Returning to sport after childbirth

Question 1

According to the study participants, when did they typically return to running and nearly full training postpartum?

Answer 1

Most participants were back running by ~6 ± 6 weeks postpartum and returned to nearly full training by ~14 ± 11 weeks postpartum

Question 2

What are some key trends observed regarding athletes returning to sport after childbirth?

Answer 2

• More high-profile athletes competing post-birth (e.g., Allyson Felix, Paula Radcliffe).
• Greater visibility and acceptance of motherhood in sport.
• Emerging research on postpartum recovery and performance.
• Maternity sponsorships & policies improving, but gaps remain

Question 3

What is a key message regarding pregnancy for athletes?

Answer 3

Pregnancy is not a career-ending event!

Question 4

Do physical and emotional symptoms occur in the postpartum period?

Answer 4

Yes, many physical and emotional symptoms do occur during the postpartum period.

Question 5

What does “postpartum” or “postnatal” refer to?

Answer 5

The period after childbirth

Question 6

What is the acute phase of postpartum, and what is characteristic of this time?

Answer 6

The first six to 12 hours after birth. You’re most likely to experience conditions like eclampsia, postpartum hemorrhage, and certain medical emergencies during this time.

Question 7

What is the subacute phase of postpartum, and what are its characteristics?

Answer 7

24 hours after birth and lasts for about two to six weeks. Your body is still changing, but you’re less likely to experience a medical emergency

Question 8

What is the delayed phase of postpartum, and what are the main changes occurring?

Answer 8

About six weeks postpartum until six months postpartum (and beyond!). Changes during this phase are gradual, mainly consisting of your muscles and tissues returning to their pre-pregnancy stat

Question 9

What broad categories are important to consider after childbirth?

Answer 9

Biopsychosocial Considerations: cardiovascular system, hormones, urinary incontinence, breastfeeding, calcuim loss, bone mineral density, poor quality & disrupted sleep

Question 10

How does the cardiovascular system change in the first year postpartum compared to pre-pregnancy levels?

Answer 10

Ventricular blood volume, cardiac output, and systemic resistance do not return to pre-pregnancy levels by one year postpartum, suggesting potential long-term beneficial impacts of pregnancy

Question 11

What hormonal changes occur postpartum and what can they lead to?

Answer 11

The rapid change in sex hormones can lead to low mood (“baby blues”) and feelings of anxiety

Question 12

What is a common postpartum health condition related to the pelvic floor?

Answer 12

Stress urinary incontinence (SUI), which is the involuntary leakage of urine when coughing, sneezing, or during impact activities, affects ~1/3 of postpartum women.

Question 13

What is the prevalence of SUI in non-pregnant rugby players compared to those who have given birth?

Answer 13

~40% of non-pregnant rugby players experienced SUI, which they perceived negatively. The risk of SUI more than doubled if the player had previously given birth.

Question 14

What does the World Health Organization recommend regarding breastfeeding?

Answer 14

Exclusive breastfeeding for the first six months of life.

Question 15

What are some challenges athletes face when coordinating breastfeeding and training?

Answer 15

• Coordinating breastfeeding and training schedules.
• Discomfort with exercise.
• Challenge training and recovery.
• Low energy availability in athletes

Question 16

Does exercise adversely impact breastmilk quality or quantity?

Answer 16

No, exercise does NOT adversely impact breastmilk quality or quantity

Question 17

Are calcium losses significant during lactation?

Answer 17

Yes, calcium losses are significant during lactation, with estimates suggesting that the losses through 9 months of lactation are double that of the nine months of pregnancy.

Question 18

What does longitudinal data suggest about maternal BMD during pregnancy and lactation?

Answer 18

Longitudinal data suggests a decline in maternal bone mineral density between 3-10% during pregnancy and lactation that typically recovers after cessation of lactation.

Question 19

How is breastfeeding duration categorized in relation to BMD?

Answer 19

• Category 1: breastfed <4 months postpartum.
• Category 2: breastfed 4 to 9 months postpartum.
• Category 3: breastfed >9 months postpartum

Question 20

According to the source, under what condition related to BMD should breastfeeding stop?

Answer 20

If BMD has a significant decrease, breastfeeding should stop! (Note: This is a direct quote from the source, but the nuance and individual considerations should be discussed with healthcare professionals).

Question 21

What are the risks associated with short, poor-quality sleep in the general population?

Answer 21

An increased risk of diabetes, hypertension, cardiovascular disease, and depression.

Question 22

How does exercise affect sleep quality?

Answer 22

Exercise improves sleep quality.

Question 23

What types of exercise are recommended in the early postpartum period?

Answer 23

Pelvic floor muscle training and light abdominal muscle training.

Question 24

What does research suggest about early mobilization and light physical activity postpartum?

Answer 24

Research suggests that early mobilization and incorporation of light physical activity (e.g., gentle walking) can facilitate postpartum recovery

Question 25

What impact does returning to MVPA within the first 12 weeks postpartum have on mental wellbeing?

Answer 25

Returning to MVPA within the first 12 weeks postpartum has a net positive influence on mental wellbeing, including a nearly 40% reduction in the odds of developing depression.

Question 26

What does research suggest about the effects of postpartum PFMT on urinary incontinence? | PFMT= pelvic floor muscle training

Answer 26

Research suggests a 37% decrease in urinary incontinence symptom severity following PFMT interventions.

Question 27

How does exercise intervention affect maternal sleep efficiency and quality?

Answer 27

Exercise is associated with better sleep efficiency and better sleep quality.

Question 28

What question is raised regarding sport and motherhood?

Answer 28

Are sport and motherhood incompatible or not?

Question 29

What is the estimated peak performance age mentioned in the studied population?

Answer 29

31.7 years

Question 30

How does a maternity break before the estimated peak performance age affect the distribution of performance?

Answer 30

(A) Group with a maternity occurring before the age at the estimated peak performance (31.7 yrs). The ability to return and surpass previous performance level is influenced by the age at which pregnancy occurs, relative to the age of peak performance.

Question 31

How does a maternity break after the estimated peak performance age affect the distribution of performance?

Answer 31

(B) Group with a maternity occurring after age at the estimated peak performance. The ability to return and surpass previous performance level is influenced by the age at which pregnancy occurs, relative to the age of peak performance

Question 32

What was observed in participants who intended to return to equivalent performance levels postpregnancy?

Answer 32

In participants who intended to return to equivalent performance levels postpregnancy, there was no statistical decrease in performance in the 1 to 3 years postpregnancy compared with before

Question 33

What is being developed as part of the upcoming 2025 Canadian Guideline?

Answer 33

A self-completed questionnaire to identify relative contraindications to exercise in the first year postpartum. If answered yes, then speak to a healthcare provider.

Question 34

What are some biopsychosocial barriers to postpartum exercise?

Answer 34

* Mental health conditions. * Pelvic floor dysfunction (urinary incontinence). * Abdominal wall dysfunction (diastasis rectus abdominis). * Lactation status. * Low energy availability or relative energy deficiency in sport (REDs). * Poor sleep. * Fear of movement. * Lack of social or emotional support. * Cesarean delivery

Question 35

How does the type of delivery affect postpartum recovery?

Answer 35

Recovery and healing are relatively quick following an uncomplicated vaginal delivery. Healing from cesarean delivery takes longer as it is major abdominal surgery.

Question 36

What are the key principles of the Biopsychosocial Model of Rehabilitation in the context of postpartum athletes?

Answer 36

* Emphasizes individualized, athlete-centered care. * Considers the risk/balance between being fully ready and “needing” to return. * All decisions should be athlete-centered with MDT (multidisciplinary team). * Progression should be based on progressive, individualized, symptom-based timeframes. * Need to screen for contraindications and barriers to participation. * Consider support items (bra, compression garments, footwear etc). * Moving away from timeframe and towards meeting functional milestones.

Question 37

What are key considerations for postpartum athlete nutrition

Answer 37

* Essential for fueling the postpartum athlete, especially if lactating. * Hydration is of key importance during lactation as breastmilk is ~87% water. * An additional 700 mL/day of water is commonly recommended. * Drink water when thirsty and monitor urine color.

Question 38

hat is a common myth regarding exercise and breastmilk?

Answer 38

Exercise will curtail breastmilk volume thereby negatively impacting infant growth. Empirical evidence has not substantiated this claim. Maternal exercise during lactation may reduce the risk of childhood obesity.

Question 39

Do lactating athletes have different dietary requirements compared to preconception?

Answer 39

Yes, lactating athletes have greater dietary requirements for vitamins and nutrients (e.g., choline and iodine). Ensure adequate calcium and vitamin D intake. Address potential iron deficiency.

Question 40

What do postpartum athletes commonly report regarding return to sport, and what policy changes are needed?

Answer 40

Athletes commonly report feeling pressured to return to sport quickly and before they feel ready, often attributing early return to subsequent injury. Required policy changes include: * Policies that ensure rank and point freezing, protection from dismissal, clear guidance on maternity leave, and private spaces for breastfeeding and childcare. * Foster a culture shift that values parenting athletes. * Normalizing motherhood in sport by providing venues for athlete-mothers to share their stories. * Providing educational opportunities for athletes on reproductive health and available supports.

Question 41

What is a key take-home message regarding the return to exercise postpartum?

Answer 41

n the absence of contraindications, a gradual, progressive, and individualized approach to return to exercise and sport is recommended when the athlete is ready to return.

Question 42

What is a critical aspect of supporting postpartum athletes in returning to sport regarding barriers?

Answer 42

Screening for, and responding to, biopsychosocial barriers to physical activity (including pelvic floor dysfunction, mental health, lactation, sleep, childcare, and social support) is critical. Utilizing athlete-centered care helps ensure a sustainable return

Question 43

What should be prioritized to optimize postpartum athlete wellbeing?

Answer 43

Prioritize fueling and hydration, as well as adequate rest and recovery

Question 44

What kind of practices and policies should be developed for postpartum athletes?

Answer 44

Develop athlete-centered practices and policies to encourage inclusion of postpartum athletes in sport settings