On pregnancy and exercise

A new study shows that exercise is perfectly healthy and safe for pregnant women whose pregnancies are low risk.

The researchers tell of pregnant competitive athletes who significantly elevated their body temperature with strenuous exercise. Doctors often worry that heating a pregnant woman’s body may harm a fetus. But those women had normal babies. And a few small studies of pregnant women who deliberately exercised to raise their body temperature also found no effects on the babies.

The researchers add that questions about exercise and pregnancy remain, making it difficult for doctors to give advice. The problem is deciding what lines to draw, and why. If the risks of exercise were low, but real, case reports and small studies would not find them.

The best way to learn how much exercise is safe is with studies in which pregnant women are randomly assigned to exercise regimens. Such studies, though, “can’t be done,” said Dr. Mona Shangold, the director of the Center for Women’s Health and Sports Gynecology in Philadelphia. No researchers or women would want to take a chance that the exercise might injure the fetus.

But that doesn’t make it likely that doctors will stop discouraging exercising while pregnant:

As a result, said Dr. Shangold, an expert recommended by the American College of Obstetricians and Gynecologists, doctors tend to play it safe.

But the advice often varies by doctor and can be based more on hunches than science, she said. Dr. Shangold says she tells women to limit their exercise time to 30 minutes a session, which she said was arbitrary advice.

“The problem is that we don’t know yet what the safe limit is,” Dr. Shangold said. “We are probably more conservative than we need to be.”

In fact, as Dr. Pivarnik found, advice to pregnant women is all over the map. He and his colleagues asked athletes who were or recently had been pregnant what they had been told.

Some received specific advice, like keep your heart rate below 140 beats a minute. That pretty much guarantees you won’t be exerting yourself much. It was in 1985 guidelines set by the American College of Obstetricians and Gynecologists, but it makes little sense, Dr. Shangold said.

“Heart rate is not a useful parameter to monitor during pregnancy,” she said. “It varies widely during pregnancy and the heart rate response to exercise also varies widely.”

Other women reported vague advice like “listen to your body.” Others got very conservative advice, like stopping all but the mildest exercise until six weeks after the baby is born.

Having never been pregnant, I was completely unaware of how strongly pregnant women are discouraged from exercise. I would be interested in hearing some anecdotes from the moms out there, about what kind of advice they received.

I also thought that the article might be overstating the ways in which pregnant women are coddled and patronized with regards to exercise. After all, it does site a case where a pregnant woman swam the English Chanel — a completely awesome feat in its own right — as either extraordinary or insane. But she was only 11 weeks along, a stage where some women still don’t even know that they’re pregnant and many if not most aren’t even showing yet. We can’t possibly see any woman who is 11 weeks pregnant that differently from how we view other women, right?

Then I came across this article, on the same day, on the same topic, in Newsday. It seems to focus almost entirely on the risks of exercise while pregnant, and doesn’t even mention the good news from the study discussed in the Times.

So what the hell? Of course, women who develop medical problems during pregnancy should try to take it easy. Many women also get very tired during pregnancy, and so rest is probably a better option than exertion during those weary periods. And of course, playing tackle football, doing roller derby or street-lugging would be risky activities. Advising women to not do anything that causes pain or discomfort is also just good general advice. But running? Swimming? Not getting your heart rate over 140 beats per minute? Come on now.

The reason for the concern is also really disappointing. Nearly all of the worries involve potential damage to the fetus. Obviously women who have chosen to continue pregnancies to term are generally going to be looking out for the best interests of their fetuses, but this discussion is constantly frustrating.

It seems like every single piece of medical advice regarding pregnancy is about the fetus, the fetus, the fetus, until it starts to seem like the woman isn’t even there. But the woman is still there, and we really ought to be looking out for her, too. For one thing, I’m tired of hearing so much about what mothers-to-be should and shouldn’t eat. Sure, that’s important, but not changing your mind every two seconds about what is and isn’t healthy, not scaring the crap out of women and not making those who don’t follow the most up-to-date guidelines feel like bad women is important, too.

Instead, let’s talk some about postpartum depression, okay? Or, forget that: let’s talk about depression during pregnancy. A study was released on the same day as the study about exercise, showing that utterly huge percentages of pregnant women suffer from anxiety and/or depression. But doctors don’t want to give out anti-depressants, yet again, because it may harm the fetus. And maybe that’s fair enough — I’ll be the first to admit that I have no idea how grave those risks are, and maybe the risk would not indeed be worth it in most cases. I don’t know. I do know, though, that exercise releases endorphins, and has therefore been proven to help with mild to moderate depression. With this knowledge, and extremely little evidence that exercise is dangerous during low-risk pregnancies, it seems to me to be downright cruel to advise women against it.

I hate seeing pregnant women not treated as people, and it happens all of the time. All of this completely unfounded advice seems to me to be more about maintaining an image of women as frail because of their reproductive capacity, and an image of pregnant women as existing solely to be a temporary home for their future offspring. Even when doctors are just trying to do good, which I imagine that almost all of them are, they’re also not immune from this portrayal of pregnant women that has persisted in Western culture for many centuries now. Neither, for that matter, are the pregnant women themselves. Anti-choice and anti-feminist language regarding pregnancy is pervasive to the point where we don’t even always recognize it for what it is. I can’t help but feel like this has to be at least a partial explanation.

Thoughts?

0 thoughts on “On pregnancy and exercise

  1. brandann

    i got plenty of so called “advice” from what i call the “pregnancy police” which is any non pregnant person who thinks they know…and usually i just smiled and nodded…but everyone has an opinion and i firmly believe no uterus no opinon when it comes to that nonsense. i was scolded for eveything from being vegetarian to dying my hair.

    i was lucky, my doctors told me that i would know what my body could handle, and encouraged to walk and swim, even light running (running is discouraged b/c of the shift in your center of gravity, which since i am extremely clutzy makes sense for me) as long as i tried to move everyday. but like i said, they said i would know what my body was capable of. i was discouraged from sit ups and push ups and anything else that might straining my abdomen. i think the common thought is if you take care of the mommy, mommy will take care of the fetus.

    but not all are that lucky, i haven’t had the pleasure (/sarcasm) but all my friends who have managed to gestate while active duty are pretty much treated like incubators on legs, no exercise and all that. the care of the woman is back burner…a woman isn’t even allowed to see her regular doctor while gestating, only the ob/gyn which certainly is fetus centric, and crap, if you ask me. but as i have said on my own blog, military medicine leaves a lot to be desired. even if she is deemed “high risk”, only the ob/gyn can see her, and even then, the military doesn’t allow for anything “preventative”, like allowing the woman time off to avoid preeclampsia (sp?). they pretty much don’t do anything outside their little timetable unless you die or lose the baby.

    two drastic examples for you.

    Reply
  2. Ran

    The women I know who’ve had miscarriages or birth complications have all felt horrible about it, wondered if it was their fault, and so on. I don’t think the doctor’s advice is very helpful in this regard — if anything, all this “you can do all these things to help your baby” talk just encourages feelings of “it’s my fault” after a miscarriage — but it comes from a good place, a (likely accurate) feeling that what pregnant women typically care most about is making sure their baby is born safely. Even among women who choose to have late abortions, I think it’s usually something like “I’m not at a place right now where I could give this baby a good life,” not something like “screw the fetus, I want it out of me.” (That’s a false dichotomy, obviously, but you see what I’m saying.)

    As for changing recommendations every five minutes — that’s really not specific to obstetrics/gynecology. If it comes up more in that case, it’s because more women feel at sea about pregnancy than about things they’ve been doing their whole lives (← not surprising), so when they get pregnant they suddenly try to pay more attention to all the ever-conflicting advice.

    Reply
  3. Jenee

    One could conceivably argue that ensuring little damage to the fetus is in the interests of the woman, that she selfishly would not want to be put under the duress of raising a handicapped or impaired child if it were at all avoidable.

    Reply
  4. Ole

    That sounds odd. In Denmark pregnant women are told that gymnastics, walking, running, cycling, swimming and yoga are good types of exercise. The general advice they receive is that you can do as much as you want, as long as it doesn’t feel uncomfortable (as with all kinds of exercise, really…). Most team sports (soccer, handball etc.) and contact sports (karate, boxing etc.) are discouraged, however, in order to avoid punches, falls, running into others and such.

    Reply
  5. sabrina

    I don’t think this can be explained by doctors being fetus centric. Actually, most mothers who want to carry their baby to term are “fetus centric” and with our litigious society, any baby that doesn’t come out perfectly will be blamed on the doctor. Ob/gyns have the highest malpractice insurance out of any other specialty. I think doctors feel playing it safely to ensure the maximum protection of the fetus is the best way. Remember, some women spend thousands of dollars and hours in clinics trying to get pregnant. Light exercise for nine months doesn’t really seem like that much of an imposition in that light.

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  6. Cara Post author

    any baby that doesn’t come out perfectly will be blamed on the doctor. Ob/gyns have the highest malpractice insurance out of any other specialty.

    The issue of insurance may be true, but it seems to me that any baby that doesn’t come out perfectly is blamed on the mother. Either way, though, it’s pretty anecdotal, and I’m sure that we could both cite evidence.

    Some do spend thousands of dollars and long stretches of time trying to get pregnant. But most women don’t. And though I agree that most women want healthy babies, I also think that they don’t want to be infantalized themselves. Again, restrictions on exercise are hardly the only imposition that pregnant women face.

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  7. Kevin

    It sounds like more of an educational issue rather than conscious anti-feminist agenda. It wasn’t that long ago that some doctors were advising pregnant women to “have a smoke instead of a sweet if you’re feeling a little fat”.

    Reply
  8. akeeyu

    Slightly off topic, but related to the ‘fetus-centric’ discussion.

    I’m pregnant and having a miserable high risk gestation. Fuck exercise, I can barely WALK, but that’s neither here nor there.

    I do feel that it’s worth mentioning that when trying to get treatment for a rapid heart rate, severe anemia, etc, etc, I was repeatedly handpatted and told “Don’t worry about a thing, sweetie, the babies are FINE.” Finally, my husband basically yelled “Yes, we’re thrilled that the fetuses are fine, but what about MY WIFE? She is barely functional. She is your patient. Please help MY WIFE.”

    Reply
  9. brandann

    the key word to any of this is “low risk”. seriously…although, i think all pregnancy comes w/ a level of risk…but if you didn’t know that going in, then you are doing something wrong…but we should be aware of our bodies…if you can’t walk, you obviously shouldn’t exercise…too many people suffer like akeeyu here…
    doctors forget who the patient is, IMHO, said fetus isn’t a patient until they are shot out the shoot…let’s take care of patients, shall we?

    Reply
  10. Elaine Vigneault

    I haven’t been pregnant but I remember an aerobics instructor who was and she had a miscarriage. Lots of people blamed her for it and said it was because she exercised too much, which wasn’t the reason and even if it was, does she need that? Who thinks it’s OK to tell a woman who just lost her fetus that it was her fault she miscarried? WTF?

    Reply
  11. Jay

    While I agree that OB care – and society in general – can be fetus-centric to an extreme degree, I’d rather take a non-pharmacological approach to anxiety and depression in pregnancy. Or for that matter, anxiety and depression in general. I prescribe the meds and I’ve taken them myself and they are incredibly valuable, but they are overutilized in ways that serve the purposes of the insurance industry and the drug companies rather than patients. I’d rather be able to offer my patients a variety of different approaches, not just meds or no meds.

    But having said that, I agree that mood issues during pregnancy and post-partum are under-recognized and undertreated. “It’s just your hormones, dear!” is not an answer. Parenting a newborn can be an incredibly isolating experience, and when you add to that the ways in which women feel pressured to be perfect mothers without any training and often without any support, it’s a recipe for depression.

    Reply
  12. Kate

    Ummm, I was told that I should exercise when I was pregnant because… you know… exercise is good for you. Of course you can go overboard, but I did yoga everyday and 2 weeks before I gave birth I hiked 3 miles up a mountain. Literally. So I don’t know what these supposed “doctors” are talking about when they tell people not to exercise. Besides that, everyone know that exercise makes vaginal birth easier. I think that this just proves the existing mindset in the western medical field that pregnancy and birth are maladies rather than something natural.

    Reply

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