Category: Weekly Tips

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Weekly Tips

Weight Gain for Twin Pregnancies

The Institute of Medicine has established some general guidelines for total weight gain in twin pregnancies based on pre-pregnancy body mass index (BMI). To determine your pre-pregnancy BMI, enter your weight and height PRIOR TO PREGNANCY at this link (https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html).

Once you have a value, use the table below to determine how much total weight you should gain.

Of note, it is not entirely clear how much a woman carrying twins with a BMI <18.5 should gain during pregnancy. For all women carrying twins, it is important to engage in frequent conversations about weight gain with your health care provider to ensure your babies are growing properly, and that you are staying healthy as well!

Citation:

Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. https://doi.org/10.17226/12584.

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Weekly Tips

F.I.T.T.

F.I.T.T. Framework for Pregnancy

F.I.T.T. stands for frequency, intensity, time, and type of exercise. This framework can help you decide on exercise programming that works for YOU and YOUR schedule! The ultimate goal of using BumptUp is to hit 150min of moderate exercise per week. Use this framework to help you do that!

Frequency- aim for exercising at least 3-4 times per week (but work up to daily)

Intensity– Shoot for an intensity that makes your heart beat faster and breath harder, but keep it to where you can still carry on a conversation. This is called the “talk test” and can keep you at a level that is not going to overexert yourself. If you are a very active person and used to more intense activity, it is okay to work even harder!

Time– anywhere from 20-60 minutes. Note: it is okay to break this up into 10min sessions throughout the day!

Type– This part should be based purely on what YOU enjoy doing the most! If you love to walk, walk! If you like to run, run! If you like to cycle, cycle! If you like to play tennis, play tennis! If you like to dance, dance! Choose a mode that sets you up to be successful! And if you don’t know what you like to do, visit our full body workout section of the app!! We can help you pick safe and effective exercises to create your own workouts!

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Weekly Tips

Can Exercise Help my Labor Get Started?

You’re a day past your due date and anxious to get the show on the road. You may have wondered what you can do to get things started and questioned whether a fast walk around the block may do the trick.

If you’ve been exercising throughout your pregnancy, it’s fine (and even advisable) to continue with your routine past your due date. Even if you haven’t been keeping fit, short walks are an excellent way to keep yourself focused and reduce pre-labor anxiety. As long as your feeling good and your doctor or midwife hasn’t asked you to avoid exercise, keep doing whatever activity feels best.

Although you may have heard other pregnancy women say that a run or fast walk brought on labor, the jury is out regarding whether exercise in itself can nudge labor. What little data there is on this subject hasn’t shown an association between physical activity and going into labor, but that doesn’t mean exercise isn’t helpful during those long days of waiting.

Many women who’ve exercising throughout their pregnancy have biked, ran, walked, or worked out in a gym the day they went into labor. We even know one woman who biked into the hospital to deliver her baby. These women would probably agree that exercising right up to when labor started made a big difference in how they felt during and after labor and delivery. Here are just a few of the perks:

  • Exercise is a great stress and anxiety reducer. Most women are a little nervous before they go into labor and exercise can reduce stress hormones.
  • Exercise helps to improve focus—helping you with your preparation for labor and delivery, as well as planning for your baby’s arrival home.
  • Physical activity helps boost self-esteem and mental outlook. A positive outlook can help reduce pain, anxiety, and fear during labor and delivery.

Although you may feel impatient for your labor to start once you’ve reached your due date, it’s important to remember that normal gestation can vary between 38-42 weeks, with some pregnancies (called post-term) can go beyond 42 weeks.  The following factors can increase the incidence of going past your due date:

  • Hormonal influences.
  • Obesity.
  • Genetic factors (if you were born post-term you might have a higher chance of your baby being the same).
  • First-time pregnancy.

With that in mind, don’t feel that you’re abnormal if you don’t feel anything happening at your due date—you and your healthcare provider can best determine whether you need to be induced or just sit tight until nature takes its course.

Internet Journal of Gynecology and Obstetrics

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Weekly Tips

Breast Engorgement

Breast engorgement is one of the leading causes of postpartum pain. It is caused by high volumes of breast milk in the breast ducts or a clogged milk duct. Symptoms include skin redness, warmth to touch and pain. You may also notice flattening of the nipple and difficulty of latching for newborn. Many women find relief with increased frequency of breast feeding, pumping or hand expression of breast milk before and after breastfeeding. You can also try cold packs and breast massage to decrease swelling. Some women may also benefit from anti-inflammatory medications such as ibuprofen.

In some situations, women may develop a condition called mastitis (inflammation and/or infection in breast tissue). If you experience the above symptoms (skin redness, warmth to touch, pain) as well as fever and fatigue, you should contact your healthcare provider immediately. You may need an antibiotic to treat the infection. Mastitis can make you feel very sick, so do not delay getting help!

Need help learning how to hand express breast milk? Click here to see a video from Breastfeeding Medicine of Northeast Ohio: The Basics of Breast Massage and Hand Expression

https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/07/postpartum-pain-management

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Weekly Tips

Planning Your Contraception After Birth

Your return to fertility (when you might get pregnant again) after having a baby is unpredictable. It is even possible to get pregnant before your first period after having your baby.  

For your health and the health of your baby, it is recommended to wait at least a year and a half before trying to get pregnant again. Leaving time between pregnancies allows your body and mind time to heal which can improve your health and your baby’s health.

It is also recommended that women wait 6 weeks postpartum before having sex. This recommendation, along with using contraception (also commonly called “birth control”), can help you heal and plan your family. There are a variety of contraceptive options. Ultimately, only you can decide which method is best for you and your family.  

Many women are not ready for sex at 6 weeks postpartum- that is very normal! Here are some reasons why:

  1. Your body is still healing! Muscle takes 2-4 weeks, your skin and soft tissues can need 11-14 weeks, and in some cases, as long as 12 months to heal!
  2. Unusual sleeping patterns may make it hard to find time for your significant other.
  3. Psychological well-being: you simply may just not feel like it, and that is okay too!
  4. Breastfeeding can lead to vaginal dryness making sex less enjoyable (can ask your doctor about a topical medication for this).

If you are ready to have sex and don’t already have a postpartum contraception plan, now is a great time to learn about your options. That way you can be ready to talk to your health care provider at your postpartum follow-up visit.

Here are some things to think about:

  • Do you prefer hormonal or non-hormonal options?
  • Do you plan on breast feeding?  Many options are safe in breast feeding, but it is important for you and your provider to discuss this. 
  • Can you make your choice part of your daily routine? For example, is it easy for you to remember to take a pill every day?
  • Do you want something permanent, meaning, you never want to get pregnant again? Or do you want to get pregnant in the future?
  • Do you want something long acting, but not permanent? For example, something that you don’t have to remember each day.
  • Are you interested in a method you place in your vagina? Or a method where a provider places a device in your uterus or arm?
  • Do you have any medical conditions, lifestyle, or factors that may limit your options, such as high blood pressure, obesity or smoking?
  • Do you want the method that prevents pregnancy the best in studies? 
  • Do you mind if your periods change? Or if you have unscheduled bleeding during the month? 
  • Have you talked with your husband or partner about your contraceptive plans?  Or their plans? Would they be interested in a vasectomy (a permanent option for men) or regularly using condoms? 

Here are some great resources to learn more about your options:

Authors: Nikki B. Zite MD MPH, Megan Lacy MPH, Laurel Carbone MD, Samantha F. Ehrlich PhD, Jill M. Maples PhD, & Jenny LaCross, PT, DPT, PhD(c), WCS, ATC, CLT-LANA

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Weekly Tips

Medications in the Postpartum Period

Congratulations, Mom! Now, some considerations for medications during postpartum. If you are breast feeding, remember that some medications you take can pass to your baby in breast milk. Medications to avoid if you’re breastfeeding include chemotherapy drugs, some mood stabilizers and antipsychotics, certain antibiotics (Metronidazole, Tetracyclines, Sulfa drugs, Ciprofloxacin, Levofloxacin), Atenolol, Retinoids, and Radiocontrast media. If you consume alcohol, delay consumption until after feeding and wait at least 2 hours after a single serving to feed again. High caffeine intake can cause infant irritability and poor sleep. Avoid illegal drugs, including marijuana, and smoking around your baby.  Remember drugs that make you sleepy or altered can have the same effect on your baby! Avoid estrogen containing birth control or medications immediately after delivery as this can increase your risk for a blood clot and decrease milk production. Let all medical providers know you are breast feeding before starting any new medication and refer to free LactMed website (https://www.ncbi.nlm.nih.gov/books/NBK501922/) or app for a full list of medications and recommendations.

Resources:

Breastfeeding and Maternal Medication, Recommendations for Drugs in the 11th WHO Model List of Essential Drugs, Dept of Child and Adolescent Health and Development

https://apps.who.int/iris/bitstream/handle/10665/62435/55732.pdf;jsessionid=A0CC6334934CFEBDBD55209660AF58D5?sequence=1

Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006.- LactMed App. [Updated 2019 Dec 16]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547435/

Author: Laurel Carbone, MD

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Weekly Tips

Postpartum Pain Management

After vaginal delivery, the most common pain is from breast swelling (also called engorgement), uterine contractions, and vaginal tears.  Cold packs and increasing the frequency of breast feeding can help with engorgement. Pain relievers like Tylenol and Motrin can decrease inflammation to relieve pain. Heating pads can help relieve pain associated with uterine cramps, which are most common during breastfeeding in the first few postpartum days. To help reduce pain associated with vaginal tears, ice packs can be applied to the perineum (the area between the vagina and anus).  Topical astringents, like witch hazel pads, or numbing creams can improve hemorrhoid symptoms.

  • Padsicles can be very helpful (homemade: https://www.healthline.com/health/pregnancy/padsicles; or purchase: Frida Mom 2-in-1 Postpartum Absorbent Postpartum Perineal Ice Maxi Pads; Frida Mom Perineal Witch Hazel Cooling Pad Liners), especially when placed inside compression underwear.
  • Compression underwear that extends above the belly can help with swelling and pain management in the vaginal and pelvic region. 
  • Using a peri-bottle with room temperature to cool (not cold or warm) water to clean following urination instead of wiping. (i.e. Frida mom upside down peri-bottle)

Following cesarean delivery, it is important to take pain medication as recommended or prescribed by your health care provider. If NSAID dosing every 3 hours does not treat your pain, low dose opiates may be used. The goal is to use low dose opiates only as needed for break through pain. Codeine containing medications pass through the breast milk and adequate precaution must be taken if breast feeding. Choosing a breastfeeding position that puts less pressure on your incision and/or using a heating pad or compression belt may also provide incision pain relief. When you poop, sneeze/cough, or vomit in the first few weeks it can be helpful to use a small pillow (i.e. a throw pill from a couch) to brace/hold against your incision. This helps to absorb force to the incision. You can also hug the small pillow against your incision when rolling to get in and out of bed as well as when standing up from a chair.

Remember, constipation is common in the postpartum period (regardless of mode of delivery) and can make pain worse so stool softeners and certain laxatives can be helpful during this time.

Tips for managing constipation:

  • Stay hydrated (with water) and eat fruits and veggies (fiber) can help to prevent or minimize constipation
  • Position yourself on the toilet with a foot stool under your feet to bring your knees higher than your hips (https://www.squattypotty.com/) will help to ease the path of bowel elimination
  • Try to blow out through your mouth when you poop by making a “SSSSHHHHH” or “HHAAAAA” sound instead of holding your breath
  • Try to make your belly big and hard like a basketball when you are blowing out. 
  • Daily movement and warm beverages, especially in the morning, can help to move stool through the system.  
  • Belly massage can also help.

For vaginal or C-Section deliveries: slow deep breathing, focusing on the lower rib cage expanding in all directions, for a few minutes can help to decrease pain and promote reduction of swelling. This also sometimes helps mid to upper back pain.

For more information: https://www.acog.org/womens-health/faqs/postpartum-pain-management

Postpartum pain Management, ACOG Committee Opinion 742, July 2018

Author: Laurel Carbone, MD and Jill M. Maples, PhD, and Jenny LaCross, PT, DPT, PhD(c), WCS, ATC, CLT-LANA

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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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