Viewing entries tagged
Dispelling Myths Series

Pregnant Athlete: Dispelling Myths Series #6

You must wait six weeks after birth to return to exercise.

FALSE

 

"I've been cleared to exercise!" are often the elated words of a new mom who is an athlete. This statement always stumps me: Is someone besides you in charge of what you do with your body? What good does abdicating responsibility for your own health do for you or your baby? Further, what does 'cleared' actually mean?

Oftentimes, new moms, following the word of their well-intentioned medical practitioner, remain relatively sedentary throughout pregnancy until six weeks postpartum when they get the magickal approval to return to training. Then they re-immerse in their training as though no time had passed since the last time they trained in earnest resulting in prolapse, exacerbated abdominal and pelvic floor weakness, general frustration, and a loss of confidence in their athletic ability postpartum. 

According to a 2014 peer-reviewed article:

Postpartum physical activity can improve mood, maintain cardiorespiratory fitness, improve weight control, promote weight loss, and reduce depression and anxiety.
— Evanson et al, "Summary of International Guidelines for Physical Activity Following Pregnancy"

Despite this motivating statement about the importance of exercise soon after giving birth, most women wait until their six-week postpartum checkup to discuss exercise with their doctors. According to the ACOG, about 40% of women decline a postpartum visit at all leaving them to wonder about when they might be ready to return to exercise. Additionally, the ACOG advises that women seek their postpartum visit between four and six weeks which means that many if not most women under the current model would be "cleared" for exercise much sooner than six weeks if they heeded these new guidelines.

Curiously, the ACOG cites no scientific evidence to support the timing of that postpartum visit instead relying on "cultural traditions" which, in my opinion, are a sorry means by which to govern health care.

The comprehensive postpartum visit has typically been scheduled between 4 weeks and 6 weeks after delivery, a time frame that likely reflects cultural traditions of 40 days of convalescence for women and their infants
— ACOG "Optimizing Postpartum Care"

Let's put aside the current model of care for a moment and think through empowering ourselves to make decisions about our bodies. Whether your care provider deems you ready for exercise or not, you are the ultimate authority on your body. Depending on your birth, your level of fitness throughout pregnancy, and how you feel your recovery is going, you might not feel ready to start training again until ten or twelve weeks postpartum or as early as the day after giving birth. I went into labor while climbing and returned to take lead falls a couple days after birthing my daughter which sped rather than hindered my recovery.

When I coach athletes through pregnancy and postpartum, they all perform differently but they all return to training much sooner than six weeks postpartum. They do this of their own accord, not at my urging. They learn through our coaching engagement to listen to the subtle cues their bodies give them about wellness and readiness to train which is a vital skill for endurance athlete whether pregnant or not. Most new moms I work with return to the gym within two weeks postpartum. They first test their bodies by doing brief, light, low-commitment sessions before progressing on to more intense or longer sessions. Precisely zero of my postpartum clients has experienced a negative outcome to their health or their breastfeeding status by returning to training this soon after giving birth. The key here is a phased reentry into training, not being sedentary for six weeks then overtraining.

So often women are conditioned by the medical system and other women (mom shaming much?) to adhere to a socially-accepted range of normal. The reality is that pregnancy, birth, and postpartum are likely to go differently for a professional athlete than they are for a weekend warrior, different as well for a mindful mover versus a dissociative athlete. The point is that the range of normal is huge spanning the luxuriously slow pregnancy some women dream of to the ultra-endurance pregnancy I had - and they are all correct and healthy ways to conduct pregnancy.

What women deserve is evidence and options so that they can make their own informed decisions about what is right for them. So before you wait to return to exercise until some doctor tells you it is 'safe', check in with your own body and ask it what is appropriate. A gradual return to training might make the difference between positive mental health and a dive into postpartum depression.

 

Read more:

My postpartum experience

Postpartum running

Postpartum climbing

Paige Reyes client interview

Postpartum body

 

Pregnant Athlete: Dispelling Myths Series #5

Exercising in the heat will damage your fetus.

FALSE.

 

Specific to summertime, preggos often hear this silly, parroted myth. Sources from WebMD to Babycenter pick up the thread, repeating this woman-negative, anti-scientific blather. Addionally, ACOG has recommended that women not exercise in the heat - citing insufficient evidence. Their issue with evidence isn't the lack of its existence but rather their use of twenty-five year old papers.

In order to potentially harm the fetus a mother's body temperature must exceed 102F - and I dare you to try and exercise hard enough to induce that kind of fever. The idea that exercise could raise the mother's body temperature to a level that may harm her child is untrue:

Of the limited studies of exercising pregnant women, there are no data suggesting that normal women actually exercise to a level of exertion that causes significant hyperthermia. However, these studies have been limited to nonathletic populations, in which the exercise has not been prolonged and of high intensity, or sufficient to induce dehydration.
— Murray/Katz "Thermoregulation In Pregnancy" (https://link.springer.com/article/10.2165/00007256-199010030-00002)

As I've discovered in the rest of my research on current pregnant athletic mythology, the myth is not only false, it couldn't be farther from the alchemic truth of the pregnant body's capabilities.

Pregnant women have improved heat-dissipating ability, which is enhanced further with exercise conditioning.
— Hammer/Perkins/Parr "Exercising During the Childbearing Year" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595006/)

Wait a tick... how the heck does that work given we've all been told that a pregnant woman will overheat more quickly? As it turns out, the same pregnant physiology that makes pregnancy function like blood doping AND the way heat training increases heat and cold tolerance (increase in plasma volume) also allows the pregnant body to more-efficiently dispel heat during exercise. Pretty neat!

So, next time the 100s plant themselves in your town and you want to take your round, strong, pregnant ass out for a run or ride hydrate up, wear your tiniest shorts, and hit the trails - fear-free.

Pregnant Athlete: Dispelling Myths Series, #4

A pregnant athlete should expect to recover more slowly from her workouts.

FALSE.

 

Increased stem cell activity initiated by the fetus in its mother's body has a two-fold positive affect on the recovering pregnant athlete's body: 1. Faster recovery from injuries and 2. Increased rates of angiogenesis.

Something NFL athletes have known, and exploited, for quite some time is that increased stem cell activity reduces their recovery time from injuries and surgeries. In particular tendon injuries seem to see a healing burst as a result of increased stem cell activity. By better understanding the meaning and utility of exercise, one can also extrapolate the importance of a boost in stem cell activity in recovery from particularly strenuous exercise.

Bones and tissue in our bodies are constantly breaking down and replacing themselves. During exercise, bone and muscle tissue breaks down as an adaptation to the applied stimulus and is replaced by stronger material. The faster this process can occur, the faster the athlete can recover, the more stimuli can be stacked close to one another, the stronger the athlete can feasibly become.

By thinking about recovery from weight-bearing and endurance exercise as the need for tissue regeneration it is easy to understand why, when I was pregnant, it was near-impossible to become sore from a workout and I felt my recovery time had decreased. It is also good to note that one major aim of endurance training is to induce higher rates of angiogenesis, or endothelial cell proliferation and an increase in capillary blood vessels.

Enter fetal-maternal microchimerism (also known as fetomaternal microchimerism or FMc). According to Zhong and Weiner's 2007 study on pregnant mice:

Fetal stem cells appear to respond to maternal injury signals and may play a role in maternal tissue regeneration during pregnancy. Massive new blood vessels were formed around the injury site which indicated the incidence of high angiogenesis events during the recovery of the skin injury. 

In an even more mind-boggling turn, the fetus continues to supply stem cell support to its mother even after it has departed from her body.

Fetal cells have also been identified in skin lesions of women with systemic sclerosis, a disease of unknown origin which often occurs in women after their child-bearing years.

This boost in FMc continues for quite some time according to Bianchi et al

In humans, PAPCs (pregnancy associated proginator cells) have been described to persist in mothers almost three decades postpartum.

 

This means that recovery times decrease and the injury-assisting qualities of fetal stem cell activity increase in the maternal body even after pregnancy. Now that is some rad sci-fi shit I couldn't dream up if I tried.

If you're into doing research on this sort of thing, doctors, please do us ladies a favor and dig deeper on the topic than I was able to do in this article. You owe it to preggos everywhere. Those burly NFL players only wish they could be pregnant athletes.

source

Pregnant Athlete: Dispelling Myths Series, #3

A pregnant woman should eat for two.

FALSE.

 

In an odd turn of events, What To Expect actually gets this one right. A 2002 Institute of Medicine study advises:

No additional calories for the first trimester, 340 kilocalories (per day) the second trimester, and 452 kilocalories (per day) for the third trimester.

That said, recommendations vary based on maternal BMI and pre-pregnancy nutritional status. It is also interesting to note:

Hytten (1980) estimated the energy cost of pregnancy to be 85,000 kcal.

That is the equivalent of 425 Larabars! Amazing. Good thing the preggo has ten months to eat that much extra food.

Also:

Energy requirements are greatest between 10 and 30 weeks of gestation, when relatively large quantities of maternal fat normally are deposited. Substantial fetal demands (56 kcal/kg per day) are offset in the last quarter of pregnancy by the near cessation of maternal fat storage (Sparks et al., 1980).

In an interesting parallel, premenstrual women have increased caloric needs that outstrip the increased caloric needs of their premenstrual peers. Check out this excerpt from a study on basal metabolic rates throughout a woman's menstrual cycle. In the premenstrual period, scientists found:

RMR was 0.99 +/- 0.16 kcal/kg/h. The energy expenditure while sitting was 1.06 times RMR, while walking it was 2.81 times RMR, and while performing treadmill exercise it was 3.47 times RMR.

This means that your increased interest in ALL THE FOOD is far more (metabolically) appropriate in the days preceding your period than it is during pregnancy. Of course, what you need to eat and what you want to eat are often different things and this is not a prescription about how you must eat. Use these data to make choices about how you eat and I urge you to not read into this data-oriented post any sort of shame about how you should eat while pregnant. If you read this and decide to eat more than you need or differently than what is simply nutrient-oriented, that is your prerogative. When you do indulge, enjoy.

So next time someone shames you for how you eat or look, tell them to step off - and share a bit of hard science. After all, science is the most effective antidote to misogyny.

source

Pregnant Athlete: Dispelling Myths Series, #2

A pregnant woman's immune system is suppressed throughout pregnancy.

FALSE.

 

In sources as diverse as the ever-incorrect What To Expect When You're Expecting to Science Daily, people positioned as experts on pregnancy trot out the same fallacy about womens' delicate immune systems. As you likely gathered from my previous post on this topic, advice that runs contrary to scientific fact (as established by peer-reviewed research) just rankles me.

So instead of continue to allow misogynists like What To Expect and Science Daily to treat the female physiology as though it were some fragile instrument, I'll allow an excerpt from Gil Mor and Ingrid Cardenas' 2011 paper entitled "The Immune System in Pregnancy: A Unique Complexity" to do the talking:

Is the systemic immunity of the mother suppressed? Although we can find numerous studies describing the factors inducing immune suppression (including progesterone, defined as the natural immune suppressor), medical and evolutionary aspects are against the concept of immune suppression. Pregnancy represents the most important period for the conservation of the species, therefore it is fundamental to strengthen all the means to protect the mother and the offspring. The immune system is one of the most important systems protecting the mother against the environment and preventing damage to the fetus. It is during pregnancy when the maternal immune system is characterized by a reinforced network of recognition, communication, trafficking and repair; it is able to raise the alarm, if necessary, to maintain the well-being of the mother and the fetus. On the other side is the fetus that, without any doubt, provides a developing active immune system that will modify the way the mother responds to the environment, providing the uniqueness of the immune system during pregnancy. Therefore, it is appropriate to refer to pregnancy as a unique immune condition that is modulated, but not suppressed.

This unique behavior explains why pregnant women respond differently to the presence of microorganisms or its products. Therefore, pregnancy should not imply more susceptibility to infectious diseases, instead there is a modulation of the immune system which leads to differential responses depending not only on the microorganisms, but on the stages of the pregnancy.

 

So, instead of continuing to falsely believe in maternal immune system suppression, let's begin to rethink the function of the altered immune system during pregnancy. The changes a mother's body experiences during pregnancy in fact allows a more sophisticated immune response and deeper cellular-level discernment in the face of immunologic threats.

This doesn't sound weak to me, this sounds downright superhuman.

 

Pregnant Athlete: Dispelling Myths Series #1

Pregnant athletes should keep their heart rate under 140bpm.

FALSE.

 

Though the incident, a final among many, that prompted me to write this salient and super popular series happened over two years ago now, I still hear from folks who have heard me interviewed on podcasts about this material, I use it in every coaching engagement with pregnant athletes, and I get weekly emails from pregnant athletes around the globe asking about this body of work. Hence, I’m reissuing the series one more time before translating it into a book.

So, here’s what happened: Another experienced athletic coach and parent who lives in the same town as me started talking with my friend and me at the crag about my talk at Vertical World on pregnant athleticism. During the event my friend had asked a poignant question about stigma, motherhood, and double-standards when it comes to being a pregnant or mothering athlete. He had more to say about the woman shaming I faced during my own pregnancy.

But before he could finish his thoughts, the other coach cut in and said (in a sadly well-timed vignette of an exchange):

"There's nothing that special about you training through pregnancy, lots of women do it. The only thing you need to do is wear a heart rate monitor and make sure your heart rate doesn't go over 140."

She, being the vastly senior and more respected endurance coach, did not expect what I said next:

"Actually, that is not based in fact and has been rejected by evidence-based practitioners. There is no heart rate limit for pregnant athletes who are well-trained."

And the evidence is on my side - and on the side of any preggo willing to push it on her next run or climb. In fact, according to the Mayo Clinic:

"If you exercised regularly before pregnancy, there's no need to focus on your heart rate for exercise during pregnancy."

Further:

"There are so many rumors out there, some started or perpetuated by popular pregnancy books, others the result of old wives' tales or outdated advice, so that many women really are confused about what they can and can't do. People are still stuck on this heart rate issue, and it was never based on anything concrete,"

says high-risk pregnancy expert Laura Riley, MD, spokeswoman for the American College of Obstetricians and Gynecologists (ACOG) and author of Pregnancy: You and Your Baby. ACOG is infamous for its overly-conservative views as they pertain to exercise during pregnancy. That rote false-fact nearly everyone who trains or cares of preggos says is wrong. No science. No evidence. Like fake news is to politics, this platitude is manipulative propaganda designed to control and oppress.

I take it seriously when other coaches, especially women, espouse non-evidence-based, misogynistic, one-size-fits-all limits on womens' athletic activity while pregnant without doing the work of educating themselves first. As a coach I am responsible for finding the right balance between challenging my clients and keeping them safe. For me, a core function of being a coach is keeping myself up-to-date on the most recent exercise physiology literature. This coach, in direct conflict with her many decades of experience, merely parroted a platitude she'd heard other coaches and medical professionals say many times before without the critical examination limits such as these deserve.

Culture limits pregnant athletes out of fear rather than equipping them with the evidence they need to choose how they would like to conduct their pregnancies––and I’d rather govern my health using evidence than superstition and old wive’s tales.

I hope you enjoy the final post of this series in this space before they go the way of the book!

Brittany Raven

Pregnant Athlete: Dispelling Myths Series #6

You must wait six weeks after birth to return to exercise.

FALSE

 

"I've been cleared to exercise!" are often the elated words of a new mom who is an athlete. This statement always stumps me: Is someone besides you in charge of what you do with your body? What good does abdicating responsibility for your own health do for you or your baby? Further, what does 'cleared' actually mean?

Oftentimes, new moms, following the word of their well-intentioned medical practitioner, remain relatively sedentary throughout pregnancy until six weeks postpartum when they get the magickal approval to return to training. Then they re-immerse in their training as though no time had passed since the last time they trained in earnest resulting in prolapse, exacerbated abdominal and pelvic floor weakness, general frustration, and a loss of confidence in their athletic ability postpartum. 

According to a 2014 peer-reviewed article:

Postpartum physical activity can improve mood, maintain cardiorespiratory fitness, improve weight control, promote weight loss, and reduce depression and anxiety.
— Evanson et al, "Summary of International Guidelines for Physical Activity Following Pregnancy"

Despite this motivating statement about the importance of exercise soon after giving birth, most women wait until their six-week postpartum checkup to discuss exercise with their doctors. According to the ACOG, about 40% of women decline a postpartum visit at all leaving them to wonder about when they might be ready to return to exercise. Additionally, the ACOG advises that women seek their postpartum visit between four and six weeks which means that many if not most women under the current model would be "cleared" for exercise much sooner than six weeks if they heeded these new guidelines.

Curiously, the ACOG cites no scientific evidence to support the timing of that postpartum visit instead relying on "cultural traditions" which, in my opinion, are a sorry means by which to govern health care.

The comprehensive postpartum visit has typically been scheduled between 4 weeks and 6 weeks after delivery, a time frame that likely reflects cultural traditions of 40 days of convalescence for women and their infants
— ACOG "Optimizing Postpartum Care"

Let's put aside the current model of care for a moment and think through empowering ourselves to make decisions about our bodies. Whether your care provider deems you ready for exercise or not, you are the ultimate authority on your body. Depending on your birth, your level of fitness throughout pregnancy, and how you feel your recovery is going, you might not feel ready to start training again until ten or twelve weeks postpartum or as early as the day after giving birth. I went into labor while climbing and returned to take lead falls a couple days after birthing my daughter which sped rather than hindered my recovery.

When I coach athletes through pregnancy and postpartum, they all perform differently but they all return to training much sooner than six weeks postpartum. They do this of their own accord, not at my urging. They learn through our coaching engagement to listen to the subtle cues their bodies give them about wellness and readiness to train which is a vital skill for endurance athlete whether pregnant or not. Most new moms I work with return to the gym within two weeks postpartum. They first test their bodies by doing brief, light, low-commitment sessions before progressing on to more intense or longer sessions. Precisely zero of my postpartum clients has experienced a negative outcome to their health or their breastfeeding status by returning to training this soon after giving birth. The key here is a phased reentry into training, not being sedentary for six weeks then overtraining.

So often women are conditioned by the medical system and other women (mom shaming much?) to adhere to a socially-accepted range of normal. The reality is that pregnancy, birth, and postpartum are likely to go differently for a professional athlete than they are for a weekend warrior, different as well for a mindful mover versus a dissociative athlete. The point is that the range of normal is huge spanning the luxuriously slow pregnancy some women dream of to the ultra-endurance pregnancy I had - and they are all correct and healthy ways to conduct pregnancy.

What women deserve is evidence and options so that they can make their own informed decisions about what is right for them. So before you wait to return to exercise until some doctor tells you it is 'safe', check in with your own body and ask it what is appropriate. A gradual return to training might make the difference between positive mental health and a dive into postpartum depression.

 

Read more:

My postpartum experience

Postpartum running

Postpartum climbing

Paige Reyes client interview

Postpartum body

 

Dispelling myths event in Seattle - 6:30pm November 8

Hey preggos, partners, and birth professionals,

Come on out this Wednesday evening to Seattle Bouldering Project's West Wall Bar. Patagonia Seattle will be there raffling off some sweet gear, the kombucha will be flowing, and we will get nerdy about my dispelling myths content. Bring your questions and your kids!

Brittany Raven

Pregnant Athlete: Dispelling Myths Series #5

Exercising in the heat will damage your fetus.

FALSE.

 

As the first co-hort of my Pregnant Athlete E-course progresses through these dog days of summer, I was compelled to pop back in with another seasonally-appropriate dispelled myth. Specific to summertime, preggos often hear this silly, parroted myth. Sources from WebMD to Babycenter pick up the thread, repeating this woman-negative, anti-scientific blather. Addionally, ACOG has recommended that women not exercise in the heat - citing insufficient evidence. Their issue with evidence isn't the lack of its existence but rather their use of twenty-five year old papers.

In order to potentially harm the fetus a mother's body temperature must exceed 102F - and I dare you to try and exercise hard enough to induce that kind of fever. The idea that exercise could raise the mother's body temperature to a level that may harm her child is untrue:

Of the limited studies of exercising pregnant women, there are no data suggesting that normal women actually exercise to a level of exertion that causes significant hyperthermia. However, these studies have been limited to nonathletic populations, in which the exercise has not been prolonged and of high intensity, or sufficient to induce dehydration.
— Murray/Katz "Thermoregulation In Pregnancy" (https://link.springer.com/article/10.2165/00007256-199010030-00002)

As I've discovered in the rest of my research on current pregnant athletic mythology, the myth is not only false, it couldn't be farther from the alchemic truth of the pregnant body's capabilities.

Pregnant women have improved heat-dissipating ability, which is enhanced further with exercise conditioning.
— Hammer/Perkins/Parr "Exercising During the Childbearing Year" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595006/)

Wait a tick... how the heck does that work given we've all been told that a pregnant woman will overheat more quickly? As it turns out, the same pregnant physiology that makes pregnancy function like blood doping AND the way heat training increases heat and cold tolerance (increase in plasma volume) also allows the pregnant body to more-efficiently dispel heat during exercise. Pretty neat!

So, next time the 100s plant themselves in your town and you want to take your round, strong, pregnant ass out for a run or ride hydrate up, wear your tiniest shorts, and hit the trails - fear-free.

Pregnant Athlete: Dispelling Myths Series, #4

A pregnant athlete should expect to recover more slowly from her workouts.

FALSE.

 

Increased stem cell activity initiated by the fetus in its mother's body has a two-fold positive affect on the recovering pregnant athlete's body: 1. Faster recovery from injuries and 2. Increased rates of angiogenesis.

Something NFL athletes have known, and exploited, for quite some time is that increased stem cell activity reduces their recovery time from injuries and surgeries. In particular tendon injuries seem to see a healing burst as a result of increased stem cell activity. By better understanding the meaning and utility of exercise, one can also extrapolate the importance of a boost in stem cell activity in recovery from particularly strenuous exercise.

Bones and tissue in our bodies are constantly breaking down and replacing themselves. During exercise, bone and muscle tissue breaks down as an adaptation to the applied stimulus and is replaced by stronger material. The faster this process can occur, the faster the athlete can recover, the more stimuli can be stacked close to one another, the stronger the athlete can feasibly become.

By thinking about recovery from weight-bearing and endurance exercise as the need for tissue regeneration it is easy to understand why, when I was pregnant, it was near-impossible to become sore from a workout and I felt my recovery time had decreased. It is also good to note that one major aim of endurance training is to induce higher rates of angiogenesis, or endothelial cell proliferation and an increase in capillary blood vessels.

Enter fetal-maternal microchimerism (also known as fetomaternal microchimerism or FMc). According to Zhong and Weiner's 2007 study on pregnant mice:

Fetal stem cells appear to respond to maternal injury signals and may play a role in maternal tissue regeneration during pregnancy. Massive new blood vessels were formed around the injury site which indicated the incidence of high angiogenesis events during the recovery of the skin injury. 

In an even more mind-boggling turn, the fetus continues to supply stem cell support to its mother even after it has departed from her body.

Fetal cells have also been identified in skin lesions of women with systemic sclerosis, a disease of unknown origin which often occurs in women after their child-bearing years.

This boost in FMc continues for quite some time according to Bianchi et al

In humans, PAPCs (pregnancy associated proginator cells) have been described to persist in mothers almost three decades postpartum.

 

This means that recovery times decrease and the injury-assisting qualities of fetal stem cell activity increase in the maternal body even after pregnancy. Now that is some rad sci-fi shit I couldn't dream up if I tried.

If you're into doing research on this sort of thing, doctors, please do us ladies a favor and dig deeper on the topic than I was able to do in this article. You owe it to preggos everywhere. Those burly NFL players only wish they could be pregnant athletes.

source