Leg Cramps in Pregnancy

 

by Martha Highfill, CNM

One of the common discomforts in pregnancy is leg cramping.  Leg cramps usually occur during the night time and can greatly affect a woman’s sleeping habits.  Some women are awoken during sleep with leg cramping with the only relief coming from movement of the affected leg.  When the foot is dorsiflexed (or when the toes are flexed towards the knee), the cramp is usually relieved.  Leg cramps often occur in one leg at a time (Hensley, 2009).  Although leg cramps do not cause any long term damage to the muscle, they may be very painful and disrupt sleep.  This can be quite troublesome for many pregnant women (Young & Jewell, 2011).

How common are leg cramps in pregnancy?
Leg cramps affect 30 to 50% of pregnant women during their pregnancy especially in the third trimester (Hensley, 2009; Young & Jewell, 2011).

What causes leg cramping in pregnancy?
It is not clear what exactly causes leg cramps in pregnancy.  They often occur in women that are physically active prior to and during pregnancy.  Some causes of leg cramping may be excessive exercise, little to no physical activity, dehydration, inadequate magnesium intake, and inadequate calcium intake (Hensley, 2009).  It has been suggested that slower blood circulation in the legs in pregnancy may contribute to leg cramps.  The pregnancy hormone progesterone makes the veins weaker during pregnancy which could lead to leg cramping, varicose veins, as well as other common discomforts in pregnancy (Young & Jewell, 2011).

What can I do if I have leg cramps in pregnancy?
Getting 30 minutes of exercise every day while pregnant will help improve overall mood, help blood circulation, as well as provide a general feeling of well-being.  Walking, jogging, swimming, and yoga are all great ways to exercise and stretch the muscles of the legs.  Make sure you stretch thoroughly before and after exercising.  Eating a healthy diet with a variety of vegetables and fruits, whole grains, lean proteins, and plenty of water is vital to remain healthy during pregnancy.

When you have a leg cramp, stand up and place your feet flat and firmly against the floor.  Some women find relief for leg cramps by wearing support hose during pregnancy.  Stretching your calves and legs before going to bed also may help prevent leg cramping during the night although there is a lack of evidence proving this.  However, there is some evidence that shows adding a daily magnesium supplement may help with leg cramping when there is a previous magnesium imbalance (Hensley, 2009; Young & Jewell, 2011).

You can also increase the amount of magnesium in your diet.  Foods that are high in magnesium include almonds, wheat bran, spinach, cashews, wheat germ, peanut butter, black-eyed peas, pinto beans, and brown rice.  Talk with your CNM about your individual needs if you have leg cramping during pregnancy.

References
Hensley, J. G.  (2009).  Leg cramps and restless legs syndrome in pregnancy.  Journal of Midwifery & Women’s Health, 54(3), 211-218.

Young, G., & Jewell, D.  (2011).  Interventions for leg cramps in pregnancy.  Cochrane Database for Systematic Reviews, 1.  DOI: 10.1002/14651858.CD000121.

Why We All Need a Little More Vitamin D

 

by Mary-Signe Kelly, CNM

As children, we spend a lot of time in the sun.  It kept us  – and our parents – happy and healthy.  The sun is needed for almost all plants and animals to live.  Humans are no different.  One of the main reasons we need the sun is for vitamin D.  It’s been a hot topic in health the past couple of years, and rightfully so, since we are finding that many people are deficient in vitamin D.  Why is this?  Our bodies can make vitamin D from sunlight, but many experts believe we cannot, or do not get enough sunlight to make enough vitamin D.  Vitamin D also plays many important roles in keeping us healthy.  Research shows that vitamin D deficiency can lead to cancer, diabetes, cardiovascular disease, osteoporosis, and muscle problems.

What is Vitamin D?
In scientific terms, vitamin D is a fat-soluble vitamin that is made in the body from sun exposure or fortified dietary intake.  The two parts that make vitamin D are ergocalciferol (D2) from plant or fish sources and cholecalciferol (D3) from sunlight (1).  The liver and kidney then change these forms into molecules that our body can use.  Also the parathyroid hormone, calcitriol, a derivative of vitamin D, helps maintain calcium and phosphorus levels in the body.  Calcium and vitamin D are the main nutrients which keep our bones healthy and strong.

Why is Vitamin D so important?
The main function of vitamin D is for bone health.  Vitamin D works with calcium for bone mineralization, bone growth, and bone remodeling.  Without vitamin D, bones become thin, brittle and misshapen.  Prolonged vitamin D deficiency leads to rickets in children and osteomalacia in adults.  Vitamin D deficiency can also cause generalized muscle aches and pains in bones and muscles and muscle weakness (2).  It also plays a part in cell growth, neuromuscular function, immune function, and reduction of inflammation.  Additionally, vitamin D helps with overall cell life (2) for example it can help prevent breast, colon and prostate cancers by causing the cancer cells to die.  Vitamin D has been shown to prevent Type 1 diabetes, rheumatoid arthritis and multiple sclerosis.  Vitamin D affects heart health – affecting the contractility of the heart, vascular tone, cardiac collagen and cardiac tissue maturation (1).

Who is at risk for vitamin D deficiency?
After looking at all the different research, it seems like everyone is at risk for vitamin D deficiency.  If you don’t spend enough time in the sun, don’t eat a lot of fortified foods or fish, have a mal-absorption issue, take certain drugs, are over 60, a child, pregnant, lactating, overweight, have dark skin, you could possibly have a vitamin D deficiency.  There are a lot of risk factors for vitamin D deficiency and it seems that since we can get it from the sun we ought to have enough vitamin D.  In fact, researchers have found we need to spend 15-30 minutes in the sun during peak hours 10 a.m. to 2 p.m., four to seven days a week, depending on our skin pigmentation.  But if you live north of Atlanta, the sun isn’t strong enough during the winter to make vitamin D (3).  With our concerns about skin cancer, wrinkles and our use of sunscreen daily, we just aren’t getting our vitamin D from the sun.

How much vitamin D do we need?
The Endocrine Society and the National Institutes of Health recommend that children less than 12 months get 400 IU (international units) of vitamin D daily.  Women and men need 400-600 IU per day.  Lactating women who do not supplement their children need between 4000-6000 IU/day (2, 3).  Pregnant women need 1000 IU of vitamin D every day.

How do we get enough vitamin D?
It is recommended that vitamin D levels in the body should be greater than 30 ng/ml.  But how do we get there?  We could move to the tropics and spend more time in the sun or we could try to increase our intake of vitamin D including foods that are high in vitamin D or fortified with vitamin D or taking supplements.  Vitamin D is a vital part of our life.  We all need to take more breaks in the sun to get our Vitamin D –Nurse-Midwife’s orders!

References

1. Syroney L & Franjesevic A. 2010. Vitamin D Deficiency: Screening and Treatment in Primary Care. Advance for Nurse Practitioners, May 2010: 37-40.

2. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad H, Weaver CM. 2011 “Evaluation, Treatment, and Presentation of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology & Metabolism, 96(7):0000-0000.

3. National Institutes of Health. (2011) Dietary Supplement Fact Sheet: Vitamin D. Retrieved from http://ods.od.nih.gov/factsheets/vitamind Jan. 3, 2012.

What Are the Differences Between a Freestanding Birth Center and a Hospital?

 

A freestanding birth center is an ideal place for healthy mothers and babies to receive care throughout pregnancy, labor, birth, postpartum, and continuing care throughout the lifespan.  At Minnesota Birth Center, we emphasize woman centered care in partnership with Certified Nurse Midwives (CNMs).  Our CNMs balance the art of midwifery with modern obstetrical care as well as providing personalized, high quality care with appropriate use of interventions.  The freestanding birth center creates an environment that is safe and empowering as well as being comfortable and homelike.

Birth centers are a perfect location for the midwifery model of care to be practiced.  The midwifery model of care emphasizes continuous care and labor support from a midwife while focusing on the unique emotional, social, spiritual, and physical needs of the pregnant mother and her family.  At the birth center, we celebrate the normalcy of pregnancy and birth in a woman’s life.  We view pregnancy, birth, postpartum, and parenthood as a significant experience in the life of a family.

Birth centers provide screening for their clients to ensure the mother remains healthy and low-risk during pregnancy.  Birth centers offer extensive education throughout pregnancy to empower women to feel confident making informed decisions about their own and their baby’s health care.  At MBC, the care our CNMs provide is evidence based and we encourage parents to closely research their health care choices.

During labor, interventions that may be standard in the hospital are not routine in the birth center such as routine IV’s, continuous fetal monitoring, routine induction of labor, or epidurals.  The freestanding birth center setting encourages specialized care to each woman’s individual needs and concerns.  At our birth center, we encourage active birth with frequent position changes, hydrotherapy in the tub or shower including water birth, eating and drinking as you like in labor, wearing your own clothes, immediate skin-to-skin contact with your baby, breastfeeding, and a postpartum herbal bath for mother and baby if desired.

We encourage you to contact us to schedule a time to attend our orientation session and tour our beautiful birth center where you will learn even more about freestanding birth centers!