Now for #4 on our "11 Ways to Prepare for Your Best Birth" series. I've gathered some of my expert friends to contribute their expertise.

#4: Prepare your Body: Focus on Nutrition, Exercise & Bodywork

There are a number of really smart things you can do to prepare for the "marathon of indeterminate length" that we call labor. For a first-time labor, it's really a game of endurance and patience as it can last 12 hours up to a couple of days with a nice and slow build up in labor sensations. We all too often go into labor without much physical preparation. I ask you: would a marathon runner or any endurance athlete go into her big race without many weeks or months — and likely some expense — dedicated to conditioning their body to give them the best strategic advantage? So it goes with birth, my friends, and I dare say birth is that much more important to make a priority! Below are some ways you can best prepare your body, as well as baby, whom we call the "passenger", for "winning" your own rite-of-passage marathon.

Nutrition

You probably already know that nutrition can help your and baby's health. For many of us this means simply taking prenatal vitamins. These vitamins, however, are more about preventing deficiencies ("insurance") than promoting optimal wellness. There's so much more to it than that! Did you know nutrition affects every aspect of your pregnancy, with things you can proactively do for you and your baby's healthy birth, as specific as:

Help prevent gestational diabetes mellitus (GDM) and preeclampsia
Thicken the lining of your bag of waters and thereby lessening the likelihood of your waters breaking at the onset of labor? (It's to your advantage if this isn't the first thing to happen.)
Lessen your chances of needing to have antibiotics before or during labor — most commonly due to urinary tract infections (UTIs) or a high colonization of Group B Strep bacteria
Reduce the risk of a macrosomic (large) baby or intrauterine growth restriction/IUGR (baby not growing enough)

Check out these great Nutrition Basics for Pregnancy & Healthy Meal Ideas from my expert CEA/MNY colleague, Lena DeGloma of Red Moon Wellness (Park Slope, Brooklyn). Also see "Eating for Two" from Choices in Childbirth, and remember that "eating for two (or more)" does NOT mean your intake by the same amount! Focus on a diet of nutrient-dense foods and variety, with lots of healthy protein and healthy fats, vegetables and fruits.

Exercise

A healthy level of prenatal exercise will give you an advantage by:

helping baby into a good position through movement (pelvic movement, in particular)
making you stronger / increasing muscle tone
increasing circulation *Please note that the farther along in pregnancy you are the more careful you need to be about raising your heart rate for extended periods of time.
building stamina for the "marathon of indeterminate length" (i.e. labor)
building a greater body knowledge of the muscles required to "push" for birth

Prenatal yoga is one of the favorites because there's such flow to it, isn't overly vigorous, and there are specifically prenatal yoga classes as compared to other fitness classes that don't have prenatal-tailored classes. It also helps prepare a mom for the deep abdominal breathing and mindfulness that are so beneficial for not only pregnancy but also labor. For those in NYC, I highly recommend Juliana Mitchell — all of my students adore her! Here's a concise list of the benefits of prenatal yoga.

While prenatal yoga has many benefits, former student of mine, NYC personal trainer and proud new dad Michael Eisenstein makes the following important points:

"While yoga is a wonderful practice and prenatal classes can absolutely help pregnant moms navigate pregnancy, yoga (like anything else alone) is not enough. There are no "pulling" motions in most yoga practices because most yoga practices do not incorporate external resistance. Most yoga involves pushing motions and isometric holds and this can leave the muscles on the back side of your body that you need to pull things and stay upright weak. The muscles on the back side of your body (posterior chain) become more important as pregnancy continues because your center of gravity shifts as your belly becomes larger. The increased weight of your belly can strain on your back as you hold yourself upright. If the muscles on the back side of your body are not strong enough, this can lead to back pain during the later stages of pregnancy."

So, you can see it's very helpful — even important— to do some strength training prenatally as well.

Keep in mind that over-exercise is always inadvisable. Prenatally, it's extra important to listen to your body and not "push through" like you might have before you were pregnant— particularly in the 2nd & 3rd trimesters. Bodily changes such as the release of a hormone called relaxin loosens the ligaments in a pregnant body, which is good for birth but can put her at increased risk of injury if doing a too-rigorous workout — among other things.

Also, anything that too vigorously tightens the pelvic floor muscles can lead to issues. For example, dancers are always taught to keep their pelvis tight/tucked in, which can lead to tightness in these muscles that need to release in birth. So, working a) under your care provider's guidance, b) with a teacher/trainer who can tailor things to your specific situation (for New Yorkers, get in touch with Michael (eisenstein.michael at gmail dot com) or take classes with Juliana), and c) in conjunction with the below bodywork can be especially helpful if you fit into this category.

Check with your care provider to identify the best approach for you.

Bodywork

So much of birth relies on alignment and balance in the mom's body so that baby can find the most optimal position to come through the pelvis. Through the stresses of life and any physical or emotional trauma, our bodies all too often become way out of whack by the time we are in our childbearing years and therefore need some help discovering balance once again. Here are a few things I recommend seeking out:

Chiropractic care - helps mom's body get into a healthy alignment, which not only helps prevent mom from getting a lot of aches and pains throughout her pregnancy, but perhaps more importantly allows baby to get into a healthy position (read: shorter, smoother labor). My amazing chiropractor (see resources below for Dr. Vella's info) would like me to mention to you the idea of "the earlier, the better" -- that is, the sooner you can work on your alignment, the easier it will be for baby to get into an ideal position in mom's pelvis towards an easier labor.
Cranial Sacral (or Cranio-sacral) Therapy - serves similar purpose to chiropractic care. CST is a light-touch manual therapy used to encourage the body's self-correcting mechanisms.

Earth + Sky Healing Arts founder/former owner Katinka Locascio (Long Island City, Queens) gives her insights: "Cranial sacral therapy can be very effective in pregnancy. It can help align the structure and center the hips and pelvis. This helps baby get in good position and drop into the pelvis near the end of the third trimester. Cranial sacral therapy helps balance the nervous system, so its particularly helpful for moms having trouble sleeping or who are feeling anxious or have had a trauma come up while they are pregnant."

Massage therapy (including Mayan uterine massage) - works well in conjunction with chiro care or CST; helps with both the above as well as helping release tension and thereby allowing the underlying skeleton to better adjust.

More from Katinka: "Massage is wonderful in pregnancy; in fact the best massages of my life were all while I was pregnant. The body is so receptive and the tissue respond easily, thanks to all the relaxin present. Many women find it also helps them snag a much needed midday nap while they get a massage. Massage can address common concerns like piriformis syndrome (when your buttox area gets tight in pregnancy), tight shoulder, low back pain, swollen feet and calf cramps. Touch is oxytocin-stimulating so it's normal to get small Braxton Hicks contractions when receiving massage in our last trimester. It's also a reason why many of our clients who are past their due date find they go into labor shortly after a massage! The relaxation, centering and oxytocin hit can all help ease the body into labor when the time has come. Most importantly, massage is a great way get in some self-care while you still have control over your own schedule!"

…and on Mayan uterine massage: "Many woman have scar tissue on their sacrum from fall or injuries. I always tell my clients that the last three weeks of pregnancy are a window of opportunity for women to resolve old scar tissue or structural imbalances, many of which precede pregnancy but may impact the nerves that run from the sacrum to the cervix which are very important for labor. Good bodywork at the end of pregnancy can clear the pathways for a good birth. Thanks to all the relaxin present, this bodywork help resolve old patterns that would have taken months to work through when she's not pregnant. I see it as a little gift for the mom after all her hard work carrying the baby!"

Acupuncture - Acupuncture has been shown to help women go into labor closer to their due date, and can also be used to manage various discomforts of pregnancy. I personally recommend having weekly acupuncture sessions in at least the last 4-5 weeks of your pregnancy as way to avoid unnecessary induction (be sure to seek out someone who is experience in the perinatal period). See NYC Serenity Health Arts acupuncturist
Christiane Seibert's insights on the topic here and here.
Pelvic Floor Physical Therapy - Studies show that 64% of women experience prenatal urinary incontinence. 50% of pregnant women experience pelvic girdle pain. Seeing a pelvic floor specialist such as Lindsey Vestal of The Functional Pelvis can prepare your pelvic floor for a great pregnancy, ….birth and postpartum. Here’s a great podcast interview she did and a super informative tip sheet. See lots of excellent NYC-area options for Pelvic PTs here.

It doesn't escape me that the cost of these things can quickly add up. So, if you need to, it's best to choose 1 or 2 modalities, seeking out providers who are expert in the perinatal period, and go as regularly as you can (or as regularly as the doc thinks you need to). This is better than trying each modality only once, as dabbling will tend to be significantly less helpful. Perhaps you can find a practice who covers more than one of these modalities, and ask if they offer a discount package price.

Something also very important (and free!) is giving your body plenty of rest. Your body is working on creating a human life, and particularly as you approach your marathon of labor, you need to think strategically and go to bed earlier than you normally would. Particularly because it gets harder and harder to sleep well the bigger baby grows inside, it's all the more important to rest up for your marathon of indeterminate length! Christiane Seibert points out, "Maybe even more important than all the things you “do” are those you “don’t do” so that you can get plenty of sleep at night and rest during the day." See her other tips for a healthy pregnancy.