From motherhood to medals: New research sheds light on postpartum return-to-sport guidelines

by Jenna Schulz, Western University and Jane Thornton, Western University

The upcoming 2024 Paris Olympics will be historic for a number of reasons. For the first time in modern Olympic history, the Games will feature an equal number of female and male athletes.

The Games will also be more mother-friendly than ever before, thanks to the support of former and current athletes. For example, a new initiative called MOMentum is creating resources to help mother-athletes with family planning and their careers.

MOMentum is led by Canadian rower Jill Moffatt, along with fellow Canadian athletes Melissa Bishop-Nriagu, Erica Wiebe, Erica Gavel and two other athletes who nearly missed the Tokyo Games due to pregnancy and postnatal measures: basketball player Kim Gaucher and boxer Mandy Bujold.

The French Olympic Committee will also provide hotel rooms to its athletes so that they can breastfeed during the Games.

The announcement came after French judoka and Olympic medalist Clarisse Agbegnenou told President Emmanuel Macron during a team visit that she wanted her daughter to be with her in the Olympic Village so that she would “feel good and fully commit to my final stages of the Olympic Games.”

Additionally, Allyson Felix, an 11-time U.S. Olympic medalist and mother of two, has partnered with Pampers to set up a daycare center in the heart of the Olympic Village.

French judoka Clarisse Agbegnenou breastfeeds her baby in France in October 2022. (Nadia Benabdelouamed via AP)

On lack of evidence

Until recently, many female athletes had to choose between participating in sports and raising a family. However, more and more Olympic athlete mothers are breaking records and changing the narrative.

Among them is athlete Shelly-Ann Fraser Pryce, who is competing in her fifth Olympic Games at 37 after giving birth to a son in 2017. Elle Purrier St. Pierre broke the American record for both the indoor mile and the 3000m just under a year after giving birth. Faith Kipyegon broke her own world record in the 1500m on July 7 after giving birth to her daughter in 2018.

These athletes prove that motherhood and elite sporting performance can go hand in hand. But despite the increase in athlete and mother success and improved advocacy, there is still a lack of evidence for a safe return to sport after giving birth.

Our research group recently conducted a review of return to activity/sport guidelines for women after childbirth. We found that most studies indicated that return to activity could begin as soon as it was “medically safe,” approximately six weeks after childbirth, but this term was generally not defined.

Only 11 of the 36 studies had specific guidelines for return to sport, and only six studies considered the importance of mental health. A study of the experiences of elite athletes returning to sport after giving birth found that mother-athletes felt pressure and expectations to return to sport too soon after giving birth, which was detrimental to their physical and emotional health.

Traditional return to sport frameworks after injury include assessing strength, endurance and functional skills, but also emphasize the importance of mental readiness. Our team suggests that return to sport after childbirth should follow a similar framework.

Returning to Sports After Childbirth

Our research proposes a five-step plan for postpartum athletes, from return to activity to return to sport.

Before beginning this process, athletes should get approval from a medical professional with expertise in women’s health. These clinicians should provide evidence-based, personalized recommendations and perform regular follow-ups.

Athletes should be screened for risk factors that may hinder success, such as pelvic floor problems, Relative Energy Deficiency in Sport (REDs), and postpartum anxiety and/or depression.

Rather than focusing on timelines, athletes should progress based on tolerance, confidence, goals, and physical and mental readiness. Similar frameworks have been developed that emphasize the importance of a multidisciplinary care team, with a biopsychosocial approach that views the athlete as a whole person, beyond their musculoskeletal system.

A biopsychosocial approach assesses both physical and mental readiness, taking into account sleep patterns, fatigue, breastfeeding, REDs, psychological well-being, fear of movement, socioeconomic considerations, and support systems.

There is still work needed to support athlete mothers

With the right support, athlete-mothers generally report positive experiences returning to sport. More than half are able to return to at least their pre-pregnancy performance level, and some even exceed it.

In addition to achievements and podiums, their newfound “dual identity” can result in a new sense of pride, motivation, resilience, and enjoyment of their sport. In addition to sports, exercise and physical activity during pregnancy have long been shown to have positive health outcomes for both mother and baby, making the benefits a win-win for more than one generation.

While there have been significant strides and successes for athlete mothers since the 2020 Tokyo Olympics, there is still work to be done to improve postnatal care and support.

We need more high-quality research to inform evidence-based recommendations for postpartum management and clinical practice. Sports policies from organizations and sponsors must evolve to support athlete-mothers to navigate a safe return to sport.

This will reduce the likelihood of long-term injuries, making the choice between becoming a mother or remaining an athlete less difficult. If we can improve the overall health and well-being of female athlete mothers and promote longevity in sports, then female athletes can live in a world where post-pregnancy competition becomes the norm.

Jenna Schulz, Physical Therapist and Postdoctoral Fellow, Fowler Kennedy Sport Medicine Clinic, Western University and Jane Thornton, Clinical Scientist, Canada Research Chair in Injury Prevention and Physical Activity for Health, Sports Medicine Physician, Schulich School of Medicine & Dentistry, Western University

This article is republished from The Conversation under a Creative Commons license. Read the original article.