In-Depth Discussion Today With Doc About Running During My Pregnancy

After two weeks of some fretting, some heart rate monitoring, a lot of self-analyzing, and a wide variety of comments from friends, I sat down this afternoon with my Obstetrician to discuss in detail the level and speed of running I can continue during the pregnancy.  At my last appointment, she had declared the one-size-fits-all rule many doctors follow that your heart rate can't go over 140, and we'd agreed to check my heart rate to see where I fell.

Going into this appointment, I sat down at the computer this morning and compiled a 3-page document to lead the discussion with my doctor.  It included

1. my training history over the last year so she could really visualize where I've come from,
2. the heart rate data I'd collected throughout the last two weeks,
3. other things I had been doing since our last appointment to improve my probability of getting to run
4. online research I had done about exercising during pregnancy for those who were active pre-pregnancy

Yes, I truly am that analytical.

When the doctor sat down, I started with telling her that I understood where the 140-heart-rate rule had come from - she doesn't know I wouldn't do something stupid like run 10 miles in the middle of the day in the heat, or that I wasn't lying or exaggerating about my training history.  But I told her that I've been a model patient (perfect blood pressure, a healthy weight, no complications, no defects spotted with the baby) aside from the complications we know from the first pregnancy would arise from my fibromyalgia, but again, the running has helped keep the effects of that condition at bay.  So I asked her to go through all the info I had prepared and decide what were the right heart rate and other exercise guidelines for ME in particular.

She was great listening and discussing each item with me.  Immediately she expressed a "wow" at the monthly mileage summary of my training over the last year.  I laughed and said, "See, I don't know that it's not always getting communicated how much I've been running over the last year.  I'm not one of those who saws they are a runner but are doing a couple miles only a couple days a week!"

In the end, she agreed to the detailed compromise I suggested with the caveat that she was agreeing to it now but things might and will change throughout the pregnancy.  Here's what I presented on the paper that she agreed to...

• Would like to compromise on the strict 140 bpm rule with the following:

• Stick with a pace that is about 160-165 bpm,
• Have walk breaks every 3 to 5 minutes of running, walk break length of 1-2 minutes, whatever gets it back below 140 bpm
• Always wear a heart rate monitor with all exercise.
• Limit distance – no half marathons, but up to 1 hour of exercise (5 miles).
• Always keeping perceived exertion no higher than an 8 on a 1-10 scale.
• Mix in lower heart rate training like elliptical, Zumba fitness, and other classes like yoga and pilates rather than running every day.

Additionally, the doctor made notes in my chart and we agreed that I'll help us remember to discuss in detail my exercising and heart rate data at each and every pre-natal visit, and I'll be having more ultrasounds routinely to monitor fetal development.

 

We also discussed an item she brought up which I had already mentioned in a previous blog post and had on my 3 page report for the doctor - my caloric intake.  I've left another pound in the last two weeks.  She's not concerned, but I was already aware that I have to work on upping my calories to account for the 300-500 I'm burning several times a week.

While some who ran through pregnancy suggested I get a second opinion or a new doctor, I love this doctor (she delivered my first child also), and this proves why she's great.  She was willing to change her opinion with further information provided and she truly listened to what her patient was trying to explain!

Happy Running All!

Would You Like To See My Tally (Marks)? A Story of Runner Hydration

Once I decided that I wanted to stay pretty active during this pregnancy and that running would in some part play a role in that, I immediately realized that hydration was one of the three key elements I would need to monitor for both my safety and the baby's (see the blog post with all 3 items here).  Hydration is important to any runner anyway, but with the stress of resources "for two" on a pregnant woman, and then add exercise on top of it, the focus becomes crucial.  And I know I wasn't feeling hydrated since I had become pregnant - my facialist noticed how dry my lips were and I was chronically thirsty (not a good sign).

Hydrate, hydrate,...am I done yet?
I'm analytical, so this big general concept of hydration means nothing without some parameters.  It's so easy to think we are getting enough fluids in the day.  So how much is enough?  Most of us have heard that 8 8-oz. glasses of water a day are fine (so 64 ozs), but that's for a regular person, not one "drinking for two".  I found a great article from the American Pregnancy Association about hydration facts and suggestions of how to stay hydrated.  They suggest 8-12 8-oz glasses a day (so 64-96 ozs), but with the caveat that more than that is suggested if the weather is warm or if you are exercising.  My sports chiropractor who has taken tremendous care of my physical health for the last 4 years told me last week that he normally suggests a 1/2 oz per pound of body weight to the standard person, but for pregnant, exercising girl in the hot Texas summer, he thought for me that almost 1 oz per pound of body weight would be advisable and do me good.

So at 157 ozs (@ 1 oz per pound), that's a LOT of water.  So for the last week, each day I've consumed between about 130 and 150 ozs of water.  At first it felt like "self-waterboarding torture" but it's funny how it's feeling more natural now.  But there's one big tip I have for how I've been getting it done.

My Big Tip for Hydration
Enter my world of a Solo plastic cup and a Sharpie permanent marker.  Everything revolves around these red cups now.  It's my non-stop reminder during the day to drink.  I put a tally mark each time I fill the 16 oz cup to the top.  Those tally marks stare at me all day, and they tell me if I'm behind or ahead based on the time of day.

So far, it's working well.  What are your tips in this heat to stay well hydrated?

Will I Boil My Baby's Brain?

My last post about my plan for cautious levels of pregnancy running that were still not as conservative as the safety level of my doctor's initial heart rate recommendation ("keep it below 140") got mixed responses.  The harshest, although I know it was said out of the spirit of caring, was one anonymous comment who actually included the statement, "...how would you feel if the extra outdoor exertion cooked your baby's brain just a little?"

Wow.  I was pretty upset for a while about this comment.  I'm trying to take the best care of both me and my baby and add the mental guilt that whatever you do could cause something to go wrong with the baby.  I'm in a place where I'm damned no matter what I do. 

I could go with the opinion of this anonymous comment who from the rest of the comments represents to me the more old-fashioned approach to pregnancy to treat the 9 months where you are an "incubator" (sorry, anonymous, if I got that wrong, and if you don't feel that way, no worries, I've still met several who do!). This train of thought has me wanting to sit on the couch or hide in my bed for fear that anything I do will hurt the baby.

The other side has me leading a more active pregnancy and then the possibility that something goes wrong with the baby, and the rest of the world (thanks to me giving my thoughts a public forum) and I would think that this decision was the cause - even if it wasn't.

At first after reading this person's opinion, I told my husband, maybe no running at all, not a stitch, is the best thing to do.  Listen to the doctor, which, I still think stupidly, would mean I can't keep my heart rate low enough at any running pace .  So walking would still be in, and cross training, but not my favorite spot, even at low intensity.

Then, I thought I should keep doing the cautious yet still a little above 140 heart rate running I wanted to do, and I would just become very private and hide my activities from the world - no posts about running, no blogging, and hope no one asks me directly so I don't have to lie.  If anything did go wrong with the baby, no one would immediately point to the fact that it HAD to be because I ran because they wouldn't know I was.  But another mom I confided in told me this wasn't right.  She'd seen how seriously I'd been weighing my options and thought I ultimately knew what was best and safe for my body, and thought I needed to stand up for all those women, even active ones we have seen, who are too afraid to stay active during pregnancy because "what if" could happen.  I felt like I'm always the one who ends up vulnerable on the front lines fighting battles, but in the end, maybe that's my purpose and role in some people's lives, to be the soldier on the front lines for whatever topic they need me there for.

In the end, I'm most comfortable to continue talking through what's happening with me, and I will welcome all variety of comments, but let's be honest, some will sting.  I have an appointment with the doctor Wednesday to talk through the heart rate ranges I've seen in my various levels of activity and see if the 140 rule still holds absolutely.

I've run or walked three times since my last blog post.  I met up with a group Friday night at 9 pm and did 4.25 miles.  I'd keep my heart rate at 160 max and worked in plenty of walk breaks to bring it back down so it never stayed there too long.  I'd wanted to shoot for 6 miles but it was still almost 90 degrees, so while I was smart about picking that run because no sun, cooler, less humidity than running during the day, I was still cautious.

Sunday, I walked 2.07 miles on my way to and from my spot cheering at Mile 12 of the Wounded Warrior Half Marathon.  And then today, I ran/walked 1.22 miles at 9 am - kept it short because I'd accidentally walked out the door without remembering the heart rate monitor so I didn't like that I didn't know how my heart was doing, and it was just plain hot.

Pregnancy Running - I'm Done Thinking, Now for Some Conclusions

I appreciate everyone who has put up with my analyzing and overanalyzing (to some) of my current and future physical condition, the safety of the baby, and my mental/emotional health in relation to staying active and exercising during pregnancy.  I know I am a weird mix sometimes of extremely emotional and yet critically analytical - and it creates a giant cluster of thoughts and feelings.  I was surprised how many read all my musings on pregnancy running and this whole situation - I had about 150 unique visitors to this blog over the last week!

So here is an update on my more recent workout and heart rate testing (test #3), research and anecdotes everyone has provided or I've found on my own in the last few days, and conclusions on my workout and total body-and-baby health plan moving forward!  I know it's long but necessary to be to get all this out and done and move on with staying as healthy as possible through the rest of this pregnancy!

Update on Latest Workout
I can tell that I feel amazing.  After a 30 minute elliptical workout of 3.5 miles yesterday morning, I also accompanied my friend Sarah to our first 1 hour Zumba class last night.  It's kinda like step aerobics without the step, then shake your hips, booty, and chest the whole time - oh, and throw in some basic salsa moves.  Kinda fun, definitely not as hard as running for an hour.  I wore the heart rate monitor and most of the class my heart rate hovered around 130, had some jump-ins for short times to 140-155, but it would bounce back down super quick.  There's a 10-20 second break every couple minutes between songs so that bit of recovery was quite noticeable on the heart rate monitor.

Research and Anecdotes from Others
A load of googling and reading articles I've found and that others have been so kind to send me has been very helpful.  I understand that my doctor appears to be using very conservative rules for exercise during pregnancy - I can't really blame her, she's just the type to want to guarantee the safest pregnancy possible for her patient.  And, while some suggested I consider changing doctors over this, that's not the best choice overall for me.  This doctor is an amazing Type A woman who is a great fit with my personality and who has already gone through a pregnancy and delivery with me - overall, I really enjoy having her as my doctor.

After reading articles, including going directly to sources like the American College of Obstetrics and Gynecology, I feel much more comfortable now knowing that there are less strict, more fluid guidelines available with ranges of safe percentages of max heart rate and a more subjective test of using perceived exertion, which can actually help a pregnant woman, by staying body aware, carefully limit her activity more over time as she feels the exertion required for the same exercises is higher.

And here's a sampling of the personal anecdotes:

• Lisa W.: "My Dr said the 140 was out of date and to run at conversation pace. As long as I could keep up a conversation without huffing and puffing I thought that was an ok pace. That did mean about 1-2 min slower per mile than my non pregnant pace though."
• Elizabeth M.: "I could not keep my heart rate below 140 when running while pregnant, which is why my doctor came to the compromise (after he did research as I was going to keep running) that as long as my heart rate went back down within 2 minutes of stopping, I was okay. There is a big difference between pregnant fit women and unfit women when it comes to heart rates."
• Abigail H.: "I read your blog and feel your pain! I ran through the first 20 weeks of this pregnancy and used the elliptical after that, up until the day I delivered last week. I used 'perceived exertion' as my guide, and my heart rate usually was between 150 and 160. Lillian was born healthy and happy with no damage. I don't want to disagree with your doctor, but that was my experience."
• Lena H. (a newly certified personal trainer): "The general consensus tends to be that it is safe to run during pregnancy if you ran before you are pregnant, are generally healthy, take some precautions, and check with your doctor (which you did). The 140 heart rate rule is considered "old school" by many, and obviously didn't work very well in your case. Rating of perceived exertion (RPE) may be a better estimate of effort. You need to work out at a moderate level, where you can talk (which means you are working aerobically). Also, your joints get looser during pregnancy, which means you are more prone to injury and have to be VERY gentle if you are stretching. Finally, a disclaimer: I'm not a doctor, just a personal trainer, and cannot tell you for sure when it is safe to run. Maybe a second doctors opinion is in order."
• Jonathan P. (medical student): "For what its worth, what I've heard both in class and in my reading is that in addition to the heart rate rule there are two other rules. 1. You should be able to hold a conversation while you are running, and 2. If you were running a lot before pregnancy (which obviously you were) then maintaining that level of activity, perhaps slightly decreased, should be fine. So if while your heart rate is around 160 you can still carry on a conversation, seems like you could be good to go. Hope you are able to come to a conclusion that both you and your doctor are happy with!"
• Jennifer K. (head training coordinator for a large Dallas running training program): "Ok- a few thoughts. I certainly don't want to disagree with your doctor- he/she knows best....but it is my understanding that the 140 HR is kind of "old school". Here's a quote from an article:
  
  
  “One of the keys is whether a woman exercised before her pregnancy,” says Burke. “If she exercised at 70 percent of her maximum heart rate (age subtracted from 220 times .70) before she became pregnant, she might be able to continue at that rate even if that number is above the 140 beats per minute (bpm) benchmark that has been established for pregnancy. Otherwise, she should keep her heart rate below 140 bpm at all times during her pregnancy. The Polar monitor will help her follow her doctors recommendation.” http://www.howtobefit.com/heart-rate-during-pregnancy.htm
  
  That being said- I think the effects of the heat are what you need to be concerned about...your core body temperature is already elevated because of the baby, you may tend to be a bit dehydrated....so consider doing the test inside on a treadmill or at a cooler time of day. Stay hydrated and cool because those things cause everyones HR to be elevated. Runner's World has a pretty good book about Running in Pregnancy- you might want to check it out.  If it continues to stay higher- you might even consider water running (although in my opinion it is about as fun as watching grass grow). Try it inside and see what happens."
• Lisa: "The 140 heart rate is very old school. New recommendations use 'perceived exertion'. 140 is very arbitrary and feels different to each person. You might want to get a second opinion. I have been through training with experts on prenatal fitness and there is no reason why you shouldn't be able to run with a healthy pregnancy. I have some articles that I can send you when I get home...  Don't get discouraged."

Additionally, some comments were more along the lines of encouraging cross-training of swimming or biking (neither sport I've ever done, including the fact I can't swim, so now's not really the best time to start out of the blue), treadmill running, taking it completely easy, that it would have been good to have a baseline heart rate before pregnancy (yeah, I know that NOW. Hindsight is 20/20), etc.

Current Conclusions on Workouts
There are currently three things I feel I need to watch out for...

1) Stressing my heart and therefore, the baby's heart:

Zumba and elliptical have proved to be clearly safe.  For running, more detailed testing on run/walk intervals and paces and different times of day still need to be performed.  But more and more, I'm willing to just TRUST HOW I FEEL.  So far, while my heartbeat may seem high to my conservative doctor, I'm at conversational pace, I'm feeling good, I'm not feeling overheated, etc.  I'm going to stick with not too many miles, work in these other types of cross-training workouts that are more heart-rate friendly, and "run happy, not hard".

2) Thermoregulation (overheating my core body temperature which stresses the baby):

Again, Zumba and elliptical will help as indoor workouts.  I'll also be especially cognizant of the weather forecast, both temperature and humidity, and adjust when and how often I run around that!  This will probably include a lot of evening runs.

Major hydration will continue to help throughout this!

3) Caloric Intake

This is an issue not previously discussed in my blogs but one I've been thinking about.  I'm not great about consistent calories throughout the day and day by day.  I wouldn't say I've increased my calories more than pre-pregnancy, and I had read that a 30% increase to daily caloric intake is good during pregnancy to provide the baby the needed "fuel".  So if I additionally burning calories by the hundreds multiple days a week, I will really need to commit to eating more often.  I've already been making changes the last couple weeks of consistently getting in a breakfast now (used to be really bad about that!).

So with a plan in hand, I'm ready to move on to the next thing to stress about - ha ha! Kinda kidding, kinda not. Those that know me well will completely understand.

Pregnancy Running Heart Rate Test 2 - Let's Take Heat Out of the Equation

So yesterday after I blogged, it took me a while to really get past that initial gut reaction of disappointment... and fear.  Yes, let's confront one of the big reasons I'm so freaked out.  I think we should go ahead and get that emotion hurdle out of the way.

I have a chronic medical condition, fibromyalgia, that running has been so beneficial at helping me control for the last 5 years I've been running.  I'm the healthiest I have ever been, and there are actually days I wake up and don't immediately feel and know that it's a another day I have this.  And my first pregnancy was hard.  Doc says there isn't a ton of data on pregnant women with the condition, especially ones who have managed their condition without drugs or major daily activity changes for 10 years.  I had come off injury and didn't have a strong base when I got pregnant, and you can't build a base during pregnancy!  With normally having some level of muscular tenderness, soreness, or pain, the growth of my belly with the baby was very painful.  I tried physical therapy, almost weekly massage, and was seeing my chiropractor twice a week to get through this.  It threw my body into a "fibromyalgia flareup" that had me on some bedrest and a lot of pain the last few months of the pregnancy.  So I'm scared of feeling so bad again in this pregnancy.

And then we have the C-section required when I have this kiddo.  I broke my tailbone during labor with my first, so there's an almost certain risk I would break it again with a normal delivery.  I'm nervous because it's something people can take nonchalantly, but it's surgery, it's cutting you open, it's stitches, and it's recovery.  And I want a fast recovery by being at my best health.

Finally, I'm scared of being shut out of this hobby I love for so many months.  Of course that's scary - I have so many running friends and will get many many months of watching everyone else's running and not my own, and it will make my heart ache.  Anyone who's had to sit on the sidelines due to injury knows this feeling.  I don't want to miss running.

I Know Such Great Runners
Everyone gave me such great feedback to my last post.  Part of my big conflict has been that if my perceived exertion was low (conversational pace) then why did my heart rate have to betray me (higher heart rate that the doc doesn't want).  I appreciated the reminders that yesterday was really hot and humid, and I enjoyed hearing that other docs were more driven by perceived exertion rather than the outdated 140 rule.  I went out online and found the Guidelines of the American College of Obstetricians and Gynecologists on exercise during pregnancy and postpartum.  Quoting from it: "The ACSM recommends that intensity should be 60–90% of maximal heart rate or 50–85% of either maximal oxygen uptake or heart rate reserve. The lower end of these ranges (60–70% of maximal heart rate or 50–60% of maximal oxygen uptake) appears to be appropriate for most pregnant women who did not engage in regular exercise before pregnancy, and the upper part of these ranges should be considered for those who wish to continue to maintain fitness during pregnancy."  It goes on to say "Ratings of perceived exertion have been found to be useful during pregnancy as an alternative to heart rate monitoring of exercise intensity. For moderate exercise, ratings of perceived exertion should be 12–14 (somewhat hard) on the 6–20 scale. Evidence of the efficacy of this approach is that, when exercise is self paced, most pregnant women will voluntarily reduce their exercise intensity as pregnancy progresses."

Heart Rate Test 2 - Indoors - Elliptical
To the task at hand, I hopped on the elliptical for 30 minutes, 12 seconds, doing 3.5 miles at a nice comfortable pace.  My confidence grew as I saw my heart rate stay a nice constant rate right around 130. Yes! Up to 140 when my mom called and I talked to her for a few minutes during the workout.  When I finished, it took about 40 seconds to get my heart rate back down to 96. 

Great, so elliptical workouts are "in" with no conflict, controversy, or discussion needed! Busy the next two evenings, but looking forward to some evening outdoor run tests later in the week to try some slower paces, more walk breaks, and less humidity and see how the heart rate responds!

For now, know that my hope is renewed!

Angry and Frustrated - Pregnancy Running Heart Rate Test 1!

First, a special thanks to Matthew for letting me borrow his heart rate monitor GPS for the next few days.  Second, this 140 beats per minute limit when running heart rate rule for pregnant women is bunk! You can tell I'm still in the denial phase (although it is a completely arbitrary number).

I went out this morning about 9:20 am for my first heart rate test.  Resting heart beat was about 70 with about 80-90 as I moved around the house.  It's important to note how warm it felt out today - my route had no shade, it was full sun, 81 degrees, and humidity a little over 80% (whew!).  Noticed on initial warm up heart rate was 110.  I warmed up by walking and jogging for a few minutes and just getting used to the display's on this particular GPS.

Then, I performed a series of "tests".  3 minutes at different paces, each test followed by walk breaks of 1-3 minutes.  Thought process in italics.

Let's start with a pace that feels easy and natural.
3 minutes @ 11:29 pace: max heart rate was 164
1 minute walk break: heart rate back down below 140 in 46 seconds. 132 at end of one minute.

Okay, that was "allegedly" too fast, let's slow it down.
3 minutes @ 12:03 pace: max heart rate was 160
1 minute walk break: heart rate back down below 140 in 45 seconds. 132 at end of one minute.
Another 1 minute walk break: heart rate was 123 at end of one minute.

Fine, slow it down again.
3 minutes @ 12:29 pace: max heart rate was 164
1 minute walk break: heart rate back down below 140 in 55 seconds.  138 at end of one minute.
Another 1 minute walk break: heart rate was 124 at end of one minute.

Slow it down more? Shoot for 13:00, wow, that's too hard for me to slow down to that.
3 minutes @ 12:40 pace: max heart rate was 156
1 minute walk break: heart rate back down below 140 in 38 seconds.  132 at end of one minute.

Fine, heart! Let's see what you think of 5K PR pace:
3 minutes @ 10:30 pace: max heart rate was 174
2 minute walk break: heart rate back down below 140 in 1 min., 21 seconds.  130 at end of 2 minutes.

So basically, I can't run and keep my heart rate under 140?!? Try "purposeful" walk (not my fastest walk)
3 minutes @ 15:17 pace: max heart rate was 143.

WHAT? Now I'm frustrated and in tears.
Final 1 min, 34 sec of slow walking.
Heart rate 129 at the end.

Summary: All paces from 10:30 to 12:40 were "too much".  Although after 3 minutes, with most of those paces, I could recover within 45 seconds, which feels pretty good to me.  The purposeful walk was done after all the other tests but was still just a little over 140.  So I shouldn't be running at all?

I walked in the door and cried for a while - hubby patted my super sweaty shoulder, don't blame him for not hugging me. :-)  So right now, I'm angry and frustrated.  Based on 140 rule, I basically can't run and even a purposeful walk is kinda pushing it?!? And at only 13 weeks pregnant? And after running 30 miles per week earlier in the year!

I'm feeling like my doctor screwed me over.  She knew I was a runner and that I wanted to run through this pregnancy before I conceived.  Maybe we should have done more cardio tests to know what my aerobic and anaerobic personal thresholds were before pregnancy.  And I'm supposed to be testing my heart rate but we set up nothing more than my next check-up 4 weeks from now to complete that feedback loop.  Looks like I'll collect more data and call the doctor Monday to schedule something in a week to review all the data and decide what's best FOR ME and the baby - not just some generic rule.  I'm not ready to give up yet!

And what tests should I perform next?  I want to try my usual evening runs, where the humidity isn't as bad.  I should probably try a slower jog from the beginning without all those faster pace tests at the start.  What would YOU suggest I try?  Should I just give up?