by Anna Kessel
Initially I tried to put on a brave face. I loved my aerobics classes at the local gym, and I’d read online that so long as you had already been doing the exercise before getting pregnant you would be fine to continue. But when I told my aerobics teacher I was pregnant she asked me to leave the class and not return until I had a doctor’s note giving me permission to join in. Her words came as a shock. I felt told off, embarrassed and guilty. Did she think I was risking the life of my unborn child with my selfish need for exercise? I never did go back. And that’s something I heard again and again: if you fail a woman at any stage of her attempting to play sport or do exercise, she’ll rarely have the confidence to go back and try again. Clearly women need more bouncebackability, but maybe the structures around us also need to be more supportive. The result was that I gave up all the fun stuff. I gave up the gym classes I loved, the women I was used to seeing week in, week out, grimacing with over abdominal crunches, and laughing with about complicated step and Zumba routines. After finally finding the joy in exercise, I was now back to exercise as a necessity, not fun.
Despite the GP’s warnings, I continued running for the early months of my first pregnancy. With the doctor’s words ringing in my head, it felt pretty contraband to run in the park, especially as my bump began to grow. Not to mention the issue of squeezing my sports bra over my newly expanded bust. My husband ran with me, for support and encouragement, and it was hard but it felt good: running along, my little baby inside me, already learning about a healthy life, a pumping heart. I worried, a little, what people might think, seeing my bump bumping along. It’s also pretty uncomfortable feeling your bump lollop around, without support. At five months I stopped running. My bump was too big. But I kept swimming and doing pregnancy yoga. It was important to me to do everything I could to be strong and healthy for the birth.
It is, of course, understandable that doctors and midwives would err on the side of caution and warn against doing anything like running, or playing a contact sport. No one wants to tell a pregnant mum that she can carry on with, say, ju-jitsu, only for a fatal blow to the stomach to bring about tragedy to an unborn child. But surely there is more detailed information that medical practitioners can give mothers-to-be? More advice for those who are already active, and more advice for those who want to be? ‘Unfortunately, GPs are the same as teachers,’ legendary Paralympian Baroness Tanni Grey-Thompson tells me. ‘They don’t get much help on how to prescribe physical activity. Add to that if you’re a female GP and you’ve had a miserable experience of physical activity, you’re just going to tell people to walk.’
Tanni says that when she was pregnant with her first child one doctor told her to stop training altogether. She ignored the advice and sought information elsewhere, gleaning it mostly from the Internet, or from contacts in Australia where she believes women are culturally more inclined to be physically active. For Tanni the priority was being able to have a healthy pregnancy, as well as doing everything she could to ensure she was able to compete in the Commonwealth Games six months after her daughter was born.
Tanni is not the only athlete who kept active through her early trimesters. Katie Chapman played football four months into her pregnancy, while Germany and Paris Saint-Germain midfielder Fatmire Alushi played in the 2015 Champions League final well into her second trimester. Topping the bill, though, is the US 800m runner Alysia Montaño who, in 2014, competed at the national championships while eight months pregnant. Sprinting down the final straight, her thirty-four-week-sized bump stuffed into a pink running vest, she was incredible to watch. The fact is that we just don’t usually see women with pregnancy bumps physically exerting themselves. It’s both shocking and incredibly inspiring. ‘I felt such an exhilarating amount of joy,’ Alysia said afterwards. ‘Having the crowd back me was so unexpected, but I was so excited for it. I was literally laughing out of joy, like, oh my gosh, thank you guys so much!’ Even the Daily Mail wrote a column in praise of her. Of course Paula Radcliffe famously ran through her pregnancy, while Mary King won team gold and individual bronze at the European Equestrian championships in 1995 when five and a half months pregnant, at a time when pregnancy and sport was a huge taboo.
Former British Olympic team doctor Michael Dooley was one of a close circle of confidants who knew about Mary’s pregnancy before it became front- and back-page news. When she revealed her secret to him just weeks away from the European championships she said, ‘I’m twenty weeks pregnant, do you mind?’
‘Well,’ said Michael, ‘I was in awe of this woman. I said, “Go for it!”’ Michael duly kept her secret for her, and has spent the ensuing twenty years campaigning for more research and guidelines around sport and pregnancy to lessen the taboo. ‘That’s how I was appointed to the International Olympic Committee to develop guidelines on what to do with a pregnant athlete – because we still don’t know! We don’t know!’ he says, animatedly. ‘It’s not only what advice to the athlete, it’s what advice to the governing bodies? At that time a culture of concealment had developed, which was a nightmare. So I changed the culture to be open about it, I said we mustn’t prevent people from competing when they’re pregnant, we must develop safe guidelines to help them. That’s my philosophy. We’ve got to make sport safe because exercise is good for you.’ There is a caveat though: too much is bad for you, he adds. ‘I’ve just seen an athlete with REDS [Relative Energy Deficiency in Sport, a.k.a. dangerously low body weight] and there are all sorts of associated problems around fertility.’
Michael and I continue to stay in touch over a period of months. He is one of a number of global experts on a medical advisory group consulting with the IOC on their guidelines for pregnant athletes, due to be published in spring 2016. He is a gold mine of information and I wish I had had a hotline to him when I was first pregnant with my daughter. A fellow of the Royal College of Obstetricians and Gynaecologists (RCOG), Michael co-wrote their guidelines for pregnancy and exercise, and his advice is so much more flexible than anything I have come across elsewhere. For a start, the paper encourages aerobic and strength-conditioning exercise, recommending working at a level that is ‘somewhat hard’, on a scale from gentle to extremely hard. RCOG advise that exercise does not increase the risk of ‘adverse pregnancy or neonatal outcomes’, and that moderate exercise does not affect breastfeeding. The only sport banned outright is scuba diving, though there are cautions around horse riding, downhill skiing, gymnastics, ice hockey and cycling because of the risk of falling. Still, existing medical conditions aside, that leaves a huge and joyful scope of exercises that pregnant women can do! Dancing and aerobics and Zumba and running and tennis and badminton and aqua aerobics. Why are none of these mentioned by doctors when pregnant women turn up at their surgeries?
The thing is, if you’re an elite athlete, chances are you will have someone like Michael or another highly qualified expert monitoring you. As Tanni told me, ‘I had a heart monitor to make sure I wasn’t overdoing it, but most women won’t have one of those.’ So what are the rest of us supposed to do? I wish those RCOG guidelines were more widely distributed, because women desperately need better advice on how to exercise during pregnancy – so that inactive women can be healthier, and so that active women don’t overdo it. Unfortunately, that can be the flip side of the equation. One friend of mine, a personal trainer, kept working – which in her case meant some seriously hard running – seven months into her pregnancy, and ended up on crutches in the final weeks before giving birth. Another attended a yoga class so hardcore that the teacher was forcing pregnant mothers into dangerous moves. She also ended up on crutches in the latter stages of her pregnancy and had to hire a nanny to collect her daughter from school because she literally could not manage the short walk. While I stopped running early on in my pregnancy, my job as athletics correspondent was pretty active and I travelled a lot for work. By seven months I was struggling to sit at my desk. My GP referred me to an NHS physio who diagnosed pelvic girdle pain, and gave me vario
us tips on how to tackle it. But working full-time didn’t allow for as much rest as I probably needed. On one memorable occasion the pain got so bad I had to lie down in-between paragraphs of a lengthy article and plead for a deadline extension from my editor. We’re all at risk of overdoing things, but in terms of medical advice it seems that moderate exercise remains the key to keeping us in the best possible shape throughout our pregnancies. Indeed, Michael mentions a study from Norway which showed that women who exercised before getting pregnant were 14 per cent less likely to suffer from pelvic girdle pain during pregnancy than those who didn’t. He also says that moderate exercise will help get you pregnant in the first place – which is a refreshing break from all the mums’ message boards that terrorized some of my friends when they were trying for a baby. One friend told me it was all, ‘lie down with your legs in the air’; exercise was definitely not on the agenda.
At the end of 2015 two new reports came out about health and pregnancy. A study from Sweden warned mothers not to put on weight in-between pregnancies – even a modest gain of 13lb – as it increased the risk of stillbirth by 30–50 per cent. Another, from Britain’s Chief Medical Officer, Sally Davies, urged women to stay fit during pregnancy and not buy into the myth of eating for two. In the latter report, Sally argued that pregnancy was a vital moment of contact between women and the health service, an important opportunity to check in on a woman’s overall health, particularly with rising obesity levels (half of all women in the UK aged 25–34 are deemed overweight). I was thrilled to hear Sally emphasize the role of GPs in advising women on being a healthy weight, and staying physically active. Too often the headlines of these news stories read as yet another example of body-shaming women. It’s bad enough that women are told they don’t look good, but worse still if we’re making women’s weight gain responsible for the deaths of babies.
Ultimately, we cannot make this solely a woman’s problem. As a society – for the health of future generations – we simply have to find a better way to support women to exercise during pregnancy. We have to make antenatal exercise classes more effective – and affordable – limiting us to lying on the floor and breathing is, in itself, not enough. And we have to find a way to give women variety and fun. If women who aren’t pregnant struggle to be physically active despite a vast array of sport and exercise on offer, then how can we realistically expect women to engage when we present them with a stultifying choice of swimming, walking and pregnancy yoga? With less than a quarter of women exercising through pregnancy, alarm bells should be ringing. This is a drop-off point where we are potentially losing women from a healthy lifestyle forever. When we talk about a cradle-to-grave approach we must make sure that there isn’t a pregnant pause when it comes to pregnancy. The last thing women need is yet another bump in the road.
The marathon of motherhood
Just as you nail your pregnancy workout, of course, along comes motherhood. And everything changes all over again. I felt like an alien in those first few days after giving birth. I remember crying inconsolably when my husband popped out to get us a Nando’s takeaway because we were too tired to cook. He came back five minutes later with half a chicken and spicy rice, while I sobbed, ‘Don’t ever leave us again, OK?’ much to his amusement. I wasn’t going mad, it turned out that it was just my milk coming in and yet another flood of hormones to contend with.
The six-week check is every mum’s milestone in terms of getting the green light to recommence normal life. It’s the moment when mums who had caesareans have their scars checked, and mums with vaginal stitches should be able to stop worrying about what the hell’s going on down there. But a 2014 survey of over 4,000 mums, by Netmums and the NCT, found that the six-week check was anything but reassuring. Over 45 per cent felt the check was not thorough enough, and no wonder, with 20 per cent claiming the appointment had lasted less than five minutes. Only 35 per cent were offered an examination of their stitches. The survey did not ask about diastasis recti; unfortunately it is not a check that doctors are obliged to do. But if we are serious about wanting new mums to go back to exercise then surely we need to give them a thorough MOT before we send them out there? As I write, the NHS are undergoing a public consultation about maternity services. But I fear for how conclusive the findings will be. In the online survey, while there are plenty of questions about pregnancy and labour, there is just one tiny box available to comment on your experiences of postnatal care. It shows a worrying lack of priority being given to this area.
If I had my way the six-week check would be offering women so much more. I’d like to see every new mother being checked for diastasis recti, and given advice on simple exercises to solve it. But the reality is that most mums are just not getting the right guidance. My friend Anjana Gadgil, a very active, fit and healthy mum, had a gap as wide as her hand in-between her abdominals. Damningly, it was only diagnosed after her second child. Here is her story:
‘When I was three months pregnant with my first child the midwife said, “Oh, your abs have separated already – that’s early.” I went on to have a second child – again by C-section – and no one, in the many prenatal and postnatal check-ups, ever mentioned it again. So after my second baby, I got to work on my “mummy tummy”. Football, tennis, yoga, Pilates, sit-ups. I lost the baby weight but not the tummy. What’s more, I had this weird and widening gulf right down the middle of my belly. Finally my sister (a geriatrician) had a look and diagnosed diastasis recti, as she sees it in older people who go on to have hernias.
‘My left and right abdominals were five fingers apart, and I was told I would need surgery. My GP had never heard of it. I then stopped all the bad exercise I was doing before. It’s not healed but it’s a lot better. I have straw-polled many friends and very few know of it, far fewer still how to treat it.’
I find it jaw-dropping that a GP wasn’t able to diagnose Anjana, or that countless midwives and health visitors never thought to check for the condition, or mention it. Anjana’s story is not an isolated one. During the research for this book I heard more and more horror stories about women with diastasis recti, including one from a woman who lay down in the playground and literally pulled her stomach muscles apart, the gap was so bad. The same story appears repeatedly on Facebook parenting sites, where dozens of women described their experiences. Many had ended up undergoing operations to solve it. Almost no one on the thread had heard of the condition before being diagnosed, often belatedly. Many found their GPs to be clueless and, like Anjana, tried to do sit-ups, planks, crunches and leg raises in an attempt to ‘improve’ the appearance of their stomach – all of which only made it worse. Surely educating health professionals so that they can diagnose diastasis recti and recommend physiotherapy to remedy it is a far easier and more cost-effective solution than leaving thousands of women to struggle, some of whom end up needing invasive operations paid for by the NHS?
Because diastasis recti is not just about having a ‘mummy tummy’. It can cause terrible backache, incontinence and even hernias. One study in the US found that 66 per cent of mums presenting with diastasis recti also had pelvic-floor dysfunction – from incontinence right through to prolapse. Sadly it all seems to be part of a negligent attitude to post-natal health. It is unbelievable to me that in the twenty-first century when a mum says she has backache the response is to shrug, and say it comes with the territory – picking up babies, carrying them in slings, breastfeeding and just general, well, mumness. It is difficult to understand why we can’t have doctors, health visitors and midwives checking post-partum mums’ abdominals? It takes thirty seconds! And why can’t buggyfit instructors, or anyone claiming to specialize in exercise for mums, take five minutes out of each session to do sensible and appropriate core muscle work including the dreaded pelvic-floor exercises that doctors, mothers and grandmothers all constantly tell new mums to do. Women desperately need guidance on how to exercise when there are so many new factors at work in their bodies.
Four years
on from my first pregnancy and I have only just found an exercise class that provides that expertise, and I live in London, a city that offers such a variety of experiences that you can even do ballet with your baby – if you’re willing to pay £20 a pop. But although my post-baby exercise classes didn’t provide the physiological support that I would have liked, they did give me something special. From buggyfit in the park, which taught me the basics of how to push a pram without hurting your body (elbows in, back straight, don’t collapse your wrists) and got me out of the house each week, to local community classes for family fitness.
With such scarce provision specifically for post-partum mums, more and more are making their own arrangements. My friend Emmi goes swimming with a group of local mums who take it in turns to watch each other’s babies while they do lengths in the pool. Another friend did her own buggy circuits in the park. I also heard about Mothers Meeting, a national movement bringing together mums from the creative industries to have power lunches, ‘netwalking’ meetups with buggies and Nike workouts, all with their children in tow.