Friday, June 18, 2010

Pelvic Floor Party Trick

Many of you have read the recent and popular posts, Pelvic Floor Party and Pelvic Floor Encore, but you may no longer be following along in the comments where the discussion lives (rages?) on. I'm thrilled Mama Sweat is the forum for such an important discussion, but mostly all I can do is nod and smile.

This week, we got a comment that made me laugh out loud and I knew that there was no way I could leave it buried and unnoticed. From Matthew J Taylor, PT, PhD (trust him, he's a doctor) we get:

Not to confuse the issue, but to introduce some fun, I presume everyone is familiar with the concept of the connection between the pelvic floor and your tongue (careful, it's a family site)?

Seriously...sit feet flat on the floor, pelvis square on a chair, spine softly erect. Now, sensing the space between your sitting bones (ischial tuberosities), gently begin to press your tongue against the back of your teeth and watch what happens to your PF as you increase the pressure, and then watch as you slowly release (old Feldenkrais lesson).

Not only that, but what you are thinking and what you believe in the moment directly impacts your breathing pattern, which also sets tone in the PF (for the evidence crowds see O'Sullivan PB, Beales DJ. Man Ther. 2007.Aug;12 (3):209-18. Epub 2006 Aug 17.)

So feet on the floor, soften the tongue and exhale...happy PF's everyone!
Isn't that great? Although I don't know who old Feldenkrais is, I appreciate the new party trick because I can't touch my nose with my tongue.

On a more serious note, another comment came in regarding the important but forgotten step of relaxing the pelvic floor. Leah F. gives us another good reason to put it into practice and stop being so "assed up" all the time:

As a counseling student, I've become aware of valuable information about pelvic floor relaxation in trauma work and in bodily health (the idea being that if we live in a constantly stressed state, in the "fight or flight" sympathetic nervous system, our bodies will burn out, hence the need for an effective way to relax). The pelvic floor is the only part of the body completely surrounded by muscle, so by relaxing the PF for 20-30 seconds, the rest of the body is triggered to relax and switch into the parasympathetic nervous system. "Being able to live in a state of 'non anxious presence' (NAP) is key to managing future potential crises and traumas. NAP is not something that can be mastered in one session, but is something that needs to be practiced and used when life is not traumatic. It is a technique used to facilitate the PNS, so that we may stay relaxed and calm. Good gauge of a NAP is a relaxed pelvic floor. Being in this state allows one to be empathetic, compassionate and bear witness as a spectator. It is about relaxed mindfulness and comfort in ones own body." (Noel Holdsworth DNH, APRN-BC, CTS www.ejhealers.com)
And included in all this pelvic floor discussion we have had a few comments calling for the need for "scientific proof."

It's there, says Christine Kent from Whole Woman, Inc. who urges us to check out the paper, "Genital prolapse: a legacy of the West?" in the Australian and New Zealand Journal of Obstetrics and Gynaecology. But as she puts it: "The people who fund large studies generally do not want to know what reverses the very disorder that is the bread and butter of gynecology." She goes on to say:
More importantly are natural and real-time testimonials of women themselves, which were never possible before the great democratizing power of the internet. Maintaining the natural shape of the spine is the only way the pelvic organ support system properly functions.
And I liked what Michael Curran had to say in response to an "anonymous scientist":

As a health practitioner, I have followed this blog with some interest. In an intelligent discussion, Anonymous provides an odd voice, without the self-respect to identify the source of strange and illogical arguments backed only by having identified one’s self as “a scientist.” Where Bowman has presented a logical, coherent and viable solution for a pervasive health problem, your contribution has been to question the scientific validity of the approach by comparing PFD with stretch marks (ladies) and "inherited bad teeth."

It’s a sad state of affairs when a “scientist” - real or self-perceived - is so quick to dismiss an unfamiliar therapy when the “correlation” evidence is compelling, the contrary evidence is non-existent, and the cost of implementation is zero.
And that's the bottom line here. In my mind it doesn't matter whether there are studies to back this up or not. If you start squatting more (and squatting more will neither hurt you or cost you anything) and this helps you, then your study of one is successful.

Heck, with all the responses to these posts and so many woman ready to drop Kegels from their life (it's like a bra-burning rally at Mama Sweat) we've got plenty of willing study participants, don't you think?

Everything I know about pelvic floor health is posted on my website, www.lifeasafitmom.com.

Thursday, June 10, 2010

Second Pelvic Floor Encore

For those of you arriving for pelvic floor enlightenment (or wish to further your enlightenment), Katy Bowman just posted a fantastic video tutorial on her blog (with a skeletal pelvic prop!) as a follow up to the frenzy we've been experiencing, and as Katy say:
"If there is anything we don't need it is more Huh? when it comes to our own equipment!"
Give yourself five minutes today for her vlog, Pelvic Floor Demystified.

Does anyone else want to be Katy's best friend?

Everything I know about pelvic floor health is posted on my website, www.lifeasafitmom.com.

Thursday, May 20, 2010

Pelvic Floor Encore

Well, well, well.

By the look of my stat counter it appears I've struck a hot topic with Monday's post: Pelvic Floor Party: Kegels are NOT invited. The comments have been flying and Katy Bowman has been along with us to answer questions. Katy even posted on the topic on her own blog, Katy Says (and the post has cool graphics, so you must check it out). As the conversation ensued in the comment section I had one more question for her--one I thought deserved its own post. Here--thanks to your standing ovation--is an encore question and answer.

And here's another question for Katy on the Kegels. I don't think you're saying we write Kegels completely out of the books, are you? Would Kegels be useful, say during pregnancy and, especially immediately after childbirth when the PF has been directly traumatized? But the difference is we should not go overboard and we still have to build up the other muscles surrounding the PF. Post birth we can go from the Kegel being something we do as an exercise (a few times throughout the day versus 200 times like people have been saying) to something we do in "real time" situations (to hold back urine when we sneeze/laugh/cough/etc.)

Katy, what say you?

I can’t believe how popular this blog has become. Do you know I have friends from elementary school emailing me saying they read this posted on Facebook by people I don’t even know? And I think it is striking such a cord because 80 percent of women are facing this problem, many times silently, and are now really confused. That isn’t what we want either, is it Kara?!

So now you may be wondering “who to trust.” Why would you listen to me? Why am I saying something soooo different than other “experts”? These are all good questions, and questions you should be asking. First off, let me fill you in on the Kegel exercise. Dr. Kegel, an OBGYN, had a device that he invented that he thought would help many of his (caucasian) patients recover from the birthing process.

Before I go any further: It is well documented that Western, modern-living women have much more difficult births than their less-modernized counterparts. During these times (mid 1800’s to the 1930’s) pelvic floor damage and baby-head smashing was a problem for “civilized women,” but not the “Tinkers” (Irish gypsies) or tribal-living women. The only differences in these groups turned out to be the size of their birthing space. The size of the birthing space (the obstetrical conjugate) is created by the bony surfaces of the pelvis. The sacrum (the base of the tailbone) makes up the back side of this birthing space. The cool thing is, the sacrum is not attached to the pelvis, but floating against it. Less-civilized women (like their male counterparts) have squatted to “bathroom” their entire lives. This squatting increased their birthing space by activating the glutes (pulling the sacrum back to open the birthing space). This extra space meant less pressure on their PFs during birth (less tearing of the muscles and tendons) and required less damage to the ligaments in between the bones.

Another way to say this is the life-long habit of squatting is what prevented the PF from being damaged in the first place. The balance between the perfect amount of glute contraction and the perfect amount of PF tone give you what you want. Good pelvic (and abdominal) organ support. [Kara's Note: read Katy's post about the Hunter Gathering Mama for more about squatting for birth preparation.]

Back to Dr. Kegel. Now he had all these women who were noticing weakness and invented the Kegelizer, or something like that. It was equivalent to the Kegel-exercisers you see now. Just insert and squeeze. The squeeze improved the lost mental connection between a damaged PF and one that was firing correctly. Firing correctly meant that when the PF was done contracting, the muscles could restore to their optimal length. This part of Dr. Kegel’s research protocol has been left out and the only part that has been passed on is the contracting part.

Science Note: The muscle tissue in your PF is the same as the muscle tissue in your biceps. When you’re done realllly working your biceps, you’d like your arm to go back to its original length, right? What if, when you were done doing your curls, your elbows stayed as bent as they were when your muscles were the TIGHTEST? If you equate strong with tight, then you’d have “strong,” contracted arms with bent elbows all the time. Tight muscles. Unusable arms.

That’s not what TONE is. Tone is having the MOST strength and the MOST length.

Doing Kegels all the time will get you a TIGHT, unusable pelvic floor. This is why people’s ORGANS ARE FALLING OUT OF THEIR BODY.

Probably the worst time to be doing Kegels in the way we think “Kegels” is during pregnancy. If you looked at the research for birthing mechanics it is clear that women (especially Western women) are allowing their pelvic girdle to collapse based on our lack of glute (and calf and hamstring tension). The research shows that PFD isn’t a problem in other parts of the world.

So, all you Hot Mamas-To-Be out there HAVE TO SQUAT THREE TIMES A DAY until these joint motions come naturally. That’s how you tend to your PF before delivery. To all of you Hot Mamas out there with your birthing days behind you: Don’t let your PF gripping become stronger than your glutes.

I came up with the perfect solution, Kara. Gently tense and fully release (shy of urinating) your PF 10 times while you are in a squatting position. That way you know you are keeping all the pelvic muscles balanced.
Thank you Katy, again, for such eye-opening and SENSIBLE information. Now, let's take a vote. The exercise Katy describes as a replacement for traditional Kegels, I'm going to hereby refer to as the Bowman Squat. Everyone raise your hand if you agree.

An hour after originally posting I'm back because I've had an hour to process this and have a few thoughts. What I'm hearing is (this sounds like I'm in a counseling session, which I almost feel like I need after such apocalyptic information) that Kegels aren't inherently bad, that Dr. Kegel meant well but our puritanic based society just got a little too anal (literally) about them. I mean, I know I for one think that if 10 push ups are good, then 20 are better. If I can do a sprint triathlon, then heck let's go for the Ironman! So it's easy to see how we heard Dr. Kegel (which became every OB on the planet) telling us to squeeze, but we ignored that bit about releasing. And now I'm going deep, folks... but who among us has an easy time "letting go." That, right there, is what childbirth is all about: letting our body open up and let go. But the majority of women can't do it without numbing drugs and interventions. Open up and let go? Huh, what? No, letting go just doesn't come natural to us in our society. We can clench and squeeze and get nice and tightly wound, but ask us to let go? I think what Katy is saying is that our pelvic floor needs balance, we can't overlook the benefits of lengthening and stretching while we're busy strengthening. The exercise of letting go is always a good one to practice in any aspect of life. And I'm telling you, to relax your pelvic floor just shy of urinating--holy cow!--it's super relaxing; like sinking into a tub of warm water... wait, that was water, right?

Everything I know about pelvic floor health is posted on my website, www.lifeasafitmom.com.

Monday, May 17, 2010

Pelvic Floor Party: Kegels are NOT invited.

You now have permission to pee in the shower.

Recently I met a woman who told me she used to be a runner. Naturally, I asked: Why don't you still run? The answer: "Because 60 hours of labor with my first child and a forceps delivery ruined my desire to run anymore."


To sum up for those who still may not infer the problem: She pees her pants when she picks up the pace.

My friends and I joke about sneeze pee, jumping jack pee, trampoline pee, and other bladder challenges. But full blown incontinence is no laughing matter. I'm a firm believer that a strong pelvic floor is the answer to incontinence (although pharmaceutical companies and surgeons often try to persuade people with other remedies). A strong pelvic floor, I've learned, not only makes the difference between wet and dry running shorts, but also keeps me running pain-free: I no longer suffer from the back and hip problems that used to plague me.

So today I bring you an interview with Katy Bowman. I have had the opportunity to interview Katy for magazine articles. Since becoming a freelance writer 13 years ago I have interviewed scores of sources. Very few I remember. Katy made an impression. She is a biomechanical scientist who applies her knowledge on the human body. Among other things, she has her own DVD program, "Aligned and Well," and is the director of the Restorative Exercise Institute. Her blog, Katy Says, is amazing (and she's as funny as she is smart). I like that combination so I asked her to chime in about the pelvic floor. I had no idea she would rock my pelvic floor world. Even if you've never peed in your running shorts even a little bit, you should still read what she has to say about pelvic floor strength.

Mama Sweat: First, a lot of women just assume it's childbirth that causes incontinence, but I've read that pregnancy itself puts a strain on the bladder (so a c-section won't necessarily save you) and that most women, as they get older--whether they've had children or not--will likely experience problems with incontinence. And even men aren't immune. All this suggests that a weak pelvic floor doesn't discriminate.

Katy Bowman: Nulliparous women (that's women who've never had a baby) and men are equally affected with PFD (pelvic floor disorder) so while child birth may accelerate PF weakening, it is not a primary cause of PFD. PFD is first caused by slack in the pelvic floor due to the fact that the sacrum is moving anterior, into the bowl of the pelvis. Because the PF muscles attach from the coccyx to the pubic bone, the closer these bony attachments get, the more slack in the PF (the PF becomes a hammock).

MS: So rather than a hammock, you'd rather your PF be more like a stretcher--more firm and able to hold up weight without buckling?

KB: I like to think of the PF like a trampoline--the material is supple, but taut...the perfect muscle length.

MS: And kegels. Everyone on my blog has heard me preach about kegels. I want to make sure all my readers are doing them right. Suggestions?

KB: A kegel attempts to strengthen the PF, but it really only continues to pull the sacrum inward promoting even more weakness, and more PF gripping. The muscles that balance out the anterior pull on the sacrum are the glutes. A lack of glutes (having no butt) is what makes this group so much more susceptible to PFD. Zero lumbar curvature (missing the little curve at the small of the back) is the most telling sign that the PF is beginning to weaken. Deep, regular squats (pictured in hunter-gathering mama) create the posterior pull on the sacrum. Peeing like this in the shower is a great daily practice, as is relaxing the PF muscles to make sure that you're not squeezing the bathroom muscle closers too tight. Just close them enough...An easier way to say this is: Weak glutes + too many Kegels = PFD.

MS: OK, I had to step away from my computer a moment to fully process this. First of all, you just said it's OK to pee in the shower, but what really has my head spinning--did I catch this right?--you said: Too many Kegels can cause PFD? Did everyone hear that loud screeching noise? You realize this goes against everything I've ever heard or read; that kegels are the be all end all for pelvic floor strength.

KB: I know, I feel like I'm running around saying The Sky is Falling, The Sky is Falling. The misunderstanding of pelvic floor issues is so widely spread, I'm a Team of One right now. But, I've got all of the science backing it up and it makes sense, the kegel is just such a huge part of our inherited culture information, no one bothered to fully examine it. Anyhow, your PF is underneath the weight of your organs, and the strength your PF needs is equal to this weight (you don't need SUPER STRONG PF muscles, just enough to keep everything closed). When you run, the extra G forces (2-3) actually increase the "weight" while running, but the PF should be adapting, just like all your muscles. One of the biggest misnomers is that tight muscles are "strong" and loose muscles are "weak." In actuality, the strongest muscle is one that is the perfect length - you need Pelvic Floor Goldilocks - it's juuuuuust right. The Kegel keeps making the PF tighter and tighter (and weaker and weaker). The short term benefits are masking the long term detriments. Ditch the kegels and add two to three squat sessions throughout the day (anywhere). The glutes strengthen and as a result, they pull the sacrum back, stretching the PF from a hammock to a trampoline. Viola! You can still practice opening and closing your PF in real-time situations, but you don't have to approach it like a weight-lifting session or anything. It doesn't need to be on the To Do list :)

MS: I am ALL for scratching items off my to-do list! Before we get too carried away with our newfound freedom from Kegels, I want to get back to the role of our glutes. What you’re saying--and I love this--is that there’s a much better reason, besides aesthetics, to avoid the flat butt syndrome found in most older women (further exacerbated in "mom jeans"). Having a booty--as in strong glutes--will not only do wonders for your view from the backside but prevent you from peeing just a little (or a lot) when you sneeze. This is revolutionary. I love what I'm hearing.

KB: Ok, I'm yelling this: YOU REQUIRE YOUR BUTT MUSCLES! There aren't any extraneous parts on the body! Every muscle is really a pulley that is holding your skeleton just so. When you let your glutes go, you allow the bones of the pelvis to collpase into themselves. The squat is the most effective and natural glute strengthener--using the full range of motion and your body weight. It is entirely more effective than any gym machine or contrived exercise. The hunter-gathering folks squat multiple times a day (or at least once in the morning), so they had a nice routine down over a lifetime. Doing this four to five times a day, every day of your pregnancy will improve the delivery as well!

MS: I’ve also read that squatting during pregnancy helps prevent the posterior position during delivery (when babies emerge face up, rather than face down), which causes excruciating back labor and with it more interventions, more cesarean deliveries. In America, where we tend to sit back and put our feet up rather than squat and sit forward, the posterior position is more common than in countries where squat sitting is the norm. I was a squatter during my pregnancies, but now I will continue: when I’m playing with The Boy, picking weeds in the yard, pulling laundry out of the dryer or getting a pot from the cupboard. Lots of opportunities to squat!

I know you've brought up posture as a culprit too. How does posture play a roll and how do we keep good pelvic posture?

KB: You can only have optimal PF function when the pelvis is in a particular position. The two bony points on the front of the pelvis (where you put your hands on your hips) should be vertically stacked over your pubic bone. Most women have become "tuckers" based on their mom or gram telling them to not stick their butt out. Athletes tend to be super-tight through the quads and psoas, which also keeps the pelvis tucked under. Wearing high heels requires women to reposition their joints to deal with the torque at the ankle, and many women will post-tilt the pelvis there as well. For optimal pelvic health, one needs to make sure the posterior muscles (glutes, hams, and calves) aren't pulling the pelvis under and keep the psoas and groin loose as well.

MS: So, this requires that we stretch out the muscles in front and strengthen the muscles in back?

KB: The muscles are weak because they are tight. More "strength" or tension-increasing exercises are going to make it worse. Instead, muscle lengthening exercises--especially stretching the calves, hamstrings, groin (adductors)--are the best prescription. Also, you need to learn how to hold your pelvis correctly to optimize strength!

MS: Which brings me to your DVD with the awesome title: "Down There."

KB: The DVD is designed to get the pelvis in the correct position so the PF can work optimally. Typical PF treatment is trying to strengthen the PF muscles with the pelvis itself is in the wrong position, which means the treatments don't work very well. That's why once you have surgery, the statistics say you will have to have a 2nd, 3rd, and even a 4th in your lifetime! It is not a permanent fix, so it's better to not even go down that road. The DVD will teach you to stretch and relax the muscles that are pulling the pelvis out of alignment--and let the correct muscle tone of the PF re-establish itself.

MS: Should we watch it in the bedroom with the shades drawn or is this something we can do with the kiddies around?

KB: Yes! You can keep the lights on and even the front door open. The exercises are mostly inner thigh and back-of-the-leg stretching, so if you don't tell anyone what it's for then they'd never know. And it's also a great program for kids to follow--especially if they are having problems wetting the bed--the muscle tension pattern is the same in the kids as they are in incontinent moms.

MS: OMG! If you were sitting here in front of me I'd kiss you right now! I am forever washing bedsheets. I can't wait to try it out.

Let's get back to peeing in the shower. Now that you've legitimized it for us (I don't advise this practice at the gym, however), let me ask this: Why do I feel the urge to pee a little (or, OK, I'll say it, sometimes a lot) when I hit a warm shower? Wasn't this covered in a Seinfeld episode? Seriously, what is it about the warm water that makes me want to let go?

KB: When the PF is weak, women start to use the glutes and adductors to keep the bladder closed (instead of the sphincter muscle of the bladder itself). When you hit the shower, those external muscles relax and HELLO! you realize that you don't have actual control of the deeper, internal muscles of the PF.

MS: OK. I thought my PF was strong, but I see I have more work to do. I suppose it’s like any muscle, strengthening must be an on-going practice. But for someone who is suffering from incontinence, or this friend of mine who is afraid to run, how soon should they expect to notice a difference once they start a "training program"? And at what point should a woman consider pharmaceutical or surgical options? Ever?

KB: I don't think a surgical option is ever a good idea, as the problem isn't coming from one time damage, but the accumulation of 1) bearing down a lot and 2) from squeezing the PF all the time. Working on relaxing the PF and keeping it closed "just enough," stretching the backs of the legs to free up the pelvis, doing regular, daily squats to strengthen the glutes, and ditching the heels (except in special occasions) are things you can do all the time for all-the-time improvement. Also, doing tons of crunches where you are bearing down on the PF will only make PF health worse. It's better to do transverse abdominal stabilizing exercises - like the plank - that will decrease any bearing down that sprains pelvic organ ligaments. Once you get yourself out of the weak and overcompensating PF tension cycle, you should feel like you have better bladder control within a few weeks. If you are already experiencing organ prolapse (it is way more common that people realize) you need to skip the run and switch to long, endurance walks (minimize G forces), and do your pelvic-aligning exercises every day--maybe even twice.

MS: Wow. This is revolutionary. And it makes sense. I can hardly believe I'm just. now. learning. this. I can't be the only one who's feeling a little cheated. Women (and men) need to know all this. Thank you, Katy, for answering my questions and sharing your knowledge. I know this information will change a lot of lives. And if I can stop buying nighttime pull-ups for my girls, the benefits are more far reaching than I thought!


****Due to the popularity of this post (where are all you people coming from?!) I did a follow up interview with Katy Bowman. This is especially important if you're a Kegel fan--we haven't written them off entirely. Check out Pelvic Floor Encore.


Monday, December 15, 2008

Everything I Know About Coping with Pregnancy I Learned from Being a Triathlete

After spending a good chunk of my life as a triathlete, it's no wonder I have applied much of my approach and methods for training to my pregnancies. I didn't do this consciously, but in the thick of this third-time-around-pregnancy I've come to realize that the triathlon lifestyle and a healthy pregnancy are excellent partners. Let me elaborate...

1. Ice is nice. After finishing my third marathon (Big Sur--a must run) I saw kiddie pools filled with ice water available for the runners. Because marathoners' brains are a bit addled after 26.2 miles, sitting in a pool of ice water seemed heavenly. And it was. Even better was the next morning, when I had enough spring in my step to walk the hilly streets of San Francisco. From then on an ice bath became my ritual after any run longer than 18 miles. Fast forward many years later, about midway through my first pregnancy--heavy with twins--it occurred to me one night that I felt like I had run 18 miles. And then I realized that an ice bath might make my aching legs feel better. Getting in the tub of as-cold-as-I could make-it-water wasn't quite as easy that time, but once there, and especially after, the benefits were worth the initial discomfort. So much so that I took an ice-cold bath almost every night until I had those babies. I've never had swollen cankles or circulation problems in my pregnancies. Am I lucky or is it my affinity for a polar plunge?

2. Don't be a martyr: modify. So often athletes want to power through their workouts, even when injured or fatigued (not the sleepy kind, rather the overtrained kind). To persevere can be a wonderful trait. Or it can be really stupid. Sometimes it's more ego than will; as in, I want everyone to know how tough I am. Smart athletes (as in they've learned via experience) know this kind of attitude most always does more harm than good. I've aspired to be that woman who ran the day she gave birth, and yet, with each pregnancy I've had a wake up call that I'm not meant to be that woman. It's come at different times with each pregnancy. I ran up until 22 weeks this time. Sure, I could have continued to run, but my gait felt strange and my quads felt tight. Walking worked better. That is, until last weekend when I hit 30 weeks. My low back ached, my tailbone throbbed. Now I have to modify my modified workout by walking in the pool. My purpose for working out this pregnancy isn't to impress my friends and neighbors, it's to maintain some semblance of fitness and have the healthiest pregnancy I can. Pain in this case, is not gain. And yet, there's something about being a triathlete that urges me to "try harder." That's O.K., too, so long as you can differentiate between perseverance and ego. Just last week, after playing Cardio Tennis, I concluded my ego was in play, especially during our last game when I lunged for a ball (and missed, I might add). Nothing like peeing your pants just a little to keep your ego in check.

3. Be good to your training partner. Most of my big races I've teamed up with friends for the training. These relationships require a hefty dose of respect for each other's time and needs, and lots of cooperation, too. For me the upside of training with a friend for long runs and rides, is worth any potential downside: a slower-than-anticipated workout if your partner is having an off day or, say, stopping for a potty break even when you don't need one. For me, the journey is most important, and I like to share it. Being pregnant means you always have a training partner along for the workout. And so, I do my best to listen to the babe: "What, too fast you think? You want to slow down a bit? OK." "You'd rather get in the pool than lift weights? Sure." "Make a potty stop now? Let's do it!" "Handlebars too low on the spin bike--getting squished, you say? Here, let me help." 

4. Follow the sleep rule. Somewhere in my mental training notes I've accumulated in nearly two decades I remember reading that for every hour of hard training effort you should sleep an extra hour. Sleep is, after all, the mode in which our body uses to repair and heal. I think intuitively or by default, I've adopted this rule for pregnancy, too. I've noticed on days when my effort was more intense (like that indoor triathlon) I've either needed a nap, crashed early or ignored my internal alarm in the morning. Now that I'm more aware of this I try to plan for it, i.e., if I see a nap coming I prepare the Princess Movie for the girls in the afternoon or I might switch the next morning's early workout to a different time.

5. Eat with purpose.  Using my first pregnancy as an example again (because let's face it, all women are obsessively healthy the first time around and tend to slack with subsequent babies), I can say with confidence I consumed food in the same way I did while training for an Ironman. Coincidentally the calories I needed for IM training were the same for fortifying a twin pregnancy: 4000 daily. This sounds luxurious until the reality of 4000 healthy calories sets in. Consuming 4000 healthy calories is not easy. Squeezing in 8 to 10 servings of fruits and vegetables became a daily contest for me, along with the other over-the-top food group requirements, most notably protein. Data on twin studies show that gaining half your pregnancy weight in the first half of your pregnancy increases the chance of having bigger, term babies. This is extremely important when the norm for twins is small, premature babies that spend time in the NICU. So, being goal oriented and knowing what "finish line" I wanted, I followed my nutrition training plan with a passion (and, well, yes, triathletes like to think they can have some control). While training for my two Ironman races and throughout my twin pregnancy everything I ate had a purpose: either to fuel my next workout or to grow healthy babies. In both instances I experienced successful outcomes. Again, luck? I don't think so. This is not to say I didn't indulge, but my indulgences either had some nutritional value or my daily requirements for everything else had already been met. It's a good rule, anyway. Want dessert? Only if you've had all your servings of vegetables, first! Now, of course, the admission is I haven't been quite as vigilant with my singleton pregnancies (perhaps made more difficult being pregnant over Halloween?) but mostly I stick with my motto: to eat with purpose. The real luck here is that I'm a person that can pine for roasted beets or arugula salad.

6. Massages are not frivolous. This one doesn't take much explaining. Massages are always an integral part of serious training. How else could you recover in between hard workouts? Pregnancy is hard work. Certain muscles become taxed with little effort, posture strains muscles you didn't know you had, circulation is challenged. Massage works.

7. Don't get dehydrated. Another easy parallel between the athlete and pregnant woman. Both have greater hydration needs and suffer the consequences when not properly hydrated. Part of my "triathlon lifestyle" is to carry a water bottle at all times and I'm glad I do, especially when I'm pregnant. 

8. Listen to your body. Pretty much every point I've made has had some component of "listen to your body," within it. But, just to be clear: Listen to your body. Generally, I believe athletes are very good at this. The mind-body connection allows an athlete to excel when capable and pull back when physical harm lurks. This connection is central to our health, our fitness potential, and naturally, to pregnancy. This is important when you go into labor, too. My second pregnancy I wasn't listening so well when labor began and my daughter was damn near close to being born in the car. 

9. Be prepared. Until I became a triathlete I was always a "shoot from the hip," kind of gal. Figure it out as you go person. Everything will work out fine. This isn't necessarily a bad way to live, but it doesn't apply to certain situations, for instance racing a triathlon, say, or childbirth. Triathlons require you to know what you're getting into, have a plan for training and racing, perhaps even a coach, know the route, use visualization techniques to anticipate the race and your desired outcome and even the plan B, C or D that might evolve. To be prepared for a baby, is not to decorate the nursery. Put down "What to Expect While You're Expecting," and pick up "The Thinking Woman's Guide to a Better Birth." If you do nothing else, hire a doula. In the November 2008 American Journal of Obstetricians and Gynecologists, an article titled "Evidence-based labor and delivery management," gave doulas the highest level of recognition and support among all other interventions. It says that in 15 clinical trials with more than 12,000 women, doula support, among other things, reduced the need for surgery and increased maternal satisfaction. A doula, along with your partner and anyone else you might want to birth with you, is your "cheering section." I don't think I could finish a triathlon without support, same is true for childbirth: I need to hear "You can do this! You're so strong! You're almost there!" (And, as was the case in my second pregnancy, had we not had a doula encouraging me to get to the hospital our baby would have been born in the car!) Bottom line is: Think about what you want out of your birth. Is your doctor or midwife going to "deliver" that for you? How about your hospital? And remember, every birth might be different. For my twin delivery I wanted to have the babies at a hospital with a level II NICU with my above-and-beyond competent OB present. As of this week, for this third, low-risk pregnancy I'm switching to a midwifery practice at a hospital that provides more support for labor: tubs, massage, volunteer doula support, among other things. My needs are different this time around and I want to be prepared. (On a side note, as I make all these comparisons between triathlon and childbirth I'm here to say that giving birth is not like finishing a triathlon, which I explain in this essay of the same name.)

10. Don't fear change. I am not the same person I was after finishing my first triathlon. No doubt, I like this person better. I think women come to that same conclusion after pregnancy, too, albeit some more reluctantly and in due time. The fear of change starts with the changing body. For those of you who don't know this already: it doesn't matter how little weight you gain, your body will change. And if  you can let go of that fear, you'll be able to revel in the amazing process. The science and miracle of how the human body adapts to the needs of creating a life and giving birth to a life is mind-blowing phenomenal. The next fear we may harbor is how our life is going to change post baby. Some people may feel adamant that their life absolutely will not be altered once baby arrives: work as usual; training as usual; or whatever else consumed life before parenthood. But then, what's the purpose of having a baby? Isn't the point of having children to change your life? We're pretty adaptable creatures, we humans are. I've had to make concessions in just about every aspect of my life since having kids, but I like the process of growing, expanding, adapting, changing (which is not to say I haven't struggled with it at times). But the thing with parenting is that you never figure it out. Because kids are growing and changing every day, parents have to as well. And the goal, of course, is to wake up each day feeling like you finished a triathlon (and some days you might physically feel this way), but in a sense that parenting has changed you into a person you like even better.

More about pregnancy and postpartum fitness is available from the Life as a Fit Mom eBook series, The Fit Mom's Guide to Pregnancy and Postpartum Speed Bumps.

Monday, November 17, 2008

Nourishment

There's something I like as much as a good workout or time spent writing. I like to cook. Not just anything. I don't particularly care to pull together dinner from a box and a few cans. That's no fun. The cooking I refer to is creative and inspired from yummy ingredients. The cooking I refer to also is best enjoyed while sipping a glass of wine (because this type of cooking often requires you to open a bottle as part of the ingredients).

This type of cooking isn't so easy to do once you become a mom. Only in the last year have I made it back to the stove with any optimism to create or be inspired. Now the girls are old enough to entertain themselves while I make dinner, and because of this, I get to enjoy this process of meal-making with a lot more pride in nourishing my family than I do when it's "sandwich night."

Still, time is of the essence and I'm also partial to "whole" food, as in, as little processed foods as possible. Sometimes those criteria are mutually exclusive to cooking a mid-week family dinner. But I now have three secret weapons that help me combine whole, healthy food with easy meals. You want in?

My first find came about a year ago during a quick trip to the grocery story. This cookbook caught my eye as I was walking past the aisle. I picked it up, flipped through a few pages and chucked it in my basket. I knew I had to have it. The book is "Meals Made Easy: Quick and Delicious Recipes for Every Night of the Week," brought to you by the editors of Real Simple magazine.  Aside from aspiring to be that cool, calm, ultra-organized person I imagine Real Simple readers to be, I am drawn like a magnet to anything that promises "easy" or "quick"! The book isn't categorized by appetizers, entrees, desserts, etc. No, this is mama-friendly cooking. The sections include: One-pot Meals, No-shop Meals, 30-minute Meals, No-cook Meals, Freezer Meals, and Short-cut meals. It speaks to every snafu you might encounter when it's 5 pm and you realize either a: you can't fathom a major post-dinner clean-up, b: you don't have much left in your fridge and there's no way you're hauling three kids to the store, or c: the kids are perilously close to consuming yet another snack.

One of my favorite recipes (and there are a lot of recipes in this book) is in the short-cut section for Inside-out Spring Rolls, which take all of 15 minutes:

You'll need (and notice how few ingredients required):
1 16 oz. bag of frozen pot stickers
1 tablespoon olive oil
1 bag of packaged slaw mix (or 1 carrot and 1 small head Napa cabbage, thinly sliced)
t tablespoons low-sodium soy sauce
1/4 cup salted peanuts.

Here's what you do:
Cook up the pot stickers according to directions. Meanwhile, heat the oil over medium-high heat. Add the slaw or cabbage/carrot mixture and toss to coat. Add soy sauce for another 2 minutes. To serve, transfer the vegetables to individual bowls, top with the pot stickers, and sprinkle with peanuts. 

Yum! Easy! Yes, my kids eat this!

My next great cooking guide came while the girls and I were at the library late this summer. I was skimming the books being promoted on a table and picked up "Feeding the Whole Family: Cooking with Whole Foods," by Cynthia Lair. I have never re-checked out a library book so many times. When I finally returned it, pages had to be pressed back flat after numerous dog-ears and a few got splattered with oil and jelly. I feel bad about this, but it was all out of love and admiration. You'll be happy to know I bought my own copy.

One feature I love about this book, but won't get the opportunity to use until next year is the note at the end of each recipe on how to adapt the recipe for babies. At what point in the recipe or what specific ingredients you can toss on a high chair tray and let the toothless wonder go to town. Genius! 

My two favorite recipes in the book are for curried lentils and cauliflower and for the Thai chicken soup. Both are easy to prepare and crazy good. Again, my kids eat. But what I'm going to share with you here is something for dessert, although I used leftovers to stir into my oatmeal the next morning. That is multitasking.

For your after-dinner or breakfast pleasure I bring you "Winter Fruit Compote with Vanilla Nut Cream." (And I might add, a laxative never tasted so good).

For the compote you need:

1/2 cup dried apricots
1/4 cup pitted prunes
1 apple, sliced
1 pear, sliced
1 cinnamon stick
1/8 teaspoon ground nutmed
1 cup apple juice

Combine all this in a pan and bring to a boil. Lower heat and simmer, covered for 20-30 minutes, until the fruit is soft. Remove cinnamon stick.

For the Vanilla Nut Cream you'll need:
1/2 cup raw, unsalted cashews
3 tablespoons maple syrup 
2 teaspoons vanilla extract
water

Grund nuts to a fine meal in a small grinder or blender. Then add in maple syrup and vanilla and enough water to give it a creamy consistency.

Put the compote in a bowl and top with the cream. I added another layer by including a slice of pumpkin bread underneath the compote and cream. Heavenly. And heavenly in oatmeal. Oh yes, and for the baby? She recommends reserving some of the fruit to puree. Of course!

My latest cooking resource came last weekend when I discovered the website, Culinary Competitor. Can a triathlete who loves to cook want anything more? Any of you who have seen me in person in the last week have likely heard me gush about it. I rarely get that excited over websites anymore. I am excited. It's witty (what do you expect when you read a blog post about onion goggles?) and informative (beets for muscle cramps, who knew?) and the recipes are exactly what I like to make and consume. I can't possibly limit myself to just one recipe here, so you'll have to check out such hot dishes as: Pan-seared steelhead with Jerusalem artichoke smashed potatoes, pumpkin spice rice pudding (excellent pre-workout snack), and another dessert as breakfast item: Carmalized apple-cranberry baked oatmeal with a salted praline topping. Come on! Are you dying here with me?

More recipes and and tips for feeding the fit family are available in the Life as a Fit Mom eBook, Feeding the Fit Family.


Tuesday, May 13, 2008

Finding Fitness in the Chaos of Motherhood, Indeed!

Maybe it's ironic that my first post on this blog is made possible because I skipped my morning run. That's sort of the whole point of this blog though, how we have to make choices and trade offs in order to balance motherhood and everything else we do, which in my case includes fitness... and now blogging, too. It feels a little insane to be adding one more thing to my list. Anyway, that choice was made easier today because my devoted running partner is out with a sinus and ear infection. Her name is Pam, by the way. I'm sure you'll hear more about her in subsequent posts, like posts about our "commune without walls" with food sharing, clothes sharing and child sharing (we draw the line at husbands). Seriously, she's front and center of my "village," and I wouldn't be as sane or as fit without her. Back to choices though, I was glad to type away in the early hours this morning instead of run because I conjured up the perfect plan this afternoon: while my twins (Mc & K) are at their nature class I will run with my 3-year-old (JC) in Pam's jogging stroller (see what I mean--but the only jogger I have is a double) with our 8-year-old dog, Zoe, a black squirrel dog, also known in our house as a "black greybador retriever," due to her lab-like head and greyhound like body. This is the perfect plan, so long as it doesn't rain. OK, I just checked the weather. By 3 pm, when my plan is to unfold, it should be 53 degrees (only in Minnesota) with a 50 percent chance of rain. Crap. Can't you just see it: dog, toddler, jog stroller, determined mom in the middle of a cold downpour? Will she find fitness in the chaos of motherhood? Stay tuned.