying to fog your glasses to clean them as you are doing each contraction (you’ll feel how that pulls your tummy inward).
  • Practice the “basic breath” where contract your lower tummy and pelvic floor and hold as you keep breathing normally. Use the basic breath to tighten your tummy and pelvic floor before lifting.

Benjamin DR, van de Water AT, Peiris CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy. 2014;100(1):1–8

Berg-Poppe P, Hauer M, Jones C, Munger M, Wethor C. Use of exercise in the management of postpartum diastasis recti: A Systematic Review. J Women’s Health Phys Ther. 2022;46(1): 35-47. doi: 10.1097/JWH.0000000000000231

Dufour, Sinéad PT, PhD1; Bernard, Stéphanie PT, MSc2; Murray-Davis, Beth PhD, RM3; Graham, Nadine PT, MSc1 Establishing Expert-Based Recommendations for the Conservative Management of Pregnancy-Related Diastasis Rectus Abdominis: A Delphi Consensus Study, Journal of Women’s Health Physical Therapy: April/June 2019 – Volume 43 – Issue 2 – p 73-81 doi: 10.1097/JWH.0000000000000130

Catherine Cram, MS and Jenny LaCross, PT, DPT, PhD(c), WCS, ATC, CLT-LANA

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Weekly Tips

How Can Exercise During Pregnancy Affect Labor & Delivery?

You probably already know that exercise helps your body deal with pregnancy changes by keeping you strong and flexible. But, did you know that maintaining an exercise routine throughout your pregnancy may help you have a lower chance of a complication during your labor and delivery?

Research in the field of prenatal exercise has suggested that there may be birthing benefits that include a lower incidence of preterm labor and cesarean section in women who exercised to the end of their pregnancy. Some research has found that exercise significantly reduce the duration of the second stage of labor in women who exercising throughout pregnancy. Exercise, such as walking, during pregnancy can also lower the odds of you needing to be induced! There’s even evidence that exercise such as yoga may help ease pain perception during labor—possibly by training the mind to focus more effectively and incorporate relaxation techniques during times of stress. Knowing that exercise may positively impact your labor and delivery can provide even more motivation to keep fit.

Here are the takeaway points for improving your odds of complication-free labor and delivery:

  • Do some type of aerobic exercise 5-6 days a week.
  • Add flexibility training and yoga to your routine.
  • Make sure you strength train three days a week.
  • Modify your fitness routine as needed so you’re able to continue exercising to the end of your pregnancy (that’s important for keeping weight gain within normal limits and, in turn, keeping baby weight from getting too high, which can increase the risk of C-section).

References

Am J Obstet Gynecol 2017;216:335–7.Berghella V, Saccone G. Exercise in pregnancy

J Gynecol Obstet Hum Reproduction 2020 Jun;49(6):101736. The effect of antenatal exercise on delivery outcomes: A systematic review and meta-analysis of randomized controlled trials. Ahmed Taher Masoud1, Mohammed M AbdelGawad1, Norihan Hatem Elshamy1, Omar Magdy Mohamed1, Zeinab Y Hashem1, Ahmed K Abd Eltawab1, Ahmed Samy2, Ahmed M Abbas

Int J Environ Res Public Health. 2020 Aug; 17(15): 5274.  Effect of Antenatal Exercises, Including Yoga, on the Course of Labor, Delivery, and Pregnancy: A Retrospective Study

Yogyata Wadhwa,1 

Pereira IB, Silva R, Ayres-de-Campos D, Clode N. Physical exercise at term for enhancing the spontaneous onset of labor: a randomized clinical trial [published online ahead of print, 2020 Mar 29]. J Matern Fetal Neonatal Med. 2020;1-5. doi:10.1080/14767058.2020.1732341

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Weekly Tips

How Much Water Should I be Drinking During Postpartum?

Did you know the breastmilk you are making for your baby is 90% water? Did you know proper fluid intake will help you recover from your delivery?  For these reasons, and many more, it is so important you are taking in enough fluids! You should drink enough water to quench your thirst and then a little bit more. A quick and easy recommendation is to drink a glass of water with every meal and every time you breastfeed your baby! Many new moms find it helpful to have a water bottle or water jug near wherever you normally sit to nurse (or pump) as a reminder to drink.  

Keep in mind, if you are exercising, you need to drink!  

You want your urine to be pale yellow or almost clear. If it is darker than this, you need to drink more.  

Keep in mind carbonated beverages such as soft drinks can actually make you more dehydrated. Water is best!

Montgomery KS. Nutrition Column An Update on Water Needs during Pregnancy and Beyond. J Perinat Educ. 2002;11(3):40–42. doi:10.1624/105812402X88830 

Rigaud M, Sevalho Corçao C, Perrier ET, Boesen-Mariani S. Assessing a tool for self-monitoring hydration using urine color in pregnant and breastfeeding women: A cross-sectional, online survey. Ann Nutr Metab. 2017;70 Suppl 1:23-29. doi:10.1159/000463000 

García-Arroyo FE, Cristóbal M, Arellano-Buendía AS, et al. Rehydration with soft drink-like beverages exacerbates dehydration and worsens dehydration-associated renal injury. Am J Physiol Regul Integr Comp Physiol. 2016;311(1):R57-65. doi: 10.1152/ajpregu.00354.2015 

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Mental Health During Pregnancy

If you fell and broke your leg, you wouldn’t hesitate to call your doctor and seek help. Mental health is just as important as physical health! If you think you are depressed, stressed, anxious, or sadder than normal during pregnancy, you should talk to your doctor.

One in every four pregnant women experience a mental health concern, and this is nothing to be ashamed of! That is almost 4 times more common than gestational diabetes, yet all pregnant women get screened for that and talk openly about the results. For some women pregnancy is the happiest time of their life, for others, it is a really difficult time both mentally and physically. A big change is on the horizon, and change can be stressful! Just because you feel sad, doesn’t mean you don’t love your unborn baby or that there is anything wrong with you! This can be totally normal!! Pregnancy is hard enough without the added challenge of fighting mental health concerns. There are many options for helping you to feel better and be the happiest version of yourself!

https://www.who.int/mental_health/maternal-child/maternal_mental_health/en/

Vesga-López O, Blanco C, Keyes K, Olfson M, Grant BF, Hasin DS. Psychiatric Disorders in Pregnant and Postpartum Women in the United States. Arch Gen Psychiatry. 2008;65(7):805–815. doi:10.1001/archpsyc.65.7.805

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