Its taken me a while to get around to writing this blog.
The reasons for this are aplenty - but mainly due to me prioritising other things - that needed prioritising at the time, but I have always wanted to put pen to paper to share my experience so that others may potentially benefit.
Throughout my pregnancy I have been contacted by a range of people keen to understand more about the experience of athlete to mum-to-be and I realised through my own reading that there was often a lack of information out there.
I will be honest to the point of potentially being cringe-worthy at times so please be forewarned ;)
Part 1
I fell pregnant the day before winning Ironman UK.
I often wonder if i felt so good that day because of the surge of hormones as implantation occurred - but the rational me sees this is romanticising a situation in the context of hindsight and the emotion of winning my first ironman (at the first attempt at the distance - and my first ever marathon).
Pregnancy was not planned, indeed training for Ironman as a pro is not a situation renowned for its fertility enhancing effects.
I stopped taking the oral contraceptive pill early in 2013 after reading research about the potential problems it could cause with reducing free testosterone levels and affecting B vitamin metabolism. Two things which undoubtedly can affect athletic performance (not to mention, energy, weight, accruing lean muscle etc..)
I almost immediately felt better and blood tests showed that my free testosterone level had improved and certainly my recovery from training improved.
Note - any hormonal contraception raises SHBG - sex hormone binding globulin - which binds up circulating hormones & reduces their bio-availability - this includes thyroid hormones.
I did have a menstrual cycle, but like many endurance athletes - both pro and amateur - my cycles were short and very light. I would bleed for ½-1 day at most and my cycles would come every 3 weeks - or occasionally i would miss one completely. We medics call this Oligomenorrhea or Luteal phase defect - read more about this and progesterone deficiency (really common in the female endurance athletes I blood test through www.curoseven.com here:
Really glad to see more research coming forth on female athlete menstrual cycle/hormones. See this BBC link and follow @rich_burden on Twitter.
My interest in health and hormones increased from listening to Dr Sara Gottfried podcasts (Author:The Hormone Cure) - and as a result started supplementing with the herb agnus cactus - which has been shown to help regulate periods. After 2 months of using this supplement to some effect, I switched to trying a natural progesterone cream which is freely available on the internet (somewhat disconcerntingly).
The main effect of which was to increase my restorative sleep, feel calmer in general and pretty much eliminated any premenstrual bloating. 1 took 1/2 pump in the evening every night, except in the week leading into my period where I took 1 pump.
I discussed this and my blood test results with my GP whom I have a good relationship - I self tested my blood through CuroSeven as she was reluctant (these are expensive tests) - and showed her the results. She referred me to an endrocrinologist at Chelsea & Westminster hospital. After more blood tests, a bone scan and a brain MRI (to rule out pan hypo-pituitarism given my history of a significant head injury in 2004). I was prescribed a bio-identical progesterone - (cyclogest) at a low dose. This regulated my cycle, improved my sleep, mood and also muscle aches and pains. Note natural progesterone is not the same as that prescribed in the mini-pill or depot injection - they contain progestins which are synthetic chemical forms of the hormones and have very different effects.
HPA axis dysregulation is common in female athletes especially endurance athletes and especially those who restrict food intake or follow a (consistently) low carbohydrate approach. This is often referred to as 'adrenal fatigue.
Key points.
1. Pregnenolone is a precursor to all of the different adrenal and sex hormones that are produced in the body.
2. Cholesterol is the precursor to pregnenolone. Restricting fat intake and hence cholesterol intake results inadequate levels to support optimal hormone synthesis.
3. The enzyme that converts cholesterol to pregnenolone is limited, and it requires a lot of ATP, which is cellular energy. Many hard training athletes have limited energy in reserve to support this.
4. Endurance training increases cortisol production. Especially if prolonged or carbohydrate restricted. Pregnenolone is channeled down the route of cortisol production to the detriment of DHEA levels and sex hormone production.
This is more commonly seen in those who don't prioritise sleep, have additional 'life' stress and/ or whose diet is nutritionally inadequate from a micro and macronutrient standpoint.
This can be seen on blood tests by a raised morning cortisol, low DHEA, low luteal progesterone (circa day 21 menstrual cycle) and low testosterone level.
5. Gut problems are often seen alongside hormone imbalances so along a functional medicine model it is important to address any underlying inflammation in the gut. Learn more through Chris Kresser's podcasts, in particular this one.
Back to me!
Pregnancy was welcomed - i had it in my mind for a long time - that 35 was the cut off point by which I wanted to have a little one - given that every risk factor in pregnancy increases after that time.
There was, however, a huge wave of anxiety of the impending life change that would ensue.
Those who have followed me know that I am a medical doctor - with post- graduate training in psychiatry. In 2010 I went part time from my medical work and in 2012-2013 I was a full time athlete. I resigned my NHS post, and set-up www.Curoseven.com with the view of working online in an area in which I am passionate, whilst I trained and competed around the world. I knew that I would return to the NHS just not in the immediate future. This meant that I when I fell pregnant, I was self-employed and would not receive any maternity leave pay which obviously has financial implications.
Early Pregnancy.
I knew I was pregnant at 2-3 weeks. As athletes we are highly in tune with our physiology and I remember clearly doing a bike session in Richmond Park with Parys Edwards and T2Coaching. Parys is a very strong bike rider and I loved riding with her because there is no faff - we would normally take it in turns leading - but on this occasion I couldn’t lead and let her go in front. She nailed a sub 17min lap of Richmond Park (averaging around 250/260 Watts) and I hung on for dear life - only to get off the bike and vomit profusely. I joked with coach Tom that I may be pregnant and on the way home bought a ClearBlue test that tells you (IN WRITING - because how many times have you looked at a pregnancy test full of adrenaline trying to work out if there are one or two pink/blue lines!) how many weeks pregnant you are. 2-3 weeks.
The First Day Of The Rest Of Your Life.
From then on fatigue kicked in - some of this may have been psychological - but I literally could not force myself to do any intensity of exercise. Interestingly I also wasn’t bothered about this.. good ‘ol hormones.. I was sleeping 10 hours most nights.
From 5 weeks I became engulfed by nausea and sickness - inappropriately labelled morning sickness - but it lasted all day every day - and was absolutely horrific. No one prepared me for this.. and i challenged its biological validity. The only time I would not feel sick was the first 10 minutes of eating - so i kept trying to eat - but often felt that I couldn’t keep anything down.
Hyperemesis gravidarum they call it. I remember feeling some solace in that Kate Middleton was suffering too (with the same due date as me… 27/4/2015).
I tried everything - if one googles ‘morning sickness cures’ - i’d been there.
Eventually the GP gave me an antihistamine (deemed safe in pregnancy - only because it has been around for donkeys years) - phenergan - which helped - slightly but I could only take it at night because it made me sleepy. So i suffered through the days.
At this time I was working at a private medical clinic in London.
From my first ultrasound scan I was diagnosed with a bicornuate or heart shaped uterus. I did not know about this before pregnancy.
The pregnancy had attached high on one side of my uterus and would grow from there. This essentially means Sophia had far less room to grow than in a normal uterus as only one ‘horn’ of my uterus grew. The risks were explained and I was monitored with scans every few weeks.
Premature birth was expected.
We just weren’t expecting just how premature.
Bicornuate uterus meant Sophia grew on the right side. You can see this here early on in my pregnancy. It meant my right side took more of the weight.
Exercise and Nutrition
First Trimester :
Every pregnancy is different. My general advice is if it feels good while you are exercising and there is no compression of the abdomen or compromise of the blood supply to the pelvis (for example downward dog pose in yoga).. then its fine.
The guideline of not exceeding HR 140 bpm is not applicable to everyone - especially if fit.
So don’t get too carried away with monitoring.
If you have a history of miscarriage or ectopic pregnancy I would advise increased caution. Moderate exercise is fine - threshold sessions on the wattbike are not. I did some weights nothing too crazy. Squats felt a little awkward but lunges ok.
The key message is whatever you did before pregnancy - it is fine to do in pregnancy - with less intensity and less volume. Scuba diving, or heli-skiing are notable exclusions.
The hormonal shifts seem to energise some, but for me, perhaps a result of being a ‘hard charging athlete for as number of years’, my energy shifted inwards towards conservation and i craved sleep and rest.
Also the hormonal shifts would be more severe in an athlete, as many of us have low sex hormone levels - for example my progesterone levels increased 600 fold. This shift in hormone levels encourages the body to store fat in preparation for fuelling the growth of the baby and its protection in-utero.
I also noticed I felt the cold alot more than normal in early pregnancy which in my mind evidenced further the theory of energy conservation.
Fatigue certainly limited what i would do - exercise wise - and I did listen to my body.
I kept active doing something most days- but the notion of training - from hereforth - was abandoned.
I have read about athletes - like Beth Gerdes Walsh who trained throughout her pregnancy often for 2hrs a day. I admire Beth and what she has acheived post pregnancy - but her regime in pregnancy was just not feasible for me - as I was working in London it was often all i could do to commute to work and back 30mins on a bike each way.
Swimming - 1.5-3k - 2 maybe 3 times per week. (more than I now manage 6 months post pregnancy!)
I noticed my breathing became laboured more easily (common physiological consequence of pregnancy as blood flow to the lung membranes increases and the lung capacity starts to decrease. It felt good to be weightless in the pool but my body position changed so it was more difficult to get a good catch.
I am one of those people who only enjoys swimming when swimming well and to swim ‘well’ i would have to swim 4-5 days a week. I didn’t have the energy or inclination to do this in early pregnancy. Everyone is different and if not affected by extreme nausea/sickness like I was you are fine to continue exercising as you want as long as nutritional needs are met and you are getting adequate sleep.
Running - Became uncomfortable from an early stage. Bladder sensitivity/frequency was a real problem. I would be stopping every 5 mins to pee and vomit so it really wasn’t enjoyable.
I also developed pubic symphasis dysfunction as a result of the hormones softening my ligaments so running became painful. I tried a Serola belt which supports the lower back and pelvis but running after 16 weeks of pregnancy was just too uncomfortable. Inherently when something feels wrong i just dont do it.
What I did do was hill walking repeats - often on the treadmill with hand weights.
For example 10 x 3 mins @ 5-10% gradient building each rep slightly in intensity.
Cycling
As a commute (about an hour most days) and some strength training as my big fear was muscle atrophy as historically i would lose muscle when not exercising or if doing too much endurance.
Nutrition
Carbohydrate craving ++. Mashed potato in particular - something I have not really eaten since my teens! I made sure I had a range of foods - and my body was pretty good at telling me what it wanted. I would eat whole large pomegranet’s - whole pineapples.. tons of fruit as this satisfied my carb craving somewhat and also perhaps I craved the extra vitamin C... but i also wanted stodge - hence mashed potato and sweet potato oven chips were the order of the day. I often was sick after eating - but tried to stomach whatever i could. One other effect of the high progesterone levels in pregnancy is to slow stomach emptying and gastro-intenstinal transit time in general - so the whizz bang pop athlete metabolism slowed down somewhat. This is why so many people complain of constipation in pregnancy ( FYI pineapple helps with this as does magnesium citrate powder taken at night.. as well as all the obvious things like high water and fibre intake).
As mentioned I was feeling very nauseas so I ate whatever i felt like i could eat whenever I could. My mum advised dry rich tea biscuits first thing in the morning on waking but the thought just made me wretch.
I became completely intolerant of coffee, chocolate and chewing gum (i have been somewhat addicted to a particular type of chewing gum for 2 years). A faint whiff would send my nausea skyrocketting. I still wretch when I smell a moisturiser I used in early pregnancy and have not returned to chewing the gum.
My body seemed to shun anything chemically - no sodas or anything with artificial sweeteners.
Alcohol - Some choose to withstain from alcohol completely in pregnancy - but I was sufficiently convinced by the research which showed no detrimental effects in healthy women of low level consumption. I enjoy red wine and it relaxes me so I would still have a few sips 3-4 evenings a week and the odd full glass here and there.
Despite vomiting up to 10 times a day i had put on significant weight during this time, in particular on my thighs, bum and breasts, which just goes to show how powerful hormones can be - even when faced with potentially inadequate calories.
Supplements
Pregnancy Complex Multi-Vitamin from Viridian Nutrition
Nordic Oil Omega 3 - 2/4 caps a day
Vitamin D 1000 IU per day (except for one month in November as I spent 10days in Thailand which boosted my levels - I test my levels x 3 per year through CuroSeven.
Green Juices (throughout pregnancy) - greens, celery, kale, lemon, ginger, lime
Second Trimester
I ran for the last time at 18 weeks for reasons discussed above - the bladder sensitivity continued/worsened as my womb grew.
I continued with some cycling - rarely commuting now, as the London traffic frankly is never safe at the best of times - but doing the odd turbo session as I felt.. Alot of big gear work, with some intensity but only short lived.
For example 20 x 1 minute with 1 minute rest break, 10 in Big gear, low cadence, 10 as fast cadence, high intensity
Nausea - Eased during second trimester thankfully but not until 16 weeks. That was tough!
I was hungry a lot of the time during this trimester and generally just ate healthily but with a bit of whatever I fancied. I also allowed myself to drink more alcohol during this time after being convinced by the research showing a reduced risk. A glass of red wine always helps me relax and is often a daily treat. I reduced this to 2-3 times a week during my second trimester. I’m not talking a large pub sized glass here. Just a small glass.
I was lucky enough to spend 10 days in Thailand at this time spectating this time at one of my favorite races - Challenge Phuket - I really enjoyed the Thai food and craved Tom Yum Soup (a spicy coconut milk based soup).
Third Trimester
In the 3rd week of my third trimester my waters broke.
I had been at work that day and had a feeling of fullness in my abdomen more than usual. As mentioned Sophia was only growing on one side of my womb and it felt like she was high up under my diaphragm. I could only eat very small meals as she seemed to be sitting right up against my stomach.
I have asked myself over and over whether anything I had done could have contributed to my waters breaking early. The following cross my mind.
I did some assisted pull ups in the gym the day before my waters broke - it didn’t feel right so i stopped.
I had some discomfort ‘down below’ perhaps from sweating in lycra on the turbo. I didnt think too much of it because it seemed mild - but it had been going on for 4-5days and in hindsight I should have seen my GP to rule out thrush or a UTI.
Infection is a common cause of waters breaking early.
That evening I had been watching an episode of Boardwalk Empire in which one of the characters waters break quite dramatically.
I woke at around 1am - sat up and found i was sitting in a pool of water. I stood up and water continued to gush down my inner thighs. I started to shake.
I went to wake my partner and said as calmly as i could muster - “we need to go to hospital”.
In 80% of cases where waters break early - labour occurs within 24 hours. I was 27 weeks pregnant and was terrified what would happen over the coming days if I delivered such a premature baby.
I was treated at Kingston Hospital, no one could tell me why my waters went so early, just that perhaps I had an infection. Despite taking swabs and blood tests - no source of infection was found.
It was now a case of sitting/lying and waiting.
I spent 10 days in hospital whilst they gave me Intravenous antibiotics and monitored the position of the baby. After 10 days the consultants were confident enough that she was head
down and not breech - the risks being if she was not head down that the umbilical cord could prolapse - a medical emergency as fetal death can occur.
Medics used to put women on strict bed rest after waters broke as little as a few years ago until they realised that this didn’t seem to be very effective and was increasing the risk of DVTs (leg clots and lung emboli).
I went out of the ward everyday but would only walk. One day I walked a total of 10 miles.. no intensity.. just headspace and movement. The proximity of Richmond Park to the Hospital was for me the saviour to my sanity.
When i was discharged I saw everyday that I did not deliver as a bonus.
I was monitored with blood tests, ultrasound and fetal heart tracing twice a week.
The plan was to keep me going to 35/36weeks of pregnancy if possible and then induce me - artificically commence labour if all was well. By this stage the risk of ongoing infection with low water levels in the womb outweighs the risk to the baby of growing any further.
People do ask how this affects the growing baby being low on water - but she did make more of her own water as a result of peeing and i managed to keep some of that in - i did continue to leak water for these 5.5 weeks which gave me a glimpse into how unpleasant it must be to live with incontinence.
I kept active but within reason. Mostly just walking and 30-60 minutes on the cross-trainer. I generally felt well as a glance at my instagram account will show.
I tried to do mindfullness meditation using the Headspace app daily - or used the pzizz app to aid relaxation/sleep I was told not to work.
On 4th March 2015 - 5.5 weeks after my waters broke I went into spontaneous labour. I had lower back pain all day - like a deep ache.. and mild contractions which felt no different from Braxton Hicks contractions which i had experienced regularly over the past few weeks. I ate dinner as normal - although felt full quickly.. and relaxed on the couch.. but the contractions became more and more intense so we gathered our things and headed for the labour ward.
Part 2 coming soon.