I concluded that there was no convincing evidence to stop my rigorous schedule of emergency medicine night shifts, distance running, climbing, and skiing. I also appreciated the counterpoint: there was no evidence that this was better than taking it easier. Of course, absence of evidence is not evidence of absence. In the case of pregnant athletes, there is much we have not studied and many topics we have studied inadequately—tiny sample sizes, retrospective methods, and leading hypotheses. For example, Kuhrt et al’s 2018 study of running in pregnancy is titled “Is recreational running associated with earlier delivery and lower birth weight?”. They could have asked: what is the effect of pregnancy on birth weight and delivery or is running during pregnancy associated with any number of untested, more positive outcomes like fewer epidurals or C sections or shorter recovery times, or less incontinence due to stronger pelvic floor muscles? But they didn’t.
So, I signed up for a fall trail race to celebrate thirteen weeks and booked backcountry ski trips to Japan for week twenty-two, Crested Butte for week twenty-six, and New Hampshire for some third trimester nordic. I found an awesome obstetrician who thought this plan sounded reasonable and FUN (bonus: she came to our first appointment in a dress covered in little skiers). We agreed that we were in a largely data-free zone but also acknowledged the benefits and risks of my plan.
Benefit: I was starting pregnancy with a high level of fitness and a demanding job and continuing this level of activity would make me happy and keep me fit for postpartum adventures.
Risk: Trail running, climbing, and skiing can injure moms and fetuses. We can take measures to mitigate this risk but these pursuits are incontrovertible riskier than a brisk walk. I agreed. I CHOOSE regular doses of prenatal athletic euphoria (with added risk of injury) over the statistically safest plan (fall and exhilaration free walking). Nothing like pregnancy and parenting to make you eat your words. I was hardly “following guidelines to the letter of the law”.
As I continued to see pregnant patients and field questions (and criticism) about my pregnancy decisions and others, I realized that patient and doctors rarely lead lives of pure science or non-science. We choose practices from evidence-based medicine, experience, anecdote, faith, and instinct. Sometimes our decisions follow science but our next decision may disobey evidence and feel just as right. In my own delivery, I chose a very medicalized setting out of anecdote and comfort (I love hanging out in hospitals as a provider or patient) as much as evidence (delivering in a hospital is a safe, evidence-based choice). I chose NOT to have a doula against evidence and trusted my adventure partnership with my husband and years of experience with and faith in medical trainees. I chose no pain control based on my love of physical challenges and very modest evidence.
Back to full schedule of ER shifts and athletic objectives three months postpartum, my lived experience as a postpartum patient-doctor-athlete has shifted my thinking. When I meet a pregnant women or a parent in the emergency room or on the trail somewhere between science, experience, faith, and the summit, I think:
HIGH FIVE! Pregnancy, breastfeeding, and parenting are freaking hard and very fun. RESPECT, for anyone trying their best for their family.
Check your biases at the door and listen. Medical choices in pregnancy and parenting are complicated and influenced by many factors (scientific evidence, absence of scientific evidence, anecdote, experience, the internet, mother-in-laws, and just about anything else). Despite beginning this journey as one of the most medicalized people out there, I made several choices based on faith in the exhilaration of mountain athletics and other choices based on science and was happier for it. My job is NOT to judge but to understand and help you be a kick ass pregnant athlete and backcountry parent.
My name is Ashley, I am a runner, climber, backcountry skier, and emergency physician. This post represents my personal experience and opinion. This is NOT medical advice. Please consult with your truest self and your obstetrician or midwife before making your own decision regarding pregnancy and postpartum athletics.
Dhana et al BMJ 2018
Kuhrt et al BMJ Open Sport Exerc Med. 2018
Woodley et al Cochrane Database Syst Rev. 2017
Myth Busting Series
Endurance as a rite of passage