Pregnant Athlete: when to stop

Clients often ask me when they are exercising during pregnancy what the concrete indicators are that they would be well-suited to stop.

Usually, I recommend that each client check in with their midwife or OB to discuss this but I’ve wanted a comprehensive resource to give my clients and followers on this topic. Despite the flaws in the rest of the report, the recently-released 2019 Canadian guidelines for pregnancy exercise has a great list on when to stop exercise to share here.

Reasons to stop physical activity and consult a healthcare provider

- Persistent excessive shortness of breath that does not resolve on rest.
- Severe chest pain.
- Regular and painful uterine contractions.
- Vaginal bleeding.
- Persistent loss of fluid from the vagina indicating rupture of the membranes.
- Persistent dizziness or faintness that does not resolve on rest.
— https://bjsm.bmj.com/content/52/21/1339

This list will still leave pregnant athletes puzzling at the difference between pre-term labor and Braxton Hicks (which, for the record, are not caused or alleviated by exercise). Though this list is useful and is a clear indicator of when to stop, my coaching equips my clients with the self-knowledge and personal monitoring tools so that their bodies are not in so much distress that they experience heart palpitations or membrane rupture before they know to curtail their workouts. Building tools of mindfulness benefits the athlete and their baby.

Brittany Raven

Pregnant Athlete E-course registration now open

Pregnant Athlete E-course
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Pregnant athletes!

It is time to drop the fear and to start training guided by evidence - and your own self-knowledge.

We will specifically cover tactics and exercises for progressing in your mountain running, climbing, and backcountry ski practices all ten months. I’ll weave in anecdotes from the pregnant clients I’ve coached, peer-reviewed science, and tales from my own pregnant to postpartum journey with my daughter, Rumi - including running two ultras, skiing the steeps, and sending my longtime sport climbing nemesis all while pregnant.

Using a mindful approach guided by science and practical exercises, we’ll develop your skills of self-assessment and your knowledge of how a healthy pregnancy progresses.

I’m looking forward to growing and training together.

Brittany Raven

Featured in Tenkara Angler's autumn 2018 issue

Late summer in the Okanogan is a slow dance with high country trees barely holding on to green, wishing the song won’t end but knowing soon the snow will dampen all sound save for a high-pitched whine of the north wind leaning on nude branches. As such, I spend more time sleeping on the ground, touching stone, and casting flies in September than any other time of the year––and these hallowed highlands will be some of the first claimed by the cold white so I had to prioritize our goodbyes.

I am honored to have my work featured in Tenkara Angler’s fine publication for a second time this year! Want to learn how fishing teaches me to listen? Want to go on a journey with me, uncertain and on foot?

Use the buttons below to read online free-of-charge or order a physical copy of the publication.

Brittany Raven

 
 

My clients do incredible/brave/laudable shit

Though they are many, I'm admittedly not great about highlighting my clients' accomplishments. In truth this is because I regard each of their journeys as spirit-athletes to be so sacred, so individual, that I have a strict non-disclosure agreement between me and them. Their stories are theirs to tell—and theirs alone.

However, I felt a quick roundup of their work was long overdue. This list is not comprehensive but I thought it useful to share a few successes emblematic of the athletes I coach.

So, some cool stories from 2018 so far:

  • Recovered from septic knee injury to run longest run ever while six months pregnant.

  • Completed the X-Pyr event, flying a paraglider and running the span of the Pyrenees.

  • Ran first ultra—while four months pregnant.

  • Climbed first outdoor lead successfully at eight months postpartum.

  • Ran ten miles in the mountains, joyfully.

  • Completed first fifty miler—and fast.

  • Used mindfulness practice and personalized training plans to recover from guiding-induced hyperthyroidism.

It is also meaningful to me that none of my athletes sustain overuse injuries or become overtrained while under my coaching. They all report that lessons on mindful movement are their most treasured takeaways. This work brings me great joy—I am honored to work with every single one of these humans and the ones I didn't mention, too.




Featured on Trail Sisters

Many athletes tread into the high country on a mission, seeking to conquer the living environment with whom they move; this is false. The athlete can never conquer the land, it is the other way around: the land owns us and our job as spirit-athletes is to attune and to allow ourselves to be formed by forces much greater and enduring than our singular bodies.

For those of you who don’t follow along on social media, I recently had a piece featured on Trail Sisters. Check it out to learn how and why to run-fish-run. Also: the product of a recent video project I worked on with Tenkara USA is embedded in that post.

Quick guides now available

In order to expand the breadth of my ability to support athletes, I’m testing out making available the guides that I use with my individual clients à la carte. My hope is that this library supports your practice on its own and, where these pieces inspire curiosity, you engage in deeper research or a coaching relationship with yours truly.

Brittany Raven

QUICK GUIDE: Your cycle
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Why I use the pronouns 'ki' and 'kin'

Objectification of the natural world reinforces the notion that our species is somehow more deserving of the gifts of the world than the other 8.7 million species with whom we share the planet. Using ‘it’ absolves us of moral responsibility and opens the door to exploitation. When Sugar Maple is an ‘it’ we give ourselves permission to pick up the saw. ‘It’ means it doesn’t matter.
— Robin Wall Kimmerer, "Nature Needs A New Pronoun"

You may have noticed in my recent Instagram and blog posts that I use the terms ki and kin to describe the more-than-human. 

While reading Robin Wall Kimmerer's Gathering Moss and Braiding Sweetgrass as well as listening to her interviewed on my favorite podcast, On Being, I developed an affinity for her work and felt it resonating deep down in my spirit. Kimmerer is a professor, a community leader, a member of the Citizen Potawatomi Nation, and a brilliant writer exploring the intersection of science, culture, and intuitive knowing.

We know we're a part of the land with whom we dance. On a cellular level, transcending all politics or spiritual beliefs, we remember ki is a part of us; the physical and experiential representation that we are, indeed, one organism incarnate in multitudinous different bodies yet all dependent on Earth and Source.

These endurance practices that bring me into greater attunement with the natural world with whom, and as whom, I move are my practices of awakening. By assigning a dehumanizing, dead pronoun to them I place myself in hierarchical superiority to kin's unthinkable power and intelligence. That is false.

As we begin speaking and thinking about the natural world in terms that recognize kin as yet another living being, other antiquated constructs also fall easily away. The paradigm of competitive achievement begins to look unnecessarily extractive to the athlete on a spiritual path of onenes. Notions of 'conquering' a mountain or 'devirginizing' a summit begin to feel as violent and non-consensual as they actually are.

By speaking about the land (snow, ice, owl, dirt, rock, trees, deer, all of them) as our equals, as co-creators in the mountain experience, we create space for beauty, connection, and recovery alongside the more-than-human and between each other.

How to run in a ventilator

Over on Da Gram, folks I follow from Montana to California have been asking all sorts of questions about me running in a ventilator when it is smoky outside. During summer 2017, I was deeply focused on an ultra running project when the Diamond Creek Fire broke out ten miles from my home in the Methow Valley. Instead of running indoors at the pinner gym in the valley or giving up my gnostic mileage altogether, I decided to innovate.

SOLUTIONS > excuses

Enter: Darth Vader Bitch in no shirt and a power braid. I hope this brief guide keeps you moving on the trails when clouds turn to ash. Enjoy your sore-throat-free run in the smoke!

Brittany Raven


Ventilator model: I am more prone to finding solutions than to allowing adverse running conditions keep me indoors. Last summer I spent most of August and September running and lifting in this ventilator. If it is your first time training in a ventilator, expect a ventilator that is effective in protecting against smoke inhalation to obscure your breathing - it felt like running at about 9000' elevation to me. Be aware of hypoxia due to the restriction of breathing and moderate your pace and the steepness of the terrain you choose to run accordingly.

When to don it: When the air smells like wildfire smoke, when I can't see Mount Gardner from Winthrop, or when I get a slight headache from the smoke I put on my ventilator. This happens around 75 AQI. With the high volume of training I do, I can't chance a case of bronchitis or the presence of a splitting headache anymore than I want to axe a planned run. If a large amount of visible particulate falls from the sky I do a different form of training as I don't want the particulate in my eyes. 

Achieving a seal: Allow the sweat to build up around the ventilator (in the space between skin and plastic) and don't wipe it away. That sweat creates an excellent seal of the mask to your face. Be sure to move the mask aside every fifteen minutes for a bite and a sip. People with facial hair might struggle to get the thing to stick completely to their faces.

The stimulus: Given that the mask will function as yet another stimulus in your training and, paired with the likely heat that will accompany it, you may perceive a dip in performance as your body acclimates. When you restrict oxygen input, your body works furiously to produce more red blood cells. When you add heat, your body increases plasma volume. With these things happening simultaneously your bod is indeed increasing its performance but it will feel discouragingly slow. 

Measuring the stimulus: Pace is nearly always the poorest measurement of training impact; time in zone is nearly always the best way to meter out your endurance production. Quit with the competitive thinking already, learn your CUSTOM/INDIVIDUAL zones, and watch your performance rise while incidences of overtraining, insomnia, and injury decrease. Especially in the mask, releasing the ego's attachment to pace and measuring the success of your run only by time in zone is of vital importance. 

The ANS: Hypoxia leads to the activation of the autonomic nervous system (ANS) and that is a bad thing for an ultra endurance machine like you. With an activated nervous system during persistent endurance training you risk poor proliferation of oxygen, inappropriate metabolism of your precious calories, poor decision-making, lack of connection with the divine, and even adrenal fatigue. 

Minor logistics: In this model of ventilator I've found a hat to be more compatible sun protection than sunglasses, a high ponytail (power braid suggested) helps hold the dang thing up better than a low pony, and wearing it with headphone cords is a hassle. Be warned that this ventilator obscures your peripheral vision - about as much as if you were wearing ski goggles. Choose your trail surface accordingly.

 

read more:

running in wildfire country

heat training

training in the heat while pregnant

Training in wildfire country

that firelight, tho.

Hey readers,

Here's an update on a post I wrote last summer. Wildfire smoke is, again, blanketing the valley, there's yet another wildfire burning just a handful of miles from my forest home, and I've put on my respirator for runs. 

Keep up the good work and forget your excuses.

Brittany Raven


As the Diamond Creek Fire nears my home in the Methow Valley, I continue my daily running practice. My home, as wild and wily and wonderful as it is, also has extreme seasons. Spanning the negative-teens and three feet of snow on the ground in winter to the sauna-like smoky days of mid-August there is always some complication to getting out the door to run - except in our paradisiac Aprils and Octobers which read like a mineralic rosé or a dense merlot on my tongue according to season.

Just like the e-book I compiled last winter containing my lessons for running in snow, I wanted to provide readers and clients with some fire country know-how to help you keep moving in the hottest summer months. More than sharing my hard-won knowledge about dancing with the changing seasons with you readers, these pieces serve as mantras for me when the extreme conditions get me down and make me consider not running. Here are a few helpful morsels I've gathered this season while I learn to move with the fire.

 

Safety: Being that wildfire can shift quickly, leaving the runner stranded, there are a number of health- and safety-related precautions to take when running the hills during an active wildfire. First: leave a plan with a responsible safety person who is able to call in the necessary support. In that plan include where you're parking, what trail or mountain you're running, with whom, and a time that you will contact them. Be sure to leave the contact information of your local Search and Rescue team with your safety person so they know who to call if you don't get in touch in time. While you're running use good common sense. Sniff the air periodically to judge the behavior of the fire nearby, watch for smoke or unusual animal activity. Be aware of your surroundings and be prepared to exit quickly should warning signs present themselves.

Checking conditions: Don't rely on mere gossip or the news to inform you of fire activity - go to the source. Check out the InciWeb page for the fires near you before heading out on your run. Take special caution on windy days. Even though that blessed wind might blow the smoke away and tempt you out to run, it is akin to being called out to ski on the deepest powder days. Just like fresh pow is tempting and potentially lethal, so too are clear skies after a couple smoky days. The wind that clears the skies is the same wind that stokes the wildfire.

Your vehicle: If you're driving to your running destination be sure to have an alternate exit if one is cut off by smoke or flame. Park your car in a conspicuous location to alert FS employees who might serve an evacuation notice while you're on the trail and to make rescue more feasible should you become trapped. If you're running in a particularly remote location leave a note detailing your route and timing on your front seat in case a team drives by to evacuate the area. Fuel up, keep on top of maintenance, and park in a visible location. Nuff said.

The heat: Fire season happens during the hottest part of the year - and here in the Methow Valley that means 100F+ conditions on ten runs in a row this summer. The heat is an excellent training stimulus - if properly-programmed in your training. Start with little bouts of exposure to the heat on your mellow run days before jumping whole-hog into long, hilly, hot runs. I find visualizing my body dissipating into the heat rather than resisting the heat allows me to become more comfortable in intense temperatures. Instead of flushing your body to hyponatremia by drinking only clear water, try this homemade hydration drink. Fill a sixteen ounce hand bottle with ice, add the juice of one lime, spritz in some micronutrient drops, and top it off with water. That bottle will add a good deal of cool to your baking-hot run. 

Ventilator: I am more prone to finding solutions than to allowing adverse running conditions keep me indoors so when the smoke near home persisted this month, I ordered this ventilator. Read the next blog post for more on wearing the ventilator.

The ANS: Hypoxia leads to the activation of the autonomic nervous system (ANS) and that is a bad thing for an ultra endurance machine like you. With an activated nervous system during persistent endurance training you risk poor proliferation of oxygen, inappropriate metabolism of your precious calories, poor decision-making, lack of connection with the divine, and even adrenal fatigue. If you are unsure how to regulate your nervous system, sign up for a consult with me and I'll teach you the way.

When to bail: If ash falls from the sky, if the smoke is thick enough to make my eyes water, and if there is lightning in the forecast I'll bail or choose a different activity for the day.

 

read more:

heat training

ventilator running

GUEST POST: Pregnant doctor-athlete - Ashley Kochanek Weisman, MD

I concluded that there was no convincing evidence to stop my rigorous schedule of emergency medicine night shifts, distance running, climbing, and skiing.
— Ashley Kochanek Weisman, MD

Special guest post today for you, reader! 

Ashley Kochanek Weisman, MD reached out to me a couple months ago with a heartening message about how my pregnant athlete material had resonated with her and had been useful through her three trimesters of skiing, climbing, and running. When she was in town for a visit a few weeks later we connected over coffee and it must have been something to overhear. We bantered about evidence on performance and pregnancy, she nursed her fresh babe, and she recounted some amazing pregnant ski trips as well as her fast return to training postpartum.

Ashley holds a BS from Yale and received her MD from Harvard. She now practices medicine as an emergency room doc in Western Washington. This brainiac also has a penchant for alpine climbing, backcountry skiing, and ultra running - as well as a brand new baby. She and I both approached our decisions about pregnant athleticism, birth, and postpartum using peer-reviewed science and our deep levels of self-knowledge. And guess what: as similar as our experiences as pregnant athletes might have been our choices about where and how to birth were quite different!

When I asked Ashley to write a guest post for this here blog I had no idea how funny it would be. Please enjoy her tales of the birth send and how she navigated her glorious ten months of blood doping through the lens of her scientific mind below. Ashley's deep trust in herself as an athlete and the evidence around pregnant athleticism are notable.

Brittany Raven


the author skiing in Hokkaido, Japan at 22 weeks pregnant

"I think this is the SEND!" shouted my dudela/climbing partner/husband Dan, “I can see his head!”

I started laughing, took a deep breath, and pushed out our son. Pushing was hard and counterintuitive: It involved relaxing the glutes, hamstrings, quads and abdominal muscles that I had trained throughout my rock, snow, and trail-filled pregnancy. The delivery wasn’t graceful but felt damn good; if labor was an undulating 50k mountain run, pushing was a 5.10d offwidth finish. Little guy nailed the birth canal couloir descent into the hands of a family medicine resident, coached by an attending obstetrician, with a senior nurse and nursing resident in the active audience. Now everyone was laughing.

On my chest was a healthy baby born in the most natural way my pregnant-doctor-patient-athlete could imagine—in a quaternary care hospital with a level 4 NICU amongst a throng of doctors, nurses, and medical trainees learning by doing, with lots of references to skiing and climbing epics, without anesthesia or analgesia or a doula. This is certainly not everyone's picture of natural, but it was mine. Like the rest of my patient-doctor-athlete pregnancy, the birth was an amalgam of evidence-based medicine, medicine with no evidence, and instinct-guided winging it, all taken with a beginner’s mind and openness to change.

I started pregnancy as an emergency physician, ultrarunner, climber, and skier, 100% confident in the medicine I had learned from my physician parents, medical school, residency, and years of clinical practice. I was ready to abide by science and obstetric and pediatric society guidelines to the letter of the law.  After my first positive home pregnancy test I dove into the medical literature to construct a list of dos and don'ts. Some recommendations were solid––don’t smoke or binge drink, minimize exposure to radiation or teratogenic diseases, get a flu shot, don’t gain too much or too little weight. Yet there was woefully little guidance on my definition of exercise--hours spent running, climbing and skiing––during pregnancy.

What do we know about pregnancy and exercise? By my best literature review, we know that healthy maternal lifestyles are good for moms and children. We also know that running does not lead to differences in birth weight percentile or gestational age. We know that pelvic floor muscle training in antenatal and postnatal periods can reduce incontinence. There is, however, no conclusive evidence showing significant reduction in gestational diabetes, preeclampsia, or perinatal depression from maternal exercise.

 
 the author's shadow while skiing in Crested Butte 6 months pregnant

the author's shadow while skiing in Crested Butte 6 months pregnant

 

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:  

  1. HIGH FIVE! Pregnancy, breastfeeding, and parenting are freaking hard and very fun. RESPECT, for anyone trying their best for their family.

  2. 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.

 

sources:

Dhana et al BMJ 2018

Kuhrt et al BMJ Open Sport Exerc Med. 2018

Woodley et al Cochrane Database Syst Rev. 2017

 

 

read more:

Myth Busting Series

Endurance as a rite of passage

Postpartum climbing