Monday, April 28, 2008

Your Pregnancy Self-Care Plan

How to nurture your health across your five Centers of Wellness

I wish I could offer you a magical formula for a perfect pregnancy and baby. But no such formula exists because “perfection” is a word that has no place in describing the human endeavor of childbearing. What’s more, differing backgrounds, histories, tastes, habits, starting points, and so on mean that no one-size-fits-all health plan can possibly have the same effect on every person. Every birth is different, too. Sure, all female bodies are designed to gestate and give birth, but while some lucky people can just step out of the way and let the body do its thing, more often challenges arise–nausea, anemia, preterm labor– where our attention and involvement can make a difference. In addition, certain aspects of birth simply fall beyond anyone’s control or understanding. We don’t know why some women develop preeclampsia or why some fetuses refuse to come out of a breech position, for example. Your goal should be to move toward a lifestyle that will support your pregnancy in an optimal way. And that’s something I can give you.

Whatever your starting point, this season of change is an ideal time to make some improvements in the way you take care of yourself. Whether you work to bring better balance into your life, shed unhealthy habits, or improve the good habits you already have, a child is the ultimate motivation. What’s more, these benefits reverberate well beyond pregnancy and childbirth. You can create new habits that persist long after your baby is born, setting yourself upfor a healthier midlife and beyond. By modeling those behaviors in motherhood, you’ll send out powerful messages that shape your child’s health as she or he grows, too.


Good health consists of five different (but overlapping) domains that must be individually strong as well as balanced overall. These five Centers of Wellness are:

1. Nutrition: food, drink, and supplements.
2. Movement: exercise for fitness as well as movement that brings you joy.
3. Mind: the state of your mind, including your stressors and your perceptions.
4. Spirit: a feeling of connectedness to self, to other beings, and to an entity larger than yourself (such as God or nature), whether via spirituality, community, religion, or other vehicles.
5. Sensation: sensuality (the senses: touch, taste, vision, hearing, and smell) and sexuality.

It’s through these five centers that you nourish your body and soul. They’re listed in no particular order of importance, because all five are important! Conventional medicine tends to value the first two and give a nod to the third. The last two are rarely even considered in a medical setting. But I believe all five interconnect to impact your well-being. For example, when you are eating well, you often feel less depressed, more energetic and apt to exercise more, and your relationships are also better. When you are not managing stress well, you may overeat and stop exercising, and your relationships and sex life may suffer.

What’s so interesting is that your needs within a given center are constantly shifting–especially in pregnancy. The way you move, your appetites and food preferences, your stress level, your libido, your sense of connection to God or to your own mother or your friends–all will be impacted across the arc of this experience and all will vary from trimester to trimester, and even from day to day. That’s why paying attention to all five of your Centers of Wellness is so important, and why you need a flexible plan that changes as you do. The Basic Self-Care Plan for Pregnancy is simple and life-changing.

In each of your five Centers of Wellness, I’ve mapped out a handful of daily goals. These are the minimum steps necessary to bring consciousness to that aspect of your health each day. Then I’ve listed a number of suggestions as to how you can attain each goal. Although the following summary of base-plan goals may sound like small steps, the ways you meet them, which I’ll outline in the following pages, add up to big health changes.


Mind Center goals
· Try to bring awareness to your level of stress every day.
· Trigger the relaxation response at least once a day.
· Explore ways to use mind-body techniques to support the specific needs of your body and your soul.

Nutrition Center goals
· Explore and understand your relationship with food.
· Bring meal-by-meal consciousness to your food choices.
· Eliminate substances that are known dangers.
· Shift to a more pregnancy-friendly, balanced diet, with:
oMore essential nutrients
oMore fruits and vegetables
oHealthier fats, especially omega-3s
oMore whole grains
oHealthier proteins
oFewer empty calories

Movement Center goals
· Make conscious choices about the kinds of activity that your body needs and enjoys every day.
· Do a low-impact aerobic activity that you enjoy at least three times a week on nonconsecutive days.
· Strength-train at least three times a week nonconsecutive days.
· Stretch every day.

Spirit Center goals
· Think about your sense of your life’s meaning and purpose.
· Build a “sacred time” into each day.
· Do one thing every day to fuel or feed a relationship that you care about.

Sensation Center goals
· Pay attention to which of your senses you are most nurtured by.
· Actively nurture the full range of your senses and sensuality each day.
· Explore and support your sexuality as it evolves throughout your pregnancy and beyond.


Your mind is the interface between reality (the world, your outer life) and your body’s response. I look forward to the day when this powerful connection is more routinely woven into the fabric of pregnancy care, because it so clearly impacts the health of the mother and her baby.We now know the state of your mind can influence your reproductive hormones, your blood pressure, your glucose levels, and the time and progress of your labor, among other things. Your body responds not to the reality of the circumstances you are in but to your perception of those realities. If you’re resting on the sofa with your feet up and a glass of lemonade in your hands after a long workday, but you’re ruminating about the dish-throwing argument you just had with your husband and what shape your unsettled marriage will be in by the time the baby arrives, your body responds as if still in the middle of the fight. Your brain goes on alert and the fight or-flight response built into your system kicks in, poising your body for action. The stress hormones cortisol and adrenaline jump, your blood pressure and heart rate increase, muscles tense, and glucose and cholesterol are released to provide quick energy. These changes are collectively known as the stress response.

On the other hand, you could be in the stressful throes of labor and yet, if your thoughts and breathing are aligned to a calm, relaxed mode, your body will respond accordingly and relax. This physiologic reaction is called the relaxation response. It can happen naturally–say, because you are actually lying there drinking lemonade and enjoying it–or you can use mind-body tools to trigger this response to counter stress.

Relaxation is to the mind what sleep is to the body. Sleep is a time when the body can truly unplug and be at rest.Your mind needs rest, too. And yet, when push comes to shove in a busy day, this center is one of the first my patients seem to ignore. Failure to relax can impact the likelihood of conceiving or of carrying a healthy baby to term. The following are some ways to nurture this center and achieve the basic mental goals of pregnancy. (Trimester-specific advice appears in the chapters that follow.)

GOAL: Try to bring awareness to your level of stress every day.
· Reflect on your stress level. Whether pregnant or not, we grow accustomed to chronic stress. Our bodies adapt to it and our minds begin to consider this state normal. Over time, we keep setting our baseline a little higher and higher, so that eventually we don’t even notice how stressed out we really are. Stop and bring a level of awareness to what you’re feeling each day.
· Reflect on your stress points. Your stress points are how stress manifests itself. Notice how and where your body holds stress. Reflect on which body systems or parts of you are most affected by stress. Do you get headaches or backaches? Are you more likely to get sick? Are you simply tired or fatigued under stress? Does your gastrointestinal system take the hit (for example, changed bowel habits such as constipation or diarrhea, or indigestion)? Do you get depressed? Do your relationships suffer? Often an individual’s stress points change or intensify while on the Fertility Pathway. Places in your musculoskeletal system that previously manifested stress–the lower back, for example–may be even more vulnerable, while areas that might never have given you much of problem–your GI system, for example–may start responding noticeably to stress. Reflect on whether and how your stress responses have changed.
· Be conscious about how much sleep you’re needing and getting. The average nonpregnant woman needs eight hours of sleep a night–and one-quarter of us don’t sleep enough to be fully alert the next day. Now add in the demands of gestation. At various points in pregnancy, your body may require more sleep than what you’re used to. Be aware that sleep is an arena that can change a lot on the Fertility Pathway, and throughout pregnancy. Pay attention to your individual needs, and honor what you learn. If your body is telling you it needs more sleep, then listen and get more sleep. Pay attention to sleep surroundings as well. During pregnancy, you may find that you require more space, more pillows (to support your body), different room temperature, or more/fewer blankets.

GOAL: Trigger the relaxation response at least once a day.
· Find a form of meditation that works for you. Essentially, meditation is a way to quiet the mind and is often done with an inner focus, in contrast to the outer-focused, preoccupied unconsciousness that we use to get through much of everyday life. Meditation is sometimes also called “centering.” It’s been used for centuries in the Far East as a practice for attaining spiritual enlightenment.You can learn this kind of formal meditation, which sometimes involves special postures and mantras, or you can attain a similar state of deep calm through such practices as deep breathing, meditative prayer, yoga, or other deeply relaxing pursuits. Meditation activates the relaxation response, quieting the mind and clearing it of anxiety and worry while also causing such physical changes as reducing blood pressure and stress hormones, and relaxing the muscles. Experiment with different forms of meditation until you find one that is comfortable and effective for you, then try to incorporate it into every day.
· Practice mindfulness. Are you connected and living in the present, or preoccupied with the future (for example, what’s next on your to-do list), the past (the argument you had last night), or a different place (such as text messaging while you’re lunching with a friend)? A certain amount of shifting out of the present is necessary to function, but when you find yourself doing too much of it, you tend to feel out of balance and more stressed. (Not to mention you’re probably missing a whole lot of your life!) Begin to notice how much of the time you are fully present and practice this skill consciously. Put down the BlackBerry or cell, and turn all of your attention to your friend, for example, or to the food on your plate.
· Try breathing exercises when anxiety creeps in. Conscious breathing is a great way to catch a few quick moments of relaxation, even in the midst of stress. Any kind of slow breathing–such as taking deep rhythmic breaths or doing the following breathing exercise–can put a brake on rising stress.

4/7/8 Breathing (Paced Breathing)
1. Rest the tip of your tongue on the ridge behind your front teeth throughout the exercise.
2. Breathe in through your nose for a count of four.
3. Hold for a count of seven.
4. Exhale through the mouth for a count of eight.With your tongue in the same position as in step 1, you should hear a hoosh sound as the air goes out. Repeat four times. Do this as often as needed throughout the day.

Try It:
Take a few minutes to practice 4/7/8 breathing right now. See how easy and relaxing it is? This simple breathing pattern, which Andrew Weil taught me years ago, has become my favorite secret sanity-saver since I became a mom. When we get really stressed, we tend to take shallow, panting breaths. Paced breathing, which is based on an ancient yoga practice, helps reverse that tendency, whether it’s subtle or pronounced, and sends a relaxation message to the body.
· Calm your mind and relax your body with mental muscle relaxation.
We hold tension in our bodies without even being aware of it. Examples include tooth-grinding at night, or a tight back that’s not in pain yet flinches when touched. This exercise–ideal to do at bedtime– relaxes major muscle groups to release stress.

Mental Muscle Relaxation

1. Sit or lie in a comfortable and quiet place with your body fully supported by a chair or the floor. (Do not lie on your back after the fourth month of pregnancy.) Close your eyes. Take a few deep breaths: deep inhale, deep exhale.

2. Begin at the top of your head, with your scalp and your forehead, noticing whether there is any tension there. Give it permission to let go.

3. Progress down your body, from head to toe, mentally assessing the muscles along the way and then mentally releasing any tension you find. Move from your head to your neck, your shoulders, your upper arms and lower arms, your fingers, all the way down your spinal column, around to your chest, your belly, your hips, your buttocks, your thighs, your knees, your calves, the arches of your feet,your toes. Let the tension go with your mind.

4. Take all the time you need. If there are places that still seem to be holding tension after you finish, return there. Only when you feel completely relaxed should you slowly bring your attention back to the present.
· Try progressive muscle relaxation (PMR). Instead of patrolling for tension and then mentally letting it go, as you do in mental muscle relaxation, in this exercise you actually tense the muscle and then physically release it. PMR helps make you more aware of when your muscles are tensed and can help invite the relaxation response in your body.

Progressive Muscle Relaxation

1. Lie on your back with your arms at your sides, on a firm but soft surface such as a soft carpet or a workout mat. (A bed is too soft.) After the fourth month of pregnancy, you should sit in a chair that supports your head and neck. Loosen any tight clothing and remove your shoes.

2. Ideally, when you are first learning this exercise, you should have someone slowly read the instructions below to you, or make a tape of them for yourself.

3. First, tense the muscles throughout your body, from head to toe. Tighten your feet and your legs, tense your arms, and clench your jaw. Pull in your stomach. Hold the tension while you sense the feelings of strain and tightness. Notice the difference between how this feels and how the muscle feels when it is relaxed. Notice that as you tense the muscles, you most likely naturally hold your breath. Hold it for a few seconds more, and exhale long and slowly as you relax all your muscles, letting the tension go. Notice the sense of relief as you relax.

4. Now you will tense and relax individual major muscle groups. Keep the rest of your body as relaxed as you can. You will hold the tension for a few seconds until you get a clear sense of what the tension feels like. Then inhale deeply, hold the breath, and release the tension as you exhale.

5. Start by making your hands into tight fists. Feel the tension through your hands and arms. Relax and release the tension. Now press your arms against the surface they’re resting on. Feel the tension. Hold it . . . and let it go. Let your arms and hands go limp.

6. Shrug your shoulders up tight, toward your head, feeling the tension through your neck and shoulders. Hold . . . and release. Drop your shoulders down, free of tension.

7. Now wrinkle your forehead, sensing the tightness. Hold . . . and let it go so your forehead is smooth and released. Shut your eyes as tightly as you can. Hold . . . and let it go. Now open your mouth as wide as you can. Hold . . . and let it go, letting your lips gently touch. Then clench your jaw, teeth tight together. Hold . . . and relax. Let the muscles of your face be at ease.

8. Take a few moments to tense your arms and shoulders, up through your face. Now take a deep breath, filling your lungs down through your abdomen. Hold your breath while you feel the tension through your chest. Then exhale and let your chest relax, your breath natural and easy. Suck in your stomach, holding the muscles tight . . . and relax. Arch your back . . . hold . . . and ease your back down gently, letting it relax. Feel the relaxation spreading through your whole upper body.

9. Now tense your hips and buttocks, pressing your legs and heels against the surface beneath you. Hold . . . and relax. Curl your toes down so that they point away from your knees. Hold . . . and relax, letting the tension go from your legs and feet. Then bend your toes back up toward your knees. Hold . . . and relax.

10. Now feel your whole body at rest, letting go of more tension with each breath. Your face relaxed and soft . . . your arms and shoulders loose . . . stomach, chest, and back relaxed . . . your legs and feet resting at ease . . . your whole body calm and relaxed.

11. Take time to enjoy this state of relaxation for several minutes,feeling the deep calm and peace. When you’re ready to get up, move slowly, first sitting, and then standing up
· Take a mental vacation. This is one of my favorites! Get relaxed using any technique you like and then let an image come to mind of a place where you feel completely at ease and safe. It may be a place you’ve been before, or a place you have never been but would like to go, or an imaginary world that does not exist. Notice every detail about the scene with each of your senses: What do you see, smell, hear, feel, and taste? Who else, if anyone, is there? Spend as much time as you would like in the scene. Relax and enjoy it. And best of all, know that you can go back anytime you wish. When you feel ready, slowly return your attention to the reality around you–and don’t be surprised when your body actually feels like you have been on vacation!

Excerpted from

Body, Soul, and Baby: A Doctor's Guide to the Complete Pregnancy Experience, from Preconception to Postpartum

by Tracy W. Gaudet
Buy this book at Barnes & Noble