Balancing act
Our resident expert obstetrician/gynaecologist Dr Anil
Sharma sheds light on what's really important when looking after
yourself and your growing bump during pregnancy.
The one thing you can be sure of receiving during
pregnancy is advice. What to eat, what not to eat, how much to
exercise, why you should relax... Some advice will be useful, but
some is unsolicited and anxiety-provoking. From the point of view
of an obstetrician/gynaecologist, here's what I
recommend.
Foods to enjoy
Your diet should ideally include all four major food groups:
• Vegetables and fruits - around seven servings a day.
• Cereals, pasta, rice or bread (brown or wholegrain is
best) - around six servings a day.
• Dairy (milk, yoghurt, hard cheeses, etc) - two servings per
day, ideally the lower-fat versions.
• Protein (fish, chicken without skin, eggs, trimmed meat,
nuts and pulses) - at least one to two servings a day. Vegetarians
should supplement with iron and possibly vitamin B12. In general, a
serving of meat should fit in the palm of your hand, and a portion
of carbohydrate should fit in your cupped palm.
Foods to avoid
Listeria is a flu-like illness caused by a bacterium, and can occur
after eating cold or raw fish or seafood products (including
sushi). It can cause significant harm to your pregnancy and these
foods should be avoided. Similarly, one should stay away from pâté,
pre-cooked chicken, ham, all pre-cooked meat products, soft cheeses
(brie, camembert, etc), stored salads, coleslaws, unpasteurised
milk products, and any food prepared and stored in the fridge for
more than 12 hours. When the munchies strike, healthy snacks such
as yoghurt, washed fruits and vegetables, nuts, dried fruit, or
drinks such as fruit smoothies are much better for you and your
baby than chocolate bars or packets of over-salted
chips.
The fallacy of 'eating for two'
For women with an ideal BMI (body mass index, calculated as weight
in kilograms divided by height in metres squared) of 20-25
before pregnancy, the recommended average daily increase in
calories is nil extra in the first trimester, 350 in the second,
and 450 in the final trimester. 350 calories is around two
slices of wholemeal bread with light butter, a 150g carton of
yoghurt and an apple. See www.nhlbisupport.com/bmi
for an online BMI calculator.
When the munchies strike, healthy snacks
such as yoghurt, washed fruit and vegetables, nuts, dried fruit or
drinks such as fruit smoothies are much better for you and your
baby than chocolate bars and packedts of over-salted
chips.
Obesity
Obesity affects reproductive health and pregnancy in many ways,
including increased dificulty conceiving, spina bifida in the baby,
diabetes in pregnancy, raised blood pressure, and clots in the legs
that can break off and go to the lungs.
Birthing outcomes are also affected,
with an increased risk of a blood pressure condition (toxaemia),
difficult labour, admission of the newborn to the neonatal unit,
instrumental delivery and caesarean section (and greater
complications of the caesarean). There are also greater chances of
unsuccessful breastfeeding and postnatal depression. In an ideal
world, women (and their partners, for different reasons) would lose
weight to ensure they are in the normal weight range for their
height before getting pregnant. Nevertheless, dieting during
pregnancy is not a good idea. Eating sensibly and doing regular
exercise can prevent the excessive weight gain that is possible
during pregnancy.
Fluids
Drinking around 2-2.5 litres of fluids a day (six to eight glasses
of water) helps prevent bladder infections. It is generally
considered sensible to stick to a maximum of two caffeinated drinks
(tea, coffee or cola) per day. Alcohol is best avoided
completely.
Exercise
If you have other medical conditions, please see your
doctor before starting any exercise programme. If there are no
problems with your pregnancy, then swimming, walking, light
aerobics, and exercycle machines are all beneficial, as long as you
are comfortable. Regular exercise is to be encouraged, as the
positive benefits, including lower blood pressure and improved
self-esteem, outweigh the theoretical disadvantages, and studies
have backed up this general advice. Aim for 20 to 30 minutes of
moderate activity each day, and walk up the stairs instead of using
the lift (maybe some of your non-pregnant colleagues will be
inspired by the example you set!).
As the ligaments (a band of tough
tissue that fixes two bones together) in your body relax during
pregnancy, you are especially vulnerable to injury, particularly in
the pelvis and back. Swimming is an excellent form of resistance
exercise in pregnancy. The weightlessness experienced during
swimming is relaxing as well as energising.
There are also a number of group
pregnancy classes that are run at local gyms, many by
physiotherapists. Camaraderie tends to aid activity. Remember to
keep sedentary activities, e.g. sitting at a computer or
watching TV, to a minimum and get up for a stretch and a walk every
20-30 minutes.
It is important not to overheat and,
in later pregnancy, to avoid exercise that involves lying on your
back. Doing exercises at a cool time of day is a good idea, and
five minutes of pre-exercise warming up and cooling down
afterwards is sensible to avoid injury.
If you have been running on a
regular basis when you become pregnant, it is generally fine to
continue until it starts to become uncomfortable. If you have not
been a regular runner, pregnancy is not a good time to take it
up!
Scuba diving, body-contact sports,
and high-altitude climbing should also be avoided. Using hot tubs,
steam rooms, saunas, or spas during pregnancy are generally not
advised.
If you have not been doing any
regular exercise before pregnancy and want to begin, walking is the
cheapest, safest, and most beneficial option. Walk for at
least half-an-hour, four times a week. Start off slowly, building
up the speed and distance as you get fitter. Another benefit of
walking is that it is easy to continue once the baby is born. Most
babies enjoy being walked (and sleeping!) in a stroller, and you
may find it is a good way to keep you both content, and your
partner fit as well.
OHbaby!'s fitness expert, Lou James
of re:ab, has experience in advising pregnant women and mums about
appropriate levels of activity for their fitness level. Visit the
OHbaby! website and click on Ask Our Experts if you'd like to find
out more about exercise during pregnancy.
Lifestyle factors
Generally, sex during pregnancy will not harm the baby, although if
bleeding has occurred during pregnancy, many women feel more
reassured by avoiding intercourse. Other issues, such as a
recent procedure (chorionic villus sampling or amniocentesis), or a
low-lying placenta, can mean that avoiding sex is important. If
there is any doubt, please ask your lead maternity carer. In the
absence of any medical conditions that contraindicate sex during
pregnancy, there is no difference between what is "normal" in
either pregnancy or non-pregnancy.
Some stress during pregnancy is
universal, as it is outside of pregnancy. We all experience stress,
although we deny it much of the time. Stress can be harmful during
pregnancy, and it is reasonable to at least try and reduce your
stress and anxiety levels as much as possible.
What can stress during pregnancy
cause?
Some studies have shown that very high levels of stress may
contribute to an increased risk of premature birth, or low
birth-weight babies. We all know that high stress levels can make
us "unwell", increasing our heart rate, blood pressure, and
producing chronic anxiety. Although we have no hard and fast
evidence, as it is difficult to allow for "life factors", there is
growing recognition that our in-utero environment, and what we are
exposed to while we were in it, can affect us once we emerge into
individual existence. In the same way that what you eat affects
your baby, so too do your stress levels.
Managing stress during pregnancy (and
beyond!)
This means looking after yourself, feeling rested and relaxed, and
finding healthy ways to relieve stress and anxiety. The idea is to
feel better yourself and thus help the pregnancy develop
optimally.
Once again, eat a healthy, well-balanced
diet, as this provides sustained release of healthy building blocks
from which you will feel better than if you eat junk food (just
watch the movie Supersize Me!). Not only will you be more alert,
but also, your baby will have healthy building blocks with which to
grow.
Get enough sleep, as the less sleep
we get, the more stressed we are. Ensure that you have comfortable
pillows or even a body pillow. Perhaps treat yourself to nice new
sheets and a relaxing bath and music before bed. To minimise
heartburn when lying down, avoid eating up to one hour before bed.
Once your "bump" is getting bigger, you may find it much more
comfortable to sleep on your side.
Once again, regular exercise is a great
way to help cope with stress and will (after a few weeks of
sustained exercise), give you more energy for life's tasks. It
should also leave you more tired and relaxed at bedtime. Avoid
exercising just before bedtime, as it may prevent you falling
asleep. Relative fitness in pregnancy can also help ease labour
pain and alleviate some of the anxiety in labour and birth.
You may wish to try other
stress-reduction techniques, including yoga or meditation. Make
sure that you seek professional advice and that the classes are
aware that you are pregnant. Some women find that aromatherapy is
useful, but again, get qualified advice. Massage therapy is another
way of alleviating stress but make sure that the therapist is
qualified and knows you are pregnant. Saunas and hot pools are not
advised, as raising your body temperature for a prolonged period is
not good for your circulation, or the baby. Talking with your
partner and planning for the forthcoming physical, emotional, and
financial changes in your lives is very worthwhile, and can help
you to work through your anxieties.
If you can afford to, try and reduce your
workload. Carrying a baby (or babies!) for 40 weeks is a lot
of hard work. Accept the help that may be offered by workmates,
family and friends. If you find you are getting very stressed about
the impending birth, ask your lead maternity carer for advice. Most
of the time he or she will be able to alleviate your worries and
support you.
Antenatal classes are designed to empower
you with the knowledge required to cope with the fear of the
unknown. If you find there is anything that only makes you
more worried, feel free to ask the educator more detailed
questions.
Take time out for yourself. Looking after
your well-being is much more important than housework. The first
and last trimesters of pregnancy, in particular, can be very
tiring.
Parting advice
Asking for help can be very difficult, but remember that many
people around you, including friends, family, and caregivers, have
been through pregnancy themselves and will gladly help if asked. If
you feel particularly low and unable to cope, do discuss this with
your caregiver, as specialised advice and help is
available.
Remember, also, that lugging around heavy baskets of
washing and vacuum cleaners is not such a great idea in the final
trimester of pregnancy, not least because of the easily injured
ligaments of the pelvis and back. If you are doing too much, cut
back in areas which aren't a high priority, and ask your partner to
muck in.
Dr Anil Sharma is a specialist doctor in Gynaecology
and Maternity.
He is very involved in lectures and updates for family doctors and
frequently takes part in debate regarding women's health and
maternity for print media and radio. He believes that anxiety and
fear can be conquered by knowledge. Anil immigrated to New Zealand
from the UK in 2001 with his wife, Rachel, and he tries hard to be
a hands-on and fun father (putting golf and cars on hold for the
time being) to their three daughters, who were all born here. For
further information about Anil's practice, visit
www.dranilsharma.co.nz
As seen in OHbaby!
magazine Issue 3: 2008
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