Climbing Pregnant: Interview with Long Huynh, OB/GYN and climber
One of the many messages I received after I started blogging about climbing and pregnancy was from Long Huynh, an OB/GYN and climber living in Boulder, CO. She had collaborated with Climbing Magazine a few years back to do a very brief summary of climbing during pregnancy. However, I had many specific questions, as did a bunch of you that I thought would be great to get answered by a medical professional. What she gave me was above and beyond and more than helpful. There is so much information below on relaxin, joint laxity, climbing, belaying, exercising, heart rate, altitude, abdominal muscles, etc. Pregnancy should not stop you completing your usual day to day routines, or even more extreme ventures. For example, get started now on house hunting as it’s not as impossible as you’d expect it to be.
I think if you were only to read one blog post on climbing while pregnant, this is the one to read. I hope this helps any pregnant women out there, or women who are thinking of getting pregnant. It provides a great guideline to what is possible during pregnancy and climbing, what to avoid, etc.
Can you tell me about the hormone relaxin and what its role is in pregnancy?
So, I thought it was interesting that you asked about relaxin, because in reading in all of your blogs, everyone seemed to mention it as an important hormone in joint and ligament relaxation. Funny, though, because in my Med School and Residency training, *it was hardly mentioned AT ALL*. Now, I’m not sure if it was because we didn’t see super active pregnant patients or maybe because it just wasn’t a hormone that was that important for us to know about. I did a little research and this is what I found out:
-A lot of the research on relaxin happened in the late 1970s. It was being explored as a pregnancy hormone indicator, ie: to see if it could be used as a hormone to confirm pregnancy. Well, it lost out to bHCG, which is the hormone that is used in urine pregnancy tests now.
-To summarize what I’ve read, relaxin is a hormone that is made by the corpus luteum cyst (this is the cyst that is formed in your ovary after the egg pops out [ie, the egg that is later fertilized by sperm]). It looks like its main role in pregnancy is to help with placental implantation in the 1st trimester — meaning, it has a role in allowing the placenta to form within the uterine lining. Part of its role may be in allowing blood vessels to develop between the uterine lining and the placenta; another role may also be to cause the uterine muscles to relax as it starts to grow early on in pregnancy so that it doesn’t contract. In addition, it may help the uterine muscles reform as it start to enlarge throughout the pregnancy and it may play a role in causing the cervix to soften in the late 3rd trimester (to get ready for labor).
Are there specific times during pregnancy that it is stronger than others?
Most of the studies suggest that the highest levels of relaxin are in the FIRST trimester, between weeks 8-12. (Makes sense if you read the answer to your question above.) It then declines to a low steady state level throughout the rest of pregnancy. There’s a possibility it may spike with labor as it may play a role in cervical softening near the end of a pregnancy.
How long is it typically in the body after birth? Breastfeeding vs. not breastfeeding
Hard to tell, but one study suggested that it drops to pre pregnancy levels about 3 days after delivery. There was no mention of whether this occurred with breastfeeding or not.
Before I move onto your next set of questions, let me say this: I think you were looking for a relationship between how joints/ligaments are affected by pregnancy & if relaxin as a hormone has a big effect. I did a search about this – there wasn’t much out there. I did find a 2003 study from the OB/GYN department at The Mayo Clinic in Minnesota that looked at 4 hormones and their affect on joint laxity. To summarize, there seems to be NO correlation between relaxin & joint laxity. If there is an association at all, it seems to be with a hormone called CORTISOL (but the association was weak; the study was small in of itself, so not the greatest either).
What IS known is that joints DO tend to relax & ligaments DO tend to stretch in MOST pregnant women as they progress through pregnancy. This makes sense, in order to allow a baby to grow & then eventually deliver at the end. What we are not sure of yet is what hormone (or combination of hormones) is truly responsible for this.
In addition, it seems like the joint and ligament changes can last past delivery, even past the usual 6 weeks postpartum recovery time. I guess what I’m trying to say is this: even after your 6 week postpartum visit with your OB/GYN, your body for the most part has recovered from the delivery, but it doesn’t mean that it has completely recovered from the pregnancy. Take it easy and gently work your way back to your former fitness self. 🙂
Can you tell me anything that women should avoid in climbing while pregnant?
#1: Do NOT fall, especially, do not take a BIG fall, like a whipper. At any time during pregnancy, this can be bad. Early on, there’s a potential to cause a miscarriage. Later on, in the 2nd & 3rd trimester, there’s a big risk of placental abruption (detachment of the placenta from the uterus). The placenta is a big organ and it is what feeds the baby. If it detaches, that is VERY BAD for both the baby and mother.
#2: So, to avoid #1– pregnancy is NOT the time to have a difficult project to work on. It IS the time to continue to stay active (for lots of good reasons) and you can still climb, but obviously be smart about it. Climb routes that you know, climb routes that are well within your climbing skill range, climb routes that YOU WILL NOT FALL ON. Probably good to stop bouldering, probably good to stop leading difficult routes, probably good to stop leading completely after the 1st trimester. I am a big fan of top-roping routes that are well within your skill level.
#3: In addition, when you’re belaying, probably good not to belay anyone who may take a whipper. Being pulled up fast by your climber or even being jerked up while being anchored in can be a shock to the system… and it can cause the same things #1 can. Soooooo… your climber is gonna have to climb well within reason of his/her level, too.
I’ve had a lot of women ask me if I’ve heard of anyone miscarrying because of climbing while pregnant – is this a common occurrence you see?
I have personally not seen this. Keep in mind: even though I live in Boulder and I work in Boulder County, I would not say I’ve seen a lot of patients who are rock climbers, maybe a handful. There may be more, but maybe they haven’t mentioned it to me? Perhaps because they’re scared to? What I have seen: any type of trauma to the belly or jarring force can cause bleeding and the potential for placental abruption in the later part of pregnancy. What I tell my active patients: don’t do anything where you could have a bad fall or where someone could potentially hit you hard. It is NOT good.
What are your thoughts on heart rates and altitude while pregnant?
I think one of your blog followers mentioned in her response to one of your pieces that the whole “keep your heart rate down below a certain level” is very antiquated, and she is correct. The american college of OB/GYN (ACOG) no longer has a recommendation for heart rate. INSTEAD, we recommend that you listen to your body as you exercise. If you’re feeling good — GREAT! If you’re feeling horrible, it doesn’t matter to us what your heart rate is — slow down or stop what you’re doing & take a break. As always, while you are exercising, it is VERY important to hydrate. That bottle of water should be near you always… and you should be drinking from it. Even if it means that you have to stop in the middle of what you’re doing to go pee. 🙂
As for altitude: I am not a big fan of patients from sea level traveling to places more than 6000ft higher than what they’re used to. You are just going to feel it and it’s not going to be fun (ie: you will get winded quickly). HOWEVER, if you already live at altitude (like in boulder — 5300ft), going up to 10,000ft or so should be fine because your body has already lived at a higher altitude level and you can adjust much easier. Again, when traveling, it’s important to hydrate. DRINK THAT WATER.
There are two sources about exercise and pregnancy that I thought you mind find interesting to read. One is a handout that ACOG has for the general pregnant patient. The other is the committee opinion that was published in 2002.
I’ve received a lot of questions about when is appropriate to continue/stop belaying while pregnant, can you tell me your thoughts on this? I know I stopped belaying Randy on anything he might fall on quite early (maybe 8 weeks?) and then after that, just belayed on very easy climbing (ie 5.6)
A lot of this depends on how good the climber is… is he/she going to take a whipper? Most likely one in the 1st trimester is going to be okay, but if you take one and hit a wall, that’s probably not good. Taking a whipper in the 2nd trimester (or when you start showing a belly) or the 3rd trimester, I wouldn’t recommend — it’s too much of a shear force that could cause placental injury. Good use of analyzing the situation & common sense are probably going to go a long way here.
I stopped climbing about 7-7.5 months when I was pregnant. I still belayed my husband after, but we made sure he was on a route that he wouldn’t fall on.
Can you tell me a little bit about using your ab muscles during and after pregnancy? Is there any danger in splitting or other worries that women should be concerned about?
Ok, so I did a little research here for you, too. Again, not a lot of studies out there (in the OB/GYN world). So, I’ll give you my little spiel of what I tell my patients (which I think falls into the common sense type of advice).
For the athletic patient with good core muscles, I usually say you can do a reasonable amount of abdominal work-outs until you start to show (ie “pop” out a belly, usually around 16-20weeks). after that point, it just begins to be physically difficult. However, leg lifts (these are NOT normal leg lifts – description is below) are a nice gentle way to keep your abdominal muscles toned in the latter part of pregnancy.
The “splitting” that you mentioned — I think you’re talking about rectis diastasis, which is the stretching of the abdominal muscles in the midline. This is very very common during pregnancy as your body is trying to accommodate a growing baby. Keep in mind, on average, a US newborn male is 7lbs 15oz and a US newborn female is 7lbs 11oz. Most female athletes have never had anything that big in their body before and so it makes sense that the body has to stretch. For most women, with time, the rectis muscles after delivery will tighten back up and the diastasis resolves. These diastasis recti exercises will be really helpful too.
As a side note, this is NOT a hernia. There is no defect in the strength layer (the fascia). All that has happened is *stretching.*
I get a lot of questions from patients as to when they can start doing core exercises again. It depends… if the delivery is uncomplicated, I tell most women they can start gentle exercises when they are about 3-4 weeks postpartum (of course, start off slowly). That changes with a difficult delivery or if there was a c-section — this time then gets extended. Most physical therapists I’ve talked to are big proponents starting off core exercises slowly regardless of how the baby is delivered, just to allow the muscles to recuperate and “remember” what it’s like to constrict without causing undo pain or strain.
I know most active women want to get back in the swing of things as soon as they can after delivery, but as I mentioned in my last email, your body needs time to recover from *the pregnancy.* You were pregnant for roughly 10 months (40 weeks), you have to allow that much time (and maybe a little more) to get back to where you were before. In addition, for women who are breastfeeding, it’s best to ease back into exercising so that you don’t lose your pregnancy weight too fast, otherwise, your body may be “shocked” and not produce milk. Once the milk sets in, the combo of exercise, diet and breastfeeding helps the weight come off.
Leg Lifts — these are NOT the ones you are thinking of in the weight room with weights. These are not too strenuous and still uses core muscles; and you’re not flat on your back which is important for 3rd trimester. When I tell my patients about this, I describe it this way:
-Stand against a wall for balance (if you need it)
-Using your own body weight (nothing attached to the ankles), flex your hip on one leg and bring your knee up to waist height with knee bent.
-Do 5-10 in a row, switch to the other leg, reps of 3
-Hands can be against the wall or on the hips
Your questions are interesting… and i’ve learned some things myself by doing some research! THANKS! 🙂