 Right, now it's my pleasure, my real pleasure to introduce Donna Mitchell. Donna is a senior midwife at Birth Village in South Indian India, has been there since 2013, and she's the creative, creator of the Active Moments Fitness Programme. She's a veteran midwife practicing since 1998 in the deep south in the USA and has worked across all birth and midwifery settings in over five countries. She's a dynamic and committed midwife who stands for women's rights and choices and is a powerful advocate for the continuing evolution of the deeper feminine through birth and beyond. Being a part of a woman's journey in pregnancy and birth is a cornerstone to all the projects she has worked on. Over the past decade, Donna has designed the Active Momma Workout combining stretching, yoga, dancing, inner relaxation and meditation with a specific focus on labour preparation orienting specifically on women's bodies and pregnancy anatomy. This is now a certified course and is used by trainers for prenatal as well as postnatal fitness. Along with working for Birth for Change in India, she has worked with Tejas Home. This is a home for minor girls who are pregnant due to violence and need a safer, respectful atmosphere to wait out for pregnancy and birth. As a senior consultant midwife at Birth Village, she has been instrumental in setting up protocols and practices, mentoring and training the midwifery team in all aspects of midwifery at this independent birth centre for the past seven years. She also has special modules covering nutrition and fitness and also teaches reproductive health and preconception classes along with menopause health. Donna is mother to nine home birth children all living in the USA. She has homeschooled her children, runs a legal covering for home educators in Alabama as well as doing consulting work for parents wanting to understand a child-led education. So it's my great pleasure to introduce to you, Donna, just let me give her the presentation. Can I come find her? Can you hear me? Oh, I can hear you. Excellent. I'm just trying to find to give you to make you present. It was awesome, Chris. It was awesome. Oh, there we are. I don't think I knew that much about myself. There you go. I can't find you in the list. Oh, there you are. Right. You now have the slides. All right. Thank you so much to Chris and Janine and the IDM. Happy BIDM day to everybody. I'm going to echo, so I'll try to get over that. So I'm in India for the past seven years and I created this fitness class. So let's get into the presentation and see some pictures of some beautiful, beautiful women. The first thing that I want to start with is that women are the best care providers for their baby. Lost Donna's. Repair to have lost Donna's sound bear with us a second while we try and sort it out. Am I back? You are back. Yes, Donna. Okay. Thank you. My foundational belief was that women always have an intuitive ability to know what is best for themselves and their babies. So when I created this program, I wanted to create a safe and enjoyable framework from which they could work within this framework, listening to their intuitive voice to how they should move, where they should move, and when they should move. The problem is they have a huge external voices, pressures, beliefs, misinformation about movement in particular. But often overrides that internal voice. So that was my main goal, trusting women to know what is best for their babies. So as an American coming to India, of course, there's a huge cultural, societal, and religious beliefs that I don't understand that I'm just coming into. So I wanted to make sure that I created a fitness class that would benefit women no matter where they were coming from. All the women won a natural birth. So I really felt strong about including the somatic arts, relaxation, body and mind, yoga, stretching, dance, and movement. This is really, really important to me. A long history of exercise programs and theories going all the way back to the 1940s. So in 1940, Grant Lee Dick Reid basically talked about deep, abdominal breathing that can interrupt the fear, tension, and pain cycle in labor. In 51, Helen Herdman developed the first exercise program with the birth squat emphasis rather than the fitness squat. Elizabeth being like in childbirth to a 12-mile hike. In 1989, Sheila was the first woman to discuss women tapping into their own rhythm of labor. In 1995, Elizabeth Noble had exercises to benefit childbirth. And Karen Diffler in 1997 even combined Callison exercise with aerobics-like dance. And then there's numerous dance fitness programs that are offered for the last several years. With all that said, what does the latest research recommend? Because really when women come to us and their families in India especially, they want to know what is the research? Why are you having these women do all these crazy, crazy things? When we think it's unsafe, so we show them the research. Across the board, the studies say that regular exercise improves or promotes physical fitness. It prevents weight gain, decreases gestational diabetes, preeclampsia, operative vaginal birth, C-sections, and postpartum recovery time. It can also be essential in preventing or decreasing body pain, sciatic pain, reduces pain disability as well as depressive orders in the postpartum time. There is no credible evidence to prescribe bed rest for prevention of preterm labor and should not be routinely recommended, though a full fitness class may be modified. Women who engage in medium intensity activity before pregnancy can continue activity during pregnancy. We use a scale called the PRE, perceived rate of exertion. Six is sedentary, 20 is the athletic level, so we ask women to keep it between 11 and 15 on their perception. And again, giving women information, they will be spot on with where they should be. We can trust women to do that. And the recommendation is 150 minutes within three days, but also daily activity. You'll notice all these women doing this workout. The size is defined as a physical activity consisting of planned, repetitive, or even structured movements to improve health. And of course, modifications may be necessary accordingly. So that's something that we also look into. Range of men, center of gravity, all of these things are changing during the gestational time. So during workout, we always try to make sure that we have modifications available. And it's shown that women who even have no healthy lifestyle to be encouraged to be pregnancy as an opportunity to embrace a healthier routine for herself. Is everybody still okay? Everybody hearing me? So let's talk about what are some of the conclusions. And again, this is coming from ACOG, from American Journal of OB, from the British Journal of Sports and Medicine with the Canadian Study in 2019. So these are all pretty much across the board. So there are, in the absence of contraindications, research shows fewer newborn complications and improved maternal health benefits. So physical activity is not associated with increased risk of miscarriage, stillbirth, neonatal death, preterm birth, premature ruptured membranes, neonatal hypoglycemia, low birth weight, or birth defects. And that's a really important thing to remember because this is some of the issues that some prenatal and family members have shared. And more physical activity, especially duration, frequency, and volume is associated with greater benefits, especially if they start in the first trimester. There's evidence of less gestational diabetes, preeclampsia, gestational hypertension, depression, and weight gain. Prenatal exercise should be considered the frontline therapy for reducing the risk of all pregnancy complications and enhancing maternal physical and mental health. And this also includes women who are inactive, overweight, or obese. But the reality is less than 15% of women will exercise the 150 minutes in three minutes. Part of this is education, part of this is family, and especially in India that is a big hurdle that we have to get over is family being very, very negative towards that. These are the five things that are often studied in research to see how the fetus works with the maternal exertion. So they're assessing fetal cardio and hemodynamic responses for central function, birth weight, fetal movement, and how the fetus protects itself. And we're going to get more into that as we get further along. So the effects on newborns. It is shown that exercise during pregnancy can positively influence developing systems for the fetus, improve neuro and motor development, and thus leading to infants who are more adept at movement and presumed to be more active. It all suggests it reduces childhood risk of obesity. And this is a point that I bring into my class quite a bit is that the additional blood flow with increased oxygen to the baby's brain is a factor in increased brain maturity. So the babies are able to deal with the labor as well as it follows them into adulthood. So there is definitely a connection between increased blood flow because of a far faster heart rate and brain maturity for newborns. So these are the recommended, some of the recommended exercises. There's brisk walking, cycling, stationary, though there's a story we'll be telling you about non-stationary cycling, aerobic exercises, dancing, resistance with weight and bands, stretching, water aerobics, yoga, and swimming. Now bear in mind that there's going to be women who come to us with a higher level of activity so they may be doing more than this. So the main thing we do in our class is dancing. Because dancing is a pretty amazing release of four different hormones. Dopamine, which is pleasure, reward, and affect movement. Serotonin, which regulates anxiety and mood swings. Oxytocin, which we all know is love and bonding and well-being and endorphins, which is euphoria, general well-being, and minimized discomfort. So dancing releases all four of those really, really nice hormones for women. Outcomes. Regular exercising can enhance the fetal protective mechanisms providing there is no utero-procental insufficiency or any other contraindications. So this is low-risk women who have no contraindications. It also suggests that heart rate abnormalities, cord entanglement, and the presence of myconium is significantly reduced for women who are exercising. And women who participate in regular exercise report lower levels of perceived exertion during pregnancy and labor. Again, this is key. The body sees a work-out session and labor as exertion. And therefore, when women are challenged in work-out to know what their challenges are, how to deal with this challenge in labor, they actually do the very same thing. So they're definitely more, they're able to deal with labor a lot better. So there are some contraindications, and this is something that the women should be discussing with their care provider. Premature labor, rupture of membranes, bleeding, per centiprity after 28 weeks, preeclampsia, incompetent cervix, IUGR, uncontrolled hypertension, gestational diabetes, thyroid issues, cardiorespiratory disorders, and fever. That's not to say that we don't modify classes, but these will definitely be the ones that the care provider, whether it's a midwife or doctor, and the fitness person who ever is teaching, should know these are contraindications. Now, there are relative contraindications also. These are ones that may or may not create issues where they're doing a full fitness class, but we can modify or we can do something different. Maybe they don't come in for the full fledged cardio, but they would come in for yoga, stretching, and a definitely meditation. So meditation is definitely good all across the board. And these can occur before the pregnancy or during the pregnancy. And so this again is the woman is keeping a really good conversation with her care provider to know what she's able to do. And this is loss, spontaneous miscarriage, anemia, malnutrition, eating disorders, twins after 28 weeks, excessive overweight, sedentary life, and asthma. So there are some guidelines. So for the pregnancy class, we're very aware of individual tolerances. And I can look at a class of nine or 10 or 11 women, and I can tell how they're doing. How do I need to modify the class? What can I do for them because maybe they're 41 weeks or maybe they're not feeling well or they are stressed. So I have to understand what's going on with the individual women. The prior fitness and level training of the women, somebody who's a dancer or a yoga teacher who's coming into class is going to have a higher tolerance of what they're able to do. And then also making sure that each one has proper medical assessment, whether that's the midwife, whether it's her doctor, whatever it is. This is a really important aspect. And fitness professionals have a lot of questions for appropriate individual needs. How to make the work out safe, enjoyable and beneficial, which is the most vital thing for women. It's safe, enjoyable and beneficial. Effective and alleviating maternal discomfort and provide a good prep for birth. And then the fitness trainer and we tend to understand what is the interactions on the physiological systems. And then we also have internal exertion, metabolism and the respiration of the woman. And also one of the things that I really want to relate to women is that class, you know, is we want to do daily life. So when we're doing squats, I say women you're going to be squatting to pick up your child. You're going to be holding one child and you're going to be reaching for another one. So we're doing squats, we're doing squats because we want to be powerful in walking. Strong core, strong PVA because that's the basis of walking, getting in and out of the car. And what I also tell the women in classes, you know, the fastest creature on earth is a toddler. If you don't have the agility and the strength to go after your toddler, then we need to work on that. This is what we're working towards. Let's be real, women have always been a part of my class. So I think for my classes, classes are abnormal ways of getting women the movements they need to make a healthy pregnancy and labor in birth. We have to do this because our society does not have women doing walking in the villages, taking care of their herds of cows, going to the river to wash clothes. We have very much a sedentary life. So this is why we have a class. This is why we have this daily life. Sorry, I'm okay. Is everybody else hearing it three or four times? Is everybody enjoying the pictures? I hope so. These are some pretty amazing women. I always tell the women, they are on the edge of India. The cutting edge of India making changes. This is the real main thing. So in designing a two-hour class, I do two hours three times a week. One is deep breathing, assessment. One thing I told women in class never say I can't do this. Always put it in what can I do today, which may include some modifications. We learn breathing and posture. To me, the two most important things is breathing and posture to make sure that their body is ready for whatever work they're about to do. We do warm-ups. It could be stretching yoga. It could be a dance song. We also do exercises with the medium intensity, which is 11 to 15 on the P-R-E. We often address specific areas of discomfort, whether it's upper strength, pelvic movements, glutes. The one thing I really want to make sure I do is do anatomical correct names for everything because really some women don't know anything about their pelvis. They don't know the parts of their pelvis, they don't know the parts of their abdominal really motivates them to keep going and come into class. We often have partner days, so then women are working extra hard when they have to bring their husbands in to see just how hard they've been working. So that's a pretty exciting thing. So there are things that can positively or negatively impact. Positively, somebody's already already active before pregnancy, loves social aspects of other women, communicates with others about her pregnancy. She's really excited. It's a fun and beneficial workout. And also another thing we see is sometimes women who've come with C-sections that may have been traumatic or they feel unnecessary, and then meet other women who are also going for V-backs. And they really, they really feel a connection. So they really, really want to come to the class, hear the stories, and then as women have babies, they hear those stories also. Negatively, we just be women who are not used to movement, who come to class new, they're overwhelmed. And then there's again societal things like proper exercise clothes. I had women come in full burkas, and full kirtas, and duplatas, and it gets very hot really quick. Whether exercising during pregnancy is good, and traveling to class can be a huge barrier which causes negativity. Cultural restrictions often women don't go anywhere without their family. So coming to class may include their mother, their sister-in-law, their father, their brother. So we have to really keep that space sacred and safe just for women. But these can be negative things when women are not used to being in a situation like a day or a religious festival. And so they're not eating well, so they have low energy and dehydration. So these are all, often we have women come in. Sometimes they bring their older child with them to the workout because they want that bonding. They want to be part of it. And then other times women come by themselves because with an older child and being pregnant with the second one, they want that connection just with that baby because they had it with the first one. So both of them are valid reasons. And it's up to the woman, again, that intuitive voice, what do I need today? And this is really, really important to encourage. Here we have a woman who brought her second, her first child. And you can see she's still doing the workout. The child is, she may be modifying a little bit. And the thing about it is this is a huge release of obstetism for the whole class. Everybody loved it. Everybody thought it was cute. So it's good for her. It's good for the child and it's good for the class. So some of my class elements are affirmations to prepare for labor and birth. We again teach anatomy and physiology. I want women to know about their bodies, muscles, ligaments, fascia, how the pelvis moves, even the importance of the diaphragm, which is part of the labor process. The diaphragm helps get a baby out. So the breeding is really important. Building stamina with body movements because again, birth requires stamina. And understanding the parasympathetic rest or the sympathetic flight or flight or freeze nervous system and how to use each one of them in any situation and why they would use one or the other. And then proper posture and breathing technique. This is again, a number one thing that I try to teach women. Again, here's family and friends discouraged them often. They often say stop all yoga. Even if it's a yoga teacher or someone has been doing yoga for years, they tell them not to go swimming because the baby will drown, water will get into the vagina, the baby can't breathe, not let him go to the pool or the seat. So there's a lot of nips around water. Exercise and cardio will affect a premature baby or a small baby or a fetal demise. Do not bend or squat because your water will break and no sitting on a hard floor. I'm going to speed up a little bit just because we got a little bit of time for questions. Medical care providers say stop all exercise even for an SGA baby with no advice to calories. Do not climb the stairs because exercising will create an oxygen deficit to the baby, which we know is opposite. And often using the threat of premature labor or small baby. So this is a story of a woman. She's on her third trimester and I'm a cyclist here and she is a cyclist and she would come to classes on her cycle. So we actually did a 21 kilometer cycle marathon. Really a lot of fun and you see her blue ribbon finishing award. And actually when she came into the birth center, she actually she gave us at least two minutes to get her baby because as soon as she walked in, we got our gloves on baby is born. So that was a really nice thing for her to do. So here's a class and we brought Halloween to India. And of course women just jump into it. So if you look really closely, you see the avocado, you can see the soccer ball. The woman, the third woman is just a very ghost story that's here in South Carolina. We have a superhero, a sleuth. We have all sorts of things and I'm in my rainbow big. So women really enjoy a fun class. And then Hannah meditation with Hannah is always a really nice way for women to relax when there's a lot of stress going on in their life. That's really, really important. So the women who have birthed their first baby without exercise and did with the second one basically said they felt babies were in a better position. They understood better what labor actually was because nobody had told them what it was. They felt more confident about their body. They felt more confident about that they could birth their baby and again enjoyed working out with like minded women with a common goal. And for women who had had their first babies with exercise and their second ones, of course, they know everything about exercise. They appreciated the energy they have, especially when they're running after their second one. Sometimes they weren't as well about coming into class with their second babies, but they always said that they missed it and they really did try to come. Now my observations is a midwife. There's a lot of things about this, but the main thing what I wanted to get across is their ability to meet the challenges of whatever the labor woman has with stamina, commitment, focusing and strength. This is my main goal. No matter what the labor throws at them, no matter what the labor is, they have the stamina and the ability to finish it in their support team. Again, another class and there's various gestational weeks, different parodies, variety of languages, cultures, backgrounds. But the goal is they all want a natural birth. They all want to exercise. They all want to feel good. And this is really the binding that creates so many friendships within this class. So then we had a lot of women asking for me to teach them this unique class so that they could bring this class into their communities because people from all over India were coming to my class and they wanted to offer this to their pregnant ladies in their community. So we decided to create the Master Active Mama's class. It's a three day intensive course, 12 hours a day with a three hour test. You'd be amazed how everybody is just astounded at the test. I don't know what it is. Women from all over India attended. They had we have doulas, childbirth educators, older teachers, physiotherapists, midwives, nurses, and they all enjoyed it. And they all learned something about how to work with pregnant women, individually, as well as in a big huge group. And to me, that was the most important thing. So you saw this woman Conchin in several of my pictures. She is a third trimester, Kalari student, which is the modern martial arts originating in Kerala, her and her husband. And she just took some amazing pictures to show that she was doing this before the birth, for her pregnancy. And she continued in her pregnancy. And it's just an it's just an ideal picture of a very strong woman who knew what she wanted to do with her body and she continued doing it. So this is a quote that I really, really love. Laughter, song and dance create emotional connections. They remind us of the one thing that truly matters when we are searching for comfort, celebration, inspiration and healing as we are not alone. This is by Brené Brown. And the women on the left or the midwives of birth village that I work with, we're at a beach party actually. And the first class that we had on the teacher training courses on the right. So this was their first class and we even have a 10 year old child there who's one of my best assistants ever Eva. So thank you for listening. And is there any questions that I can answer? I think we have a little bit of time. Thank you, Donna. That's that's wonderful timing. We certainly have a good 10 minutes or so if people would like to ask any questions in about 10 minutes time, I will wrap up the session with a couple of closing slides. So if you have any questions, type them in the chat box and Donald answer if you would like to actually voice yourself, we'll see if we can sort your microphone out. And I have to say I really enjoyed the presentation too, Donna. It was it was really inspiring and excellent to see how you're empowering women. Chris, I have a question. Yes, go. So thank you, Donna, for a absolutely amazing presentation. Some comments are very, very positive. They're saying that you bring women alive and they're desperate to get online class details and they would like your guidelines. But I'd like to ask you one question. How difficult was it to convince partners, male partners to support their women to access their classes in the first place? Well, I have to say we have, for the most part, a captive audience. Most of these women are coming to birth village to do a natural birth. So exercise is a high recommendation and their husbands are supporting them. So if their husbands are there, I mean, they don't necessarily want to come to class, but they're there to support their wives. And once they get there, they're actually enjoying it. So I don't think it's that hard. Even some of the ones that husbands did actually horrible in class, they came there to support their wives. So I don't think it's that big of a deal. Okay, thank you. Thanks, Janine. There's a couple of questions in the chat here. So one firm from Red Miller, which is how can we get this program help to get this program happening throughout the country rather than just birth village? That's what we've been doing is we've had a class and coaching and Goa. And we really wanted to have one, of course, this year and a couple other places that that's not been there. So we're just trying to figure out when's the next time we'll be doing a teacher training and definitely keep track of birth village on the Facebook and they will announce any dates as far as the reaction of medical providers. I don't know. I mean, there's still a lot of providers that are wanting women to exercise. I don't think they're understanding it, the level of exercise that we're doing. They're thinking really small walking, a little bit of yoga. But we really haven't seen a lot of medical providers as far. I know they're discouraging women when they will mention that they will discourage them. I think a lot of times we even have mothers who the mothers of the client who've been very much against everything until they'll actually bring them to class. And we've actually had mothers come to class with their daughters and do the workout with us. And so sometimes their exercise class is a game changer because women, they maybe remember their grandparents moving a lot. They remember that, you know, there's always been activity. And so it brings out that intuitiveness about movement is good for pregnancy. So sometimes we get a lot of converts from the parents of the client by then coming to the exercise class. Well, that's good, because if you can get to that generation, then there's hope for the generation of mothers themselves if their parents are interested. Jean asked another question. Are you are you going to visit other countries back to the USA or maybe Europe or whatever to encourage other providers on your technique? We would definitely love to bring it outside of India. That's been always been on the books as far as taking it to countries where people want it. I have to say in the US, I don't know how well that would go because as a midwife in the US, I don't see my clients doing this kind of class, mainly because the distance, the distance is so far. But we're always open to going to other countries and teaching this. We have a few more minutes if anyone has any more questions. I know that during during the labor off and then remember the words I've said, the affirmations I've given, they ask for the workout song so they can do movement on the stairs. They can do all the all the medium intensity during their labor. So these are things that are really embedded into their minds and into their bodies so that in labor they're able to bring forth that intuitive voice of movement. And this is really, really important. Thanks everybody. It was easy to start classes because the women coming to birth village wants the best optimal pregnancy and movement is part of it. So we didn't have a lot of problems getting people to classes. We've had more problems getting people outside of that mindset who are still seeing medical care providers to come into class. It's also really nice to see testaments from people who know your work, who have attended this presentation. That's really, that's really good. Yes, a lot of women have. It's been amazing. I really am thankful to them that they stepped outside of their comfort zone and societal beliefs and really decided that they were going to do this and everybody just really goes to the occasion to make this exactly what it is. Excellent. There's a technical question from Rubio there. Can they do, can you do deep squats for a long time if the baby's head is not engaged? This is not, I can't answer that because it has to be an individual case. So that's something that I'd be able to give information on. Do I find demographics? Yeah, all societal levels, religious levels, everything. That's one thing I liked about India is there's so many different people represented everywhere from village women to women who are very well off to all the religious beliefs from full modern women to women wearing full burkas even during class. So definitely it's there and it's been very nice to see them. And it was, yeah, it was easy to start a class. Excellent. That's good. Thanks. Probably time for one last question and then we'll, we'll wrap up the presentation. I'm gonna, I'm gonna ask them because it was quiet. Do you feel that you've left a massive legacy to the women in India? I think that I have made a difference in the women who have come to me and I'm hoping in by training and they can take it into their communities because really that's my goal is I want to bring it to them so that they can take it in their communities because that's the way I think it should be. But I think I've definitely given a lot of people a lot of things to think about when it comes to movement and exercise and fitness. And I think from talking to women that have been in my class, they definitely will bring that down to their children. They will bring it into their families, they'll bring it into their communities. Whether they teach it or not, they are talking about it and that's where the change is going to come in India is these women who are so brave coming into class and they'll take it to their communities with their conversation. That's your legacy then. And what a fine place to finish. So I'm going to take back the presenter and say thank you very very much Donna for a really interesting presentation and obviously lots of people were interested in the audience as well so thank you very much for that. A couple of credits from Donna and some references.