Category: Expect

The French Postpartum Exercise Routine (reéducation)

The French are darn good at having kids, and they have a lot of them. I asked a coworker why every woman I met seemed to have at least 3 or 4 kids and she winked and giggled, saying that “the French like romanticism.” Did I mention these women all look fantastic? Seriously the pounds seemed to melt off postpartum as effortlessly as breathing. Like any good expat who shows up in another country to have a kid — I kept asking, what is their secret? And as I was soon to find out, breathing it off wasn’t far from the truth.

One of the big tenets of French obstetric care is specialized postpartum rehabilitation that is covered by insurance for every single mother. Ten visits with a kiné (physical therapist) to literally reeducate your perineum and abdomen (reeducation perinee and abdominale). Rumor has it that this tradition began after the first world war to help French women quickly repopulate the country. The joke is that it sticks around so women can quickly continue to be intimate with their husbands (before he gets a mistress!). And like every French exercise program, it can be done sans workout clothes or a gym membership (see here for other French exercise strategies). I can personally vouch for the fact that four months after my second child I am better recovered than one year after my first. Inspired by my experience with the French system, I’m posting a sample postpartum schedule and workout plan that non-French mamas can do at home.

Postpartum schedule for every mama

Immediately postpartum: REST! French hospitals can keep Moms for 3-6 (yes, 6!) days postpartum (and possibly more if birth was a bit complicated). This means that aside from the occasional walk through a maternity ward women are resting postpartum. Husbands are not allowed to spend the night, nor are other children. Moms focus on their newborns and themselves.

After discharge and up until the first postpartum visit at 4-8 weeks: Light gentle activity such as walking, household chores, and gentle yoga are allowed. After being cleared by her gynecologist a mom is given a prescription for physical therapy. Over the next few weeks she will have 10 x 30 minute visits to “reeducate” her perineum and abdominal muscles. What is pleasantly surprising is that no hardcore fitness efforts are required – you won’t even break a sweat. But you will notice your body parts starting to move back to where they used to be. At four months after my second birth, my body looks better than it did 12 months after my first. In addition to physical therapy, once you are cleared by the gynecologist activities like walking, swimming, yoga, and bicycling are encouraged. But no running until at least 5 months postpartum, due to those pesky hormones that are still loosening joints in your body!

Like everything French these physical activity recommendations are expected to be accompanied by good eating habits.  See these articles for more information:

  1. French advice for eating well during pregnancy (concepts apply for postpartum period and when breastfeeding)
  2. General French dietary guidelines

Postpartum exercise regimen (each session is 15-30 minutes, to be done after being cleared by a gynecologist for activity)

Sessions 1-3:

  • Kegels and kegels and more kegels.
  • The key is spicing it up (as much as kegels can be spiced)!
    • Start with 1 second kegels (contract your perineal muscles for one second, release for one second)
    • Work up to 5 second kegels
    • At the end of the 3rd session, end with deep breathing exercises. Inspire deeply, expanding your belly as much as you can, exhale gently, and then actively push out as much air as you can. This extra push activates deep abdominal muscles that you didn’t know existed, but support your organs.

Sessions 4 – 8: These sessions are focused on both abdominal work and perineal work.

  • Continue kegels, even going up to 10 second kegels
  • Continue deep breathing exercises. Once your perineum feels stronger you can do combination exercises
  • Lay on your back with your hands on your belly. Breathe deeply into your belly, feeling your belly expand. Contact your perineum (a kegel) and breathe out, pushing out extra air. Then suck in your abdominal muscles and contract your perineum even stronger. Release.
    • At first it will feel awkward and difficult to coordinate your muscle movements but keep practicing, and try to make these movements fluid. That actually works out your muscles more effectively than jerky movements.

Sessions 9 and 10: Boosting the abdominal workout. Once you feel comfortable with the combo exercises in the last session you can add extra little challenges.

  • Do the combos in tabletop position (on your hands and knees). Focus on keeping your shoulders relaxed.
  • Lie on your back and raise your legs, optimally rest your calves on a stability ball or cushions. Using your hands, push into your arms every time you do a kegel and suck in your abdominal muscles.

 

Bonne chance! I hope you find this routine doable and helpful.  Would love to hear your thoughts *  *  *

References

  1. http://healthland.time.com/2012/02/22/why-france-pays-for-postpartum-women-to-re-educate-their-vagina/
  2. https://www.theguardian.com/lifeandstyle/2009/mar/26/france-postnatal-care-sexual-health

 

Pregnancy Survival Guide: Tips to feel your best each trimester

Pregnancy Survival Tips: Basic strategies to improve your mood, energy, and well-being during pregnancy

Pregnancy is one of life’s blessings, but let’s be honest and admit that growing that little miracle can be a difficult and frustrating experience for your body. Two pregnancies and two continents later, I want to share the tips I have learned for surviving the various challenges of pregnancy. As always I’ll include specifically French-inspired tips because these French women are darn good at being glamorous no matter what stage of life they are in.

 

First trimester:

A time of changing moods, unbelievable fatigue, dizziness, and horrendous nausea (I personally find the first trimester to be the most difficult). To top it all off no one knows your pregnant so you just seem super lame and lazy! Here are some tips to help you muscle through it:

Survival secret Morning Sickness Extreme fatigue
Sleep
Physicial activity
Balanced diet
Ginger
  • Sleep it off: The best cure for a bout of morning sickness or extreme fatigue is a good nap. This tactic works well during the first pregnancy, but becomes difficult when you already have other children, just try to sneak in extra sleep whenever you can (like going to bed at 6 PM with your toddler!).
  • Move it off: The nausea and vomiting associated with pregnancy can be very severe, and triggered by almost anything – food, smells, motion, iphone screen, TV, and reading. If you can get yourself up and moving it will help boost your energy and fight nausea; if nothing else it will pass the time. A long leisurely walk is the French secret to good health and a slim figure! If you are feeling up to it, prenatal yoga is also a gentle way to exercise (Prenatal Yoga with Desi Bartlett is my favorite video, used it through both pregnancies).
  • Arm your diet: At first it may seem like any type of eating is an accomplishment when you’re struggling with morning sickness but there are tricks to keep it better controlled. The French are all about preventing digestive problems before they have the chance to get the best of you.  Here’s how:
    • Always have a carbohydrate rich breakfast (ie oatmeal).
    • Prevent nausea before it hits by eating every couple of hours (but less at each sitting) and eating well-balanced meals whenever you feel well enough to do so.
    • Keep your food choices simple and decrease the amount of spices and seasoning you would normally use.
    • Avoid overly greasy foods and foods with strong aromas, because these can trigger morning sickness.
  • Ginger! Ginger is an amazing all natural way to fight morning sickness. The French are hesitant to prescribe unnecessary medications during pregnancy, and my obstetrician recommended ginger as the first line treatment to my awful nausea. Use any form: tea(Yogi Tea Ginger, Herbal Supplement, Tea Bags, 16 ct), dried ginger, or my favorite – pills!

 

Second Trimester:

Also known as the golden trimester of pregnancy, the second trimester marks the time when most women experience relief from their morning sickness, along with a boost of energy. Plus that adorable baby bump is starting to form and become conspicuous!

  • Take advantage of this time! Travel, be social, enjoy romantic one-on-one time with your partner before those sleepless nights, which are coming sooner than you think…
  • Sleep: Invest in a pregnancy pillow (love this one: Leachco Snoogle Total Body Pillow, Ivory). Seriously, the minute you have trouble sleeping order one, its only going to get worse. When you sleep well all your other pregnancy symptoms get better.
  • Lotion it up. The minute you feel the itch on your belly, invest in high quality lotion or oil and rub it on your belly daily to prevent stretch marks. Every time your belly grows your skin gets stretched and becomes itchy, so this is a secret sign to moisturize. My favorites are Burts Bees Mama Bee Belly Butter 6.6 oz, Weleda: Pregnancy Body Oil for Stretch Marks, 3.4 oz, and Clarins Stretch Mark Minimizer Lotion for Unisex, 6.8 Ounce.
  • Pamper your skin: Your skin changes and may be more sensitive during pregnancy. Basic pregnancy itchiness can be improved by changing your soap (AHAVA Moisturizing Salt Soap is my favorite), laundry detergent, and daily lotion application. Please note that an itchy rash can be a sign of a serious medical condition in pregnancy and should be evaluated by a doctor.
  • Gain weight gradually. Although you are ecstatic to be done with morning sickness and reach for those French fries, take it slow and healthy. The faster you gain weight, the more uncomfortable you will be, and the more difficult it will be to stay active and energetic.  French women gain weight at or below the recommended guidelines.  For French secrets on gaining weight slowly and healthfully during pregnancy click here.
  • Be sexy. When you sadly realize your underwear no longer fits, fight your disappointment and indulge in a French luxury – lingerie! Just one chic lingerie set in a size that actually fits and shows off your blossoming figure will boost your mood and self esteem.
  • Keep moving! The French never stop (their national motto is mangerbouger which literally means eat and move).  Here are French tips for exercising without going to the gym.
  • Sciatica: Here are a few tips to fight it.
    • Limit the amount of heavy object lifting you do.
    • Practice prenatal yoga/stretching regularly.
    • Switch from a purse to a backpack
  • Constipation: Include high fiber fruits and vegetables into your diet, stay hydrated, and be French and eat yogurt and cheese daily to improve your gut’s bacterial population. If your stomach will allow it, even a bit of coffee can help.

Third trimester:

As pregnancy draws to a close you may find yourself with a new collection of uncomfortable symptoms. Heartburn, nausea, bloating, swelling, constant peeing, aches and pains, etc. Hang in there and know you are almost there!

  • Aches and pains: these are an inevitable part of pregnancy, but take it easy and give yourself as many breaks as possible. Keep practicing that prenatal yoga and going for walks, these are surprisingly helpful at improving your comfort level!
  • Fatigue: fatigue may come back at full force, especially since you can no longer be able to enjoy a good nights sleep with your baby gymnast, heartburn, and unhappy bladder. Again take it easy as best you can with work and domestic chores.
  • Heartburn/nausea: your enlarging uterus is squashing your stomach and bowels, making it difficult for your digestive system to hold food. Decrease the size of your meals and increase the frequency of your eating to help these symptoms. Also try avoid too many acidic foods (coffee, chocolate, tomatoes, etc). You can try eliminating one food item from your diet at a time and see if that improves the symptoms.
  • Swelling:
    • French doctors prescribe medical compression stockings for those last few weeks to prevent swelling and clot formation. This is also a good trick for fighting light-headedness throughout pregnancy.
    • Remove rings whenever you notice swelling in your fingers.
  • Embrace nesting, if you get the urge. Not everyone gets the urge to nest, but if you do, have fun with it! It can really help mentally and emotionally connect you to your pregnancy and growing baby child.
  • Prepare yourself for labor and delivery.  I did not prepare at all for my first delivery, and I read voraciously for my second.  I’m not going to take sides  on the natural versus medical birth conflict but I truly think it would help most pregnant women to read about what your body will do during labor and learn mental and physical tips to help you get through it, or at least get you to the epidural!  The following are basic and popular introductory books: Ina May’s Guide to Childbirth, Mindful Hypnobirthing: Hypnosis and Mindfulness Techniques for a Calm and Confident Birth, Birth Skills: Proven pain-management techniques for your labour and birth by Juju Sundin (2008-03-06).  What to expect when you’re expecting has a nice little labor section at the end too.

Keep your head up and keep telling yourself you are literally creating a human being every second of your pregnancy.  What your body is going through is an amazing and grueling process that you should be proud of!

Newborn Necessities, Extras, and Secrets to Save Money

newborn must-haves items

NEWBORN MUSTHAVES 101: What you really need to have on hand when your little bundle of joy arrives

Being pregnant can be terrifying. You want to do the best for the baby who has not come yet and you want to be prepared, but have no idea what you actually need. There is plenty of marketing to further convince you that you will be a terrible parent if you don’t buy certain items. Don’t believe it! There are plenty of lists out there striving to be minimalistic, but I feel that many still over recommend items so I thought I would throw my two-sense out there.  I’ll tell you the most important products, products for breastfeeding, and finish with some some hacks to get by in those first few weeks without emptying your bank account upfront!

The Essentials

      • Onesies (these are a popular baby shower gift so you may not need to buy any):
        • (1) Until the umbilical cord falls off, it’s better to dress newborns in kimono shirts than onesies. The hospital sent us home with a few of these, but its nice to have a couple around in case they don’t.
        • (2) After the cord is off, we loved kimono (or crossover) onesies. These are shirt onesies that can be taken off without pulling them over the baby’s head). For the first few months of your little miracle’s life, they will have monster poop blowouts on a regular basis and its so much better to avoid the whole pull-the-shirt-over-the-head thing. Obviously we hadn’t anticipated this and had stocked up on all sorts of cute onesies that got stashed away, and ended up using a couple hand-me-downs from wise friends over and over again (we literally did laundry on a daily basis at first). I’d recommend having a handful of these in both newborn and 0-3 month sizes, because you can’t be sure which size will fit the baby better.
        • (3) A couple full body onesies are nice too, especially for once the umbilical cord falls off, and if its cold when the baby is born.
      • A couple pairs of soft comfortable pants. They should be easy to put on and off (i.e. baby denim is super cute but completely unnecessary).
      • Swaddle blankets. The hospital sent us home with some, but its great to have extra thin swaddle blankets of your own. Layering the swaddles was our secret to getting any sleep with a newborn at home, and choosing your own patterns means better photo ops. Some prefer swaddlers over fold-it-yourself blankets, like swaddleme; we like both systems, and out of convenience transitioned to the swaddleme’s exclusively after the first couple of months. Aden and Anais makes great all purpose large blankets that can initially be used for swaddling and then repurposed as nursing covers, burp clothes, stroller covers to protect the baby’s skin from the sun or support a nap, etc.

      • Changing pad. There is one thing I can guarantee even though I don’t know you or your baby: your baby will pee, and poop, a lot. Having a designated changing area is crucial for your sanity and your back. This doesn’t have to be a fancy changing dresser, it can be as simple as a cheap changing pad placed on top of an elevated surface (for example a dresser, desk, or table). It should be waterproof or have waterproof covers because your baby will pee and poop all the time, even on you while you are delicately trying to change their diaper. Once the baby gets a bit older, they will actually love being on the changing pad, and what starts as the most dreaded place in the apartment becomes the most beloved as they start cooing, smiling, giggling, and even dancing on their little pad. A big bonus if you can designate a little storage area nearby to keep diapers, wipes, and protectant lotion (Aquaphor Advanced Therapy Healing Ointment Skin Protectant 14 Ounce Jar is a nice preventive lotion to keep diaper rash far far away).
        • You know what’s also great?  Simply giving your baby’s bottom a couple minutes to air dry before putting on a new diaper.  This is a *free* way to avoid and treat diaper rash.  Its obviously difficult if you have an unhappy camper or other children in the house, but if you can sneak in some “naked time” your baby’s booty will thank you.
      • Diapers/wipes: Again your hospital may give you a small supply of these, but its nice to have some around. For the first couple of weeks its recommended to use only water based wipes (without soap).
      • Baby carrier. Little newborns are used to being in the womb. They love to be held and cuddled, and you will love to hold and cuddle them in return. But sometimes, you need to get things done. So when your baby has evening terrors for hours every night, every day, and wants to be held and bounced, or you are ravenous and fantasizing about eating a real meal, a carrier that frees your hands is a godsend. We loved the Boba Baby Wrap, Grey, which is perfect for tiny newborn size babies and is very soft, comfortable, and lightweight.

    • Comfortable mommy outfits: Don’t burn your maternity clothes as soon as you deliver! You’ll want to be comfortable so you can focus on your newest addition.  If you are still pregnant and considering breastfeeding, try to invest in maternity clothes that also double as nursing clothes.
    • A place for the baby to sleep: Decide which sleeping strategy you’d like to follow, i.e. crib, bassinet, cosleeper, etc, and invest in it before the baby arrives.  For our first baby we had a classic cheap crib and that was fine.  We had to leave it in the States when we moved to France, so this time we bought a cosleeper so I won’t have to get out of bed a million times at night to breastfeed, but the baby still has their own mattress, and it doubles as a travel crib.
    • A couple of slow flow nipple baby bottles: Even if you are planning to exclusively breastfeed these can come in very handy. Breastfeeding is hard and many women encounter obstacles, especially at the beginning. If you are one of the lucky ones who smoothly and gracefully is able to feed your child instantly, great, but there is nothing more terrifying than being awake at 4 in the morning with a 2 day old who is screaming, and wondering if your child is getting enough nutrition. You may have to pump to provide breastmilk, or supplement, and having the equipment available is just one less thing to think about during a very stressful time. If you don’t end up using the bottles at the beginning, you will likely use them in a few months when going back to work or starting to engage in the outside world again so no waste there.
    • Baby bathtub: Not a must-have for when you first come home, but chances are you will need this.  Some people like to use their sink, but if you have any concerns about your sink being small, cleanliness concerns, or holding up the baby by yourself while washing at the same time, a baby bathtub is a great investment.  Bath-time can be one of the most exciting activities for your developing baby, so why not make it a great carefree experience?  We loved this one because it has a newborn insert for extra support that can be removed and the tub itself is huge so it lasts until your child is ready for an adult size tub.

Breast feeding must-haves

  • If you decide to breastfeed having the following will make your life much easier:
      • Nursing bras: You are about to be a human cow. Set up yourself to be as comfortable as possible, and wear clothes and undergarments that easily lend to quick breastfeeding.
      • Nipple ointment: Forget lanolin, there are better options. Seriously I started with lanolin but it didn’t help and is so thick it can cause infection.  Simple kitchen olive oil is all natural, edible, and very useful. If you prefer a formulated ointment, Motherlove Nipple Cream Certified Organic Salve for Sore Cracked Nursing Nipples, 1 Oz.is great.  You can apply with a q-tip so your fingers are not constantly greasy.
      • Nursing pads: Ugh, the leakage and soreness are so frustrating! At first I used disposables but they irritated my skin so I switched to washable bamboo pads which were insanely soft and comfortable.
      • Breast pump: You don’t need this right at the time of delivery, but it can save you from the headache of picking among many options after the baby arrives. I personally loved the Spectra Baby USA Double/Single Breast Pump with Rechargeable Battery, 3.3 Pound, it is a hospital grade pump that optimizes your milk production and is super quiet so you can multitask while pumping. Bonus is that it can run by battery or be plugged in, so its easy to use when traveling or at work.  Many mothers love the Medela Pump In Style Advanced Breastpump Starter which is more widely covered by insurance and may work faster for some.  Please note your insurance should pay for your breast pump, it should not be an expense for you!!

     

    Newborn Hacks

    • While a nursing pillow often makes this list, just using regular pillows or your pregnancy pillows for support should work just as well. If you do get a nursing pillow the Boppy Nursing Pillow and Positioner, Peaceful Jungle is great because you can repurpose it as a cushion or support system for your baby as they grow and start practicing tummy time and and sitting.
    • Bottles can be warmed by submerging milk in warm water, rather than investing in a special bottle warmer.  Just placed the bottle in a bowl filled with warm water.
    • Burp clothes: any towels, washclothes, or clean clothes will do.  Or just use swaddle blankets.
    • Baby towels: these are stinking cute, but you don’t technically need them.  Create a comfy drying area near your bathing area by placing a clean towel on top of a folded blanket so your little angel has a cushy place to lie down after a bath.  Dry with the towel or use a separate smaller towel to pat dry.
    • If you use bottles right away, you can sterilize them at any time by submerging in boiling water.  You also can air dry them on a clean towel placed on the counter.  (Our dishwasher warped them and left residues so we hand washed)
    • You don’t need to go crazy buying toys and books at the beginning.  A newborn can’t appreciate them, and you may get a ton as gifts.  The first objects a baby will appreciate, after your boobs, are black and white images, rattles, and mobiles.  This can take weeks to months so these items are definitely not prehospital necessities.
    • Don’t forget about yourself mama!  After this pregnancy I’ll be taking care of the myself the French way.  This means eating like the French, exercising like the French, and stealing their beauty secrets.  I’ll also be participating in rééducation perinéale (perineal and abdominal re-education), a specifically French postpartum routine to get your body back.  Don’t worry, I’ll share all the details once I get there!!

Hope this helps!  Here are some items we really loved, even though some were a splurge!  We will be reusing many of them too so I’m telling myself they were investment purchases!

French Advice for Eating Well During Pregnancy, and Common Myths Explored

Moving to France I heard a variety of bizarre claims about how French women don’t follow the basic dietary laws of pregnancy known to all Anglophone women:

  • “French pregnant women have a glass of red wine each day!”
  • “French women drink loads of coffee”
  • “French women keep eating unpasteurized cheeses throughout pregnancy”
  • “French women barely gain any weight, and after birth they leave the hospital in their pre-pregnancy pants!”

So I have been very curious to find out whether French women follow different guidelines, and whether these statements are true or not. I’ll start by addressing these claims and finish with French lifestyle tips for staying healthy throughout pregnancy.

Myths Debunked: The Forbidden Foods

Sorry ladies, but at least among the locals I know, French women do indeed avoid alcohol, improperly cooked food (cheese, meat, fish), and moderate their caffeine intake. They crave sushi, wine, and brie for 9 months, just like the rest of us deprived English-speaking pregnant folk.

There are some nuances to the guidelines that they know about that many Americans may not. For example, local cheese experts will advise you that only unpasteurized soft cheeses are risky, whereas the hard cheeses of any kind are acceptable. Sometimes a cheese itself can be safe, but the rind (the rigid material surrounding the cheese) may be contaminated. If you walk into a reputable fromagerie (artisanal cheese store), the vendor should be able to tell you which individual cheeses are safe choices.

Also some women are exempt from avoiding undercooked meat, and French women are more likely to fall under into this group. The reason behind consuming only well cooked meat is to avoid a toxoplasmosis infection. Although toxoplasmosis is a mild infection in healthy adults, this tiny organism can cause catastrophic effects on the developing fetus if the mother gets infected during pregnancy. However, if a woman contracted the infection before pregnancy, there is no increased risk to the child.  Since French and European women eat more raw meats in their diet they may be less susceptible to the dangers of toxoplasmosis during pregnancy because they are more likely to have already had the disease. While only 10-20% of women are immune to toxoplasmosis in the United States, some 40-60% of French women are immune, and may therefore enjoy their filet mignon medium-rare. As a family member in Belgium explained to me, “I am already toxoplasmosis positive, therefore I don’t worry about raw meat.”

The only French women that seem to resist modern medical prenatal dietary recommendations are women of the older generation. “Well when I was pregnant I didn’t know about these dangers, and my kids came out fine!” And on the subject of foie gras, “mais il faut vivre!” (you must live a little!) But of the people I know, who are admittedly quite well educated and recently mothers, all followed the rules carefully, and my doctor grilled me for the first few visits to make sure I understood all the recommendations.

Myths Debunked: Prenatal weight gain

One of the biggest myths I’ve heard is that French women are told to follow different pregnancy weight gain guidelines. In actuality, the recommendations are the same: French doctors recommend a net gain of 12 – 15 kg during pregnancy, which corresponds to about 26 – 33 lbs. The real difference is that French women actually tend to stay within or below these limits, and therefore gain less than their American counterparts. For more details on how French women gain weight during pregnancy click here.

This brings me to something the French are doing much better than the Americans: they are fantastic at controlling their diet and weight gain throughout pregnancy. What are their secrets??

French Lifestyle Tips for a Healthy Pregnancy

 

The French pregnancy mantra is on n’a pas à manger deux fois plus! This means, don’t eat for two! Dietary advice is publicly made available by the government for all pregnant women with very practical and specific advice. Here are some eating hacks I’ve stolen from the French so you can achieve your belly-only pregnancy!

  1. Add a snack into your daily routine if you find yourself hungry. This assumes you are like most French women who do not snack in between meals (darn that iron fisted self control!).

 

 

The government even gives specific examples of acceptable snacks that I find hilariously French:

French Pregnancy Diet Snacks
Translation: In the clockwise direction the snacks shown are: 1/6th of a baguette + 1 portion of cheese + 1 glass of water, 1 yogurt + 1 banana + 1 glass of water, 4 biscuits + 1 glass of water, or 1 cup of farina/rice pudding + ½ cup of 100% fruit juice.
  1. Meals still need to portion controlled. For an idea of how much French people eat for a major meal, here’s a nice diagram:
French Meal Suggestions Portion Size
Translation in a clockwise direction: an open faced tuna or chicken sandwich + vegetables + yogurt, a vegetable salad with meat/fish/cheese + a piece of bread, a piece of quiche + raw vegetables, and an asian dish with meat skewers + rice + sauteed vegetables
  1. There are three and only three acceptable French ways to increase the size of your meals: (1) Add a yogurt, (2) Eat a piece of fruit, or (3) Eat a larger portion of vegetables.
  2. The French are very concerned with preventing cravings. What is their secret? Make sure to include grains and vegetables with every meal, and spread out your meals throughout the course of the day so you eat the same amount but you are eating more often.  I imagine there’s some serious discipline at work here too although no French person will ever admit that.
  3. Avoid sugary and fatty foods! Increasing your food intake does not mean letting yourself eat unhealthy food. French people will rarely pass judging looks for your food choices, but the one time I walked into a Burger King with my obvious baby bump to pick up dinner for the hubby, I got so many death glares I was truly scared for my life.
  4. If you suffer from heartburn, nausea, or indigestion, start eating more frequent and lighter meals.
  5. Stay hydrated throughout the day.
  6. Don’t forget to move move move! French women do not stop being active when they are pregnant. Here are pregnancy specific French exercise recommendations, or general French lifestyle hacks to include activity in your daily routine.
  7. For more information and tips on general French dietary recommendations, click here.

 

References

  1. See mangerbouger.fr for the official French dietary guidelines for pregnancy, or shoot me a message and I’ll be happy to send you the detailed guide (in French)

Recommended Weight Gain during Pregnancy: Comparing the American and French Guidelines

How much weight should you gain during pregnancy to maximize your and your baby’s health?

pregnancy weight gain

Weight gain guidelines during pregnancy can be frustratingly nonspecific, and there is conflicting advice everywhere. Many doctors don’t even counsel patients on safe prenatal weight gain! Nine months is a long time, and if you’re like me and can easily scarf down a pint of Ben and Jerry’s in one couch potato sitting, you may crave a structured plan to help stay on track for a healthy gain throughout pregnancy. Since I’ve now been pregnant in two countries I wanted to put together all of what I’ve learned about how much to gain, and at what rate to gain it.

I’ve heard some crazy myths about French pregnancies and one that I wanted to clarify is that French weight gain guidelines are drastically different than American guidelines. From my experience that is not true. For a normal weight woman throughout pregnancy, the American medical guideline is to gain 25 – 35 pounds; the French medical guideline is to gain 12- 15 kg, which translates to roughly 26 – 33 pounds, which is basically the same goal. What I have noticed in both countries is that providers and published guidelines often will not give you a monthly breakdown of weight gain recommendations, so I’ve put together a detailed compilation of advice from obstetricians and medical texts:

 

Pregnancy Weight Gain Recommendations America France

As you can see the overall weight gain recommendations are similar but the French and Americans recommend spacing the gain out in a slightly different way. Please note that these are more of guidelines to keep you on track rather than rigid goals.  In both countries it is expected that you will vary from this timetable on a weekly and monthly basis. From personal experience the American attitude that more weight should be gained in the 2nd trimester seems more natural because that is when your appetite reaches crazy monster levels to nourish that quickly growing baby.   By contrast during the morning sickness ridden first trimester your baby is tiny with fewer caloric requirements, and during the 3rd trimester there is an increasingly small amount of abdominal real estate making it difficult to eat heartily and pack on the pounds.

So here’s the lowdown on French versus American weight gain trends:

The recommended guidelines that doctors are adopting in their practices are similar. The real difference is that French women actually tend to stay within these limits, and therefore gain less than their American counterparts. In fact many French women stay at the lower end or slightly below these limits. By contrast, at least half of American women are gaining excessively (5)! Some of this may be due a lack of knowledge of the guidelines, or ingrained cultural attitudes. One study showed that if a woman expected to gain excessive amounts of weight during pregnancy, there was a strong possibility that she would. What caused the women in this study to believe they would gain more weight? Starting out overweight in pregnancy and receiving contradictory or incorrect advice from friends and family seemed to predispose women to gaining excessive amounts of weight(6).

The French, by contrast, are not only by the book, but they all seem to be on the exact same page. French ladies are aware of the guidelines, and follow them religiously. There is a real preoccupation in French culture with returning to your pre-pregnancy weight after you deliver, and a strong sense that gaining excessively can not only cause the baby to be large, but will also make it difficult for you to lose weight postpartum. Culturally it is frowned upon to surpass the recommendations: one woman I met admitted to me that she had gained a whole 17 kg! That’s 4.4 pounds over the recommended amount. Most Americans wouldn’t think much of such a small amount, but she was clearly worried and embarrassed about it. The French mantra is on n’a pas à manger deux fois plus! This means, don’t eat for two! And they take it seriously.

These cultural differences impact how medical practitioners approach their patients. For both of my pregnancies my weight gain has been similar and within the recommended range, but my doctors reacted differently to my weight gain pattern. My American provider tended to continually caution me on not gaining too much. In fact, when I started gaining weight quickly after a long period of morning sickness she became instantly worried about gestational diabetes and advised me to restrict my diet. My French provider is quite the opposite: she is more worried about me not gaining enough weight and even became suspicious that I was smoking when morning sickness prevented me from gaining anything in the first trimester. I think this is a reflection of the types of weight gain trends they are seeing in their respective patient populations.

 

For more information on how French women stay on track to a healthy prenatal weight gain, see these related articles:

 

Citations

(1) http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2009/Weight-Gain-During-Pregnancy -Reexamining-the-Guidelines/Report%20Brief%20-%20Weight%20Gain%20During%20Pregnancy.pdf

(2) http://www.whattoexpect.com/pregnancy/weight-gain/

(3) http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric- Practice/Weight-Gain-During-Pregnancy

(4) Topsante

(5) Weight Gain During Pregnancy: Reexamining the Guidelines, by National Research Council, Institute of Medicine, Board on Children, Youth, and Families.

(6) Association of Gestational Weight Gain Expectations and Advice on Actual Weight Gain. Krukowski et al. Obstetrics and Gynecology. Vol. 129, No. 1, January 2017.

 

 

The difference between your FRENCH and AMERICAN pregnancy due dates (Why have one when you can have two??)

Pregnancy due date Estimated delivery date

One of the first things I learned when I moved here is that the French do not readily accept the ways of English-speaking peoples. They turn their noses up at mayonnaise (quelle horreur), wonderbread (who needs wonderbread when you have baguette), and show a general disregard for the English language. Even those American traditions that have been adopted are disguised in French terms so nobody catches on: McDonalds is macdo, pronounced with perfect tonal indignation, and hamburgers are elegantly referred to as le burger (pronounced leh boorgare). So I shouldn’t have been surprised to discover that the pregnancy due date I was given in the US – April 16th – would not be accepted here, and my new given French due date would be April 24th.

Why the difference in due dates? And what difference, if any, does this make? Lets take a look at how those dates are calculated:

How to calculate your US or UK due date:

Your due date is calculated from your last menstrual cycle (LMP). You add 40 weeks (9 months and 1 week) to that date, so in effect your menstrual period and ovulation days are included as part of pregnancy, even before there is a fertilized egg. It’s a little bonus that makes you feel better about yourself when after a month of conception you are hugging the toilet, interminably nauseous, vomiting, and wondering how you are going to make it through nine months of this. But ultimately at the 40th week marker, you have only been pregnant for 38 weeks.

How to calculate your French due date:

There will be no cheating or bonuses with the French. The French start the count at your estimated date of conception (when your little miracle was conceived), and add 39 weeks (exactly 9 months) to that date. In effect that makes your due date 41 weeks after your last menstrual period, and 39 weeks after becoming pregnant.

This roughly translated to a due date that is one to two weeks later, as your obstetrician may do some mysterious calculations trying to estimate your monthly cycle length and shoots out an adjusted number, which is how I have two due dates 10 days apart from each other.

Is this difference splitting hairs or does it actually matter?

The due date is more of a temporal marker than an actual appointment: only 4% of women deliver on their actual due dates(1).  Indeed many women, and especially first time mothers will go on to deliver within the two weeks after their delivery. By 42 weeks after the last menstrual period 90% of women will have delivered. While the due date itself is not that important, receiving term appropriate prenatal care (such as genetic screening tests and gestational diabetes screening within the appropriate time frame) and identifying when a woman has progressed past a “term pregnancy” (i.e. is post-term) is. After 42 weeks there is an increased risk to the fetus (2), both in terms of death and functional impairment. Thus as long as a pregnant woman is receiving regular prenatal care by an experienced professional there should be no blaring changes in their care based on differences in the estimated delivery date.

However the difference in definitions here may lead to more subtle alterations in care. If you set your expectations for a later delivery date, both pregnant women and obstetric providers might get through the entire term period (37-42 weeks) with less anticipation and anxiety that an arbitrary deadline is upcoming and has been passed. Furthermore, the time for induction of labor is 42 weeks in France, which is closer to the French due date, whereas guidelines in the US are less specific, leaving many providers to choose to induce prior to 42 weeks of gestation and closer to the 40 week due date. The indications for inductions can vary from emergent concern for maternal and fetal safety, urgent concern for post-term dates, to semi-elective and elective reasons, but there is research suggesting that there is an increased rate of “psychosocial induction” in the United States(3). Unsurprisingly, US data has been showing an overall increase in the number of labor inductions (4). This may have unintended negative consequences as artificial inductions may lead to increased discomfort during labor and a greater need for further medical intervention. Thus at the very least, the earlier US due date may lead to more maternal anxiety once she becomes “term,” and at the worst it could theoretically mean more artificial inductions of labor leading to less maternal satisfaction and well being with the birthing process.

I hate to admit this, but perhaps the French have a slight advantage on this one? At heart I am a true American patriot, and whenever someone asks for my due date I either average the two dates out (as if spewing out a third arbitrary date makes any difference), or blurt something out about having two dates which only confuses people further. Why do the specifics of the date even matter in conversation? If as a medical professional, aware of the nuances of the system, I have still become inexplicably wed to the idea of having a specific date represent the conclusion of my pregnancy, perhaps it does suggest a neurosis of human nature that likes to place a label on a natural process, and unconsciously build up expectations around that set point. In which case we should perhaps look to the French on this to decrease our level of national anxiety surrounding an arbitrary expiration date.

 

Citations

  1. http://www.bbc.com/news/magazine-31046144
  2. http://www.aafp.org/afp/2004/1201/p2221.html
  3. Trends and Issues in Labor Induction in the United States: Implications for Clinical Practice. Simpson, Kathleen Rice et al. Journal of Obstetric, Gynecologic & Neonatal Nursing , Volume 32 , Issue 6 , 767 – 779
  4. S. national trends in labor induction, 1989-1998. Zhang, J, Yancey, MK, Henderson, CE. J Reprod Med. 2002 Feb;47(2):120-4.

Prenatal Exercise Advice from French Doctors, & the Surprising Exercise You Should NOT Do While Pregnant!

Common prenatal exercise advice from medical practitioners in the United States is that you may continue whatever preconception exercise you did. Don’t increase your workout intensity, but maintain whatever routine you had. That’s why I was shocked to discuss prenatal exercise with my French obstetrician.

Once my morning sickness finally started to wear off I went to my obstetrician, thrilled to be able to start participating in activities other than sitting on the couch staring up at the ceiling because every other activity in the world made me dizzy and sick. When she asked how I was feeling, I enthusiastically replied that I was much better, and was going to start jogging again soon. “No, don’t do that!” she exclaimed. “Why not? I’d like to exercise again.” “Yes, you should be active, but do any exercise but THAT!” I was completely confused at first, but here is why. French doctors are very concerned with postpartum recovery and believe that jogging during pregnancy, when your joints and ligaments are loosening (in preparation for childbirth) and your pelvic floor is dealing with extra weight and pressure, will greatly increase your risk of having urinary incontinence later down the line. Basically, if you jog during your pregnancy, you may ending up peeing yourself for life.

They do strongly recommend staying active, eating a nutritious diet, and maintaining a healthy weight gain during pregnancy, not only for the health of your baby, but also so your postpartum recovery will be easier.

So what specific exercises are advised? Here are the French obstetrician’s recommendations for exercise during pregnancy:

  • Prenatal yoga: highly recommended, wonderful and gentle, helps destress, ease back pain and general pregnancy aches
  • Swimming: a fantastic low impact cardiovascular sport
  • Walking: walking is the favorite French form of exercise. Especially if it is walking through a farmer’s market, quaint neighborhood, local park, or shopping district.  For more on how the French like to exercise, see this post.
  • Biking: biking is also a great exercise, up until later in pregnancy, or whenever your doctor tells you to stop (some pregnancy conditions, such as abnormally low positioning of the placenta can make it dangerous for some women to bike during pregnancy)

Beyond this, they aren’t even all that concerned about the intensity of your working out. “Just make sure you stay active and get adequate rest. If you’re too tired after exercising then you’ve done too much” was my doctor’s final piece of advice (sometimes my doctor is really unimaginative in her wisdom).

This advice is radically different from what is advised in the States, so I thought I’d share!  Happy exercising fit mamas!

 

 

Rampant Vampirism in the French Medical System

I might be a doctor, but I hate getting my blood drawn. As I would come to discover, France has a love affair with blood tests. After my initial consultation with my obstetrician, in which she could scarcely hide her incredulousness at my maternal neglect of having had no prenatal blood tests by 9 weeks of gestational age, I was promptly sent to the local laboratory. Unlike doctor’s offices in the United States, in which there are often nurses, physician assistants, phlebotomists, or earnest medical students present and available to draw blood on-site, French clinics do not have the capacity for on-site blood draws. Clinic staff in France may consist solely of a doctor and possibly a secretary. This means most clinical and housekeeping work is done by the doctor, who certainly does not have time to draw blood, and does not have the capacity for storing, analyzing, or transporting the blood to the appropriate processing center. As such patients are sent to local laboratories, which exist for the sole purpose of poking you with sharp objects.

There are laboratories conveniently spread out throughout the city (within a 15 minute walk of my apartment there are at least three laboratories). In fact, part of my husband’s work orientation included a walk by the lab adjoined to his office to tout the convenience of getting your blood drawn during your coffee break. The lab is a walk-in center where you take a number, present your lab prescription, and wait your turn. There is a little play area to occupy your children while you wait. During my first consultation I waited two hours for the nurse to take me back. One pinch later, and the blood was flowing, filling one, two, three, four, and then I lost count of how many tubes the nurse was taking. As my eyes widened and popped out of my skull with disbelief she laughed. “You must be American, and yes the answer is we take a lot of blood. This is the French way.”

I left slightly dizzy, relieved that my prenatal blood drawing experience was done. Until I returned to the obstetrician, and discovered that in France pregnant women have monthly blood tests to make sure they haven’t contracted an infection from the uncooked meat, fish, and unpasteurized cheese lurking in every gastronomic corner. “Oh doctor,” I pleaded, “I never eat those kinds of foods.” She was unimpressed: “You will get a blood test every month anyway.” Apparently this French rule is nonnegotiable: after all, the people must protect their right to have widespread access to culinary pleasures, even at the risk of food safety and blood loss induced anemia (in English, low blood count). Just to make sure I wasn’t the crazy one, I checked with my Dutch friend. She laughed heartily when I told her I would be getting monthly blood tests and said, “I always wondered how French women dealt with the pregnancy-unfriendly food everywhere. In the Netherlands, even having one blood test is completely optional! After all, pregnancy is a blessing, not a disease to be monitored.”

I’m five months pregnant now and have therefore been to the lab at least three times. After much trial and error I’m finally starting to figure out the system. During my second obstetric appointment I was scolded for not bringing my blood tests. “But doctor, doesn’t the lab send you the results?” “Sometimes, but you can’t rely on them. “You, the patient, are expected to pick up and show me the results.” Oops. Why would the lab trust me to do that? In the States your doctor directly receives your results and presents them to you. For my second blood draw I went to the lab and was promptly sent home because I hadn’t brought the results of my first ultrasound. Why lab personnel cared about these results still eludes me, but now I am always armed (with all of my medical information) and prepared for any bureaucratic battle. And after waiting two plus hours per blood draw, I’ve finally figured out that right after lunch there is a lull, in which I can be seen immediately. Perhaps the notion of being tortured while still enjoying the aftermath of a luxurious French lunch break is culturally unacceptable? I’ll have to get back to you on that one. In the meantime, I’ll be stocking up on red meat to survive my next visit to the lab.

Finding your friendly neighborhood (English-speaking) French doctor

We moved to France when I was eight weeks pregnant, and hadn’t had a single prenatal visit. When we first arrived in France the first week of our lives was sucked away into the black hole of baby jet lag, culture shock, and the general panic of how we were going to survive in this strange land with pink toilet paper for a whole year. So at nine weeks of pregnancy, I set out to find a doctor, an English-speaking doctor. Of course there is no obvious way to find such a doctor using the English internet. For an entire day I tried Google, searching governmental web sites (such as the American embassy), Yelp, and eventually resorted to combing through expat blogs to find any mention of English-speaking doctors. After wasting the day I found one English-speaking doctor an hour away in the Marais who received 2.5 stars on google reviews and was described as “aggressive, expensive, and without a single social skill.” Hmm. When I called the office in desperation, I quickly found that the term “English-speaking” was being used very liberally: the secretary did not speak a word of English and promptly put the doctor on the phone, who in turn could not understand a single question I had, and brusquely said in broken English, “just come for vee-zeet, I tell you everyzeeng.” I begged my French-speaking husband for help. In five minutes, he performed a search in French, and found three qualified doctors with great reviews within 30 minutes away. French survival rule number one for foreigners: Don’t try to get anything done without French. Don’t speak French? Deal with it.

We promptly called all three offices and were immediately scolded for our delinquency. “Your wife is nine weeks pregnant and hasn’t had a single blood test??” Even though this was apparently a national disgrace (in America this would have been perfectly within the range of acceptable), two of the offices couldn’t fit me in until what would be my second trimester, which left me with the obvious choice of a nearby obstetrician with an office in a lovely historic Parisian apartment, who spoke decent conversational and medical English. Her secretary, of note, did not speak any English so my husband still had to schedule the appointments for me. For safe measure, we also booked appointments with the doctor in the Marais and with another who couldn’t see me until my second trimester, but ended up being pleased with the first doctor we met*.

"La vie en rose" is so much more than a song
“La vie en rose” is so much more than a song

*If anyone is looking for a doctor, email me and I’ll be happy to pass along recommendations. In my search the American Hospital of Paris and the Hertford British Hospital came up numerous times as highly rated centers, but I was personally looking for a doctor near our home in the 15th arrondissement (both hospitals are actually outside Paris) and a more prototypical “French experience.”