Introduction

Fetal Development

The Danger Signs of Pregnancy

The Pregnant Patient's

Weight Gain

Communication Skills

Labor Coping Strategies

Birth Options and Preferences

What to Take to the Hospital

Labor

Addendum

Weight Gain During Pregnancy

The total number of pounds that women normally gain during pregnancy is highly variable.  Rather than an emphasis on the total number of pounds gained, a woman should be concerned with meeting three basic goals:

1. Weight gain should provide the necessary nutrients for the growth of a healthy, well-developed baby.
   
   
2. Weight gain should be adequate enough to allow the woman to remain healthy and should not drain her stores of nutrients.
   
   
3. Food eaten to provide the calories for weight gain should be very nutritious.  The scale does not reveal whether each pound gained was from nutritious foods or from doughnuts, French fries and sodas.

Weight Gain Recommendations

Current weight gain recommendations take into account the following:

1. The woman’s weight at the time of conception.
2. The adequacy of the woman’s diet at the time of conception.
3. The number of babies the woman is carrying.

For a woman of adequate weight and nutrient stores at the time of conception, the weight gain pattern may be as follows:

Recommended weight gains are as follows:

Weight Gain Components

There are eight different components that make up the total weight gain of pregnancy.  The amount of weight gained in each component varies from woman to woman.  The figures below represent the averages from a large sampling of women.

“Regardless of how much women weigh before they become pregnant, gaining between 26 to 35 pounds during pregnancy can improve the outcome of pregnancy and reduce their chances for having the pregnancy end in fetal death.”  (ACOG Newsletter, 1986).

The weight of the fetus at birth is due to many factors including:

1. Maternal health prior to conception
2. Maternal nutrition and eating habits prior to conception
3. Maternal nutrition and eating habits during the pregnancy
4. Maternal health habits such as smoking, alcohol ingestion, drugs or medications taken, etc.
5. Maternal age
6. Parity (number of deliveries a woman has had).
7. Placental sufficiency
8. Maternal weight during pregnancy

REMEMBER!  There is no class you can take, no book you can read, no video you can watch, no exercise you can participate in, that can take the place of a healthy diet in pregnancy.  The pregnant woman’s diet directly affects the health of the developing fetus.  Nutritious foods are building blocks of better babies!

Recommended Daily Food Guide

When a woman is pregnant or breastfeeding, her baby obtains its nourishment from the mother’s diet, meal by meal.  In pregnancy, the placenta does not have the ability to rob the maternal stores of nutrients for the developing fetus.  Following is a review of the nutritional requirements of pregnancy (and lactation):

Vitamins, Minerals and Folic Acid

The increased requirements for vitamins during pregnancy can usually be supplied by a well-rounded diet that provides adequate calories and amounts of proteins, including protein from animal sources.  The Committee on Maternal Nutrition of the National Research Council states that in the majority of cases regular vitamin and mineral supplementation to pregnant women is of questionable value except for iron and folic acid supplementation.  In other words, vitamin supplements should not be considered by the pregnant woman as substitute for food ingestion.

Folic acid is now recognized as an essential component in the woman’s diet prior to conception to prevent NTD’s (neural tube defects).

Prenatal Exercise for Body Toning

Prenatal exercises are intended for toning and conditioning purposes only to prepare the pregnant woman for the rigors of her labor and delivery experience.  These exercises should be done daily during the last trimester and can be done alone or with the aid of the coach.  Always take a cleansing breath (deep inhalation in through the nose, exhalation out through the mouth) before beginning and after finishing each exercise.

Exercises

Tailor Press
Method:
Sit on the floor. Pull feet with soles together as near your body as is comfortable.  Press knees gently toward the floor without bouncing.  Repeat 5X.

If this exercise is easy for you, i.e., if your feet are against your body and your knees are touching the floor, then do the following: Sit on the floor with legs stretched well apart.  Turn knees out and lean your body forward bouncing your upper body gently.  Keep your back straight.  Repeat 5X.

Purpose:
Stretches the muscles of the pelvic floor and inner thighs.

Pelvic Rocks
Method:
Lie on your back with your knees bent and feet flat on the floor.  Press your back and shoulders firmly against the floor.  Contract your abdominal muscles and press the small of your back to the floor.  You will feel the pelvis rock upward.  Release.  Repeat 5-10X.

This exercise can also be done standing with your back against a wall while rocking your pelvis and pushing the small of your back against the wall.  Another comfortable method of doing pelvic rocks is in the hands and knees position.  In this position, start with your back straight, then pull the pelvis inward and out while not arching your upper back.

Purpose:
Improves posture and relieves backache.  (In the hands and knees position, it also brings the uterus forward allowing better circulation in the area.)

Knee Reaches
Method:
Lie on your back with your knees bent and feet flat on the floor.  Lift your head off the ground and reach toward the outside of one knee with the opposite arm (i.e., reach with the right hand to the outside of the left knee, and visa versa).  Lie back down. (This is a diagonal reach that exercises mainly the oblique muscles). Repeat 5X to each side.

If you should feel light-headed while on your back, just turn to your left side until you feel better.

Purpose:
Abdominal muscle toning and improved circulation.

Leg Raises
Method:
Lie on your back with your knees bent and feet flat on the floor.  Straighten one leg vertically upward.  Slowly lower this leg with the knee as straight as possible until the leg is horizontal to the floor but not touching the floor as yet.  Hold the leg parallel to the floor for a moment, then return it to the bent position with the foot flat on the floor.  Repeat 5X with each leg.

Purpose:
Abdominal muscle toning and improved circulation in the legs and pelvis.

Butterfly
Method:
Sit on the floor in the tailor sit position.  Place arms with hands crossed on the floor in front of you.  As you inhale slowly, raise your arms straight up over your head, making sure that your upper arms brush over the breasts as they go.  As you exhale slowly, lower both arms back behind you so that your fingertips touch the floor.  Clasp your fingertips as you inhale again slowly.  Move your hands with fingers clasped behind you up and down a short distance three times.  Be careful to keep the hands near the floor so the stretch is in the chest muscles and not in the shoulders.  As you exhale slowly, bring the hands around in front of you and return them to the starting position.  Repeat 5-10X.

Purpose:
Improved circulation in the chest area and arms.  Expansion of the rib cage can relieve some symptoms of shortness of breath and/or heartburn.

Blowing Out The Candle
Method:
Sit tailor style on the floor.  Take in a large cleansing breath through the nose, then blow out slowly though pursed lips as though you are trying to flicker a candle flame 12” from your mouth.  Continue to blow out until you feel at least the abdominal muscles pulling in.  When you feel as though you are running out of air, you still have residual air volume so you may be able to continue exhaling a bit more.  With increased exhalation, you not only feel the muscles pulling, you may also feel them quivering or shaking, indicating an increased tightening of the muscles.  When your exhalation is complete, take in one or two quick cleansing breaths to prevent hyperventilation.  Repeat 5-10X.

Purpose:
Abdominal muscle toning in preparation for expulsive pushing during second stage labor.

Foot Circles
Method:
Sit on the floor with both legs out straight in front of you.  Use your arms to support yourself.  Place one ankle on top of the other (e.g., place the right ankle over the left ankle).  With the top foot, make circular movements with the toes so that the rotation is all within the ankle.  Start going outward first, then reverse the direction.  Change legs and repeat with the opposite foot.  Repeat 5-10X with each foot in each direction.

Purpose:
Improves circulation and muscle stretching to help prevent or alleviate muscle cramps.

Kegels
Method:
The Kegels, or pelvic floor muscles, are the muscles which surround the urethra, vagina and rectum.  When these muscles are contracted, the feeling is similar to having urinary urgency and needing to stop the flow of urine by tightening the pelvic floor muscles.  As an exercise, visualize the Kegel muscles as an elevator going up 4 floors and contract the pelvic floor muscles slowly from the first floor and hold it, to the second floor and hold it, to the third floor and hold it, and to the fourth floor and hold it.  Then release in a similar, slow and step-wise manner, until the pelvic floor muscles are at complete rest or relaxation.  Repeat this exercise 10 at a time, at least 10 different times during a day (=100/day).

Purpose:
Control of this muscle group is helpful during second stage labor (pushing or expulsive stage), for improving circulation and aiding healing to the episotomy site, and for general muscle tone.  Kegel exercises may also improve sexual feeling during intercourse, and can reduce the incidence of pelvic floor muscle relaxation leading to prolapsed bladder and/or prolapsed uterus in later years.

Next: Communication Skills