Tag: Pregnancy Article

Your body is supporting and growing a child.  It is essential you are at your best in order to carry to term, deliver, and care for this life.  A WHPT understands the needs of women and the changes that occur during pregnancy, labor and delivery, and postpartum.  During pregnancy a women’s health PT can help address the pains associated with your changing body. These include but are not limited to lower back pain,, pelvic pain/pressure, neck/shoulder pain, bladder and bowel issues (leaking, constipation), and abdominal wall concerns (e.g. diastasis recti).   Although many attribute these as “normal” conditions, these are issues that are manageable and treatable!  A women’s health specialist can improve your quality of life through the pregnancy, prepare you for delivery, and prepare you to care for your new baby postpartum.

A Women’s health physical therapist (WHPT) is a licensed clinician trained to evaluate and treat neuromuscular conditions related to pregnancy, postpartum, and pelvic pain. We commit ourselves to learning and caring for women in all phases of life. 

Written by Women’s Health Physical Therapist: Dr. Emily Davenport, PT, DPT, WCS

© WKU {2022} All rights reserved.

A kegel is an important exercise to do both during pregnancy and postpartum. This pelvic floor contraction can help strengthen the pelvic floor muscles, support the pelvic organs (uterus, bowel, and bladder), and help reduce the chance of pelvic floor disorders such as incontinence and pelvic organ prolapse. However, 1 in 2 women do not know how to perform a kegel correctly even if given verbal directions. This is why seeing a pelvic health physical therapist is very important, as they will assess your ability to activate these muscles and provide individualized coaching to help optimize your muscle performance and eliminate/prevent symptoms.

The kegel is a two-fold exercise of contraction and relaxation; both are equally important. To do a kegel, you’ll want to contract and lift the pelvic floor, try longer holds of 5-10 seconds and shorter holds of 1-2 seconds, then fully relax.

When contracting and lifting the pelvic floor, here are a few do’s and don’ts to help you get it right.

Do:

– Do be sure you lift the pelvic muscles up and in. If you place a flat hand under your perineum (the space between the vagina and anus) either directly on skin or over your clothing, you should feel the perineum pull away from your hand. When you relax, you should feel the perineum gently rest back into your hand with the same amount of pressure you felt before starting the kegel exercise. 

– Do fully relax at the end of the kegel

Don’t:

– Don’t contract surrounding muscles like your glutes, abs, or thighs

– Don’t squeeze as hard as you can. More isn’t necessarily better.

– Don’t do kegels while you are in the middle of urinating or having bowel movement unless specifically prescribed by a pelvic floor physical therapist

Having trouble with targeting the correct muscles?

– Visualization can be helpful. Imagine picking up a blueberry with your vagina. Strange, I know, but this can help you target the lifting action of the kegel as well as reminding you to lift gently.

– Check yourself. As long as you are comfortable, you can check yourself internally as you perform a kegel. Simply insert 1 clean finger into your vagina. As you perform a kegel, confirm that you feel both a contraction and a lift of muscles around your finger and that the contraction happens equally all around. Don’t feel comfortable inserting a finger? That’s OK!! You can follow the same steps over your underwear with a flat hand and fingers on your perineum (the space between the vagina and the anus). You should feel this area lift away from your hand/fingers as your squeeze and feel it fall back into your hand as you relax. Still uncomfortable? You can also check this using a hand held mirror with your underwear off. Instead of feeling, you will be watching in the mirror to see the perineum pull up and in on the squeeze and return to the starting position on the relax.

– Schedule an appointment with a pelvic floor physical therapist. They can do internal and external checks to ensure you are properly performing a kegel as well as prescribe specific kegel exercise patterns as needed.

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

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Everyone loves a good snack. Here is a list of healthy snack ideas to keep you full and satisfied as you go through your day. It is also important to eat a snack before exercising or prior to attending a physical therapy session.

• Hard boiled eggs
• Apples and nut butter
• Smoothie
• Chia pudding
• Full fat greek yogurt with berries
• Edamame
• Carrots and string cheese
• Raw vegetables and yogurt based or hummus dip
• Grapes and cheddar cheese
• Orange and pumpkin seeds
• Guacamole and bell pepper
• Whole grain crackers and cheese
• Pineapple and cottage cheese
• Dark chocolate and nuts

Casey Thomas-Hardesty, MS, NTP

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Pregnancy is a great time to quit smoking. Not only will it have a positive benefit on your long term health, but quitting smoking (and reducing your exposure to second hand smoke) will also greatly benefit your baby as well.

Risks of smoking during pregnancy

• When you smoke, the toxins from the cigarette (and e-cigarette) pass through the placenta and keep your baby from getting the proper nutrients and oxygen that they need.
• Smoking during pregnancy can lead to long term health risks for your baby, including an increased risk of colds, lung problems, ear infections, and growth restriction.
• Smoking during pregnancy can lead to a preterm delivery.

How to quit smoking

• Many states offer free smoking cessation programs that pair you with a dedicated coach for increased accountability and support.
• Have a support team that you can reach out to whenever needed.
• Set a quit date – and stick to it!
• Talk to your OBGYN or midwife about available local resources to increase your chance of success.

There are resources and support persons out there to help you quit smoking. You don’t have to do it on your own.

Casey Thomas-Hardesty, MS, NTP

Two Peas Wellness

Long term health risks

https://americanpregnancy.org/pregnancy-health/smoking-during-pregnancy/

Smoking cessation programs

https://chfs.ky.gov/agencies/dph/dpqi/cdpb/hpdocs/QNKFactSheetPregnancy.pdf

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Are you really eating for two? While you are definitely providing nutrition for two, you do not need that many more calories during pregnancy than your normal intake. The first trimester does not require additional kilocalories – 340 kilocalories are required in the second trimester and 450 kilocalories are required in third trimester for those at a healthy pre-pregnancy weight/BMI (Academy of Nutrition and Dietetics, 2023).

When assessing nutritional needs during pregnancy, it is important to maintain a balanced plate in terms of macronutrients (protein, fat, and carbohydrates) but vary the macronutrients regularly to help ensure intake of various vitamins and minerals.

Macronutrients for pregnancy

You could get into percentage breakdowns, but the easiest way to plan your meals is by using the plate method. This assumes:

• ½ your plate is non-starchy vegetables
• ¼ of your plate is protein
• ¼ of your plate is carbohydrates

Where is the fat? Many foods play double (or triple) duty and fall under more than one category of macronutrients. Such is the case with fat. Your fat intake will generally be included with your protein source, cooking fat like butter or olive oil that is used in vegetable preparation, and dairy that may make up a portion of your carbohydrates.

While the plate method is the preferred and easiest way to track macronutrients in pregnancy, it is important to note that many women drastically underestimate their protein needs. If you’re counting or weighing, 71g of protein per day is a good guide for the first half of pregnancy while increased need does not occur until second and third trimesters. Protein needs depend on weight — 1.1 g/kg of body weight, so some women may need more than 71 grams. If you’re struggling with protein due to meat aversions, see the below list of good sources of protein for alternatives (Academy of Nutrition and Dietetics, 2023).

Food Serving Size Protein Content

Lean beef: 3 ounces, 22 grams.

Chicken breast: 3 ounces, 26 grams

Salmon: 3 ounces, 22 grams.

Eggs: 2 eggs, 12 grams.

Milk: 1 cup, 8 grams.

Greek yogurt: 6 ounces, container 16 grams.

Northern beans: ½ cup, 6 grams

Peanut butter: 2 tablespoons, 7 grams

Meeting protein needs in pregnancy is relatively easy. Good sources include lean beef, chicken, seafood, dairy foods, beans and nuts. Keep in mind that a 3 ounce portion of meat is only about the size of a deck of cards, or the palm of a woman’s hand (FoodData Central, 2023)

Good sources of macronutrients

Protein

– Eggs

– Lean meat

– Greek yogurt

– Beans, peas, and lentils

– Chickpeas

– Nuts and nut butters

– Fish

– Protein powders

Fat

– Avocado

– Nuts and nut butters

– Pasteurized cheese

– Full fat yogurt

Carbohydrates

– Fruits and vegetables

– Sweet potatoes

– Rice

– Quinoa

– Dairy

– Whole grains

Casey Thomas-Hardesty, MS, NTP

Two Peas Wellness

Reviewed and edited by Heather Emerson-Payne, RD, PhD, 2023

References

Academy of Nutrition and Dietetics. Nutrition Care Manual. Comparative Standards, Gestational Diabetes Mellitus. https://www-nutritioncaremanual-org.wku.idm.oclc.org/topic.cfm?ncm_category_id=1&lv1=5517&lv2=18188&lv3=273833&ncm_toc_id=273833&ncm_heading=Nutrition%20Care. Accessed July 12, 2023.

Academy of Nutrition and Dietetics. Nutrition Care Manual. Comparative Standards, Normal Pregnancy. https://www-nutritioncaremanual-org.wku.idm.oclc.org/topic.cfm?ncm_category_id=1&lv1=272980&lv2=26918&lv3=268758&ncm_toc_id=268758&ncm_heading=Nutrition%20Care. Accessed July 12, 2023.

FoodData Central. U.S. Department of Agriculture, Agricultural Research Service. https://fdc.nal.usda.gov. Accessed August 14, 2023.

Institute of Medicine. 2005. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, DC: The National Academies Press. https://doi.org/10.17226/10490.

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It is important to adjust your nutrition as needed in order to support a healthy pregnancy. Below is a list of foods that are generally considered unsafe for pregnancy and are best to limit or avoid.

Avoid

• Alcohol – Alcohol can cross the placenta and can impact your growing baby’s development.
• Raw shellfish
• High mercury fish – The bigger the fish, the more mercury it will contain. Shark, swordfish, tilefish, king mackerel, big eye tuna, marlin, orange roughy should be avoided.
• Pre-cut fruits and vegetables – While there is no reason to limit or avoid fruits and vegetables as a whole, pre-cut fruits and vegetables have a higher risk of contamination with food borne illness. This does not apply to canned or frozen items. When purchasing fresh produce, it is important to follow food safety guidelines and wash and store them properly before consuming.
• Pre-made salads such as ham salad and chicken salad should not be consumed by pregnant women unless they are prepared at home.
• Toxoplamsa gondii is a parasite that is present in cat feces. Pregnant women should not change litter boxes for this reason.

Limit

• Caffeine – It is recommended to limit to 200mg of caffeine per day
• Sugar – Sugar does not directly cause gestational diabetes, but there are several things that increase risk, one of which is overweight/obesity prior to pregnancy. Eating too much added sugar can lead to eating too many kcal, which could lead to overweigh/obesity, which can in turn predispose someone to gestational diabetes (“Centers for Disease Control,” 2022).
• Artificial sweeteners – Research is suggesting that artificial sweeteners can interfere with our gut microbiome as well as increasing the likelihood of your child preferring sweet foods as they grow up (Ruiz-Ojeda et al., 2019).
• Deli meat – Deli meat and hot dogs should be heated until steaming hot. If you’re worried, heating deli meats to 165F greatly reduces the risk of listeria contamination.(“U.S. Food and Drug Administration,” 2022).
• Good choices rich in omega3 fatty acids, but lower in mercury include salmon, shrimp, tilapia, flounder, canned light tuna (includes skipjack tuna) but albacore tuna and yellowfin tuna should be limited to 4 ounces per week (“United States Environmental Protection Agency,” 2022).

Casey Thomas-Hardesty, MS, NTP

Two Peas Wellness

 Reviewed and edited by Heather Emerson-Payne, RD, PhD, 2023

References

Centers for Disease Control. (2022). Diabetes Risk Factors. Updated, April 5, 2022. Accessed August 14, 2023. https://www.cdc.gov/diabetes/basics/risk-factors.html

Ruiz-Ojeda, F. J., Plaza-Díaz, J., Sáez-Lara, M. J., & Gil, A. (2019). Effects of Sweeteners on the Gut Microbiota: A Review of Experimental Studies and Clinical Trials. Adv Nutr, 10(suppl_1), S31-S48. doi: 10.1093/advances/nmy037. Erratum in: Adv Nutr. 2020 Mar 1;11(2):468. PMID: 30721958; PMCID: PMC6363527.

U.S. Food and Drug Administration. (2022). Food Safety for Pregnant Women, Their Unborn Babies and Children Under Five. Pages 1-3. Accessed August 14, 2023. https://www.fda.gov/media/83740/download?attachment

United States Environmental Protection Agency. (2022). EPA-FDA Advice about Eating Fish and Shellfish. Updated November 3, 2022. Accessed July 12, 2023. EPA-FDA Advice about Eating Fish and Shellfish | US EPA

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During pregnancy, your usual energy level may take a dip at times, especially as your body adapts to hormonal shifts and increased body weight. Sometimes you may feel like lying on the couch all day, but inactivity can increase your fatigue. Try the following tips to help boost your energy level on those days that you’re feeling tired.

• Watch your diet. When you’re feeling tired, you naturally reach for sugary foods to help boost blood sugar levels. Eating sugar-rich foods will give you a spike of energy, but at the expense of a big dip afterward.  Instead, reach for protein-rich snacks that have some fat to help keep your blood sugar level steady. Try swapping a cookie for peanut butter on a cracker, or low sugar yogurt. 

• Get up and move a bit. You may not be up for a workout, but a short walk can wake up your body and boost your energy. Just think about doing 10-15 minutes of any activity, such as walking, doing several sets of going up and downstairs, or a portion of an exercise DVD. The key is to keep the intensity down and just move your body.

• If you don’t feel like aerobic exercise, spend 5-10 minutes strength training with a resistance band or hand weights.  Choose a weight or resistance that allows you to do at least 12 repetitions and 2-3 sets. Avoid overloading your weight lifting when your feeling tired–the goal is to get your blood pumping with some gentle reps.

• Take a power nap. You may think this is counterproductive, but if you feel exhausted, sometimes the best remedy is a short nap. The rules for an effective power nap are to keep it between 15-20 minutes, and avoid napping after 3 PM.  The sweet spot is sometime just after lunch and before 3:00 PM—any later than that can disrupt your nightly sleep. Remember to set the alarm, so you don’t oversleep, and even if you don’t fall asleep, taking the time to rest can be helpful. 

• Take a shower. One of the best ways to increase your energy level is by taking a shower. Avoid having the water temperature too hot, and end with a cold rinse if you can tolerate it. 

• Increase your fluid intake. Mild dehydration can make you feel tired, so monitor your fluid intake to make sure you’re drinking enough. Water is the best choice, but juices and even tea and coffee count. Aim for eight glasses of fluid or more a day. A good way to determine whether you’re dehydrated is by checking the color of your urine. If it’s deep yellow, it’s your cue to up your fluid intake. Aim for urine that is pale to almost clear.

• Use your breathing to decrease stress and improve your energy level. Pregnancy can be stressful, and when you’re feeling tense, your breath can become shallow. You can improve your breathing and reduce stress by “belly breathing.”  Hold your hands over your tummy, and as you breathe, allow your abdomen to expand outward (you should feel your tummy expand into your hands).  Avoid breathing with your upper body (where your shoulders lift and tense) and relax your shoulders as you slowly breathe in and out with your belly expanding and relaxing. Practice belly breathing several times a day to help train yourself to breathe correctly. 

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Exercise isn’t an all or nothing situation.  Although you may not always be able to fit in a gym visit or run into your day, you can easily up your physical activity levels by incorporating these simple tips into your daily routine.

• Break the habit of parking as close as possible to your destination. Consistently adding a short walk whenever you drive somewhere can add lots of healthy steps to your day.
• Take the stairs. Never take the elevator or escalator whenever possible. Stairs are a great way to get a burst of cardio, and stepping strengthens gluts and legs.
• Sit on an exercise ball.  Swap an exercise ball for your desk chair. Sitting on an exercise ball helps to improve posture, balance, and core strength. Roll your hips on the ball every 30 minutes or so to improve circulation and ease back strain. 
• Stand up often and consider a standing desk or treadmill desk. Standing burns more calories than sitting, and you’ll supercharge your energy output by using a treadmill desk.

• Skip a seated lunch and add a walk. The benefits of fitting in a bout of exercise mid-day are many and include burning calories, improving mood, and boosting energy. 
• Stretch at your desk. Set the alarm for every 30 minutes as a reminder to do some stretches. You can do many stretches in your chair, twisting to each side, or dropping down in front to stretch your back.
• Work out around the house.  Make everyday tasks double as an exercise by upping your pace as you move around the house and doing several stairs sets (up and down) whenever using your stairs. Think about how you can create a habit of exercising throughout your day, such as having a hand weight in your bathroom so you can do one-handed lifts while you brush your teeth, or squats while you’re waiting for your coffee to brew.
• Use technology. Set up an alarm on your phone to let you know it’s time to get up and move for a few minutes. It helps to keep the phone far enough away that you have to get up to turn off the alarm.  Also, if you’re a tech person, consider getting a fit bit or other fitness tracker to help motivate you to exercise more consistently. 
• Use TV time to move.  Instead of settling on the couch to watch your favorite program, set up a mini workout area in front of your TV, with a resistance band, hand weights and a jump rope or step for some cardio. 

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