Baby on Boards

Baby on Boards 1103

So is it safe to ski when you're pregnant?

"No," says Dr. Rick Frieder, an obstetrics and gynecology instructor at UCLA's medical school.

"If you're in early pregnancy and used to skiing, then it's probably OK—but not after four months," says Dr. Ezra Davidson, a Los Angeles-based ob-gyn.

"I'm your doctor, not your father, so I won't tell you what to do, but I can give you some guidelines," says Dr. Ed Cohen of Vail, Colo.

At the confusing intersection of skiing and pregnancy, opinions fly as wildly as the snow. And while the majority of ob-gyns say that skiing isn't highly recommended for pregnant women, some are more emphatic than others. Ski-town doctors are slightly more open to schussing-for-two than their urban counterparts, but they also have concerns. Most skiers, however, are risk-takers at heart. Ski-town ob-gyns estimate that anywhere from 50 to 90 percent of their patients ski at some point during pregnancy. It's not surprising, really: There are no studies or statistics on miscarriages from skiing, and anecdotal reports of skiing-related miscarriages are rare. And when added to the already long list of don'ts during pregnancy—everything from avoiding soft cheese and deli meats to staying off your bicycle and away from the cat box—eschewing the mountain entirely is too confining for many expecting skiers. But should it be? The decision, of course, is yours alone. Here, we outline the risks.

To understand the issue, first realize that it's the job of doctors to protect a woman and her growing baby as much as possible, so most err on the side of caution. The American College of Obstetricians and Gynecologists (ACOG), for example, suggests in its guidelines that skiing be avoided altogether. But keep in mind that ACOG has traditionally been conservative; some 15 years ago, pregnant women were advised against exercising at all—a stance that has now been reversed.

Despite ACOG's thumbs-down, Raul Artal, M.D., chairman of the department of obstetrics and gynecology at the St. Louis University School of Medicine and a spokesperson for the ACOG who helped draft those guidelines, doesn't state the case quite so directly. "ACOG has taken the position that pregnancy should not be a state of confinement and that pregnant women should continue to engage in the same types of activities that they engaged in prior to pregnancy," he says. "However, there are activities (like skiing) that we know are quite risky. The same risks that are there in the non-pregnant state are there in the pregnant state and may even be amplified."

Ob-gyns believe the main risk for women who ski while pregnant is the most obvious one: falling. Slamming directly onto the belly is the first concern, but there are other potentially harmful falling scenarios, and experts say it's hard to categorize exactly which will harm the baby and which won't.

Still, most ob-gyns are primarily worried about direct trauma to the baby, and the danger there is in what you hit: the ground, your ski, a tree or another skier. The worst potential result is a ruptured uterus, which can end the pregnancy. Direct trauma is most risky after the 12- or 13-week mark, when the uterus emerges from the protective shell of the pelvis.

Falls can become more common during pregnancy for a number of reasons. First, the extra weight in the belly, particularly during the second half of pregnancy when most weight-gain happens, throws off a skier's center of gravity and thus her balance as well. Second, because pregnancy itself is taxing, women might fatigue more quickly, making them more apt to fall. Last, during pregnancy, ligaments and tendons tend to loosen due to higher levels of a hormone called relaxin, which can make it harder for a woman to control her skis.

There's also something called shear force, which can affect women at any point in their pregnancies. Under shear force, the outside of the body stops moving before the internal organs doas often happens in a car crash), causing separation of the uterus and the placenta, the organ that supplies the baby with blood, oxygen and food. This results in a miscarriage. While speed can be a factor here, shear force is ultimately determined by the rate at which you decelerate, Vail's Dr. Cohen says. For instance, there will be much more shear force if you're skiing at 10 mph and hit a tree, stopping suddenly, than if you're cruising at 20 mph, fall and slide to a full stop 100 yards later. On the hill, shear force does require a crash or fall, however; simply stopping short does not create enough impact to cause harm.

During the last two months of pregnancy, there's another danger: A fall or injury can bring on premature labor, says Dr. Steve Thompson, an ob-gyn in Truckee, Calif. And some doctors believe that if there's one time during pregnancy when women should really stay off their skis, this is it.

Though not as serious a concern as falling or shear force, altitude is yet another factor to consider. Moderate altitude itself most likely won't hurt a developing baby: Studies of women up to 32 weeks pregnant at 8,000 feet found that all hormonal and chemical changes are normal during exercise, says Peter Hackett, Ph.D., an altitude researcher in Telluride, Colo. But coming down with altitude sickness is something to think about. Losing your appetite, vomiting or getting dehydrated may keep your baby from getting the nutrients it needs, though a day or two of this probably won't cause serious harm. The real dangers are the rarer but more serious forms of altitude sickness, such as high-altitude cerebral edema (HACE) or high-altitude pulmonary edema (HAPE). Also, you'll want to be extra careful if you're in your third trimester, when altitude sickness can trigger contractions, increasing the risk of premature delivery.

To be safe, Hackett and Thompson agree that a good rule of thumb is to sleep below 10,000 feet. When you're sleeping, your blood oxygen is lowest (you're not moving so you don't need as much oxygen), and if it gets too low (the higher you go, the lower it gets) it can stress your organs—and the developing baby.

It all sounds ominous, but many women say they know the risks and don't believe it's all so bad. "There's a real cautiousness among obstetricians, and it translates into 'don't do anything,'" says Deb Wheeler-Hackett, a 46-year-old ski patroller at Telluride, Colo., who skied until she was 7 1/2 months pregnant. Wheeler-Hackett, like many expert skiers, says she's so comfortable skiing—as much as she is walking—that setting aside her skis during pregnancy wasn't even an option.

But even top-level skiers have their worries. "I was totally comfortable with myself, but there's only so much you can do about the other skiers out there," says 35-year-old Kristin Vallant, a former U.S. Ski Team member and two-time Olympian who quit skiing during her last trimester for fear of collisions on the hill.

Dodging others on the mountain is the biggest concern for less proficient skiers, too. For Maryjane Kresic, a 42-year-old intermediate skier from Ridgefield, Conn., the camaraderie of skiing with her family while pregnant outweighed the risks at first, but when she hit five or six months, she didn't feel confident enough in her own abilities to defend herself against other skiers on the slopes.

In the end, skiing during pregnancy comes down to a matter of your own judgment. As ACOG's Dr. Artal puts it: "If someone wishes to take the risk, then that's what it is—a risk."

Ski it Safe

If you do choose to ski during pregnancy, here's how to help make your experience safer.Assess your ability level. Anyone can have an accident, but less experienced skiers tend to fall more often.

Ski below your ability level, and stick to groomed runs.

Ski when the conditions are good, not when the snow is icy, slushy or heavy.

Ski midweek, when there are fewer skiers on the mountain.

If you're traveling from sea level, stay for a week rather than a weekend. Don't over-exert yourself in the first two days, and drink plenty of water.

Be extra careful, and take breaks often.

If you've had previous mis-carriages or premature laborin a previous pregnancy or you experience health problems like high blood pressure, bleeding or symptoms of premature labor, doctors say you should stay off skis traveling from sea level, stay for a week rather than a weekend. Don't over-exert yourself in the first two days, and drink plenty of water.

Be extra careful, and take breaks often.

If you've had previous mis-carriages or premature laborin a previous pregnancy or you experience health problems like high blood pressure, bleeding or symptoms of premature labor, doctors say you should stay off skis altogether.