Baby's First Triathlon

by Mimi Winsberg, M.D.

Pumping milk in the front seat of her car is not Tina Pretre’s typical pre-race routine. But as the new mom prepared to dive into the 58-degree San Francisco Bay waters to race in an olympic distance triathlon, she found herself doing exactly that. To her surprise, she was not alone. A competitor next to her was also breastfeeding her baby.

Despite the unusual warm-up, Pretre went on to place fourth in her age group. Her daughter was among the spectators at the finish line. She was eight weeks old.

In the year after her daughter was born, Pretre had podium finishes in seven triathlons, and she finished the season with two ironman-distance races, including the Kona world championships. At age one, her daughter had been to more races than most people attend in a lifetime, and crossed more finish lines -- in her mother’s arms.

Pretre is one of a growing number of women who are returning to exercise faster than ever after giving birth, generally with their doctors consent. Athletics have been the backdrop of their lives. Being active is a significant part of their identity, and they are trying to reconcile this identity with their new status as moms.

When Pretre was pregnant with her daughter, she heard over and over again “Your life will need to change.” Her then boss went so far as to say, “You can kiss triathlons goodbye.” That translated to Pretre as “Your life is over.”

The fear of falling behind the fitness curve, however briefly, is not a phenomenon limited to moms who compete. The cultural norm is becoming for women to resume exercise within weeks, not months of childbirth. To confirm what new mothers are worried about, one need look no farther than the myriad of websites offering suggestions to speed the race back to pre-pregnancy shape.

But there is shape and there is shape. For some women, it’s the pressure to shed those extra few pounds. For others, exercise is a way of life, something they depend on to feel good, part of their identity and accomplishments. How soon can women regain not just their physiques, but race fitness? Age-groupers like Pretre have raised the bar, and challenged traditional views of what is possible. This has brought new opportunities and new risks.

Exercise During and After Pregnancy
The American College of Obstetrics and Gynecology revised their guidelines for exercise in pregnancy and the postpartum period. They now recommend that healthy pregnant women engage in regular, moderate exercise, and resume activity gradually after delivery based on their capability. Many health benefits of exercise have been cited for pregnant women, but also, more surprisingly, for their babies. Babies born to mothers who exercise tend to be more alert, less fussy and may have increased cognitive function.

A number of studies have also shown benefits of exercise during the postpartum period including cardiovascular fitness, weight loss, as well as decreased anxiety and depression. Dr. Erika Ringdahl, author of “Promoting Postpartum Exercise,” believes that “the postpartum period may be an opportunity for clinicians to promote the importance of physical fitness and help new mothers incorporate exercise into the many lifestyle changes they face.”

San Francisco obstetrician, Dr. Laurie Green, is concerned that women are being made to feel inadequate if they are not jumping back into exercise. “The idea that women should be able to return to exercise immediately may be the most anti-woman thing out there right now,” she says. “Women are taking care of their babies alone, nursing every three hours round-the-clock, and they’re perceived as just sitting on their duffs if they’re not exercising? We are setting the benchmark way too high.” Dr. Green has seen women underestimate the effect of dehydration and fatigue when nursing.

Doctors also think it’s important to give women the flexibility to return to exercise earlier. Kaiser obstetrician Dr. Sarah Szal says: “The traditional view in Ob-Gyn is that women should wait six weeks before returning to exercise. There is no evidence for that.”

Obstetricians remain vague about the risk of strenuous activity in a conditioned athlete, acknowledging that it has not been well studied. Most doctors are telling their patients to use common sense. “If they’ve maintained activity through pregnancy, picking it up postpartum isn’t usually a problem as long as they listen to their bodies” says Dr. Szal.

Experienced athletes, who understand injuries, may be better able to listen to their bodies. “I’m a runner,” says Pretre, who ran college varsity track, “but running was the last thing to come back.” Her obstetrician (a triathlete himself) advised her that she could swim after 14 days and run when she felt ready. She tried running at three weeks and “felt as though my insides might fall out.” At five weeks she eked out a slow mile. At six weeks she competed in a local 10K and came second. “I felt a little uncomfortable, but amazingly fresh.”

After the birth of my son, inspired by Pretre, I competed in a sprint distance triathlon at five weeks and to my surprise I won my age group, but I can think of many adjectives to describe how I felt besides “fresh.” I did an olympic distance race at six weeks with much less discomfort, so every week does help.

Clearly, each case is individual and it’s important not to have pre-conceived expectations about how quickly fitness will return.

Returning to Training and Racing
A few things to keep in mind in when returning to training and racing:

Core strength: The thing that suffers the most during pregnancy. Attempting to resume training and racing without taking time to re-build core strength creates a set-up for injury. Make sure to incorporate Pilates or core strength program into your routine.
Joint laxity: Peripheral joint laxity increases in pregnancy but does not return to normal ranges within six weeks postpartum. As ligaments lengthen, there are areas of the body that are more vulnerable to injury: feet, knees, pelvis (pubic bone and SI joint), low back and the shoulder girdle (exacerbated by carrying baby). Best to avoid rough trail running, and downhill running until ligaments have regained full stability.
Iron levels and nutrition: Labor and nursing can be a big source of iron loss and energy demand. Caloric demands for milk supply can be 400 calories a day. There is a small margin for error with deficits in quality nutrition. Replace lost iron stores, and make sure you are consuming quality calories. Consider the use of a vitamin supplement.
Hydration: Nursing makes women very thirsty. In order to maintain milk supply and avoid dehydration, extra fluids will be necessary. Drink up to one pint of liquid before exercising and one cup every twenty minutes during exercise.
Keep workouts short: Many new mothers feel an emotional tug-of-war between their athletic identities and their babies, much in the way they struggle with the decision to go back to work. Keeping workouts short (two hours or less) can minimize this conflict. This has the advantage of keeping workouts focused and efficient.
Sleep: While the temptation may be to skip sleep in favor of exercise, this will only serve to dig a hole that will be very hard to crawl out. Prioritize sleep and recovery, and keep workouts at a level where they are stress relieving rather than stress provoking.
Intensity: Exercise should start at a level that does not result in pain or excessive fatigue. It is tempting to pick up where you left off before pregnancy, but accepting where you are along the fitness curve increases the probability of a successful coming season.
Choosing your first race: Pick a short, local, less competitive event. Leave your ego at home and just have fun.

Mimi is a psychiatrist, multiple-time Kona qualifier and Endurance Corner team member. You can contact her at m.winsberg@gmail.com. You can also learn more about Mimi in her recent athlete profile.