Are You Really Eating for Two? Food and Nutrition During Pregnancy

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hey welcome to belly to baby i keep
transposing the words baby to baby but we’re
belly to baby. This is our third
week that we’re doing the show live on
Facebook. We’re so excited that everyone
is joining us again. Today we are joined
by Dr. Shelby Dickinson. Thank
you so much for joining us we are going to
be talking about I think the all
important topic when you’re pregnant…
Food! Yummy— gotta eat it. Oh my gosh—
Gotta eat it is the right words to use
because i don’t think i’ve ever
experienced hangry, the likes of which I
will now. I was in meeting it was a new
meeting the other day and if a co-worker
is watching this, I swear I don’t hold it
against any one of you, but it was a noon
meeting and the pizza that
was supposed to be at the meeting was late
and I walked in a couple minutes— uh no!
Where I truly thought
I was going to burst into tears before one
o’clock when it arrived and all was fine
with the world again, but I’m here
with all of these executives and
co-workers and colleagues and bringing
together bringing together. Yeah but
didn’t you say that’s pretty normal um
Yes twice you can ask my
husband about hangry. He’ll be like Shelby’s hangry
again. There may have been some
food in the center console we’d be
driving and he’s like “oh do you need to
eat?” oh yeah where’s that food. Oh yes
not always keep snacks handy that is not
one thing I have learned. If last
week I just so happened to have
a slim jim, which it is not my snack of
choice it was a random, random…
Good protein! I’m sure it has protein
in it, but usually there is not a sort of
prepackaged snack in the purse which
brings me to my first question about you
when we first, everybody wants to be as
healthy as possible during pregnancy
but yes I have Cheez Its in my purse and is
that okay? or you should you have the
apple instead? and is it. You’re never
ever going to fault yourself by
eating the Apple first. Okay? Fruits and
vegetables should be a mainstay pregnant
or not, but every now and again you need
a carb and I think some of those
cravings will lead you towards more
carbohydrate based foods. Some of that
may have to do with the increase hormones in
pregnancy, but if you have an apple go
for the apple. If you’re so hungry you can
go for the cheese’s because your caloric
intake or how many calories you need to
take in does increase during pregnancy
and how much does it increase because
we’ve all heard the you’re not really
eating for two exactly not affecting the
quality that you people need but not
necessarily the quantity. So what is the
change in caloric need that your body
experiences? You really only need an
extra 300 calories per day to support a
pregnancy to be honest with you. A little
bit more when you’re breastfeeding them
500 maybe skip that work out— just kidding
Nice! I was going to say that just
made that decision so much easier for so many of us
But no, you just need an extra 300 calories
a day, so you’re not really eating for
two. And is that throughout pregnancy?
That’s throughout pregnancy so even in the
third trimester I thought I thought
it went up again, but it doesn’t go up
again? Well it kind of does so in general
that’s how much I shouldn’t say that’s
how much extra but that’s how much extra
you’ll burn okay? I was about that do you
burn— your larger, so do you burn more? So
it’s typically 300 calories a day that
you burn. In the first trimester, you want
to eat about total for yourself and for
your baby about 1,800 calories a day. It
does go up like you— in the
second trimester 2200 calories and then
the third trimester about 2,400 calories
okay and not all on ice cream I’m guessing?
You can rack that up really fast! Yes, you can
So the recommendation for weight changes
in pregnancy kind of depend upon how
much you weighed when you got pregnant to
be honest with you. Yeah and it is
interesting because i was just, I have read so
much about this, which is probably
dangerous and I should also say right
now I always forget the introductions
part aside from giving names, Shelby you
are a doctor or I should say Dr. Dickerson
you’re a physician with Wash U— call me Shelby it’s
fine everybody else does too. Dr. Shelby
Dr. Dickerson I respond! oh no Dr. Shelby
I’m game.
But you are a Wash U physician you
deliver babies and take care of
women at Barnes-Jewish. Ah yes I do and I
work at St. Louis Children’s Hospital in
a non-clinical role, so I don’t actually
take care of the babies, but I see where
they are all cared for very well on
daily basis and some of your little ones
wind up there as well. Yeah uh-huh make
They sure do! Terrific! Well and I’m not the
only one who’s allowed to ask questions
here either, by all means please send us
your questions we will so we will get as
many of them answered as we can live and
if there are any that we need to take
off line we can certainly do that as
well so keep that in mind as we’re going
and back to the topic at hand on weight
gain like I have been so paranoid just
about how much because there are some apps
and the websites all the time out there
that give you pretty strict guidelines
as to as far as we can go and I will say
I’m 17 weeks now and i am nine and
a half to ten pounds higher than where i
was at my first doctor’s appointment
which was around seven eight weeks, so i
was fortunate never sick in the first
trimester. I know a lot of women
first of all who sometimes lose weight in the first
trimester. They can. And then do they gain it back?
They do? A lot do gain it back they do they do
gained it back so typically what happens
you either in the first trimester have
no weight gain or maybe just a little
bit like five pounds. The second and
third trimester you can increase that or
what we see I should say is that on you
may gain a half a pound to a pound a week
throughout the second and third
trimester. What we really really care
about is making sure you don’t gain too
much weight because there are some bad
outcomes associated with that and you’re
gaining enough weight so that your baby
doesn’t grow small okay because we have
seen like in third world countries where
starvation is an issue there’s an
increased risk of small babies a lot of
it having to do with malnutrition. In
this country, we don’t see them as often.
It’s more on the other other spectrum of
things where too much weight can
actually be a problem too. And what does
that does that cause— I’m trying to think
of this it’s a multi-part question
I mean as far as weight gain goes right
now and
I’m not carrying 10 pounds of baby. No
you’re not what where is that all. I can
tell you where it’s going. But what what
is that why does this, I mean why does
your body need or want to gain that
weight? Well a lot of it has to do with the fluid
Even in the first trimester, the amount
of fluid your body retains significantly
increases and the reason why is we have
to circulate all the micronutrients and
then also the calories to the baby and
we do that via our blood volumes and so
a lot of what you’re experiencing is a
volume of fluid and essentially at
this gestational age. Okay and so then as
you can just go on with pregnancy
because is that something that you need
to worry about with the baby growing
small but also growing large with waking
Yes, you’re right! So there are some risks
associated with too much weight gain and
pregnancy. They include the following:
blood pressure conditions of pregnancy
gestational diabetes or diabetes of
pregnancy, large babies which have
different outcomes. Okay such as
c-section, so there is an increased risk
of c-section associated with too much
waking. Those are the big ones. The
other one that I think we don’t think
about— we’re always so focused on the
pregnancy. Postpartum— I mean a postpartum
period, there is a lot of literature that
shows that if you gain too much weight
during a pregnancy that you tend to hold
on to that woman’s afterward, which has
long-term complications such as
cardiovascular disease so heart attack
stroke diabetes you got to be alive to
take care of everybody, right mom’s? Yeah.
Now you come in handy after the
pregnancy too. It’s not just carrying. You
do forget that that’s funny that you
bring that up and it I guess it’s called
the fourth trimester for a very good
reason and you all see that all the time
that you don’t stop and my doctor went
over that was last week too was your
care does not stop the day that you
deliver the baby you know as your
maternity care goes well
past that. We say six
post pardom but there’s developing literature
all the time that physiology extends
3 months after delivery, six months after
delivery. It’s kind of been a focus field
over the past several years all right
we’ll get into the whole how you’re supposed
to eat when you’re breastfeeding and
postpartum and all of that eventually
yeah right now we’ll go back to while
pregnant. Did you see the eating
pattern? Did you experience that you’re
eating pattern changed a whole lot? Oh my
goodness! Yeah sometimes
that’s the first clue you’re pregnant
Yeah— where are those pickles?
They’re not custom made?! They
actually taste delicious! Oh they do
They’re so salty. You know some of
that— a lot of them are myths as to why
we crave what we crave. Okay I think
personally it has a lot to do there’s some
physiology behind that. Your hormone
levels really really rise during
pregnancy, so I think that is a trigger.
The other thing too is that salty foods
will help your body reabsorb water but
it’s not a hundred percent. People create
different things depending on the
pregnancy too I should say. Were
yours different? Oh completely different
really! I wonder if my husband will try
to do Facebook. Ed if you’re listening
please please say something nice.
Just be nice that is all. I am still a
little sensitive seven months out in
month out hazardous postpartum. So
on my first pregnancy qdoba this is no
plug for qdoba very bad. We have a
history of plugging different things
accidentally so keep going. Okay okay
okay good! Um pickles on everything and
they had to be Schnucks pickles sliced dill the
big jar yeah. That was first my pregnancy.
That was my first pregnancy
Then my second pregnancy which
is very odd umm fruit, so hey I know! I
think I have a shirt that says “I want
fruit, but the baby wants cake” or
something yeah yeah it’s awesome the baby wanted fruit too
Babies a little
smaller of a guy but Drew was
my big one in the second trimester and
the other interesting thing is I
can’t drink coffee during pregnancy. Really
I’m a coffee drinker. I have to have at
least two cups of coffee a day, but when
it comes to pregnancy— that’s the
other clue. Shelby doesn’t want coffee
you better check a pregnancy test. Oh my
god how funny! And I don’t really know that unless
there’s some sort of inherent aversion
to bitter tastes associated with coffee
but that’s the only time though and this
is sort of a side note but did you get
if you’re a 2 cup of day drinker did you
get headaches whenever you went I
wouldn’t suddenly didn’t like it anymore
I did initially. Yeah I had some withdrawal
headaches, but the aversion to it didn’t
matter you really get over pretty
quickly. It was literally a couple of days and
they’re probably back way you’re feeling
like you don’t know what made it to begin with
You don’t feel good, so you’re eating other stuff
and you honestly don’t notice it and I
will say I had a very similar experience
come to think of it I would stick at the
time I had a cold just a nasty nasty cold at
the time I found out I was pregnant. I am
a coffee first thing in the morning
person and it was really easy to
decrease it down to half CAF well
last because it was it just was
completely unappealing. The other
thing I found that was that, I don’t know
if I’m allowed to mention it, but I love red wine
and the second, I mean it was minutes
after I found out I was pregnant I really
Thank God I mean it was a nice thing to
not want it because can have it yes
but the smell even bothered me, the smell of alcohol
in general and it was only in the
first trimester. Oh Shelby
your husband just chimed in! Oh no
mm-hmm. You should have bought stock in
Schnucks sliced pickles. He was right!
Stock in Schnucks fried pickles
The best pickles— I wonder if they’ve
got that we’ll have to look into it
We’ll tag Schnucks in this after this
Oh yeah Schnucks pickles, they’re cheap
Schnucks brand. Oh yes yeah hey it works out
it works out
works just fine. My standards i said my
thing is that my standards are no longer high
I love food I look for me food. Now, I
want all random things— fried chicken
but and not on the bone to describe
like chicken fillet and umm I was eating it
with mustard
and pickles the other day and I thought it
was the most delicious thing in the
world and everyone at the table was
looking at me like I had lost my sanity
and still doesn’t sound weird to me it
sounds delicious and what are we having
for lunch today? I don’t eat fried chicken
every day, but I did eat the doughnuts
this morning I feel like I need to
get the truth out okay finally finally thank
you okay in summer you’ll be all right
It was green it was for Saint
Patrick’s day so someone brought them into
the office it was her fault come on but
the in chocolate ice cream was the other thing, which I
couldn’t care less. Oh where did those ten
pounds come from? I know exactly where do they
come from? Where did they go? No I don’t
buy for the purpose if it’s in the
fridge or in the freezer I will eat it
and then fried chicken is there or
if it’s not because I know it’s bad for you
but if I we were we were out
gallivanting sounds delicious and it was! Oh
cinnamon toast crunch that was the
second one. I knew there was it was my
second pregnancy. One I was
driving home and one day it came to me
like an epiphany uh-huh cinnamon toast crunch!
I’m serious oh my god I had to have it
routinely, routinely and then after
delivery not none interested anymore.
Okay I oh you’ll get over that we have a
question but I won’t mind what women out
there to text us or go ahead and tell us
too what they’ve been craving
because your
husband also wrote it again. Stop
writing in! Oh this was very nice
he didn’t mind going out at 3am to
have to get them for you. Oh so sweet
show really nice husband ah okay Jocelyn
has a question about red meat she said
when it comes to steak, can I have it
medium-rare. My husband who was a chef says
yes. He says the bacteria lies on the
surface of the steak and not inside. Yeah
so what she’s alluding to is getting
concerned about listeriosis and eating
raw meat and I think it’s okay as long
as just like with her husband says that is
if it if the bacteria is inside of the
meat there’s only something wrong with
the meat, so I think it’s completely safe
Now as long as it’s cooked I wouldn’t do
rare, but I think a medium steak is fine
It depends on the temperature and
every place is different. Okay, so maybe
if she’s eating out she should get it medium, but if in
home with a chef husband we’re good yeah and
even better understand do medium rare?
It’s probably fine overall but yeah. And
this is a great segue into the whole
what you can and can’t eat. And we had talked
previously with Dr. Robin
you can eat the turkey mm-hmm. Do you
feel the same way? I mean it’s the
listeriosis that’s the problem with all
of the foods or a great many of
the foods that we’re told
It’s because of that risk which
is actually really really rare to be
honest with you. It’s the uncooked meat
it’s the unpasteurized dairy so that’s
the other thing because I really like
Gouda or not gouda or not gouda— feta!
Gouda’s fine because it’s that extra
Feta’s the problem? Well it’s packed— you have
to make sure it’s packed okay. I was going to
say it came out of a plastic thing is
that is pasteurized
pasteurized uh-huh uh-huh you’re
right! The FDA’s gotten a hold of it
somewhere. I know I know. It’s all good
make sure it’s pasteurized. There is some not
pasteurized cheese in whole foods. Yeah
right generally so and now is the other
thing I would we were told very early is
that you just have to check and make
sure. I met a lot of restaurants most
restaurants you’re fine but it’s worth
checking at some of the nicer places are
more adventurous places let’s say
just to confirm that they are safe.
You’re right I’m sorry it was the
unpasteurized cheese’s, deli meat, what
else are the things that are worthy of
concern or at least if I have look at
the label? Yeah uncooked sushi is the other
one for the same reasons as mentioned
above. Just make sure that it’s cooked
Okay yes Liz Rodin she’s having cravings
for Smacks Cereal it’s a daily staple she
hasn’t had it in 20 years, but now its
daily. Smacks wow! I forgot about that I
remember those commercials from when I
was a kid they were funny! That’s amazing isn’t it
the Frog I think it’s the Frog guys
gotta go to the frogs it’s
amazing that’s amazing. That is so weird a
girlfriend of mine also had the
cinnamon toast crunch thing and I
thought that sounded like a brilliant
idea i gots some for myself and I was like man it’s okay
okay it wasn’t for you it wasn’t it
wasn’t fried chicken with pickles in
So that is so those are the foods you
can’t eat as far as amount that you eat in
this day. I’ve noticed it’s like a
different pattern I mean I used
to be able to be just fine eating
breakfast lunch and if I was busy in the
afternoon I make it to dinner just fine
yeah now it is every two hours. You need
that constant caloric source okay. A lot of
patients will get real nauseated if they
don’t have a little something on their
stomach. Yes. And honestly if you eat big
meals like a big breakfast, a big lunch,
and a big dinner that can also be a little
unsettling on your stomach as well. Well
and that was the thing that I learned
just about myself early on was that if I
don’t know that you’re running out of
space or if it’s heartburn or what
exactly, but I couldn’t I was raised
with three brothers, so I eat meals
quickly because you eat protected it I
think there’s a whole psychology behind
this, at least one that I developed
with absolutely no authority
But I have continued that unfortunate
pattern to this day and I will say I
can’t do it right now. Like I can eat a
certain amount and know that I just have
to stop because two hours later okay
First of all going to be really
uncomfortable very quickly and then two
hours later I’m going to want something
else yeah this is the way it is. So there
are two factors to that. In the beginning
and now you’re GI system slows because
of the progesterone. I think that’s a
component of that now, but then as your
pregnancy progresses and your uterus
grows and that baby’s grows I mean
literally there’s only so much room in
there. So that starts playing a bigger
part as your pregnancy progresses. So
it’s a factor of two things and your GI
system slows your metabolism speed up?
How’s that impacted? Now
your metabolism does speed up ok. I don’t
know I think in my mind I think it slows
you can get as much chloric intake as
you can from
the foods that you eat. It seems that way
from like an evolutionary or
anthropologic perspective, but the your
metabolism does increase and hence the extra
300 calories a day that you need to help
support the pregnancy okay and just
to put 300 calories in perspective I
was looking up different 300 calories
snacks and it’s like an apple with 2
tablespoons of peanut butter and that’s
it in a day I mean that’s pretty
remarkable I mean that’s so many
calories remember you also gain fluid
which is from the water that you trained
to help circulate the nutrients and the
oxygen and the pregnancy. And is there
do you and I have only had this
experience a couple of times myself but
did you experience any point with your
pregnancy did you wake up at night hungry?
Apparently there was a 3am run to the
grocery store. But yeah yeah that other
than for cinnamon toast crunch that one
time that well that wasn’t my big thing
but i have many patients and many women
who will wake up hungry in the middle of
the night and then they start looking
what can i eat what can i eat? And it was
the first I do it’s only happened to me
a couple of times yeah first time I did
it was so bad I was like oh my gosh
it was first trimester and I can’t
figure out there’s something wrong with
my stomach and I thought oh my gosh I’m
hungry I don’t think I’ve been hungry
enough since I don’t know 1992 I don’t let
myself get hungry I know I know yeah
usually. It’s just so funny it’s such an
odd sensation but I mean I went up went down
the stairs, got a sandwich and made
a peanut butter and jelly sandwich went
back to bed but was totally fine. Yep. So wild.
Okay so your food pattern intake changes
a little bit. Do you expect that
things will evolve over the course of a
pregnancy? Do you see that? yeah how do
they change? I would say first trimester
patients fall into a couple of categories
I feel fine, I don’t feel pregnant and
then you have those that feel terrible
can’t tolerate food
they need a little bit more extra
support and then you have others that
have to eat all day, all the time just
small meals constantly otherwise they start
feeling sick, so it’s kind of the
opposite. They need food to prevent them
from feeling sick whereas you have some
patients that can’t even eat food because then
they’ll get sick. It was so interesting and I
think we’re three for three on me
bringing up my sister-in-law or one of
my sisters-in-law and these episodes
but she was sick and I just do it
because I look back at this now I think
she has got to be some sort of saint for
having gone through what she did, but she
was sick from week six to week 36,
but she was saying the other day that
she’s still gained more than she wanted
to in the pregnancy and I was like how is
that possible you were sick the entire
time and she said all I could eat was
carbs and cheese yeah and so I did and
so you do what you have to do, I do agree
with that you do what you have to do. Are
there any things any any restrictions
you would put on people just in the
sense that okay say you come in with unique
dietary situations being with vegetarians, vegans
yeah people who have gluten
aversions, whether they are physical
versions or just prefer not to eat gluten what
are the regulations that you give them
We should probably take them
one by one yeah they’re a little bit
different. Yeah so vegetarians can you be
a vegetarian through pregnancy? Yes you
can be a vegetarian through pregnancy.
Here are the micronutrients you need to
really focus on and make sure you get
enough of. So calcium okay calcium is
very important for developing babies they
have bones, they have teeth that needs that
calcium. They will take it that they will
take it for it. So make sure you get
enough calcium on but a lot about your
vegetarians will still have dairy the
problem is when you take out that dairy
and we’ll talk about vegans here in a
second, but calcium is very important. The
next is iron so which is probably even
bigger for vegetarians, but iron is
really important that there are foods
that aren’t meats that you can get your
iron stores from because you need about
twenty seven milligrams a day
of iron in pregnancy, which is about
the double of somebody who’s a not
pregnant okay. Some things that they
can eat like beans and legumes. And can just get that
from a vitamin? You can. I mean
is it the same quality that you’re
going to get from food? No foods tend to
you tend to tolerate it better from foods
than you do from a vitamin, but vitamins
are helpful. One of the things I
recommend is taking vitamin taking foods
with vitamin C in them like orange juice
if you’re trying to supplement with iron.
Or if you’re eating foods that are high
in iron that are plant-based to help
really absorb that iron that’s in those
foods. Red meat our bodies have a really
great ability of absorbing the iron in
them and so that’s not as problematic
for people who eat meat. Now we’ve talked about
vegan, vegetarian. Vegans so sorry
Vegans I get a little bit more
concerned about because they lack that
calcium and the iron that they
need and so I really think it add
something that their diet and sometimes
we have to coordinate with a dietician
to help them do that. Even
supplementation would be sufficient. And
so that’s something whenever you see a
patient to the pretend it’s not a good
idea to bring up with your doctor if you
have any I mean if you are a vegan if you
are a vegetarian oh yeah I
definitely would find that right away
yeah I definitely would. Every now and
again ACOG doesn’t
recommend routine testing of vitamin D
in all women, but if you have somebody
who’s at risk of having low vitamin D
that’s something that is a part of the
history we could get from you that would
be important we could check to see
supplementation is an option. And ACOG is?
American College of Obstetrics and
Gynecologists. They tell me what to do.
Yes I was going to say I know the American Academy
of Pediatrics so they really want to
do yet but so you are you are they up
dating regularly their recommendations
and what they see out there is best
practices? Yes yes definitely.
So the third one I think we were going to talk about
was gluten-free. Gluten-free shouldn’t be
a problem. Avoiding gluten a lot of carbs
don’t need it any way. We have a little bit
too much in our diet, so a gluten free diet
generally are not a problem. We need that
iron and that calcium. In terms of what
kinds of food you’re eating in a breakdown
of carbs, protein and fat in a day. Do your
needs change? Throughout pregnancy? Yeah.
Um I would say that you may need more because
that caloric intake increases. But
proportionately one more than the other?
Not necessarily. Okay, so it’s just
whatever gets it through to the end of
the day? Mhm. Alright so that’s the food
which it is an all important topic. The
next one that is also just as important
though not much fun to talk about is
exercise. Oh before we go to exercise
though, I forgot one important
micronutrient— folic acid. Oh my god! How
did we leave that out? I’m so sorry
We’re talking about yummy foods and you
know what it’s so funny this
last appointment was the one where my
doctor was asking about the spina bifida
testing, so the reason is for folic acid
and could you tell us a little bit about what
it is and why we need it? Yeah yeah so
folic acid has done a lot of green leafy
vegetables and prenatal vitamins the
biggest thing there are a couple things that
are different for prenatal vitamins and
multi violence, but the biggest thing is
amount of folic acid they have in it
which is more than just a regular
multivitamin. Typically prenatal vitamins
have about one milligram of folic acid,
which is a little bit more than what you
need which is fine. The guidelines
include taking in 600 micrograms of
folic acid a day, so by taking a
prenatal vitamin you’ll get that
supplementation. You need it because
there’s an increased risk of spina
bifida or spinal cord malformations in
people who lack folic acid and so
that’s why we do encourage women to
supplement with it even before pregnancy
because that spinal cord forms before
you find out you’re pregnant. Oh my gosh!
Yeah so which is pretty pretty some
interesting embryology, regardless three
months before you attempt pregnancy should
be taken a multi vitamin
at least three months. Is there any harm
in women taking a folic acid supplement
in addition or involved in folic
acid and their daily vitamin intake
before they ever even think about
getting pregnant or is it something that
you just that is just for. You can
take it, but a lot of what happens a lot
of times people get sick of taking more
and more pills. But yeah
if you want to take it whenever you’re
not contemplating pregnancy that’s
completely safe and completely fine and
reproductive women who aren’t using any
form of birth control should consider
taking enough folic acid in case they do
become pregnant. That’s so
interesting I didn’t I didn’t realize I
the spinal cord was formed long before you
ever knew you were pregnant
We don’t see it until later, but
a lot of those things have already
happened in that time period. There have
been other things that have shown an
increased risk of the spinal cord mouth
forming, so like hot tubs like hot like
not like my showers hot, but like a hot
tub it’s a hundred degrees that you get
into that’s been associated with it as
well. And women who have a history of
this, so let’s see if you had a pregnancy
with some sort of spinal cord
malformation or if they’re on
anti-seizure meds because that can lower
the amount of folic acid in your body.
They should actually take even more. They
should take about four milligrams and is
that something you recommend people talk
to their own doctors about right away
Oh definitely! Oh how interesting. Alright so
that is now that’s an even better segue
because when you mention the hot tubs I
think this does fall there are so many
things that we can talk about the
idea of exercise. What can we do? What can we not do?
Under the heading of especially of exercise
And no sitting in a hot tub is not exercise, but
00:29:50,179 –>00:29:54,889
it’s related to exercise for example
if you go skiing and then you get in the
hot tub afterwards, first of all can you
ski pregnant? No sorry. Why is that? Well there
are two reasons. The first reason is you
want to avoid contact sports and skiing
as kind of a physically demanding
contact sport— not necessarily physically
demanding part of it, but it’s a part of
trauma or injury you could easily fall
over and hurt your abdomen or your belly
I will say I’ve only been skiing one time
and skiing is a loose word I only went to
the ski school for one day and I was
asking the group i was with on the way
up the slope how do you stop? What do you
mean how do you stop? I mean if you’re
going to come at something how do you
stop and and they’re like you’ll stop you’ll figure
it out they will teach you how to stop
and trust us you’ll figure it out. Yes
you’ll figure it out you throw yourself into
the side of the mountain. It’s just
the bunny slopes
It was not anything by any chance but there
were 18 month olds
that slid right by me on
ski’s but I’m you just might
intentionally knock yourself to the ground
and I don’t know I mean at what point
the become a real problem and it isn’t
a huge problem now but I will say I bump
into things more often because i think
as your body starts to change and you’re
not fully aware of. Oh you’re totally right
yeah and I mean this is the center of
gravity it changes Yeah let me show you I need to
know you can I show them? Yes I do need a
second demo are we going to watch them
afar? As well alright I will watch
from afar. So I had kind of bad posture
but um typically when you’re not
pregnant you have this posture where
you’re spine is a little bit curved on
both up here and back here. What happens
with pregnancy your center of gravity
changes you’re starting to carry what’s
going to become a watermelon you develop
what we call lordosis so it’s physiologic, it’s
normal, but basically this curve right
here really accentuates and that’s why
sometimes pregnant women looks like
they’re waddling. They have to change
their center of gravity back here
because they’re carrying a watermelon
here. And so this curvature and their
spine changes and your ribs will also
move up, their heart will move up as
loads of pregnancy progresses, if by that
center of gravity changes and so because
of it they walk a little funny they made
waddle side to side, but in addition to
they’re prone to falling. They’re really
prone to falling, so having good shoes.
These are not good shoes, but I’m not
pregnant. They’re very cute! They’re very
cute shoes but having a nice solid
tennis shoe of trying to avoid
flip-flops as you can we’re getting on
summer now— everyone loves their flip
flops, but a nice supportive shoe like a
tennis shoe is really helpful because
you’re prone to falling and if you’re
prone to
injuring your belly, so that’s
essentially why skiing for two aspects
isn’t helpful because you’re prone
to you’re moving very fast and prone
to hitting your belly, but also your
center of gravity changes you don’t have
as good of a balance and you really need
that to ski. But what about seeing
another sport though is like riding a
bike? You could fall riding a bike, is
that is hazardous? Sorry
yeah yeah it is ok because once again
riding a bike you have your own center
of gravity, which you’re going to have to
change and in addition to it balancing
on a bike. So if anything I’d recommend a
stationary bike where you have a little
bit more support and you’re not likely
to have a dog roll through or a squirrel right?
Oh and then oh and then your yeah and
they are going at higher rates of speed
But exercise is good we’re talking and I
do know that I shouldn’t have started
with the one you can’t do. Yeah I
did all of the things you can’t you should always
start with a positive. So um I won’t be a
have friends who was on a spin bike from
I mean up until she was eight
months pregnant. Okay. She said my
doctor said I can keep doing what I did
before. I mean is that the general rule?
Is there what would you recommend for?
Spin bikes like a stationary? Yeah.
Yeah oh sorry, sorry. Yeah so I
was amazed because it’s intense when
you’re not pregnant and I get really
winded now. I can’t even imagine trying
to keep up the intensity of a sport like
that yeah for any duration of time, but I
mean she was she was incredibly fit to be
oh yeah and would do that on a routine basis and said
I just kept going and I never needed to
stop. Yeah so I guess I should have I
didn’t quite understand what you’re
asking me before. A bicycle. I was
asking about my okay okay i was asking
about something you could fall off. Yes
yes it makes me really I just sorry. In
my mind i moved to stationary bikes but..
I ok ok so a stationary bike is fine.
There are a couple of things though.
Do what you can so
you shouldn’t be able to sing when you
exercise, but you should be able to talk
ok making sure it’s not too hot, so I
don’t know they use but like the hot
yoga hot pilates I don’t know if they do
hot spinning I don’t think so but just
just like pilates you’re pretty hot
and gross so you know
making sure that you’re in a
temperature-controlled work which you
generally are when you’re spinning or
on a stationary bike i should say um
The only thing I get a little concerned
about is because of our anatomy and our
pelvis, you may notice increase
pelvic floor pain from that position
From what position? Riding a stationary
bike. Okay but if you don’t it should be
fine and when you say pelvic floor pain
you know what is what is it? Yeah I would
you just know when you feel it and you
know but you don’t know? Ask your doctor
if you experience it?
yeah no not really let’s back up
what is it? So you’re
pelvis the bottom part of your hips
basically has an intricate musculature
that sometimes with stationary bikes
leaves us a little restricted and can
cause a little bit more strain on those
muscles that they attach to your hips. They
attach to the front of your pelvis. They
get a lot of pressure on them from a
growing pregnancy. In addition, they can
cause your vagina hurt! Oh my goodness!
And I can say vagina right?
Alright good good
okay yes so you say I mean if you
experience that kind of pain what do you
do you need to call the doctor check on it?
What exactly are the symptoms that
you need? Yeah so I would just discuss
with your doctor. Is it because of the
pressure of the growing pregnancy in
general or could it be some pelvic floor
dysfunction? And there are physical
therapists out there that can work with
patients that you have some problems
with their pelvic floor muscles.
And that is what specifically yeah
that I mean those physical therapists
specifically work with women with
pelvic floor issues i did not realize that. Yes
there yes it is a thing it is a thing ok
So we talked about it with different
kinds of classes, but general rule want
to you tell patients when they come in
to you for their first appointment and
they say well I mean I’d like to keep
exercising what is your response?
Continue ok. Do what you’re doing just
nothing hot too hot, um no contact sport,
do what you can and you’re going to
notice as a pregnancy changes you may
feel a little bit limited ok and that’s
okay but continue to exercise. Exercise
is super important it’s helpful for the
labor process and it’s also helpful in
keeping you from gaining too much weight
during the pregnancy. That’s so
interesting that you talk about helping
during the labor process I know that
there has there has been at least the
perception in the world at some point or
another that you should be very calm and
laid back and not doing any major
activity when you’re pregnant. However, it
does seem a little counterintuitive when
really you are nine months gearing up
for one heck of a game. Oh that’s true
and you’re body needs to be prepared and
are there things that you can do to best
prepare your body to be an optimal
physical shape for labor? Is that a
thing? So we don’t have a lot of research
into it but anecdotally I can tell you
that women stay physically fit during
their pregnancy tend to tolerate labor
much better than women that don’t
because if you don’t you tend to gain
weight and you put yourself at risk of
other complications that we talked about
earlier but I would say just keeping
your overall health and not feeling like
you have to be a bump on the log
it’s most important. And we can touch I
know Dr. Robinson mentioned previously
Pilates is fine. I do a workout called
bar and it’s a combination of yoga and
pilates it’s not very low-impact yeah and I
had asked one of the instructors early
on to avoid anything just a
little you know you’re not supposed to
be flat on your back after 20 weeks, but
really your body is going to tell you
what it can and cannot do otherwise
you’re fine and there are certain I mean
you can’t it definitely already awkward
to twist certain ways, but it’s so so it’s
so true that you’re right your body does
kind of give you some indication. You’re
totally right. You’ll know when you
can’t do something or you don’t feel
good so if you lay on your back for a
long period of time, you may feel
nauseated you may feel a little dizzy, you may
start breathing heavier and if you stand
for long periods of time you may feel a
little dizzy as well and sometimes fluid
can collect in your legs and it needs to
come back up so. So one question that was
submitted earlier in advance for this is
what about like CrossFit and lifting
weights and sit ups and pull ups? Oh
that’s a good question and
CrossFit and there are some those what
is a high-intensity interval training type
work those that are really hot right now
hot as in trendy
not temperature hot with air
conditioning uh-huh. The one thing I get
concerned about lifting heavy weights
would include I’m dropping something on
your belly, losing any sort of balance um
Pull ups should be fine, sit ups should
be fine, but they’re going to become
harder to do at that pregnancy
progresses. I was asked my next question
too about it it just seems
counterintuitive that you could do a
crunch when you’re pregnant. Yeah uh huh
you kind of can you kind of can yeah um
you may not be able to towards the end
because your rectus muscle really get
stretched out. In the beginning you can
and it’s perfectly safe and are there
I’ve seen people who wear support bands
underneath is what is that and do you
recommends that? Oh do they help? oh
yeah even without exercise it’s really
really helpful. You can imagine like I
showed you guys earlier you start carrying
this watermelon and your muscles and your
ligaments have to accommodate this
watermelon. So you can imagine everything
gets stretched out and as everything
starts leaning forward a pregnancy belt
can really help you support that extra
weight— especially whenever you’re
exercising. It’s just like the
weightlifters, only a little bit
different. It’s just and the the thing
you’re talking about the bat curving
and is that what leads to back pain early
on too? Okay yeah yeah. In addition to that,
your pelvis is made of three different
bones that relax because of hormones
that your body makes and that relaxing of
those hips can also cause pain too, but
you’re right. And does exercise can it
hurt that? Can aggravate it further or
does it help? Tends to help it and get it to
help be honest with you ,depending on
what you’re doing though. Everybody’s
body’s a little bit different. A
friend of mine was saying it was first
trimester and so a little bit now of
being so exhausted and trying to avoid
that late afternoon caffeine run um some
just go for a walk it’ll help
and it does. I mean… it doesn’t help
as much of coffee people. I’m sorry it
just doesn’t. But it does get your blood
moving a little bit better and that seems again
on the counter intuitive scale to be
kind of on there. As did because I
started to experience a little bit
of lower back pain. It’s not it’s not
horrible it’s not unbearable just
annoying. Oh yeah is it ain’t.
It’s going to get worse oh yes at all oh
yeah I was told if you think it hurts now you ain’t seen
nothing yet. I mean so many of my
complaints now if I was very just people
yeah. But it’s very important you and
your feeling at now. And I feel bad even
though I said this in our first episode
to you feel bad complaining about it and like I
say I’m not complaining though. I realize
that you’re experiencing it! Especially when
we’re talking like this every week and I
feel compelled to highlight every single
minute experience so please— no I don’t
mind all the time I try and just save
that for my husband um so that and the
ice cream runs.
um but the just a little bit of exercise
can help boost your energy yeah yeah
definitely definitely and if you need a
little topper with a coffee it’s okay
yeah that is it I’ve heard the same
thing as well and I bear news there has
been coffee in my life a couple of days I cannot tell
a lie. Are there any other tips or tricks
that you would give women as it relates
to diet and exercise in pregnancy? Well
balanced diet we talked about a little
bit of the nuances, but a well-balanced
diet okay. Weight— too much weight gain can
be not as good as too little, so that’s
equally as important. Where do you draw
the line where it’s too much? I know it’s where
somebody starts. Yeah it does
depend on where somebody starts. So if
you’re looking at somebody who’s
underweight um typically they can gain
up to 40 pounds in a pregnancy okay
we’re from 28 to 40. If somebody who’s
obese typically their weight gain should
goal would be like 11 to 20 pounds.
Really? Yeah and your body can sustain
just based on what it has there? And then
your average pregnancy is what? Your
average pregnancy for somebody who’s of
normal weight is 25 to 35 pounds.
So eat the apple. Yeah
but these are for patients
who have just one singleton
pregnancy yeah. Very very smart to point that
out because there are some that carry
two or more! Oh we see many multiples
Yeah yes you do I can’t even imagine. I
don’t even want to imagine that’s terrifying
right now. But for all of you who
are experiencing the joy of getting
ready to welcome two, three, or four babies
we’re really excited for you! Yeah.
So is there any other anything
else you? Just stay healthy
exercise is okay, eating a well-balanced
meal, make sure you’re getting plenty of
water, and plenty of sleep and this will
really tip you off to the rest of
enjoying the time enjoying your baby.
Keeps you healthy for well not only the
duration of the pregnancy, but for that
time period after the kid comes when you
want to at least be present and
physically able to enjoy this much as
possible. Exactly well Dr. Shelby
thank you for joining us and your husband as well
Yeah! Thanks Adam. I failed to look at the
topic list, but i think next week we’re
talking about what tests to expect in the
duration of a pregnancy. So there is one
of the— Sorry i cannot hold a sentence
together today. The gestational diabetes
test is which one? The glucose is
the one you were drinking the syrup? Yeah
yeah so that one is typically 24 to 28
rate weeks and if you have risk factors
they may do it in the first trimester.
Okay, so there’s a preview of the fun in
store for next week join us next Friday
Thanks so much!

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