Participant characteristics
Eleven elite athletes participated in the study. The mean (SD) age of the athletes was 31(3) years and duration participating in elite sport 10(5) years (Table 1). Two participants were pregnant at the time of interviewing and prospectively described their return plans, while nine had returned to sport post-pregnancy. Participants were involved in nine different sports, including team ball sports (n= 3), sprint and endurance sports (n= 5), power sports (n= 2), and combat sports (n= 1). Four athletes were 1-2 years postpartum, two were three years postpartum and four years postpartum respectively and one was five years postpartum (Table 2).
Table 1. Participant characteristics
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Mean (SD)
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Age (years)
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31 (3)
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Ethnicity
|
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White British
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8 (73)
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White Other
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1 (9)
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Black Caribbean
|
2 (18)
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Duration in sport (years)
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10 (5)
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Retired
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0 (0)
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Currently pregnant
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2 (18)
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1-5 years post pregnancy
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9 (81)
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Type of sport
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N (%)
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Sprint and Endurance sport, e.g. rowing
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5 (45)
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Team ball sport e.g. football
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3 (27)
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Power sport e.g. powerlifting
|
1 (9)
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Precision and Technical e.g. shotput
|
1 (9)
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Combat sport e.g. judo
|
1 (9)
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Highest level of competition
|
|
Olympic games or world championships (Tier 5)
|
8 (73)
|
Paralympic games or world championships (Tier 5)
|
1 (8)
|
Elite/international competition (Tier 4)
|
2 (18)
|
Table 2. Themes and sub-themes
Navigating the Mother-Athlete Identity
Changing priorities and shifting identities
Athletes described a shift in their mentality from sport being their principal focus to having a new perspective where personal and professional experiences were more balanced.
“It's given me a bit more of a well-rounded perspective and approach on success and happiness and stuff. And I guess I'm doing my sport because I still feel I'm good at it and I enjoy it. But ultimately, it's not the be all and the end all now to me.”
Victoria, combat sport
“The couple hours that I would get to be able to train each day or three times a week was actually just quite a nice break from motherhood and more feeling like myself.
Victoria, combat sport
“And it was nice to do things that I used to do and go back to, like being old me”
Beatrice, technical sport
However, changing priorities and the shift from having control of factors such as time and sleep to focusing on the baby first was considered challenging.
“I think. It's just quite hard when you're an athlete and you're used to. I guess yeah, one being able to be like really selfish with your time and then suddenly I couldn't and I wasn't in control of it. And also looking after yourself really well. And then suddenly I wasn't getting to sleep for an hour, wasn't able to eat at regular times or what I needed to. Because you look after the baby first and then yourself”.
Elizabeth, endurance sport
Breastfeeding and the return to sport was an issue spoken about by many athletes. Breastfeeding was in part discontinued for an athlete who participated in contact sport due to it being painful. While another athlete described the challenges of breastfeeding and milk supply in the postpartum period and concerns around pumping and leaking breasts while training.
“I stopped breastfeeding at seven months post part, and that was partly due to coming back to [sport] and it being painful to do [sport] with one while breastfeeding. Like every time someone hit into my chest, it really hurt.”
Victoria, combat sport
“if I were to carry on breastfeeding when I went to things like training [I’d have to] to worry about, you know leaking and also pumping. When I pumped I didn't produce enough milk and when I breastfed she wasn't getting what she needed. You know luckily, she had the most important part of the colostrum so that was great, but there was a lot of pressure on it and I just couldn't produce what I needed to so that obviously made me feel bad that I couldn't breastfeed. But I actually think that it was a blessing in disguise really, because from you know, weeks six, she slept through the night and, you know she wouldn't. She didn't become too dependent on me.”
Jane, team ball sport
Impact of having a changed body
Athletes described the physical impact of childbirth on the return to sport, in particular pelvic floor health and how it impacted the type of exercise an athlete could engage in.
“ I've never had bad pelvic floor or anything, but when I was well, I don't know how old she would have been. Maybe about 3-4 months. I was doing these jumps [and wetting myself]. I have a male coach and we’ve never thought about jumps before and I was doing these jumps up. Ohh. I don't think I'm fully ready for quite so many jumps”.
Beatrice, technical sport
“if I need to go for like a wee, I need to go for a wee. I can't hold it anymore. I feel like definitely around pelvic floor like. It's so crucial for a woman, and it is especially when they had a baby and then want to go [do sport]”
Miranda, sprint sport
Some participants acquired multiple injuries post-pregnancy as a result of a lack of information regarding the body’s ability to return to pre-pregnancy health and fitness.
“I got a rib stress fracture and I've never had one of those before, and looking at, I think you know, I was breastfeeding…for over a year and lots of things that I still have not had actually anything investigated…I've had more niggles and more injuries than I used to get, but nothing that's taking me out of the [sport] so there's not quite kind of been that emphasis to look for answers.”
Jemima, endurance sport
Several of the participants referred to new injuries post-pregnancy, as a direct consequence of the pregnancy or from a prolonged period not exercising. Athletes spoke about not investigating any niggles post-pregnancy further as they were not perceived as serious enough to miss sport, but also there was a perception that injuries post-pregnancy were normal due to the physical demands of being an elite athlete.
“No, just the shin splints, and that you know that probably could have been as a result of not exercising for so long, and then all of a sudden go back into to full training. I didn't really have, like, a reduced training plan. It was just kind of do what you can.”
Jane, team ball sport
“I had a really bad hip issue. I think that was brought on because of pregnancy and I had it in the past, but somehow it got better, but then it got worse and then it got really, really bad. But learning how to manage that and do the right exercises and like pushing your body every day, you are always going to have some sort of niggles.”
Miranda, sprint sport
Mental Preparedness
The athletes also reported mental health benefits of returning to sport as it allowed them time and space for themselves.
So, I think if anything coming back to training really helped me mentally. It helped me to, I don't know, feel good, it was my feel-good factor.”
Victoria, combat sport
Some athletes reported that their pregnancy had provided them with a shift in perspective which improved their psychological well-being when competing.
“I think it's been good and I'm in a way better mental place. A growing one as well. Like when I compare my stress levels, my anxiety and my worries about things like [previous Olympics], where I just thought [sport] was life and like my mood was determined by how well a session had gone. Now I think my perspective is much wider, much broader. I'm just kind of generally much more balanced around both areas of my life”
Jemima, endurance sport
Overall, there was a reported increased mental load associated with returning to sport post-partum. Athletes expressed that tasks that were considered simple before were now more difficult, particularly because of the lack of guidance from managers. Responsibility was largely on the athlete in terms of gauging how the return to sport was going.
“I couldn't turn like I used to. Or even the mental part, so even the decision-making processes and, you know, looking where to pass the ball and just simple things like that checking your shoulder [were difficult]. I'd forgot how to do [it]”
Chloe, team ball sport
Athletes spoke about the struggle of having to start from the bottom again and not being as physically fit as they were pre-pregnancy. Some athletes described how their postpartum body impacted their return to sport.
“I'd put on a bit of weight from having baby, and I'm actually personally like I didn't feel comfortable in the kit and stuff, so I was really, really not feeling good about playing.”
Jane, team ball sport
“…”physically it was hard because it was like a fatter version of myself. And I've never not been able to lose weight before.”.
Beatrice, technical sport
“One of the biggest stresses I had was, like, not knowing what support I would have postpartum. As in financially, I didn't know whether how long I'd stay on funding for and it was kind of like a or. We'll let you kind of know when you get to that point. So there was never like that, that real ability to like plan ahead and be like, OK, I know I'm gonna be supported for X amount of time”.
Victoria, combat sport
Personal Support and Inspiration
Peer and family support
Family members were spoken about as being critical to facilitate returning to sport.
“… I've got a very supportive family around me and my husband's very supportive. He played [sport] himself, so he knows and they want me to go back to [sport] and they want me to try and go to the Olympics and everyone says, don't worry, we'll help. We'll help you. We'll make it work.
Isabel, team ball sport
The athlete’s team or peer group were also seen as very important.
“also the fact that all my teammates love having him around and they I mean this I think is like above and beyond … I can see why this really wouldn't work in a lot of situations, but yeah, my son gets to come to load all training camp. Quite a lot of races and stay with the team. It's a really, really nice.”
Lily endurance sport
Athletes spoke about the importance of their support network when returning to sport. The support from teams and teammates was spoken about in terms of a lack of pressure to return, access to medical staff and the overall environment that facilitated bringing children to training camps and competitions.
“And the team was really supportive of me as a professional [sport] and I had absolutely no pressure from them, it was kind of a case of return when you want to …I think they didn't think that I would but I could see the physio and the doctor and I got a lot of support from them in terms of private healthcare”
Lily endurance sport
Role modelling
In figuring out a way back to sport postpartum, athletes highlighted how important it was to see how other athletes had navigated the postpartum return to sport.
“I think if you're reading stories of other athletes who have done it and who have been through it… how the postpartum journey went, I think that would be great support for other women considering doing the same thing.”
Victoria, combat sport
“it does snowball like you've seen it in [sport]… one person comes back after baby, then another, then they start winning and then 3,4,5 people come back…as soon as you see those people being successful, it just kind of squashes any questions”
Lily, endurance sport
Systemic Support
Structural flexibility
The return to sport was managed differently across different sports and thus had a different impact on athletes. Flexibility was described by the athletes as being a key factor in supporting a return to sport. This included flexibility around training and being able to adapt as necessary.
“They were really flexible with me. And I think initially I only started at three days a week and then I moved from three to four [days], and then it wasn't really until, like, I don't know, eight months or so postpartum, really, that I kind of went to, like, a full program. And so maybe even later than that, actually, because it was kind of just before comp that went before program.”
Victoria, combat sport
Not all sports had the same focus on flexibility. Athletes spoke about the challenges associated with the lack of flexibility and how it impacted managing the demands of motherhood and her sporting career.
I just say like for me like there's so little flexibility, so like. I've had an issue with. If I go in and [sport] first thing and don't make it back for [name] nap time, he doesn't nap and then it means he's up all night, but the coaches won't take me out at a different time, so I literally do a session then I get straight back in my car … it could be an hour, hour and a half before I get any food because I'll get through the front door I have to deal with [name]. And then once I've dealt with him, then I'd like deal with myself. And I think the coaches aren't always willing to engage with that side of it.”
Sarah, endurance sport
Athletes who felt supported and safe during the returning to sport were able to get specific advice from team trainers and health professionals.
“I think that was kind of a conversation that we had quite openly and we talked a lot about breastfeeding as well with the physio and the gym coach … I think because breastfeeding causes you to keep quite a bit of relaxin maybe, so the same thing as when you're when you're pregnant, you need to be a bit cautious around gym training because of all the relaxin in your muscles and tendons.
Lily, endurance sport
One athlete who was pregnant and intended to breastfeed spoke about future concerns, in particular how mixed feeding would work, pumping, and how it would fit into their routine. Exclusive breastfeeding and participation in sport as an elite athlete was perceived as not being achievable.
“The biggest issue is gonna be breastfeeding logistics… and working out how that will work and… you need to stop to like pump. In transition and things… But my intention is to…try and get like the dual feeding thing going on quite early. So he can take both breast and bottle because I can't obviously do any kind of sport if he's exclusively breastfeeding”
Georgina, endurance Sport
Maternity policies and advice
Athletes described how they were given very little, or no nutrition advice. Advice provided was often generic, not tailored to being an elite athlete post-pregnancy.
“No. Do you know this is making [Sport Organisation] [look] really bad. Because I did, I have actually asked the nutritionist and I asked for any information on whether I should be taking calcium or iron or anything like that and that hasn't come back to me”
Jemima, endurance sport
There were also instances of athletes receiving incorrect, and potentially harmful, advice. In the absence of specific information athletes may approach weight restoration in less healthy ways.
“No, I think like I think nutrition like I didn't have much guidance … For me, I got told that if I did lose weight postpartum too quickly and my milk would become toxic and it's things like actually normalizing weight gain and weight loss and not crash losing it postpartum, which I think you could be tempted to do as an athlete.”
Sarah, endurance sport
Funding and the financial impacts of combining sport and motherhood was discussed among the athletes. Athletes described the challenges associated with losing funding due to motherhood, which impacted performance. The stress related to uncertainty around funding support post-pregnancy and the lack of clarity from their sport was highlighted.
“A lot of things changed… I lost like my sponsorship with [brand sponsor]…I lost my funding because I didn't [perform in specific sport related activity] in 2021, but I just had a baby the last year. Like it just didn't make sense. And yeah, I lost my access to the team physio then. And it was, yeah, it was tough. It's been tough like since 2021. It's been tough because it you just feel like, oh, not supported like that. You're not like I just had a baby”
Miranda, sprint sport
The financial impact of childcare costs was also highlighted. This included the lack of childcare provision for sporting events and how maternity policies which include childcare provision are not universal across sports.
“Let's say I go to this trip…who looks after the baby?… me and my husband have discussed it and he would actually come out to [Country]… But that's a financial cost that we would have to pay for… I read the women's rugby RFU maternity policy and they pay for their babies to come on tours, which is amazing. So that kind of level of funding doesn't exist… we will have to look for some paid childcare as well… So that's another barrier… that does come down to money again, because if you're paying for childcare… you might not be able to afford it.”
Isabel, team ball sport
Introducing maternity policies was referred to as a ‘game-changer’ to ensure funding is secure, however, there was also a frustration that maternity policies were not universal leading to differences in support available.
“I think having the maternity policy makes a huge difference. Like without the maternity policy, like you can't fund it and or certainly you wouldn't want to risk having your funding cut whilst being pregnant and like you're not eligible for statutory or anything like that because we don't pay tax. So if you don't have the funding, you literally lose your entire income. So I think that's been like quite a big game changer. The only thing I'd say is like I know rugby have written a full policy and [sport governing body] are yet to write any policy and for me, that's quite frustrating because I'm aware like there's another person I know it's his wife having the baby, but already what they're allowing him to do is very different to what I was allowed… [sport governing body] won't be consistent with how they treat new parents and which just means like I can't pass that advice because what I say. Will be different, potentially to what someone else will be eligible for, so there's not really the security from that side.”
Sarah, endurance sport