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  • Paige Smathers

48: Pregnancy: Nutrition, Exercise & a Healthy Body Image


Kristi Spence, MS, RDN, CSSD is back for the third time on NMP to discuss how to have a mentally and physically healthy pregnancy. Pregnancy can be an amazing time full of wonderful experiences, but it can also bring up some difficult feelings about food, weight and exercise. In this conversation, we talk about ways to prepare for a healthy pregnancy, how to exercise during pregnancy, how to think about weight gain in a way that hopefully feels less daunting and overwhelming, and ways to get in adequate nutrition during pregnancy. We also briefly touch on lactation and postpartum nutrition.

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Full transcript:

Paige: Hey everyone, thanks for joining us for another episode of Nutrition Matters Podcast. My name is Paige and today I have Kristi Spence with us again. You guys might remember her. She’s been on the show a couple of times. We’ve talked with her about milk and dairy and then there’s also an episode about endurance training and how to fuel appropriately for endurance training while also maintaining sort of a gentle approach with your body. So Kristi is joining us for a 3rd episode which is a record on Nutrition Matters Podcast. We’re so glad she’s here again. She so graciously offered to chat with us about exercise during pregnancy which I think is a really interesting topic and she has a lot of really great things to say about it. So Kristi, welcome to the show!

Kristi: Thanks so much for having me again. It’s great to be here.

Paige: You too. We just, we love you, and we just love everything you have to teach us about your expertise. So just in case this is someone’s first time with you, Kristi, do you just want to briefly sort of introduce yourself and talk about what you do and just talk a little bit about your history with sports and athletics as well.

Kristi: Sure! So I am a dietitian. My background is in sports nutrition but I didn’t start out there. I ended up, I was an athlete when I was in college, a runner, and it wasn’t until 4 years after college that I realized that I could actually marry my interest in athletics with an interest in nutrition. I had majored in religion and ended up going back to graduate school and getting a degree in dietetics. And it’s been really rewarding. So I spent the first 5 years of my career working as a sports dietitian and also doing a lot of eating disorder counseling. And then the last 6 years I’ve actually worked more in the agriculture field. I work for dairy farmers and my role there is connecting people to agriculture and where their food comes from. So doing all of the communication efforts for local and national dairy farmers related to what happens on the farm all the way through what ends up on people’s plates and it’s been a really fun learning experience for me. You know, I didn’t grow up in agriculture and also neat way to connect people to a different element of nutrition.

Paige: Yeah. I always learn something new about you, Kristi. I didn’t know you majored in religion. Very interesting.

Kristi: I did. Yeah. Philosophy and religion. It was really cool.

Paige: We should philosophize sometime. That sounds fun. Hahah

Kristi: It’s so funny because I end up talking to people a lot about how food is, the way people believe in food and what they eat and the choices that they make is almost religious for a lot of people

Paige: Oh, I’ve said that before too. I use the word dogmatic.

Kristi: Have you? Yeah!

Paige: Yeah that’s so true!

Kristi: So I had a professor in graduate school who just thought it was neat that I had this background in relgion because of the way people feel about food. It’s served me well. It’s been fun.

Paige: Yeah, it can become sort of like a religious zeal, to be so obsessed with one way of doing things or this is the right way or this is the clean way or the perfect way or whatever it might be, yeah.

Kristi: Absolutely. So I guess, so a personal introduction which allows me to talk about the topic we’re going to talk about today. I have a little boy who turns 3 tomorrow actually so

Paige: Oh, happy birthday to him!

Kristi: Yeah, I know! It’s exciting. And then I have one that’s due imminently. So another little boy so I’ve gone through, this is my second pregnancy and I’ve been very very fortunate in that I’ve been able to exercise, kind of throughout my pregnancy and I’ve had great doctors who really been supportive and encouraging and provided some really good advice and so I’m happy to share what my experiences have been and knowing full well, it’s not everyone’s experience. I have lots of friends who have not been nearly as lucky as me and I always feel a little bit sheepish talking to them when they’re pregnant or about pregnancies just because everyone is really different and I have been so fortunate.

Paige: And well just in case this is anyone’s first time getting to know me too. So I have 2 little ones as well so I’ve had 2 pregnancies and we might have different experiences with what type of exercise we’ve been able to do too. So I’ll offer some of my own experiences in this conversation as well.

Kristi: That’d be great.

Paige: Awesome! And I think it’s important to mention, and I know you’re too, what’s the word? Humble to mention here but last time we talked about how you went to the Olympic trials. You’re quite the athlete.

Kristi: Oh thank you.

Paige: I think that’s awesome. Remind me, was it in the marathon?

Kristi: In the marathon, back in 2008.

Paige: Oh that’s so cool.

Kristi: So it’s all of a sudden, all of these years have passed now but I still run all the time and so I’m not competing anymore but I’ve been able to run through my pregnancies.

Paige: And people can’t see you but right behind your head, where we’re talking right now, in your room it has the word “Run.”

Kristi: Oh yeah, I’m in my office.

Paige: it’s a big part of your life! You and your husband, right?

Kristi: Yes, both of us.

Paige: Ok cool, so thanks for sharing sort of some background. So let’s talk about you. Tell us about your pregnancies and what your journey with figuring out, navigating exercise is and pregnancy has been like for you. Has it been different, your 2 pregnancies? Has it been the same? Kind of give us an idea of what has been going on.

Kristi: Sure. So I guess the first thing I’ll share is in, when I first became pregnant with my first little boy, I went and met with my doctor and she was a gynecologist, she wasn’t going to be the one who delivered me but she had some really good advice. She was very familiar with me and running and I asked her, you know I’m like 8 weeks pregnant and I said, well you know, what about running? If I feel ok can I do it? And her advice was great. She said, Kristi, just listen to your body. Yes, you can run. Remember that if you’re breathing too hard, the baby’s not getting enough oxygen. And it was like, the most simple thing for me to hear but it was so impactful and so what that translated to for me, I was living in Oklahoma at the time, but we ended up moving back to Utah, was that when we moved back, being back at altitude, I couldn’t run up any hills. And so because I would, I was breathing too hard and so whether it was an excuse or I just knew it was the right thing for my body, I walked up any hill that I…

Paige: Ran to the hill, walked up it. Perfect.

Kristi: Hahaha and our house happens to be on top of this big hill and so after every run, I have this big hill to go up and end up walking up the hill on the way back. So with Aiden, my first little boy, I was able to run really up until 37 weeks and I’ve had friends who’ve actually run up until the day they delivered. But that wasn’t quite me. At 37 weeks, it just didn’t feel right anymore. I thought you know, I think I’m gonna stick to hiking and walking but that was the other part of my doctor’s advice, was just listen to your body and kind of know what your limits are. And for me, it was a really great exercise and a great opportunity to do that. To honor what felt good. I didn’t feel like I had to go a certain distance or a certain time, it was just some days I might have felt better than others. Some days I might have ended up walking a little bit more than others. But what was really nice, I feel like and I’ve heard this from other people as well, being able to exercise and continue your normal level of activity, even if it’s modified, during pregnancy really helps with recovery. It helps with body image. It helps with so many things.

Paige: And the delivery. Your strong.

Kristi: Absolutely!

Paige: You need those muscles.

Kristi: You do! And so that was my first one. But the difference this time around, everything’s been generally the same, except just recently. And I’m glad we ended up having to delay our conversation and it was good because it provided some more information for me to be able to talk about.

Paige: Oh good.

Kristi: A couple weeks ago, so I was having some pelvic pain and I didn’t know exactly what it was from or I figured it was increasing levels of relaxin, hey I’m gonna have a baby of course, things are moving around and shifting. There’s weight in different places. It’s my second pregnancy, maybe ligaments are looser than they were the last time. So I started having this pelvic pain and I was alternately days of going out for a 40 to 45 minute run and then days where I would just walk. And it had been pretty sore. But one day I thought, I wonder it’s fine walking, it’s a little sore but it’s manageable, I wonder if running would make it worst. And I kind of made a, it wasn’t necessarily a poor decision but I ended up running on it and really making it more sore. So I had about 10 days where it was just really rough and sore and tough and my doctor, I was worried about a stress fracture actually because I had had friends who had pelvic stress fractures and I thought, that’s not something I want before I go into delivery but over the last 2 weeks it’s actually improved. It’s still sore but my doctor really thought it was just where the round ligament attaches into your pelvis. She thought that that had just gotten inflamed. Of course when you’re pregnant, you can’t take ibuprofen and so you just worked through it and I was able to take a little bit easy. But that was my definitive sign, this time around and it was at about 36 and a half weeks so almost 37 weeks where I said ok that’s enough. I’m gonna stick to walking and taking it a little bit easier.

Paige: And you’re almost there in terms of being done.

Kristi: I’m almost there. Yeah. I’m almost there. I’m due in 10 days but last night I started thinking he might come earlier so we’ll see.

Paige: Oh my goodness. Wow! I hope so. I hope it’s not 10 days of thinking that. It’s brutal.

Kristi: Thank you!

Paige: Yeah and just to make sure we’re being really clear, this is not, you and I do not want to be you know, telling every person that they should just exercise whatever they want to or whatever we’re talking about is normal or good for each of us. That’s definitely something to think about and to talk about with your doctor and see what specific recommendations are for you as an individual. Definitely don’t just listen to this and say, oh well Kristi did all kinds of stuff during her pregnancy so it’s fine for me too. I think it’s a really important point you made at the beginning of just kind of, every pregnancy and every person is going to be a little bit different here so.

Kristi: Yeah, I couldn’t agree more and one of the reasons I thought talking about this might be interesting, I gave a talk at a university earlier this year and it was about pregnancy and nutrition and exercise to some students and it was a room full of men and women and afterward I got a lot of comments, especially from the men that were in the room that just said, I had no idea you could exercise when you were pregnant. And that really surprised me because it didn’t seem, it was something that was not even a question for me when I got pregnant but I realized that if he had that question that there must be a lot of people who have that question and so the answer is yes. The American College of Obstetricians and Gynecologists actually just revised their exercise guidelines in December of 2015 so just about 6 months ago and they really recommend moderate intensity exercise, 20-30 minutes a day, most days of the week, assuming of course, that you don’t have any other complications or any contraindications for exercising. But if you’re having a healthy pregnancy and your doctor agrees that’s where the recommendations are because there is such a benefit to most women. So I hundred percent agree, like this is not, we’re sharing experiences that we’ve had and I think hopefully shedding some light on. You don’t have to be sedentary when you’re pregnant.

Paige: Right, right.

Kristi: You can really continue your normal lifestyle in a modified way.

Paige: So I have to ask, do you, did you ever feel like there was a lot of pressure on your bladder when you exercised a lot pregnant? Cuz that’s something for sure I experienced. I just felt like I had to pee the whole time.

Kristi: Yes. And I had the hundred percent the same experience. I would go right before I left the house and then I’d start and then, you’re joking. How is this? And that was especially true toward the end of my second trimester into the beginning of my third trimester. There were so many times where I would just have to find the porta potty at the construction site and just go in because there was that pressure and it was so uncomfortable. So absolutely, I think that’s a reality for a lot of people.

Paige: Yeah. Ok. It’s just, it’s such a strange feeling because you want to make sure you’re not holding it for too long but at the same time you’re like, I can’t. I can’t be. I just…

Kristi: I just went.

Paige: So that can sort of make it tough to, I don’t know. That plus some of the other uncomfortable, general uncomfortableness of being pregnant, right? So for me, I don’t know how you feel, Kristi, but I feel like my posture just gets so thrown off where I’m trying to balance this big belly and trying to… I like lean back a lot so I feel like my back gets a lot more arched and so, I don’t know. That can kind of make movement a little bit awkward. I mean pregnant women do have a certain way of walking a lot of times. Just sort of like that waddle.

Kristi: Oh yeah.

Paige: Especially toward the end when you’re loosening all of your joints and is it the ligaments are loosening too? With that relaxin?

Kristi: Yep.

Paige: That hormone. So yeah, a lot of it can feel uncomfortable and then there’s definitely that difference between uncomfortable feelings versus just your body is like screaming at you to not do it.

Kristi: Yeah. That’s definitely true and I think that this is where listening to your body really comes into play is for some people, the discomfort as your stomach grows, how that actually feels and the lack of support that you have as it gets bigger and your balance is thrown off, your center of mass is shifted. It makes it so you feel a little bit unstable so running is a little bit scary because you don’t want to fall and that’s when I’d say it’s not worth it.

Paige: Right.

Kristi: So just walk or do something that feels better.

Paige: Well walking is great too.

Kristi: Walking is excellent too and you get a really good workout when you’re out walking. So I think it really depends on what type of exercise you’re most comfortable with. So here’s a good example for me. I’d love to get on my bike at this point but I am not the most skilled bike rider. If I was a great bike rider, I think that that would be no problem but with my balance being what it is, trying to bend over, it’s not worth the risk of me falling off my bike. And so that’s something that I’m unwilling to do. Another thing is, think about the type of exercise that you’ve done prior to your pregnancies. So I have a good friend who does crossfit and she’s been doing it for a long time, she’s really good at it and she did crossfit throughout her pregnancy. So you can do different types of exercise whether it’s endurance type exercise, strength training type exercise. I think that the key is you don’t necessarily want to start a new exercise regime when you become pregnant.

Paige: Right, you don’t want to all of a sudden take up crossfit.

Kristi: No, that would not have been a good idea for me. I probably would have really hurt myself. I’m not that coordinated to begin with. So I think look at what your comfort level is with different exercises. What feels good and then what you’ve been used to doing before. And then you know, you can kind of map out a plan that’s going to work during pregnancy.

Paige: So Kristi, you mentioned sort of the latest recommendations but do you have a sense for what the exercise during pregnancy recommendations have evolved from throughout the last few decades? I don’t personally know what they are but I would imagine when our parents were pregnant, when our mom was pregnant is probably like, don’t lift anything! Don’t run. Don’t exert yourself at all, right?

Kristi: I think so. So I don’t have that information either. I think that same speculation. I do know, my mom shared with me so this is almost 40 years ago, my mom said when she was pregnant with me, she went out when she was 8 months pregnant and jogging around a track and people looked at her like she was crazy. Even still, I get looks.

Paige: That was my next question.

Kristi: I’m a little bit crazy.

Paige: I was wondering do people judge you or are people rude about it?

Kristi: It’s really funny I feel like, my husband actually runs with me and he pushes the baby jogger and I’m running next to him. When I’m not pregnant, we switch off with the baby jogger but now I get full…

Paige: Special treatment.

Kristi: I don’t have to do it at all. Yes. And we kind of become this little mainstay in or community so I think people see us and they just, you know, whether they shake their heads.

Paige: Oh there’s that crazy pregnant lady again.

Kristi: Right. I did get with my first pregnancy, I was actually still doing a little bit of trail running, fairly late into my pregnancy and I remember I was probably 35 or 36 weeks and I was doing a little trail run and it wasn’t a crazy trail by any means but I got some funny looks then and so I think it’s just what people are used to. I get comments about taking it easy but for the most part, I think people are pretty open. Sometimes I get a second look like, woah really? Haha

Paige: Do I need to report you?

Kristi: You ready to deliver? Do you need to go to the hospital? Yeah.

Paige: People are so funny about their comments during pregnancy. I don’t know if this is a little bit of a tangent but people think it’s just fine to completely look you up and down and judge your body and say, oh you look like you’re gonna pop and you’re like, I’m only 6 months along so thanks. People don’t hold back in their comments during pregnancy.

Kristi: No. Not at all. It’s really interesting. Or touch your belly.

Paige: Are you getting that a lot? People touching your belly?

Kristi: No thankfully no.

Paige: Ok. That is so not cool.

Kristi: I think so too.

Paige: So let’s talk about sort of, so we sort of said it’s best to kind of stick with what you do on average, not adding in extra exercise during pregnancy. But also, not automatically assuming that you just can’t and just sitting for 9 months.

Kristi: Right.

Paige: So let’s talk about how much is too much.

Kristi: Sure. So this is going directly from the guidelines that just came out and I think that how much is too much is definitely a very individualized thing. 45 minutes of running might be way too much for some person and it might be just fine for someone else.

Paige: Right.

Kristi: Intensity level too. You have to think about what you were used to doing before and then what you’re currently doing but there are absolute signs of, hey let’s discontinue or take a step back if you’re experiencing any sort of bleeding, regular painful contractions while you’re exercising, any sort of leaking of amniotic fluid, dizziness, headache, chest pain, muscle weakness. All of those things that are even more alarming during pregnancy. I mean none of those things are great if you’re exercising outside of being pregnant, let alone if you are pregnant so I think those are immediate signs that hey your body is overdoing it a little bit so take a step back. So I think those are, I don’t think there’s a time or intensity hard fast guideline but those are signs that your body is telling you it’s probably a little bit too much.

Paige: Yeah, Kristi, as you were saying that I was having sort of this flashback of a couple years ago I was pretty much a regular at this spin class. I used to go to all the time and there was a woman there who was very visibly pregnant but very obviously going super super hard and each week it almost seemed like her belly was growing but her limbs were like getting more and more emaciated and I’m hoping not to judge or come off judgmental here but it just really worried me as someone who’s aware of people in the population of eating disorders and restriction and all of that and I know that, I know it’s hard to be pregnant. I mean body image-wise, like you mentioned earlier with how exercise can be good for body image, I think it’s useful and meaningful to point out the fact that being pregnant can be really difficult for someone who has struggled with body image and food and weight in the past. And even if you haven’t it can be a little bit triggering because again, people are making these comments, people are touching you, people are thinking it’s fine to call you fat. Straight up using some of these words, most of the time you don’t get on a regular basis so I guess because I know people who struggle with eating and possibly maybe do struggle with restriction or have had that in their past, listen to this podcast, I’m just curious if we could sort of help outline how someone might know if they have maybe not a problem of that particular exercise, how much is too much in terms of that exercise duration but how does someone know if they’re engaging in too much physical activity during their pregnancy sort of in a dangerous way on average? Does that make sense? What I’m trying to say.

Kristi: It does. And here’s what I would say, I think there’s a couple things to remember, one – in your second and third trimester of pregnancy, you need additional calories anyway. I mean you’re growing a human being and sometimes I would just think back, just sit down and reflect on what your body is actually doing and it’s pretty remarkable…

Paige: It’s amazing.

Kristi: That you have this ability to create a human being. And it’s 9 months of your life that yes,

your body is outside of your control a little bit but I really felt like my role as a mom started when I became pregnant. To nurture and take care of this child. And so I think reframing the whole thing from a body image, this is out of my control, I’m gaining weight, I look different, into what your body is actually doing and what you’re able to create, can help. So changing that perspective and I know that doesn’t relate to exercise but…

Paige: No, it’s important though.