Episode 6
The Active Pregnancy Foundation: Bridging the Gap for Expectant Mums
Join Suzy as she chats with the incredible co-founders of the Active Pregnancy Foundation, Marlize de Vivo and Sally Kettle. Frustrated by the lack of support and advice for women on physical activity during pregnancy and the postnatal period, Marlize and Sally launched their foundation in 2020. They're dedicated to breaking down barriers and empowering women to stay active through preconception, pregnancy, and beyond.
Marlize brings a deep research background to the table, including a PhD focused on predicting physical activity behaviours in pregnant women. Her expertise has directly shaped the guidance and policies that support and empower women on their pregnancy journeys.
Sally, a prolific adventurer who has rowed the Atlantic multiple times and is a renowned public speaker, shares her personal journey of navigating activity during her own pregnancy. She's driven by a powerful passion to ensure future generations of women don't face the same lack of clear, supportive guidance.
This episode is packed with evidence-informed insights and practical advice for both women and healthcare professionals. You'll hear them tackle common fears, discuss the nuances of activity levels, and advocate for a holistic, individualized approach to movement in the perinatal period. Discover how the Active Pregnancy Foundation is working to ensure every woman feels confident and supported in embracing physical activity.
Produced with support from the British Society of Lifestyle Medicine.
Find us at https://themovementprescription.co.uk/ and join the conversation!
Transcript
Suzy: I am absolutely delighted today to welcome two power women to come and speak to me today.
Speaker:Suzy: This episode was requested by Callum's wife, who is a keen runner.
Speaker:Suzy: And during her recent pregnancy, she was cautioned to avoid micro concussions
Speaker:Suzy: to the baby by a very well-meaning healthcare professional.
Speaker:Suzy: I am hoping that by the end of this podcast, we will not have any more such
Speaker:Suzy: discussions from healthcare professionals.
Speaker:Suzy: And who better to keep us right than co-founders of the Active Pregnancy Foundation
Speaker:Suzy: since 2020, which is said to be dedicated to breaking down barriers to engagement
Speaker:Suzy: with physical activity during the preconception, pregnancy and postnatal life stages.
Speaker:Suzy: What could be better? Welcome Marlies and Sally.
Speaker:Sally: Hello. Sorry, can we just back up? Micro concussions. Micro concussions.
Speaker:Sally: I have never heard of that in my entire life. That is hysterical.
Speaker:Marlize: I remember Callum sending me the message.
Speaker:Suzy: Yeah sorry.
Speaker:Marlize: I was going to say Callum sent me the message on LinkedIn and I at the time
Speaker:Marlize: didn't know if I should laugh or cry but yes Sally micro concussions because
Speaker:Marlize: of running during pregnancy unbelievable that's what we're dealing with.
Speaker:Suzy: Yeah speechless hopefully we're going to put everyone right I mean hopefully
Speaker:Suzy: people who are tuning into this will probably be a self-selecting group of people
Speaker:Suzy: but I thought this is the perfect combination of both the information and the
Speaker:Suzy: inspiration and I am looking forward to hearing more about you.
Speaker:Suzy: Let's start with you Marlies, people may not have come across you before,
Speaker:Suzy: could you give us your elevator pitch?
Speaker:Suzy: What is it that you, what is it that you do, what has been your journey to the
Speaker:Suzy: Active Pregnancy Foundation?
Speaker:Marlize: I think it's more a question of what don't I do. And Sally and I have recently
Speaker:Marlize: come across a brilliant quote in that we are cockapoos.
Speaker:Marlize: We have cockapoo of careers. We do franken jobs. So a little bit of everything.
Speaker:Marlize: But a professional background as a clinical exercise specialist,
Speaker:Marlize: so a qualified biokineticist from South Africa, relocated to the UK pregnant at the time.
Speaker:Marlize: And this is not an elevator which is a bit of a long story but
Speaker:Marlize: anyway pregnant at the time and working
Speaker:Marlize: with pregnant and postnatal women or qualified to do
Speaker:Marlize: so and coming to the UK I was met with
Speaker:Marlize: an awful lot of finger pointing and judging you know should you be doing that
Speaker:Marlize: you are harming your baby you're irresponsible and that made me ask some questions
Speaker:Marlize: and I approached my midwife at the time who couldn't answer the questions and
Speaker:Marlize: then I realized there was no guidance in the UK in place at the time,
Speaker:Marlize: and that changed my career forever.
Speaker:Marlize: So I then took it upon myself to fill the evidence gaps.
Speaker:Marlize: I did a master's and a PhD in this space, and then through a mutual friend, met Sally.
Speaker:Marlize: And we realized that the evidence base was now moving forwards.
Speaker:Marlize: In 2017 and 2019, the UK chief medical officers launched guidelines,
Speaker:Marlize: but it wasn't necessarily reaching
Speaker:Marlize: the healthcare professionals and the women that it was intended to.
Speaker:Marlize: And that's how the Active Pregnancy Foundation came about.
Speaker:Marlize: So that's our passion project. But in terms of the day job, I am still a researcher
Speaker:Marlize: based at Sheffield Hallam University.
Speaker:Suzy: Excellent. My goodness me, so many things to pick up on there.
Speaker:Suzy: But whilst we're on context, you mentioned it about Sally as well.
Speaker:Suzy: So let's get the background of you both. And then let's go back to some of the
Speaker:Suzy: research findings and this evidence-informed approach for these guidelines that
Speaker:Suzy: didn't exist during either of my pregnancies either.
Speaker:Suzy: So Sally, I'm awestruck. The things that you've done are incredible.
Speaker:Suzy: Can you do an elevator pitch? But actually, I like the background story too.
Speaker:Sally: Yeah, of course. So I left school, went to university, did theatre,
Speaker:Sally: very random and not really related to this at all.
Speaker:Sally: But I then had a quarter-life crisis and decided to row across the Atlantic Ocean.
Speaker:Sally: And that led to rowing across the Atlantic Ocean twice.
Speaker:Sally: Got a world record for that, became a professional adventurer.
Speaker:Sally: And during that time, I was trying to conceive, went through an IVF journey.
Speaker:Sally: It was difficult. And yeah, it left me with PTSD, unfortunately.
Speaker:Sally: But I'd also qualified as a personal trainer. And at the time,
Speaker:Sally: I hadn't got a pre and postnatal qualification because I didn't think it was
Speaker:Sally: relevant to me. And of course, it wouldn't have been because I couldn't get pregnant.
Speaker:Sally: And, you know, we look at many pre and postnatal qualified instructors,
Speaker:Sally: and they're mostly women who have had children.
Speaker:Sally: So um went on to have
Speaker:Sally: a baby uh she's now eight which is fabulous and
Speaker:Sally: fantastic and um during the kind
Speaker:Sally: of process of IVF and then into my pregnancy I
Speaker:Sally: was actually very worried and scared about being active just in
Speaker:Sally: case I you know lost lost her
Speaker:Sally: you know and I think many women have this have similar fears and
Speaker:Sally: uh I was lucky enough to
Speaker:Sally: be able to afford to get a pre and postnatal instructor
Speaker:Sally: to support me and I kind of could sense that
Speaker:Sally: many women weren't able to do that so it
Speaker:Sally: was a real privilege and I needed something to
Speaker:Sally: focus my energies and passions into and
Speaker:Sally: of course when I met Marlies and there was a team a
Speaker:Sally: small team of women we got together and the APF
Speaker:Sally: was was conceived and born and since then it's been yeah definitely a passion
Speaker:Sally: project and one that has really enabled me to kind of push into that space of
Speaker:Sally: supporting women with their mental and their physical health so it's been a
Speaker:Sally: yeah it's been it's been a journey.
Speaker:Suzy: That is so powerful, actually, listening to what you said there about the struggles
Speaker:Suzy: and the importance of physical activity that is safe, accessible.
Speaker:Suzy: And the goal is not fitness and how you look, it's how you feel and how you are.
Speaker:Suzy: And I think that is so important for women. And, you know, in my day job as
Speaker:Suzy: a GP, I come across so many women struggling with their fertility.
Speaker:Suzy: And the stress that that causes and and the
Speaker:Suzy: problem with stress is obviously that you you're then mounting this
Speaker:Suzy: and and you'll keep me right on the the evidence behind this malice um
Speaker:Suzy: mounting a sort of stress response with all the stress hormones that just take
Speaker:Suzy: away from your your um fertility hormone profile in a very simplistic way um
Speaker:Suzy: and and how on earth do you break out of that cycle um and for me physical activity
Speaker:Suzy: is is has always been my stress relief it's not physical activity for exercise sake,
Speaker:Suzy: it's movement for feeling better, to keep it very simple.
Speaker:Suzy: But you're right, women are frightened, aren't they? I was frightened.
Speaker:Suzy: I remember my first pregnancy, I was petrified of miscarriage and I remember
Speaker:Suzy: this wanting to wrap myself up in a cotton wool ball.
Speaker:Suzy: Marlies, what does the evidence say about women's perceptions of physical activity
Speaker:Suzy: around the preconceptual and pregnancy period?
Speaker:Marlize: I actually noticed a bit of a change recently. I think when we first started out,
Speaker:Marlize: it was one of fear and uncertainty and that sort of women had this sort of onus
Speaker:Marlize: of responsibility on them to see through the pregnancy successfully and that
Speaker:Marlize: was the sort of perception.
Speaker:Marlize: But of late, I've seen a change or a perceived change in that women want to feel good.
Speaker:Marlize: They sort of recognize that to take care of others, they also have to take care of themselves first.
Speaker:Marlize: And that is more and more of that is coming to light.
Speaker:Marlize: But I think the reassuring thing around the evidence is that for the majority
Speaker:Marlize: of women, it is not only safe, but it is very beneficial to engage in physical
Speaker:Marlize: activities throughout their pregnancy.
Speaker:Marlize: We have seen good evidence supporting reduced risks in developing gestational
Speaker:Marlize: diabetes, hypertensive disorders, positive effects on mental health as well.
Speaker:Marlize: So this has really supported the messaging that we can currently support women with.
Speaker:Marlize: And I actually just wanted to pick up on the fertility comment as well.
Speaker:Marlize: I have a PhD student currently, well, she's submitting in a few days actually,
Speaker:Marlize: who's done some excellent work in this space.
Speaker:Marlize: And the reality is, when it comes to fertility treatment.
Speaker:Marlize: There's mixed messages around the intensity and level of activity and how that
Speaker:Marlize: can possibly impact a pregnancy.
Speaker:Marlize: So, healthcare professionals are reluctant to provide that advice during fertility treatment.
Speaker:Marlize: But what we have picked up on is that physical activity is a really helpful
Speaker:Marlize: means to manage cortisol levels and with reduced stress, the chances of getting
Speaker:Marlize: pregnant actually increases.
Speaker:Marlize: So it's around the right messaging for the right person at the right time.
Speaker:Marlize: And I think that is where the magic happens. If you can get that conversation
Speaker:Marlize: timing right and the messaging, then it has a positive effect on behavior.
Speaker:Marlize: However, if the advice is not provided, it's quite often perceived as not being
Speaker:Marlize: important or even being harmful.
Speaker:Marlize: And then women can refrain or stop from activity. So I think we have the evidence
Speaker:Marlize: and we've moved on from asking, is it safe?
Speaker:Marlize: We've now come to a stage where we are asking, how can we best support women in this behavior?
Speaker:Suzy: And I think that's a massive part of it, isn't it? It's the practical application.
Speaker:Suzy: Sally, how do you find that or how have you tried to help scale up your experience there?
Speaker:Suzy: Because you mentioned I was lucky I was able to want somebody to give me one-to-one
Speaker:Suzy: advice what is it that the Active
Speaker:Suzy: Pregnancy Foundation has been able to do to bring that to more women.
Speaker:Sally: Yeah it's an interesting question because that is pretty much our reason for
Speaker:Sally: being you know it's very nice all sitting in a room together and going isn't
Speaker:Sally: this important but actually if it's not reaching the women we're serving then
Speaker:Sally: it's kind of it's a bit pointless really so we have the This Mum Moves Ambassador training program,
Speaker:Sally: which is our means, I suppose, of kind of getting the message out to as many
Speaker:Sally: of those people who we meet along the way.
Speaker:Sally: So it is tailored for fitness and healthcare professionals and allied professionals,
Speaker:Sally: and it enables them to come and,
Speaker:Sally: sit with us for four hours, gain some CPDs as well, which is really,
Speaker:Sally: really good for those who
Speaker:Sally: need them and kind of tune into exactly the key messages and the evidence base
Speaker:Sally: that they can and probably should be sharing with the women that they work with,
Speaker:Sally: so you know they're one of our key audiences but in terms of women themselves.
Speaker:Sally: We're having to access them through social media
Speaker:Sally: I think that's where many women are looking for their
Speaker:Sally: advice and I think Marlies
Speaker:Sally: and I are both kind of very passionate to sort of support
Speaker:Sally: the idea that they need to be getting it
Speaker:Sally: from the right people instead of just influencers who happen to have had
Speaker:Sally: a baby and you know suddenly think oh I can
Speaker:Sally: talk about this now right so um it's a
Speaker:Sally: slow build though social media and um
Speaker:Sally: you know we're taking it one step at a time but fingers crossed
Speaker:Sally: with more professionals talking
Speaker:Sally: about it and actually having those
Speaker:Sally: conversations in the consultation room um hopefully
Speaker:Sally: they will come across us online but if
Speaker:Sally: you if you are listening to this and you want to come across us online look for
Speaker:Sally: active pregnancy foundation you'll find us across social so um please
Speaker:Sally: do that and then point moving towards us and we have some incredible um
Speaker:Sally: free to download guides as well which are mum facing
Speaker:Sally: women facing called the find your active guides and
Speaker:Sally: they cover off lots of the activities that
Speaker:Sally: are most popular with women so everything from aqua natal to yoga and all the
Speaker:Sally: bits in between and um we're looking to review those in the not too distant
Speaker:Sally: future and add more to that catalogue of guides so yeah it's a it's a complex
Speaker:Sally: beast but um a friend of mine said when eating elephants small chunks at a time.
Speaker:Suzy: I actually love those guides that you just mentioned there, the friend you're active.
Speaker:Suzy: And it says on your website, you know, no pregnancy is the same,
Speaker:Suzy: but there is an activity for everyone.
Speaker:Suzy: I think you've got a really good range of guides there and they are packed full
Speaker:Suzy: of information, evidence informed information as well.
Speaker:Suzy: You know, do's and don'ts and really practical guides that GPs can signpost
Speaker:Suzy: people to, midwives can signpost people to. Are there hard copies available?
Speaker:Suzy: Old fashioned, but.
Speaker:Sally: Um well no no you
Speaker:Sally: know what there aren't but because they're downloadable anybody can print
Speaker:Sally: them off i think we're we're almost in a culture now where we we don't tend
Speaker:Sally: to have the hard the hard copies anymore and one thing i didn't mention actually
Speaker:Sally: which i think is quite important is we have um two video graphics which kind
Speaker:Sally: of talk through in women facing language the cmo guidelines,
Speaker:Sally: to pregnancy and postnatal and they
Speaker:Sally: are available to those who have maybe access to a screen in a consultation room
Speaker:Sally: or in a waiting room and if you get in touch with us there's an opportunity
Speaker:Sally: for us to share those video graphics with you and then you can kind of put those
Speaker:Sally: in those patient-facing waiting rooms. Does that make sense?
Speaker:Suzy: Brilliant yeah no fine the reason I asked about printable ones
Speaker:Suzy: is that um i actually work in a very deprived population um in
Speaker:Suzy: in a deprived pocket of edinburgh and and some people don't
Speaker:Suzy: have access to to as much um media as you imagine even of childbearing age but
Speaker:Suzy: but that's fantastic and and you know waiting room videos this is a great idea
Speaker:Suzy: i you know people are stuck in waiting rooms unfortunately um for longer than
Speaker:Suzy: we'd often like but but what a great use of that potential time.
Speaker:Suzy: You alluded there to the guidelines. Marlies, I know you had quite a lot of
Speaker:Suzy: input into those guidelines.
Speaker:Suzy: For people who maybe haven't come across them before, what do primary care colleagues
Speaker:Suzy: need to know? What do midwives need to know?
Speaker:Marlize: So it was only in 2017 then that the chief medical officers released the first
Speaker:Marlize: set of being active during your pregnancy guidelines.
Speaker:Marlize: And they presented them in the form of an infographic with the key messages.
Speaker:Marlize: And it was then in 2019 that I was fortunate enough to be part of an expert
Speaker:Marlize: working group who produced the postnatal version.
Speaker:Marlize: Now, both of these sets of guidelines, I think it's important to recognize that
Speaker:Marlize: they were never intended to be public facing.
Speaker:Marlize: They were always meant to act as cheat sheets, really, for professionals to
Speaker:Marlize: have a conversation around the key messages within those infographics.
Speaker:Marlize: But what I've seen is, you know, these are quite often printed off or it's a
Speaker:Marlize: poster somewhere in a waiting room.
Speaker:Marlize: But it's actually really important that we have the conversations around those key messages.
Speaker:Marlize: So, for example, if you were to pick up these infographics,
Speaker:Marlize: the first key message you would see is that it's important to accumulate 150
Speaker:Marlize: minutes of moderate intensity activity throughout the week and also engage in
Speaker:Marlize: strength training activities on two days of the week.
Speaker:Marlize: However, what the infographic doesn't say is that these guidelines apply to
Speaker:Marlize: healthy women with uncomplicated pregnancies.
Speaker:Marlize: So if these just are handed out to women, then they could absolutely interpret
Speaker:Marlize: those things in the wrong way.
Speaker:Marlize: And we've recognized that as a bit of a challenge. So what we've done is also
Speaker:Marlize: support a tool, the Get Active questionnaire for pregnancy UK version.
Speaker:Marlize: And then very recently, the postnatal version was published and we're just adapting it for the UK now.
Speaker:Marlize: But these tools are essentially then for women
Speaker:Marlize: to determine, you know, do I have an uncomplicated pregnancy and at what stage
Speaker:Marlize: do I need to speak to a healthcare professional?
Speaker:Marlize: But in reality, for the majority of women, it is safe to continue without having
Speaker:Marlize: to have that discussion.
Speaker:Marlize: And in that way, we are ultimately reducing barriers to movement and engagement.
Speaker:Marlize: And we've also developed a second part of the tool.
Speaker:Marlize: So if a woman has ticked yes to any of the questions on the tool,
Speaker:Marlize: we then encourage a conversation with a healthcare professional.
Speaker:Marlize: And for them, we've also devised a tool to help guide the conversation.
Speaker:Marlize: So for us, it's very much around recognising the barriers, not just in terms
Speaker:Marlize: of uptake, but also in terms of professionals engaging and having meaningful conversations,
Speaker:Marlize: and then producing tools and solutions to help address those barriers.
Speaker:Suzy: Yeah, because often, you know, we're not taught as healthcare professionals
Speaker:Suzy: what to do in that situation. You've got someone who's come in and they've got
Speaker:Suzy: some sort of pregnancy complication, and the woman's wanting to ask your advice
Speaker:Suzy: and you think, oh, I'm not prepared for this.
Speaker:Suzy: So, you know, what I teach my trainees is, well, just go back to basic principles.
Speaker:Suzy: And I think that comes through in everything that you have produced is that,
Speaker:Suzy: you know, it's all, it is common sense, but it's about giving people the confidence
Speaker:Suzy: to say, okay, well, look, let's meet you where you are and let's just nudge
Speaker:Suzy: you forward a little bit.
Speaker:Suzy: Start low, go slow. It's the same principles. I go on about this in every single
Speaker:Suzy: podcast and it applies here as much as it does anywhere else.
Speaker:Suzy: Find where you are and move a little bit, then move a little bit more and a
Speaker:Suzy: little bit more again. It's one change, then another.
Speaker:Suzy: And in your language, it's slightly different, but I see it coming through on the website.
Speaker:Suzy: Any other advice that you would give to midwives or to GPs who maybe feel uncomfortable
Speaker:Suzy: with someone that's slightly more complex?
Speaker:Marlize: I would also say that, for example, with the This My Moves ambassador program,
Speaker:Marlize: we are not there to create experts in the space.
Speaker:Marlize: This My Moves is a little bit of a leveller because what we have found is that
Speaker:Marlize: women have told us that they would go to their GP or their midwife to say,
Speaker:Marlize: I am an active woman. I want to keep running.
Speaker:Marlize: And that professional would quite often say, well, check with your coach or
Speaker:Marlize: speak to your personal trainer or pre and postnatal instructor.
Speaker:Marlize: They would do that and that person would then say well you need to be,
Speaker:Marlize: signed off or cleared by your midwife or gp first
Speaker:Marlize: so it creates a bit of a gray area and
Speaker:Marlize: what women then perceive the safest thing to be is to stop and do nothing and
Speaker:Marlize: that is ultimately where we lose women to the physical activity journey because
Speaker:Marlize: it's really hard to pick up that behavior once you have a child and all sorts
Speaker:Marlize: of additional life complications then makes it really hard.
Speaker:Marlize: So my advice to professionals would be is you are not expected to be an expert,
Speaker:Marlize: but we can provide you with resources for signposting.
Speaker:Marlize: And what we'd ultimately like is if you feel it's outside of scope or you are
Speaker:Marlize: perhaps asked about a specific activity and you don't have the answer,
Speaker:Marlize: is to provide reassuring messages and signpost in the right direction.
Speaker:Marlize: And that's sort of where ambassadors and the Active Pregnancy Foundation can play a big role.
Speaker:Sally: Can I add in here, you know, there'll be many women, but the women that we are
Speaker:Sally: supporting are on a continuum.
Speaker:Sally: You know, you have those who are incredibly active, who are maybe even an athlete.
Speaker:Sally: And then you have women who are not active in their minds, not active at all.
Speaker:Sally: And I think it's not being frightened to have a conversation with those women
Speaker:Sally: who may not be asking those questions.
Speaker:Sally: They may not be asking about activity because they
Speaker:Sally: don't see it as a space in which they already exist so um
Speaker:Sally: and i know that can be a place of discomfort for many um
Speaker:Sally: professionals um so you use
Speaker:Sally: that lovely language around you know meeting women where they're
Speaker:Sally: at and that is exactly it it is you know who is
Speaker:Sally: sat in front of you and um what is
Speaker:Sally: it that they need and how can you support them the best way which i'm sure
Speaker:Sally: you are already doing and that may be for
Speaker:Sally: someone who has a perception of not being in that active space
Speaker:Sally: and activities not for them is actually opening up
Speaker:Sally: that conversation which isn't around weight loss
Speaker:Sally: for example right or weight management and i
Speaker:Sally: think many women feel very nervous about that um but
Speaker:Sally: also for those who are very active already what
Speaker:Sally: kind of conversations are needed for them who you
Speaker:Sally: know where you're maybe having a conversation about let's you
Speaker:Sally: know bring it down a little bit let's kind of adapt as you become um
Speaker:Sally: um bigger uh and your you know your pregnancy kind of progresses but also returning
Speaker:Sally: to activity may be a little slower than than you probably would like to already
Speaker:Sally: you know so it is very much seeing the person sat in front of you and not being
Speaker:Sally: fearful of opening up that conversation.
Speaker:Suzy: It's so true balance.
Speaker:Marlize: If I might add to that as well I think what Sally has said there I think the
Speaker:Marlize: language of movement is quite important.
Speaker:Marlize: And something we've picked up really early on when we co-produced the This Mammu's
Speaker:Marlize: program is that the word exercise in itself is a barrier for women,
Speaker:Marlize: particularly for the 75% who do not meet the recommended guidelines.
Speaker:Marlize: So it's about opening conversations quite wide.
Speaker:Marlize: We often use the example, and I'm just looking out the window today,
Speaker:Marlize: and it's quite bright and sunny. And it's like, well, how did you get here today?
Speaker:Marlize: It's a lovely day for a walk, isn't it?
Speaker:Marlize: And that, you know, that just starts off a conversation around movement.
Speaker:Marlize: And then it is about meeting them where they are at.
Speaker:Marlize: So if they are, you know, if exercise is perhaps part of their identity,
Speaker:Marlize: speak about exercise and their Pilates class or whatever it is they're doing.
Speaker:Marlize: If they are sporty and preparing for an event, then absolutely meet them where they are at.
Speaker:Marlize: But I think it's quite important that we recognise using the right language
Speaker:Marlize: when trying to promote activity in the perinatal period is really important.
Speaker:Suzy: It's so true, isn't it? And then finding things that people really enjoy.
Speaker:Suzy: So you brought us, Sally, quite nicely towards the sort of the postnatal period
Speaker:Suzy: and, you know, pointed out all the complications.
Speaker:Suzy: You're tired, your baby's waking you up at night. The last thing you want to
Speaker:Suzy: do is put on a pair of leggings and get out and do some activity.
Speaker:Suzy: But I know for myself, there was a buggy boot camp where women are encouraged
Speaker:Suzy: to bring their babies and come to the park, get some fresh air.
Speaker:Suzy: And that was an absolute godsend throughout both my postnatal periods.
Speaker:Suzy: I don't know what I would have done without that. It's not for everyone,
Speaker:Suzy: but isn't it brilliant that these things exist?
Speaker:Suzy: You know, what other ways can we help women to embrace that postnatal period and get active?
Speaker:Sally: Yeah, that's an interesting question. And funny how you were saying about,
Speaker:Sally: you know, mum and baby groups.
Speaker:Sally: Having that connectivity in those early days with other women who've been through
Speaker:Sally: a similar experience is hugely beneficial.
Speaker:Sally: And being outside as well is hugely beneficial and
Speaker:Sally: having those conversations being able to support each
Speaker:Sally: other and I think that is also something that we
Speaker:Sally: can kind of lean into is how do we encourage
Speaker:Sally: women to participate in those sort of activities for
Speaker:Sally: the benefit of actually just meeting other women to be
Speaker:Sally: able to kind of talk to them and share experiences and
Speaker:Sally: have that connectivity but there are significant barriers
Speaker:Sally: to that as you've mentioned maybe you're tired maybe you don't
Speaker:Sally: have anybody who's able to look after your baby if
Speaker:Sally: that's what you choose to do if you want to go do something on your own um
Speaker:Sally: so I think there's a kind of cultural shift
Speaker:Sally: though and that is permission to do it we are giving you permission to be active
Speaker:Sally: postnatally right um I know from my own experience that a lovely well-meaning
Speaker:Sally: friend said to me oh you know if you'd like me to look after your daughter I'm
Speaker:Sally: really happy to do it I said oh you know what that would be great Yes, please.
Speaker:Sally: I'd love to go back to the gym." She went, oh, I thought it meant that you could
Speaker:Sally: go to the cinema with your husband.
Speaker:Sally: There was a perception there that there was a selfishness for me to want to go to the gym.
Speaker:Sally: And the gym was my happy space, my mental health space. So that never happened.
Speaker:Sally: So I wasn't able to do it. And also there's something around consideration around language as well.
Speaker:Sally: When you're going in as a woman going into a
Speaker:Sally: postnatal activity forum for
Speaker:Sally: example you know like a mother's and baby
Speaker:Sally: swimming club or a mum and baby's walking group and for
Speaker:Sally: somebody who had birth trauma I don't always want to kind of shout across the
Speaker:Sally: room yes I had a vaginal birth yes I had a cesarean section so it's kind of
Speaker:Sally: being very cognizant of those deep sometimes deeply personal experiences,
Speaker:Sally: because you could easily lose somebody if that place is a place of discomfort.
Speaker:Sally: And I certainly stopped going to a mum-baby walking route because I didn't feel
Speaker:Sally: that the PT at the time was very in tune with how difficult that conversation was for me.
Speaker:Sally: So I'm just sharing my personal experiences. But there are many barriers to
Speaker:Sally: women returning to activity postnatally. They're just some of them.
Speaker:Suzy: What about women who come in and ask for advice about pelvic floor,
Speaker:Suzy: for example, because this is an area of discomfort, particularly for,
Speaker:Suzy: I know if Hussein had been able to join us, I think he wanted to bring up some
Speaker:Suzy: questions that maybe some of our male colleagues might not be sure how to answer.
Speaker:Suzy: How do we respond to women when they say, well, I'm not sure about my pelvic
Speaker:Suzy: floor, can you advise me?
Speaker:Marlize: I think this is a really interesting topic and something
Speaker:Marlize: that within the pregnancy guidelines I
Speaker:Marlize: advocated for and wasn't in the end included is
Speaker:Marlize: the timing of when to start pelvic floor
Speaker:Marlize: exercises and I actually think you know this
Speaker:Marlize: education should start much earlier in women's lives perhaps even during adolescence
Speaker:Marlize: and we need to really normalize this conversation much earlier so pregnancy
Speaker:Marlize: is a moment in time to remind women that it is important to do pelvic floor
Speaker:Marlize: exercises, but actually,
Speaker:Marlize: you know, this is a part of a life course approach, not just for women,
Speaker:Marlize: but also for men, and to normalize this type of conversation much more widely
Speaker:Marlize: and not just limited to pregnancy.
Speaker:Marlize: Now, we do have within the postnatal guidelines specific reference to start
Speaker:Marlize: your pelvic floor exercises as soon as you can if you haven't started them already,
Speaker:Marlize: but I think you know as you know these conversations need
Speaker:Marlize: to start much earlier and we also need to recognize
Speaker:Marlize: particularly in the postnatal space that
Speaker:Marlize: there are some symptoms that are really common but they are not necessarily
Speaker:Marlize: normal and to make the distinction and perhaps empower women to start to ask
Speaker:Marlize: the right questions when things don't feel quite right and not just to put up
Speaker:Marlize: put up with them and live with them you don't have to.
Speaker:Suzy: Can you give us some examples of what you mean there Malise?
Speaker:Marlize: Urinary incontinence, for example, you don't have to suffer with that.
Speaker:Marlize: Speak up, ask for health, ask for a referral.
Speaker:Marlize: I think pelvic health physiotherapy is becoming something that we really need
Speaker:Marlize: to start paying attention to. There are great physiotherapists out there that
Speaker:Marlize: offer specific services.
Speaker:Marlize: And if you are a healthcare professional working in this space,
Speaker:Marlize: I would strongly advise you to be familiar with your referral networks.
Speaker:Marlize: So if the question comes up that you are ready to refer on or to signpost to
Speaker:Marlize: evidence-based information.
Speaker:Marlize: I know, for example, the POGP do excellent work in terms of their professional
Speaker:Marlize: and patient-facing resources.
Speaker:Marlize: So signpost to the website. I think there's some excellent things out there.
Speaker:Marlize: But we are perhaps afraid to start the conversation. And I think that's the
Speaker:Marlize: first barrier we need to get over.
Speaker:Suzy: Brilliant. The other problem area I think some primary care colleagues struggle
Speaker:Suzy: with is women who've really suffered with symphysis pubis disorder.
Speaker:Suzy: And the problems that that brings, you know, with relaxing around and everything's
Speaker:Suzy: shifting, ready for having baby and then the postnatal period.
Speaker:Suzy: Any advice on that, Marliese?
Speaker:Marlize: Oh, absolutely refer. There are professionals who are trained to support women during these times.
Speaker:Marlize: So, yeah, there's no need for women to suffer in silence or,
Speaker:Marlize: you know, to feel that they are not being listened to.
Speaker:Marlize: Please refer not just to professionals, but also to really helpful resources
Speaker:Marlize: and evidence-based trusted resources that exist.
Speaker:Sally: Can I jump in and it's not you know this is
Speaker:Sally: not my um my you know
Speaker:Sally: professional area but I think
Speaker:Sally: again it's around talking to the to the woman
Speaker:Sally: who sat in front of you because um as somebody
Speaker:Sally: who had gone through um uh IVF
Speaker:Sally: and PTSD and all those kind of
Speaker:Sally: quite difficult that very difficult
Speaker:Sally: journey when asked the question directly
Speaker:Sally: maybe in a consultation I would probably
Speaker:Sally: have been quite nervous to answer it because by that
Speaker:Sally: time by the time I'd had my daughter I didn't
Speaker:Sally: want to be touched anymore I didn't want to be in the
Speaker:Sally: medical space anymore so how do
Speaker:Sally: we have those kind of soft opening conversations so
Speaker:Sally: that women feel comfortable with the
Speaker:Sally: person in front of them that they trust and it's delicately kind of couched
Speaker:Sally: around are you having difficulties with you know you're in incontinence are
Speaker:Sally: you you know are you still in pain is there still anything going on is there
Speaker:Sally: anything that you want to bring up that you feel maybe you're you're not you
Speaker:Sally: know you're feeling a bit nervous about and having those.
Speaker:Sally: Gentler conversations to be able to bring that out um and i know in my six to
Speaker:Sally: eight week check It was all about baby. It was all about baby.
Speaker:Sally: And I probably at that point could have sought more medical support for the
Speaker:Sally: experiences I was having in my body, but the conversation wasn't had yet.
Speaker:Sally: So I think we're missing out on supporting these women.
Speaker:Marlize: Sorry, I was just going to say, Sally just mentioned the six to eight week postnatal check there.
Speaker:Marlize: I have a fabulous student, Dr. Jo Moorwood, who's going here to study in that space.
Speaker:Marlize: And I think, you know, we have recently seen some evidence or some guidance
Speaker:Marlize: around what good looks like at the six to eight week postnatal check.
Speaker:Marlize: And what is reassuring is that, you know, women's health and checking in on
Speaker:Marlize: the mum herself is now starting to become more prominent in those conversations.
Speaker:Marlize: And Sally is right. This wasn't really a priority a few years ago.
Speaker:Marlize: But I think that perhaps in terms
Speaker:Marlize: of the postnatal phase, there is another appointment that is missing.
Speaker:Marlize: And I've quite often felt that there should be perhaps another touch point.
Speaker:Marlize: And I'm not entirely sure which professional would be best placed to have this
Speaker:Marlize: conversation or how we make it work within the pathway,
Speaker:Marlize: but perhaps a, you know, a woman's health check postnatally or a return to work
Speaker:Marlize: check or some additional touch point where a woman can raise concerns or have a conversation.
Speaker:Marlize: I sometimes feel and I think Job has also found that the six to eight week postnatal
Speaker:Marlize: check is quite a lot to discuss.
Speaker:Marlize: For many women, it might be too early to discuss some of the challenges that
Speaker:Marlize: might still come up in their postnatal journey.
Speaker:Marlize: So I think, yes, there are some good things in place.
Speaker:Marlize: You know, having the check in itself is good, but we need to take better care
Speaker:Marlize: of women as a whole. And that might mean rethinking what the postnatal journey
Speaker:Marlize: looks like in the context of women's long-term health.
Speaker:Suzy: And I don't know if the system, because I'm based in Scotland,
Speaker:Suzy: I don't know if the system's different up here, but we certainly have a six-week check for baby.
Speaker:Suzy: And certainly in our practice, we have a separate six-week check for mum that
Speaker:Suzy: is hers and hers alone. That doesn't happen down south.
Speaker:Suzy: There's also regular touch points with our health visitors who,
Speaker:Suzy: you know, if they are worried about mum, they will absolutely.
Speaker:Suzy: And I had one yesterday that young woman who was booked in with me because the health visitor,
Speaker:Suzy: she couldn't quite put her finger on it she was worried and she just booked
Speaker:Suzy: her in with me and and we've started a conversation to be followed up so i would
Speaker:Suzy: hope that that it's more like that up and down the country but it sounds like it isn't.
Speaker:Marlize: No i think that's
Speaker:Marlize: that's the real challenge that it is very inconsistent um
Speaker:Marlize: across across the country and what i would even in terms of physiotherapy referral
Speaker:Marlize: in some places you can self-refer in some places you need a from a healthcare
Speaker:Marlize: professional and in some places you do have access to private service but I
Speaker:Marlize: think there isn't much consistency you know in terms of the UK as a whole.
Speaker:Marlize: What I just wanted to add is that we have a really good relationship with the
Speaker:Marlize: Institute of Health Visiting and they are the training delivery partner of the
Speaker:Marlize: This Mom Moves program and what we recognize is that as part of a women's perinatal journey,
Speaker:Marlize: there are several stakeholders and organizations and professionals that have
Speaker:Marlize: a role to play and it's not just on primary care professionals or on midwives.
Speaker:Marlize: We are all part of this bigger system and everybody has a role to play.
Speaker:Marlize: You know, someone might just plant the seed, someone might give it some water
Speaker:Marlize: and Some might shine some light on things, but I think we need to step away
Speaker:Marlize: from thinking that it comes down to one professional or one moment in time,
Speaker:Marlize: but start to think more of it as a system,
Speaker:Marlize: a whole system and where everybody has a part to play.
Speaker:Suzy: Ladies, you're doing the most incredible work and you have thought of everything, I think.
Speaker:Suzy: And we have done a whistle-stop tour. I'm very aware of the time.
Speaker:Suzy: And I said we'd be about half an hour or thereabouts.
Speaker:Suzy: And I know it's rapidly going on. You've been the perfect combination of the
Speaker:Suzy: information, the background, the research.
Speaker:Suzy: And Sally, you're shining a light on your experience as well with that plea
Speaker:Suzy: there for people just to be gentle with women.
Speaker:Suzy: And it's all about just asking the right questions in the right way.
Speaker:Suzy: It's not necessarily what you say, but sometimes how you say it.
Speaker:Suzy: So at this point in any podcast, I put people on the spot for their take-home messages.
Speaker:Suzy: What is it that you want to leave us with? Because people remember the beginning
Speaker:Suzy: and they remember the end and they might listen in the middle.
Speaker:Suzy: But this is the bit where people really sort of take home that nugget.
Speaker:Suzy: What is your call to action for people who'd like to go first?
Speaker:Marlize: I think Sally's pointing at me. I was going to say, given the audience for this
Speaker:Marlize: podcast, my message would have been different if it was for women.
Speaker:Marlize: But given the audience, I would say promoting physical activity is not someone else's job.
Speaker:Marlize: It is every practitioner's responsibility.
Speaker:Suzy: Brilliant. Sally?
Speaker:Sally: Mine is to remember the Active Brugnancy Foundation in your work.
Speaker:Sally: Refer to us, come and work with us. Come and do the course.
Speaker:Sally: Come and do the course.
Speaker:Sally: There is my moves ambassador training. Please come and sign up to that.
Speaker:Sally: It's excellent and will give you all the tools you need to begin to have those
Speaker:Sally: gentler conversations.
Speaker:Suzy: Absolutely fantastic. So an invitation for some brief interventions and for
Speaker:Suzy: those who want more to come and join the ambassadors.
Speaker:Suzy: Out of interest, how many ambassadors do you have and are there some in Scotland?
Speaker:Sally: Oh, that is a question. It's over 300, isn't it?
Speaker:Marlize: I don't know. No, we've trained 412 in the last year alone,
Speaker:Marlize: alone but we work on a cascade model so as I've said before so it's about that
Speaker:Marlize: professional then having a ripple effect within their organization and going
Speaker:Marlize: to cascade the training onto other professionals so we we don't count those
Speaker:Marlize: but in terms of professionals I think nearly 500 trade in the last year alone.
Speaker:Suzy: That is absolutely brilliant well hopefully there'll be a few more
Speaker:Suzy: after this podcast goes out it's been an absolute pleasure and
Speaker:Suzy: a delight to listen to you I've been playing bingo in
Speaker:Suzy: my head with all the wonderful things you've said that I love to say the ripple
Speaker:Suzy: effect meeting people where they are planting a seed you've just added to that
Speaker:Suzy: planting a seed shining a light and throwing some water on top brilliant ladies
Speaker:Suzy: thank you so much and safe onward journey especially you Sally thank you.
Speaker:Marlize: Take care bye.
