Breastfeeding While Getting Back to Running Post Partum

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The first few weeks after labor and delivery will probably go by as not much more than a blur and the life you lived before your baby was born will, for better or worse, be little more than a distant memory.  Running will likely be one of the furthest things from your mind during this time, as it probably should be.  But once things have begun to settle back down and you start to get a better handle on your new life routine, you’ll probably feel the urge to get back out for a run growing.  When your body is actually physically ready for a return to running is a somewhat more complicated question which will be the subject of a future post(s).  But once you are able to resume running don’t think that this will automatically have a negative effect on your ability to continue breastfeeding as some would suggest.

You may have heard stories about babies refusing to nurse after their moms exercise because higher lactic acid levels in the breast milk gave it a bitter taste.  As with many of these unsubstantiated “old wives’ tales”, the truth of the matter is a bit different.  Medical studies have shown that moderate or even high intensity running does not increase the levels of lactic acid found in breast milk, nor does it negatively affect breast milk quality or quantity.  It is usually only after sustained exercise at a maximal level of effort that increases in lactic acid levels are actually observed.  So unless your trying to jump right back into maximal intensity workouts, which would be problematic for several reasons, you should probably be able to continue breastfeeding without issue even as you begin incorporating running and/or other forms of exercise back into your routine.

However, always remember that while you’re breastfeeding, a significant amount of your daily fluid and caloric intake will be dedicated to the production of breast milk.  Because running burns plenty of calories and causes significant fluid loss through sweating, you’ll need to make sure that you replace both the fluids and the calories that you lose during your runs so that you don’t run into problems with insufficient milk supply.

If you are having trouble producing sufficient breast milk, there are several ways that you can try to stimulate an increase in your milk production:

  • Make sure that your baby is nursing efficiently and not just sucking for comfort.
  • Offer your baby both sides at each feeding.
  • Try feeding more frequently and/or adding pumping sessions in between or after feedings.
  • Try breast compression, which is a technique that can help keep your baby feeding longer.
  • Make sure that you’re drinking enough fluids, getting as much rest as possible and eating a balanced diet.
  • Try using natural herbal supplements, like Fenugreek, Blessed Thistle, Red Raspberry and Brewer’s Yeast.
  • Talk with your doctor about prescription medicines that are available, like Domeperidone (Motillium) or Reglan, which have been shown to help with increasing milk supply in some women.
  • Get in touch with a La Leche League Leader or a board certified lactation consultant who may be able to offer other suggestions.

If you’ve already tried several possible solutions and are still having problems with insufficient milk supply, you may want to try reducing your mileage or even stop running temporarily to see if that helps in correcting the situation.  As was discussed in a previous post, breastfeeding for as long as you’re able is better for the health of both you, by reducing your cancer risk, and your baby so if you need to put your return to running off for a short while longer to continue breastfeeding, it’s best for everyone.

Putting Interval Training to Work For You (Part 2)

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If after reading Part 1 of our Putting Interval Training to Work for You series, you’re thinking “maybe there is something to this interval training thing after all”, you may now be wondering ” but how do I put together an interval training plan that will work for me?”  There are so many ways that you can incorporate some form of interval training into your running program that it can be as simple or as complex as you want it to be.  At the simple end of the spectrum, it can be just throwing a few up tempo bursts, like for example, doing 6 or 8 X 30 seconds hard, 30 seconds easy, in between at least a mile or two of easy running to warm up and an additional easy mile or two to cool down afterwards, into some of your normal everyday runs.  On the more complex side, it could be a set of narrowly focused intervals on a track where you’re attempting to maintain a specific pace and tightly controlling the recovery time in between each interval.  But no matter how simple or complex you intend to make your interval workouts, you should make sure that you have a good, solid base of mileage before adding them into your training program.

If you do already have a solid mileage base, then the next thing to consider is what type of interval workouts you should be doing.  Now there are some who would say that the focus of your interval workouts should be based upon the type of muscle fibers that you have.  Muscle fibers are broken into two basic categories: slow twitch and fast twitch (there are two further subcategories of fast twitch fibers, but we’ll ignore that distinction for the time being).  Slow twitch fibers, which “fire” more slowly, are more efficient at using oxygen to generate fuel for themselves which makes them better for endurance activities, like marathons or Ironman distance triathlons because they can go a lot longer before they fatigue.  Fast twitch fibers, which “fire” rapidly, are much better at providing short, explosive bursts of speed and strength.  They, however, fatigue quickly.  While everyone has at least some of both of these types of muscle fibers in their bodies, runners who have more of the slow twitch fibers generally do better at the longer distances, like the half marathon, full marathon, or even ultra marathon and runners with the highest concentrations of fast twitch fibers generally excel at the sprinting distances.

Some running coaches subscribe to the idea that during interval training you should focus most heavily on the development of the areas where your strengths lie which would mean that runners with more slow twitch muscle fibers should primarily do workouts consisting of longer intervals (those from 800 meters up to 2400 meters or more), which mostly build strength and endurance, and those with more fast twitch fibers should focus on shorter interval work (intervals below 800 meters), which instead emphasize speed and speed endurance.  While there is definite merit to this approach, there is also a lot to be said for working on those areas where you’re weaker in order to attempt to turn that perceived weakness into a strength.  Therefore, we favor a more balanced approach when it comes to structuring an interval training program, however.

But regardless of where you choose to put your focus (speed, endurance, strength, etc.), you should make sure that you incorporate at least some intervals from both categories into your program in order to give yourself the best chance of maximizing your overall fitness.  In our third and final installment of this series of posts, we will delve into the nuts and bolts of putting together both individual interval sessions and an overall interval program, including pacing, rest and recovery, and how often you should do interval workouts.

Ask Dr. Beth…Send Us Your Questions

The Ask Dr. Beth posts are some of the most viewed ones on this site, but we need your help in order to keep putting them out.  Send us your questions, long or short, simple or complicated, about running, pregnancy or both to admin@runningthroughpregnancy.com or dr.beth@runningthroughpregnancy.com.  No matter what kind of answers you’re looking for, there are probably many other women out there who have the same or similar questions as you and are looking for the same type of guidance as you are.

Putting Interval Training to Work for You (Part 1)

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In order to run fast, you need to….run fast.  It may seem like an obvious statement, but there are many runners out there who are completely missing out on the tangible benefits that adding an interval workout component to their overall training program could bring.  Used correctly, interval training can make a significant difference in an athlete’s speed, endurance, strength and, ultimately, in their finishing times no matter what distance they’re competing at or what level of runner they are.

Now, when it comes to interval training you may be thinking “that’s not for me, I’m just a casual runner…that’s something that only the really, really serious, or perhaps even just the elite athletes do… it’s just too complicated for me.”  While this may have been true at one time, today, runners of all levels are using interval training to lower their 5K, 10K, half marathon and even marathon finishing times.  In addition, while it is possible to make interval workouts into intricate, complex affairs, they also can be as simple as throwing a few, relatively short, up tempo bursts into one of your normal everyday runs.

You may also be thinking “interval training means running at an all out speed, going as fast as you can go, and that’s a little bit more of an intense workout than I am looking for.”  In actuality, the focus of interval training isn’t about running at a 100% effort, instead, it’s simply about pushing yourself out of your comfort zone with a controlled, sustained effort.  You should be working hard when you’re doing an interval workout, but you shouldn’t ever feel like you’ve reached a state of complete exhaustion after you’ve finished.

There are several great benefits that can be gained through interval training:

  • Increased aerobic capacity and cardiovascular efficiency: allows you to run longer and/or with more intensity
  • Increased tolerance of lactic acid buildup: improves both the ability to run hard without going into oxygen debt and the ability to break down lactic acid more efficiently
  • Increase in calories burned during each workout: by increasing the intensity, you also increase the number of calories burned during each workout
  • Ability to increase training intensity without increasing risk of overtraining: allows you to continue to improve your strength, speed and endurance even though you’re running less actual mileage
  • Helps beat boredom by adding variety to your workout routine: keeps you mentally fresh by giving you a break from doing the same or similar types of runs every day

The addition of interval training into your running program could allow you to reach a level of fitness that otherwise would have been difficult, if not impossible, to get to if you continued to run just basic distance mileage alone.  Obviously, each runner is different and what works well for one person may not work at all for another.  Consequently, flexibility is key when designing and doing interval workouts.  In our next post on interval training, we’ll discuss how you can go about putting together an interval workout program that works for you.

The Right Clothing and Gear for Running in Warmer Weather

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Because it’s so important not to get overheated especially during the early stages of your pregnancy, having the right clothing for running is essential when the temperatures begin to climb, during the late spring and summer months. Dressing in lighter weight, loose fitting shorts, skirts, skorts and running tops made of breathable, synthetic materials is a must as these types of clothing will allow the body to breathe and keep itself cool. It’s also a good idea to stay with lighter colors, which do a better job of reflecting sunlight, in hot and bright conditions. Darker colors tend to absorb the sun’s rays which can lead to a larger increase in your core body temperature during your run.

Don’t underestimate the importance of choosing the right type of socks, either. Feet really heat up during runs in hot weather, and consequently they sweat significantly. Cotton socks will hold on to this moisture, causing the feet to slide around inside their shoes which invariably results in the formation of painful blisters. Instead, you should always wear socks that are specifically designed to wick moisture away from the skin, keeping your feet drier, and you much happier.

Other vital warm/hot weather gear includes running sunglasses and a hat or visor which are important because not only do they keep the sun’s damaging UV rays out of your eyes, they can also prevent the headaches that many times will result when you’re forced to squint in the bright sunlight through your entire run. You should also always remember to use plenty of sunscreen on all skin that is exposed to prevent getting a nasty burn.

Finally, and perhaps most importantly, unless you’re certain that there are more than enough places for you to get water along your running route, it’s critical that you bring your own source(s) of hydration with you. Water bottles, hydration packs and fuel belts are all good options for this. Water bottles generally come with a hand strap, while hydration packs are worn like a backpack and fuel belts are generally worn around the waist. While it may seem like a major inconvenience to drag any of these choices along with you, especially if you think you’re just going for a short run, their importance in helping to keep your body from overheating cannot be overvalued. During a run you should be taking in at least 6-12 oz. of water for every 15 minutes of running. On especially hot or humid days, sports drinks can be even more helpful because they help to replenish vital nutrients that your body loses through sweating. So play it safe and fight through any inconvenience that toting one of these hydration sources along with you may cause.

It’s vital that you do everything you can to keep your body temperature down to acceptable levels both for your health and the health of your baby. Sometimes, no matter what you do, the weather is just too hot and you’ll need to move indoors. It may not be the kind of workout you wanted to do, but it’s a small sacrifice that’s best for everyone.

Running Safely in the Summer Heat

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Spring is now in full swing and summer isn’t too far behind.  Outdoor temperatures will be on the rise and you’ll need to keep this in mind when you head out for a run.  Running in hot and humid conditions can always get a little uncomfortable, but it’s important to remember that it can also be potentially dangerous.  If you’re pregnant or trying to get pregnant, it’s vitally important that you don’t get overheated by raising your core body temperature above 101 degrees.  Numerous medical studies have shown that when an expectant mother’s body temperature repeatedly exceeds this temperature, it can have a decidedly negative effect on the health and development of her baby.  You can monitor your core body temperature either rectally or vaginally and if you find that after a run your temperature has reached 101 or higher, it’s time to start making some changes in order to prevent this from happening again.

If you have previous experience training in hot, humid conditions, your body is likely to be a little more suited to dealing with them.  However, don’t let this cause you to become reckless or overconfident.  Now is definitely not the time to be taking risks with your health or the health of your baby.  As with most things, a little common sense can go a long way.

There are some simple ways that you can keep your risk of overheating while running to a minimum.  Sunrise is generally the coolest time of the day, so if you have your mind set on continuing to run outdoors even when the temperatures start to really get hot, getting out there early is definitely in your best interest.  It’s also important that you make sure that you wear running clothes made of synthetic fabrics that will wick the sweat away from your skin allowing your body to cool itself more efficiently.  Avoid darker colors which will absorb sunlight and heat and go with lighter ones that reflect them.  Wear a visor instead of a hat so that heat can escape through the top of your head and always make sure that you apply plenty of sunscreen to any skin that will be exposed.  If you’ve been doing regular interval or fartlek type workouts, it may be time to decrease or eliminate them, as easy running is a lot less likely to make your body temperature spike.

If you feel like you are starting to overheat while you’re out on a run, slow down and look for a safe place to get into the shade and out of the sun.  If you brought water with you, (which you should always do) dump some of it over your head to help cool yourself down.

Water is obviously critical to maintaining an adequate state of hydration especially when the conditions are hot and humid.  Make sure that you drink plenty of water before, during and after your run.  During a run you should be taking in at least 6-12 oz. of water for every 15 minutes of running.  Sports drinks can also be helpful, especially post run, because they help replenish vital nutrients that your body loses through sweating.  However, because they’re high in sugar and empty calories they should be used in moderation.

Sometimes, no matter how badly you wish it were otherwise, the conditions are just not suitable for running outside safely.  There are many other workout alternatives available, but if you really are intent on getting a run in and the treadmill holds little or no interest for you, try deep water running instead.

Deep water running is done in a pool deep enough that your feet do not come in contact with the bottom.  A belt or other flotation device is generally used to help keep you upright, but it can also be done without one.  A regular running motion is used for both the upper and lower body and because of the extra resistance that the water provides, your upper body will actually be getting even more work than it would on a regular run, so be prepared for some possible soreness the next day.

If you do decide to try deep water running it probably won’t be the most exciting workout you’ve ever done.  In fact, it may turn out to be the least exciting.  However, it is one of the best ways to get in a quasi-running workout while all but eliminating concerns about overheating.

Running and Common Late Stage Pregnancy Complications

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We started this website to provide information and encouragement to women who wanted to continue their running for as long as they could through their pregnancies.  However, there are certain medical conditions that can occur during the latter stages of an otherwise healthy pregnancy (weeks 24 and beyond) where running, and most other forms of exercise, may be contraindicated and therefore should be discontinued.  Some of these conditions you may be familiar with, others you may not be.

  • Short Cervix  This is a condition that is generally diagnosed during a sonogram.  Depending on how short the cervix actually is, there may be a significantly increased risk of preterm delivery.  In most cases, women with a short cervix will be advised to discontinue running and if you’ve been diagnosed as having a short cervix you should not continue to run without approval from your doctor.  If, however, you’re able to reach 37 weeks or so (early term) without delivering, your doctor may allow you to go back to running.
  • Preterm Contractions  Many women who have even significant preterm cramping or contractions do not ultimately end up going into preterm labor.  However, if you’re experiencing considerable cramping and/or contractions during the third stage of pregnancy (weeks 25-34), your doctor may decide to run one of several tests which can help determine if you’re at a higher risk of going into preterm labor.  If you sometimes experience cramping or contractions while you’re out on a run, this is not necessarily a cause for concern as long as they stop once you‘ve finished running or shortly thereafter.
  • Gestational Hypertension  Gestational hypertension, which usually occurs after 34 weeks of pregnancy, should not be confused with chronic hypertension or preeclampsia.  The usual method of treatment for gestational hypertension is rest, and in some cases bed rest, so if you do develop it, you’ll most likely be advised by your doctor to discontinue running.
  • Preeeclampsia/Eclampsia  Preeclampsia is a potentially a life threatening condition.  It can develop at anytime during pregnancy, but more commonly occurs towards the end.  When it does develop early on, it is usually more severe and frequently results in a preterm delivery.  There’s an increased risk of cesarean section for women with preeclampsia.  Treatment for preeclampsia is usually bed rest either at home, or in more severe cases, in the hospital and in many cases the doctor may decide to deliver the baby early.  For the health and welfare of both you and your baby, you should NOT continue running or any other form of exercise if you’ve been diagnosed with preeclampsia.
  • Preterm Premature Rupture of Membranes (PPROM)  If the membranes that are holding your baby and the amniotic fluid around her rupture prior to 37 weeks, this is considered a preterm premature rupture of membranes (PPROM).  Women who feel a steady flow or sudden rush of fluid coming from their vagina will need to call their doctor’s office so that they can be evaluated in order to determine if their membranes have indeed ruptured.  Women who experience PPROM are at increased risk of preterm labor (50% of them will go into labor within the following 24 to 48 hours and 70% to 90% of them will do so within the next 7 days).  There is also an increased risk of infection for mom and baby with PPROM.  In some cases, PPROM can also lead to cord prolapse.  Cord prolapse occurs when the umbilical cord drops into the birth canal before the baby’s head does.  Once the head begins moving downward, the cord may then become compressed denying oxygen to the baby.  If it’s confirmed that you are indeed prematurely ruptured, you’ll most likely be admitted to the hospital for bed rest.  If you aren’t in labor, aren’t showing the signs and symptoms of impending labor or infection and your baby’s overall health looks good, you can expect to have a prolonged hospital stay.  You’ll be given antibiotics to protect against infection and if your baby’s lungs are not yet mature and there’s no current infection, you’ll also likely be given steroids to help them mature more quickly.

There are obviously many benefits that may be gained by running through your pregnancy.  There are also, however, certain situations where due to health concerns, it’s just not a safe option.  Always remember that the ultimate goal is a healthy baby AND a healthy you, rather than just one or the other, so it will never be a good idea to take chances when it comes to dealing with any of the conditions discussed in this post.

Staying on Top of Your Asthma Symptoms During Pregnancy

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If you have asthma and are taking medication to help keep it under control, it’s important that you let your doctor know this at your first prenatal visit so that the situation can be monitored throughout your pregnancy.  During pregnancy, just under half of all women with asthma see little or no change in their symptoms.  About 30% of them will actually experience an improvement in their asthma symptoms and less than a quarter of them will see their symptoms worsen.

For those women whose asthma does in fact get worse, the symptoms will usually be less severe at the beginning of pregnancy and then they’ll increase in severity as the pregnancy gets further along, generally peaking sometime between weeks 29-36.  Women who begin to experience worsening asthma attacks may need to see a pulmonologist for more intensive therapy in order to deal with their symptoms.

If, at some point, you’ve become concerned and want to determine if your asthma is indeed getting worse, you can use a peak flow meter, which usually can be found at most drugstores, to assess whether or not there’s been any narrowing of your airways.  To use a peak flow meter:

  1. Make sure that it reads zero.
  2. Stand upright and take as deep a breath as possible.
  3. Place the meter in your mouth, keeping your tongue under the mouthpiece, and close your lips around the mouthpiece.
  4. Blow out as hard and as fast as possible.
  5. Take a few breaths without the meter then repeat the process two more times.
  6. Write down the highest reading of the three.  Do not average the readings.

Decreasing flow rates usually signal a worsening of asthma and the need for more intensive treatment.  So if find that your flow rate is decreasing contact your doctor’s office or your pulmonologist’s office as soon as possible.

Some runners experience exercise induced asthma, a condition usually occurring within the first five to fifteen minutes of exercise, where increased blood flow to the vessels lining the airways results in constriction of those blood vessels and subsequent obstruction of the airways.  If you have exercise induced asthma, it’s important that you remember to bring a rescue inhaler with you on your runs in case you experience an asthma attack during one.  To reduce the chances that you’ll have an attack during a run, if you’ve found in the past that pollen or other allergens often seem to negatively affect your asthma, you may want to consider running indoors when the air quality outside is poor, just to be safe.

Compression Sleeves and Socks

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You may have seen them on other runners and wondered exactly what they were for.  Those brightly colored long socks that go all the way up to the knees or the colorful calf sleeves that start just above the shoes and rise to that same knee level.  They’re examples of what’s referred to as compression gear and believe it or not, they aren’t just a snappy fashion statement.  Compression leg wear has actually been around for quite a while and has been used for years by medical patients, elderly individuals and people whose jobs require that they stand or sit for extended lengths of time, such as airline pilots, to promote better circulation and blood flow while helping prevent the formation of blood clots in the lower extremities.

Recent medical studies have shown, however, that wearing calf length compression gear can also provide several benefits for runners.  For example:

  • Wearing this type of compression gear can reduce swelling in the legs and feet which leads to a decrease in post training muscle soreness.
  • It can also help speed up recovery after hard workouts by stimulating increased blood flow to damaged tissue which helps with reducing lactic acid buildup by flushing the lactic acid out of the muscles in much the same way having a massage would.
  • Compression gear may also help relieve some of the pain associated with shin splints because it holds the muscles, tendons and bones of the lower leg tightly together.
  • Runners who regularly wear compression gear during, and especially after, their workouts often find that their legs feel more refreshed the day following a particularly long or hard run.

There are several different brands that manufacture calf length compression gear.  All of them are made out of a strong elastic material which should fit tightly around the lower legs and/or feet along their entire length.  All of the different brands’ offerings should be made of a breathable material and there is at least one brand that offers a material that’s treated with silver ions to reduce the growth of bacteria and the odors that they may cause.

No matter which brand you choose, make sure that before you walk out of the store with a new pair of compression socks or sleeves that you measure your calves so that you end up with the correct size for you.  If they’re too tight, they’ll be uncomfortable (and that’s if you’re even able to get them on at all) and if they’re too loose they won’t provide enough compression, blood flow won’t be sufficiently increased and you’ll get limited or no benefits from wearing them.

Use of compression gear has the potential to be a double bonus for pregnant women who are continuing to run.  Obviously, swelling in the lower extremities is a common symptom during pregnancy in general and running can often just compound this problem.  Wearing calf length compression sleeves or socks regularly can essentially act as the solution for both issues and while compression gear may still look a little funny, at some point, comfort has to outweigh style.

Compression gear, especially the socks, may prove to be a little difficult to get on, particularly at first, so for a tutorial on a simple method of getting them on more easily click on the video link below.  The video is geared towards transitioning triathletes, but the technique will work just as well for runners.

http://youtu.be/wdgT6-bc9Zk

Ask Dr. Beth (Edition #55)

Hi, I am 6 months post emergency cesarean section (my 2nd) and I’ve been back running for about a month. Yesterday, I ran the furthest distance (6.5k) I have run so far and experienced no discomfort while running. Today, I woke up with muscle strain type pain across my scar area that hurts when I walk and even when I cough. What advice would you give me? Should I stop running? Thank you.   Kimberley P.

Based on the symptoms you’re describing, it doesn’t sound like you need to stop running at this time. While it does take a year for complete tissue healing at the incision site, after six months it should be healed well enough to tolerate the “strain” associated with a long run. As long as you don’t feel any type of bulge over the incision site, you should be safe to continue running. However, if the pain continues you may want to get in contact with your health care provider for evaluation.