We can work [it] out, Part I

Now that we are heading up on the completion of Year One, so many things come to mind. Pumping. Diapers. Baby Food. First steps.  It’s a time to reflect, a time to enjoy. Ah, motherhood.

Is this a tad sentimental? Ok. There were things that I didn’t enjoy about doctoring and pregnancy and mothering and one was weight gain. That holdover from my training days was certainly something I was ready to do without.

You see, residency really messes up the Dr. Mom’s life. While some docs are disciplined enough to keep up physical activity and to prioritize healthy eating even with the hectic schedule, not all of us get it right.  During residency, before even the considerations of a “Little L” came to my mind, I went from one extreme to the other of eating. The low point for me, which I hesitate to recall, arrived during my first month on the hospital floors. I started out having my usual cereal with milk in the morning, but when went into work, I got very busy. So busy that I got to noon conference late, grabbed something to eat, and worked again, staying in the hospital until 8pm at night. By the time I got home I managed to eat a little bit and fell asleep, only to wake up again at 4:30 to repeat it all the next day. By one week into the rotation I was skipping breakfast at home, grabbing a yogurt at work and eating it during conference, skipping lunch and noon conference altogether in favor of trying to get morning work done, and then working up until 7:30 or 8 at night. At that point I would return home to usually skip dinner because I was so plain tired. You can imagine the deterioration inherent in this scenario. On the weekend it was no wonder that I ate with reckless abandonment. When a night out presented itself, I ordered two appetizers, an entree, and dessert.  I never looked at the scale and waistline-friendly drawstring scrubs became my best friend. Exercising “a few times a week” turned into “not at all,” and although I was able to resume workouts after my stressful intern year, I still didn’t exercise nearly enough to match my caloric intake. For two years my weight gained steadily; I graduated to new sizes of pants without blinking my eye. And I was content with all this.

Then, a few months prior to completing residency, I became pregnant. My first trimester wasn’t too complicated when it came to food revulsion and morning sickness; I felt a bit nauseated and was always sleepy but that was it. Thankfully, as residency was coming to a close and as my body clamored for more attention, I just. plain. had to pay attention to my diet.  My body was tolerating smaller quantities of food at a time and it was becoming more than a little perturbed when I binged on pasta and tomato sauce. So my first steps to a healthy pregnancy included paying more attention to what my body was asking for and finding high quality – nutritious but speedy-to-eat food. I began carrying snacks with me constantly, but power bars didn’t do it. Instead I stuck to Greek Yogurt with fruit, apples, eggs and filling salads. I still ate terrible things at nights while on call. It’s only the way in the hospital, but if all they have in the middle of the night is grilled cheese and tomato, that is what you eat.

The truer manifestation of healthful eating came once residency had finished and I was moving into second trimester. Suddenly, with tons of time on my hands, I was able to pay more attention to my diet. My nutritional advisors including my doula and midwife really encouraged me to increase my protein intake during pregnancy and to balance it with healthy carbs and reduced fats. So I scoured the babycenter websites and began to really increase my protein intake with healthful sources: lentils, chicken breast, tofu, eggs. I went from eating no eggs a day to eating two eggs a day during pregnancy.   This is a quick and easy fix for any Dr. Mom – so much nutrition and it only takes few seconds to eat (a large egg has about 90 calories, 7 grams fat, 6 grams of protein, and almost no carbohydrate)! I also had to really cut down on the bad stuff: the cakes, unhealthy carbs which were really interfering with digestion, but this ended up doing better for me because I ate more whole grains and fruits and vegetables instead. I ended up carrying a healthier diet for the remainder of pregnancy, and incidentally at this time, we ended up eating out less than we had during residency, so I was able to keep in check the 2,000 – 3,000 calorie meals I used to gobble up on a night out .

We keep our home exercise equipment in strategic locations to maximize space. The yoga mats and the fitness ball are in the corner behind the couch.

My eternally unfit self knew that the other side of the health kick during pregnancy involved becoming more physically active. I enlisted trainer Laura Kraman, who owns Delaware Mobile Fitness, to come to my rescue.  She trained me twice a week in weight training and cardio work, and encouraged me to run on my off days. Soon I was working out 3-4 days a week, which was still far from perfect, but at least   3-4 days a week more than what I had been doing beforehand!

Prenatal Pilates: The 10 Minute Solution and Julie Tupler’s Maternal Fitness became my new best friends. Strengthening my core became paramount to my pregnancy exercise routine because I knew I wanted to have good strength to push.  Laura and I also worked on increasing my upper body strength since we knew I would be holding a child through much of the rest of the next several years!
For most of pregnancy I was active, on my feet, jogging lightly when I could (and increasing incline later on in pregancy as my ability to run faster went down) and training with light weights. We made sure that I wasn’t laying on my back, which is a no-no during pregnancy because you wouldn’t want to theoretically harm a child’s blood supply by pressure placed on the umbilical cord during exercise.  Safe exercise during pregnancy is key!  On off days I found my center as I learned deep breathing exercises and practiced those pesky kegels.  I worked out through most of pregnancy, all the way until about 2-3 weeks before delivery, when I was able to do little more than walk on the treadmill. And then little L was born.

As you probably read from my blog, my birth story reflects a birth that for me was successful both for how fortunate I felt to be able to deliver naturally without interventions AND for my little loving L that came from that fateful day in January.  My nutrition during pregnancy and my workout schedule – I think – had a great deal to do with that success . . among other things that I think I touched on at the time. Not to mention a lot of luck that accompanied the entire experience!

Anyway, once I was finished with pregnancy and was now a Mom, given the challenges residency had posed in terms of quality of life in terms of my health and weight, I fully expected myself motherhood to give me one heck of a time trying to lose baby and post-marital weight. I wasn’t able to work out for the first month or so after delivery – for some reason it’s NOT a good idea to work out right after pregnancy, who knew??!!  🙂  Ok, so your body has gone through the biggest natural trauma of life, maybe it’s a good idea to let yourself slow down for a little while!  So I did, and resumed workouts when L was about 2 months old. But how to get down on that post-pregnancy weight?

Enter breast feeding. The one-stop-shop to maternal weight loss. I have talked to so many moms who were amazed at how, just by breast feeding, they were able to shake off that baby weight and get to a size that “they hadn’t been in since college.”  I didn’t really believe that this one would happen as hoped, but I think that this is the single most important contributor to the rapidity of the weight loss during early motherhood. Delivering L had taken about 12 pounds off from predelivery to postdelivery weight. Breast Feeding gradually removed another 10-15 pounds, but then I hit a plateau. I was back to below prepregnancy weight but I had only just started back up with weight training workouts.  My diet was pretty regular, higher in calories to accommodate the 500-odd-calories that L was requiring daily, but with how busy we were we were still eating out a lot.  Something still needed a tweak, which we would not approach till June, about 5 to 6 months into Little L’s Little Life.

I will touch on this subject – our habits over the past six months – in my next post.

Being able to take care of your children demands that you stay healthy yourself. Have you chosen to make your health a priority in your life? What steps are you taking and what have been your successes and challenges?