Thursday, August 22, 2013

Reduce Leg Fatigue, Varicose Veins and Restless Leg Syndrome during Pregnancy!

Do you stand up on your feet frequently during the day?

A Mum-to-be who just doesn't get the chance to sit down, sound familiar?!

If you are suffering with leg fatigue, muscle cramps, restless leg syndrome and varicose veins?
Wearing compression tights can actually help alleviate these frustrating pregnancy symptoms and it may be time to invest in a pair! 

It was during my second pregnancy that I started to notice my left calf muscle was sore. I wasn't exercising as much as I had been during my first pregnancy and I was on my feet ALL DAY.
I personal train clients 20-24 hours a week standing up around 90% of the time and this second pregnancy I had an 18 month old to look after who didn't sleep, like mother like daughter!
I don't know about you but second time around I couldn't just go home after work and put my feet up to relax and rest like I had managed first time!

 I was quite surprised at 20 weeks when I noticed veins which were very apparent and often sore in my left leg.  I was worried that they would be varicose veins and stick around forever!. They were uncomfortable and I certainly didn't want them to get any more painful. 

Varicose veins can increase with each pregnancy. It is not unusual for you to suffer with them in subsequent pregnancies even though you may not have had them during your first. Your veins are prone to this due to the pregnancy hormones relaxin and progesterone along with increased blood volume. 

Poor circulation is also a factor contributing to varicose veins and work and lifestyle changes in my second pregnancy decreased optimal blood circulation:

  • During my first pregnancy I only ever did 2 hours of clients in a row, now I was doing 4 or more clients back to back.
  • First Pregnancy I was exercising 1-2 times a day
  • I lived in my compression tights as this is what triathletes did.
  • I rested and put my feet up often.
I started wearing my compression tights again during the day and would wear lite compression tights in the evening and for a couple of hours at night.

The tights immediately stopped the soreness and if I wore them during the evening the veins would have disappeared by morning.
I also reduced the time on my feet by consciously sitting down more regularly when I was with my clients, making sure I had enough time to cool down properly after exercise and would stretch most evenings.
You also need to make sure that you are adequately hydrated to reduce these pregnancy symptoms.

I am sure that the compression clothing played a huge part in stopping the veins from becoming permanent varicose veins.

During my 3rd pregnancy the veins came back with a vengeance and looked much worse but again I managed to stop them aching and turning in to varicose veins by wearing the compression clothing, sitting down frequently and stretching during the evening. Stretching in the evening and light exercise can help reduce restless leg syndrome.

The veins in my legs had completely disappeared 2-3 weeks after giving birth.

Robyn at 32 weeks pregnant has worn compression tights every day, she has continued to work full time standing up all day and has only just stopped running. 

You can even wear whilst exercising: Robyn training with me at the gym 34 weeks

Compression tights help increase blood flow by improving venous return this can help prevent varicose veins, calf muscle cramps and reduce restless leg syndrome.

Compression clothing may also reduce fluid retention both pre and post pregnancy as studies have found that the fabric reduces muscle fatigue, swelling and muscle soreness.

Post birth they can also be worn to help recovery as they will help to reduce extra pregnancy fluid retention.

2XU are the market leaders in compression clothing and I would strongly recommend you invest in a pair during your pregnancy. Tights can be worn under clothing so are perfect for hairdressers or for women who work with small children and teachers.

If you are suffering with any of the above pregnancy symptoms then I would definitely recommend that you trial a pair of compression tights. You may have to go up just one size from your normal pre pregnancy size so that they last your entire pregnancy.

2XU Websites:
Auckland NZ

Research on compression tights:

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If you feel any pain or discomfort whilst exercising, stop. If pain continues consult you L.M.C or G.P. The information included in this article has been written by Lorraine Scapens: She is not able to provide you with medical advice, information is used as guide. You cannot hold Lorraine liable in any way for any injuries that may occur whilst training.

Saturday, August 17, 2013

New Pregnancy Book Challenges the old Rules!

During Pregnancy we are bombarded with information telling us how we should, eat, drink, sleep and exercise to keep ourselves and our babies in the best possible health.

It can be extremely hard to work out what's right as with most topics one person says one thing and another can completely disagree.

Take for instance my profession Pre and Post Pregnancy Exercise.
I advise all women not to do Full push ups, crunches, frontal planks and pilates 100's after 15 weeks pregnant as it increases diastasis recti-abdominal muscle separation BUT there are still so many other professionals promoting these 'wreck your belly' type of exercises!

So when one woman Emily Oster has come out and stood up against many controversial issues surrounding pregnancy it is bound to create a stir especially when she suggests that drinking wine is ok! Her new book is called 'Expecting Better'!

There are many topics discussed in the book but a couple discussed below in the news piece are: sushi, alcohol and bedrest.

New Book Challenges No Drinking During Pregnancy 

Here is the latest news report, comment with your thoughts!

New Pregnancy Book: 'Expecting Better' 

Thursday, August 8, 2013

How to Push with an Epidural

Sounds simple enough doesn't it, pushing? What could possibly be hard about that? Well thats what I thought anyway!

The thing is we haven't EVER pushed out a baby before and if you have an epidural then theres a good chance that you won't feel a contraction telling you to push, never mind know and feel what to do!

My First Birth!
The first time I was in labour, my baby turned posterior after 5 hours so it took a little longer than expected, after 2 gas canisters and Pitocin about to be administered I was asking actually begging for an epidural!

Once the epidural took effect I could rest on the bed which is what I really needed as I had been on my feet for 24 hours up to this point. I could now relax and watch my baby's heart-rate on the monitor.

After the epidural I was surprised that I could feel and move my legs, I didn't  request a top up but my midwife gave it to me anyway. Soon after the second top up she checked to see if I had progressed and to determine baby's position. Hooray I was 10 cm and baby had turned anterior. Since then I have always questioned if the top up was necessary? 

On this assessment I would now have to wait for the effects of the epidural to wear off to enable me to push, I just wanted to get it over with!

I'm not sure how long I waited but I don't think it was long and I was encouraged to start pushing, this was when the real marathon phase started! 

First time Pusher!
I couldn't feel a thing, I had no idea when my uterus was contracting to be able to push and then when I did push nothing was happening! So after 2 3/4 hours an Obstetrician came in to check everything was ok?

She (the Ob) wasn't happy, adding to the epidural, was a full bladder which she emptied, you can't push a baby out with a full bladder. I couldn't feel the need to go but my midwife should have possibly checked me more frequently than she did?

I also know now that my Pelvic Floor Muscles (PFM) were too tight from too many pelvic squeezes/kegels and it was almost impossible for me to relax these muscles. I had a lot going against me, it was looking like an episiotomy, my worse fear!

Midwife to Obstetrician
Now the Obstetrician in charge changed a few things, first of all she said if I didn't get this baby out soon she would have to cut me, she got me to sit up, so I was now inclined with my knees bent and then she showed me. Yes thats right she put a mirror right where I could see everything, I nearly had a heart attack there and then! BUT it was amazing I had a visual. 

As this phase had taken some time, I could now feel the contractions slightly as the epidural had started to wear off with this, the threat of stitches and the mirror view it gave me the strength to continue, I had a chance! 

The main benefit of these changes was that I could now see for myself that I was making progress each time I pushed, I don't think I could have done it without this?
By sitting up and holding on to the back of my legs to help me push whilst watching everything gave me valuable feedback I would definitely recommend the above.

I didn't tear and our first daughter, Kate was born within 15 minutes of these changes.

How to Push:
We are often not taught how to push, even at many antenatal classes, why is this often not discussed?!

I try now to help and educate my clients on how to push and pushing effectively with or without an epidural and the different techniques that women can use.

Pregnancy- Prepare yourself!:
First of all don't over exercise your pelvic floor muscles, I certainly didn't make that mistake again and my next 2 births were a damn site easier!

Practice relaxing your pelvic floor muscles and do exercises regularaly that help you prepare specifically for labour and birth:

Exercise during your pregnancy will assist you in labour and can even shorten your labour time.
Specific exercise enables you to adopt better birthing positions during a labour with or without medical interventions.  

I have always found that it helps to have something to use to push against so you can exert force downwards towards your bottom a bedpost, ledge of a bath, your partner can work very well.
You can also pull a towel or sheet held by another support person to help you exert a similar pressure, you just have to make sure that you are not stronger than the other person! 


Lets have a look at what happens when your uterus contracts:

During a contraction your uterus muscles form opposing spirals from the top of the uterus first progressing to the lower section.

During the dilation phase your cervix becomes incorporated into the lower segment of the uterus. When your uterus contracts the muscles also contract causing the upper segment to shorten which draws the lower segment upwards this happens in a gradual but expulsive motion!

Work with What's Happening Naturally!

During a contraction I have always suggested to clients to think about themselves as a tube of toothpaste try to do what your uterus muscles are naturally doing.

At the start of the contraction squeeze your abs together from the top of your rib cage first gradually squeezing down whilst counting slowly to 10 or more seconds, pushing downwards.
Breath out slowly, as you do this relax your face and mouth this is when you can scream/curse which I found really helpful in a natural birth situation with numbers 2 and 3!
You may be able to push twice like this if its a big contraction. Some professionals may teach holding your breath but I believe this increases tension in the face which therefore tenses your bottom-relaxed face equals relaxed bottom! 

Lastly what you really need to do at the end of your push is make sure that your PFM are relaxed, like my friend Beth from Fit2b added in a blog and I hadn't thought of it this way until she mentioned it- don't push down and leave the top on the toothpaste!

All women and labours are different and each women may react differently to an epidural, some may find that they lose complete feeling whilst others can find if their epidural has been administered correctly they can feel enough of the contraction to push effectively.
I would suggest if you need or have to have an epidural it will help you deal with the situation if you have discussed the effective pushing techniques with your LMC.

Two questions I asked NZ, Auckland Hospital Anaesthetist:

Why do some women experience varying levels of pain relief?

" An ideal epidural gives good pain relief but there is a sensation of when the contraction occurs with no motor block i.e. local anaesthetic blocking nerve-muscle transmission causing leg, pelvic and abdominal muscle weakness.
Too much motor block hinders the woman's ability to push during second stage."

Is the measure of anaesthetic based on a woman's weight?

"To achieve this we use relatively dilute local anaesthetic which is given in incremental small doses which are standardised and not weight based. The effect of this is tested and then further given if necessary. 

Women differ in how much local anaesthetic they require to achieve an optimal block.
Many things will affect whether an epidural is effective mums expectations, fetal position, previous pain experiences, the rate of progress in labour.

There is usually a mild degree of motor weakness though on average this will only prolong labour by 15 minutes!

However if the epidural is in for a long time (<12hrs) the motor block becomes more prominent. Also there may be cases when a stronger local anaesthetic is required to achieve pain relief the side effect of this is more motor blockade.

If a caesarean is required we use a very strong local anaesthetic which totally stops all sensation from skin, internal organs and there is no sensation of contractions. A womans legs will be immobile for 4-5 hours then return to normal" 

 This is a video I found on Youtube teaching different pushing techniques, the squat however may be challenging as I am unsure how many hospitals have the bar facility. There is also increased pressure on the knee and the pelvis is in a posterior position (tucked under). It is a very different squat compared to a squat that you can hold in a natural birth situation.

I hope you have found the article helpful, please feel free to add any other advice and positions you used whilst using an epidural and what helped you to push, it may help others. 

I also wish to add that I have nothing against midwives I don't want to offend any with my comments above, I went on to birth my next 2 daughters with 2 different totally amazing Midwives and had 2 natural births.

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If you feel any pain or discomfort whilst exercising, stop. If pain continues consult you L.M.C or G.P. The information included in this article has been written by Lorraine Scapens: She is not able to provide you with medical advice, information is used as guide. You cannot hold Lorraine liable in any way for any injuries that may occur whilst training.

Tuesday, August 6, 2013

Horse Riding during Pregnancy: Should Zara Philips continue to ride, is it safe?

Should Pregnant Athletes take the risk if their chosen sport is deemed unsafe

Zara Philips is in the headlines yet again after riding at Gatcombe horse trials taking part in the Dressage section at approx 4-5 months pregnant. This is just a few weeks after she competed at the Barbury Horse Trials where she took a fall and yes a Polo Event at 4 months pregnant. 

Zara Philips 4 months pregnant at a Polo Event
Now just what is Zara Philips doing you might ask, is she trying to prove a point, what statement is she trying to make or is she just out to prove something to herself?

As an ex age group triathlete I can understand how professional athletes feel when they are pregnant and how they may wonder if they can continue their chosen sport which is often their job, safely during their pregnancy.
Some outsiders may say that they should not be pregnant if this is their focus?!

I say, why take that risk? It is not worth it and there are alternative sports and exercises that women can do during their pregnant months.

Safe Sports:
There are many sports that are safe to continue to do during pregnancy running, cycling and swimming for instance. There are also many sports that can be continued with modifications golf, tennis and weightlifting are just a few examples.

Sports that carry a Risk:

Sports not to do after the first trimester would be contact sports and sports that have an increased risk of injury. 

 Pregnancy is not a time to challenge yourself or prove a point!
Zara Philips Riding at Barbery

Horse Riding During Pregnancy

Now I am also an ex 3 day event rider! Women who have rode for years and have a deep understanding with their horses can continue riding safely at theirs and their babies risk, but this is not galloping around fields, jumping cross country fences or taking on polo which all increase the risk of a fall and abdominal trauma. It could just be a casual hack around the farm but again this could still cause a risk if the horse got spooked!

As a triathlete even though it is safe to continue I gave up road cycling almost immediately as I myself didn't want to take the risk of getting hit by a car, the roads here in NZ are terrible and many of my friends have been knocked off their bikes. I chose the alternative-indoor cycling.

Why are some sports more of a risk?
Once your uterus becomes an abdominal organ, it has grown in size and moved upwards out of the safety of the pelvis which normally happens around 14-16 weeks then blunt abdominal trauma can damage the pregnancy.

So it would seem like common sense for a women to modify or eliminate performing exercise that carries a high risk of abdominal trauma horse riding, water skiing, serious rock climbing, or the like. 

So no I don't think that Zara Philips should be jumping fences and putting herself and her baby at risk I can only think that as a first time mom she has no conception of just how lucky she is to be pregnant?

Instead of trying to continue to compete and take risks I think that she should be training for her pregnancy in the same way she would train for a riding event, with serious planning!
Focus on commitment, flexibility and compromise which in the end equate to success. Preparing specifically but safely for pregnancy, labour, birth and baby if she does that then she will truly cherish the Gold Medal award that awaits her.

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If you feel any pain or discomfort whilst exercising, stop. If pain continues consult you L.M.C or G.P. The information included in this article has been written by Lorraine Scapens: She is not able to provide you with medical advice, information is used as guide. You cannot hold Lorraine liable in any way for any injuries that may occur whilst training.