As a fitness professional, I’m hyper-vigilant about documenting little details regarding my wellness and changing body. I have charts and notes recording mileage and training plans from various marathons, bulking/cutting programs, my bridal workout plan, and both pregnancies, to name a few. I’ve come to appreciate these notes, even while admitting they’re a bit over the top. Referring to them has led to some helpful insights, especially in regards to my first pregnancy.
I kept detailed notes on every week’s symptoms throughout my first pregnancy (with my son Carter, now a true “threenager” whose favorite angsty response to questions is “nothin”). That pregnancy ended abruptly when I experienced PROMS at 36 weeks 2 days (Premature Rupture of Membranes – aka my water breaking before full term). My mom had my oldest brother at 6 weeks early, for no apparent reason and without any strong risk factors, so I suppose I had filed away the possibility of an early baby in some remote corner of my mind, but it still shook my world. I didn’t have any risk factors for preterm labor outside of my mom’s single experience (the rest of us kids were full term). So, when approaching the preconception planning of a second child I was torn on whether or not to accept the advice that OB after OB gave me; to receive weekly progesterone shots throughout the pregnancy to reduce the risk of preterm labor.
If I had given birth a few weeks earlier than 36 weeks (which is considered “late preterm”), then I think I would have accepted the progesterone shots without question. But I felt like I was so close to full term that maybe…just maybe…if I looked back over my pregnancy notes and did copious amounts of evidence-based research, I could consider alternatives. As it turned out, my notes were very revealing and made me realize a couple of things; 1) my cervix is very sensitive when pregnant so internal checks and even sex can trigger changes more rapidly for my body than other women’s, and 2) my signs of preterm labor began around weeks 34-35, a time when progesterone temporarily dips down in pregnancy before jumping back to new highs in the last month.
I had to ask myself a difficult question:
Could I risk going against doctors’ advice and try natural approaches for preventing preterm labor and increasing progesterone throughout all 40 weeks of gestation? Could I live with myself if my actions didn’t work out? Could I live with myself if I didn’t try to let my body self-regulate with a little extra TLC from a healthy lifestyle?
I decided to give Mother Nature one more shot… and I delivered my second baby at exactly 40 weeks. I can’t be sure that my actions deserve credit for a full term birth – it might just be happenstance or luck. And I can’t recommend that women at risk for preterm labor do the same. But I can share my story a bit and help women consider all the ways we can help our bodies along, regardless of whether we’re also using additional medical interventions, like progesterone treatments, to prevent preterm labor.
To start, let’s talk a bit about what preterm labor is and how to identify it…
Disclaimer: The contents of this article are not medical advice. If you have concerns about preterm labor you should contact your medical provider to discuss your risk factors. If you believe you are currently experiencing symptoms of preterm labor contact your medical provider or call 911 immediately.
36 weeks 2 days…aka day one of my oldest son’s life
Preterm labor
*All information in this section is quoted directly from the March of Dimes.
Definition: Babies born before 37 weeks.
According to the March of Dimes, signs of preterm labor in a pregnant woman may include:
- Change in your vaginal discharge (watery, mucus or bloody) or more vaginal discharge than usual
- Pressure in your pelvis or lower belly, like your baby is pushing down
- Constant low, dull backache
- Belly cramps with or without diarrhea
- Regular or frequent contractions that make your belly tighten like a fist. The contractions may or may not be painful.
- Your water breaks
A few of the top risk factors for preterm labor include:
- You’ve had a premature baby in the past.
- You’re pregnant with multiples (twins, triplets or more).
- You have problems with your uterus or cervix now or you’ve had them in the past.
Medical risk factors before pregnancy for preterm labor and premature birth:
- Being underweight or overweight before pregnancy. This can include having an eating disorder, like anorexia or bulimia.
- Having a family history of premature birth. This means someone in your family (like your mother, grandmother or sister) has had a premature baby. If you were born prematurely, you’re more likely than others to give birth early.
- Getting pregnant again too soon after having a baby. For most women it’s best to wait at least 18 months before getting pregnant again. Talk to your provider about the right amount of time for you.
Coming home from the hospital with baby #1 (my son Carter)
Things I Did Differently in My Pregnancies
Although I did a lot of things differently in my second pregnancy, there are a few things I did the same that I feel are worth mentioning first. In both of my pregnancies I avoided smoking and alcohol. Some moms feel like by the third trimester the baby is “fully baked” and an occasional glass of wine or beer won’t do any harm. I can see the logic, and to each their own, but I feel that the evidence regarding baby brain growth accelerating in the third trimester (the brain triples in weight!) is enough to confirm that I don’t want to flirt with any toxins beyond an occasional “taste sip” of someone else’s beverage.
In both pregnancies I followed a healthy diet, eating plenty of fruits, veggies, lean proteins and healthy fats (plus a daily sweet indulgence after dinner!), and maintained an exercise regimen focusing on lots of hip and core stabilization. Lastly, as is my nature, I nested like a crazy person both times. My husband may be experiencing PTSD from my latest “honey do” list that had him scrambling up ladders, re-caulking our kitchen, and car shopping for a new vehicle.
The things I did differently the second time I was pregnant were primarily actions driven by the desire to avoid another preterm labor. As mentioned, it’s impossible to say whether these actions influenced my body’s ability to get to full-term this time around or if I was always going to have a second baby at full term. Either way, these natural approaches to preventing preterm labor are ones any woman can incorporate into her prenatal care after talking to her OB about her personal risks for preterm labor and whether or not progesterone shots are strongly encouraged for her…
C-Reactive Protein
This protein can be high in a mother’s bloodstream because of acute or chronic infections, and may be the reason why women with urinary tract infections during pregnancy are more susceptible to preterm labor. C-reactive protein is a marker of inflammation but it can be lowered and controlled by a Mediterranean diet, adequate vitamin C, and probiotics. Hence, I tried to eat fruits higher in vitamin C during my pregnancy (kiwi, strawberries and citrus), started a new, higher CFU probiotic designed for prenatal health, and made sure that I ate the maximum allowance of low-mercury fish for pregnant women alongside other healthy fats like nuts, flax, avocados and olive oil.
Omega 3s
There is some evidence that an increase in Omega 3 fatty acids can help reduce the risk of preterm labor primarily thanks to their effect on balancing prostaglandins (which help the cervix ripen in preparation for labor and help the uterus contract – hence a better balance of this hormone would do the reverse and slow down physical preparations for labor). Thanks to this research, I made sure to bump up my Omega 3s, starting with adding a serving of ground flaxseed to my morning oatmeal.
Mega-Hydration
Uterine irritability can be triggered by dehydration. I was informed of this when I went in to the labor and delivery unit at 24 weeks with pregnancy #2. I was throwing up uncontrollably thanks to a virus that my toddler and husband had been ill with just a couple days prior. They only suffered a fever and lack of appetite whereas my body went into full-blown chaos; fever, chills, violent vomiting, etc. While I was getting treatment for an anti-nausea medication at the hospital the nurses hooked my belly up to monitors to assess potential contractions. Extreme dehydration can throw some women into preterm labor or labor because uterus begins to experience contractions. My belly wasn’t contracting in full but it was “irritable” – aka experiencing an abnormal amount of tightening that could potentially progress to contractions. The nurse who was caring for me sent me home with one of those giant hospital cups that has a handle and straw, and that holds up to 32 ounces when full. She told me to drink 3-4 of them a day in addition to my other beverages. I was a bit shocked by the volume but took it to heart and can say with certainty that I stayed better hydrated in my second pregnancy than my first. (Summary: To prevent uterine irritability and contractions drink at least 10-12 cups water/day.)
Coming home from the hospital with baby #2 (my son Colby)
Dental Health
Believe it or not, it’s true; challenges in dental health (ex: gingivitis) can contribute to preterm labor. Say whaaaa? Yup, bacteria from the mouth actually migrates to the placenta and can cause inflammation that can trigger preterm labor. Most women who experience a direct correlation between poor dental health and experiencing preterm labor are women who haven’t had proper dental care, but that being said, it never hurts to cross your T’s and dot your I’s. This is why, despite not having any former dental problems, I became extra diligent about brushing my teeth for a long time and flossing each day during pregnancy. Admittedly, my flossing habits were in need of some improvement.
No High-Intensity Interval Training
We’ve known for a while that exercise can impact hormones. It helps women who are estrogen dominant become more balanced and it releases feel-good hormones like endorphins. Men and women benefit from a boost in testosterone during exercise too. Changes in body composition in response to exercise bring additional benefits for the endocrine system. As it turns out, progesterone is yet another hormone that can be impacted by exercise…more specifically, it can be lowered by high-intensity interval training (HIIT).
During my first pregnancy I did a couple HIIT workouts each week – it was my jam. I always kept my heart rate within safe ranges and I knew how to modify high-impact and intense exercises for safety. It felt like I was doing no harm. In retrospect, maybe that kind of exercise wasn’t the best. If nothing else, it didn’t kill me to put it on the back burner during my second pregnancy, plus I think my pelvic floor enjoyed a rest from high-impact moves – and for that, my body is already saying thanks (and I’m only 2.5 weeks postpartum!).
Lowered Physical Stress
Studies show that women who spend 5+ hours on their feet each day are at a higher risk for preterm labor. This is a tough pill to swallow for a busy body like myself who works in fitness. With this knowledge in my back pocket, I worked to lower physical stress during my second pregnancy. I took more naps and got off my feet when I was fatigued instead of powering onward in my stubborn determination to get stuff done. It was difficult to discipline myself at first but with a toddler to care for, this may have ended up becoming my saving grace.
Delayed TTC
Women who wait 18 months from giving birth to one child to conceiving another are at less risk for preterm labor. In other words, any woman who gives birth to or gets pregnant with subsequent children in under 1.5 years is at a higher risk for a preterm baby. Hence, I took my time gradually weaning my son around a year and a half old and let my hormones stabilize for a few months before jumping into the TTC roller coaster for the second time.
Right to Refuse Internal Prenatal Checks
It’s hard to feel like we have a right to deny basic prenatal routines like internal cervical checks in the third trimester – but as mothers, we totally can reserve that right! You have full control over the process and no one can force you to do something you’re not comfortable with. I was thrilled when I told my OB that I was concerned internal checks might cause my water to break early again (it broke a handful of hours after an internal check in my first pregnancy). Thankfully, my OB understood my concerns and said that internal checks don’t do a lot for most of the third trimester except satisfy curiosity. I was blissfully in the dark until 39.5 weeks when I got my first check and discovered I was already 4 cm dilated! (So *that’s* what the random back pain and cramps were at 38 weeks – early labor contractions!).
Visualization
I’m not sure if there’s any science to pointing to visualization helping you get to full-term in pregnancy but I will hang my hat on how a difference in my mindset facilitated a healthier and longer pregnancy the second time around. I was so anxious and ready to be “at the end” in my first pregnancy. Perhaps that caused me to have higher inflammation, push harder, ask for more internal checks and more. There are a number of ways this could have caused me to treat my pregnancy differently. I’m so glad that I wanted nothing but to be extremely (even painfully) pregnant instead of having a preterm baby in my arms. This mindset drove small daily actions that I believe added up and helped me achieve a healthy pregnancy.
I did a few other things differently in my second pregnancy too, like avoiding most decaf coffee brands due to how the beans are decaffeinated using chemical solvents and requesting that I be allowed to drink an organic fruit juice drink for my prenatal glucose screening instead of that nasty, unhealthy orange drink they offer in the office. I also stood my ground in labor and delivery, electing to avoid pitocin and an epidural and marveling in shock (and pain) when my natural labor efforts jumped me from 6 cm dilated to 10 cm in one contraction (in a warm bathtub!).
It wasn’t always comfortable trying to do things differently for my second pregnancy but it was well worth it (just check out the sweet, healthy glow of my full-term baby boy Colby!).
Worth the wait for this little sweetie
(Please forgive any typos…still only a couple weeks postpartum over here! See y’all in a few months for some fresh content…okay…maybe even longer…we’ll see how mothering two headstrong boys shakes out.)
Yours in health and wellness,
Maggie
