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Do we unwittingly make our clients feel like they are broken?

I'm currently pregnant, due to give birth for the 3rd time in June. There is a 22-month gap between my first and second children. There will be a 4-year gap between my youngest and this baby. This large gap has led quite a few people – both friends and perfect strangers – to ask: “Was it unplanned?” To which the short answer is “no”. The longer answer is that this third baby has been mulled over extensively by my husband and me for the past 3 years. Back and forth we’ve been, weighing up the pros and cons for our little family. Postnatal has been a challenge for me both times from a mental health perspective. I’ve written about this previously in this blog. We survived those times. But a third baby? Would we cope? Would our marriage?

Adding an extra layer of complication to the decision-making process was my caution about how a third pregnancy might affect me physically. After having my second child, my body did not get the bounce-back memo. I thought I was pretty fit. I looked slim and toned. But then I experienced urinary incontinence during a circuits class at 18 months or so postnatal, which was frankly terrifying. I subsequently discovered that I also had moderate diastasis recti (DRA - separation of the rectus bellies/the six pack muscles due to the thinning of the linea alba, the connective tissue that runs between them), though it's important to note that the two conditions were not necessarily linked. My rehab journey has been deeply enriching in many ways. It prompted me to shake up my life significantly, changing career from lawyer to personal trainer, which has been a real gift. But did I want to go through that rehab process all over again? Not desperately. So, as you can imagine, when people have asked me whether this pregnancy was planned, I’ve largely stuck with the short answer.

Fast-forward to mid-January 2019 and I was 21 weeks pregnant. The worries I have set out above did not magically dissipate with the positive pregnancy test. I remain cautious about my postnatal mental health and my physical recovery, but my husband and I are being proactive in trying to ensure that this time is more positive all round, rather than just winging it. I was fortunate to get a spot on The Female Athlete Course with Antony Lo in London. Throughout the weekend, Antony welcomes attendees to volunteer for assessment. I nervously volunteered, as I was keen for Antony’s thoughts on my DRA having noticed that I had already lost the ability to manage intra-abdominal pressure in certain situations. I want to share a few of the key takeaways for me from that interaction.

1. Our words and actions as fitness professionals or physios matter.

This probably seems like a no-brainer. We all know this in theory, don’t we? And we are, in our heads, doing all the right things to put our clients at ease. During my assessment with Antony, as my belly bulged and domed with movements during the assessment, there were gasps, ‘uh-ohs’ and other such noises from some of those observing. These reactions were – I am sure – borne out of professional curiosity in a classroom setting and not representative of what would happen in real life. BUT. This was a bunch of individuals who surely see doming/coning/poor management of intra-abdominal pressure day in and day out in their work. Why were they so shocked? I felt extremely vulnerable in that assessment setting. Sure, early on in the assessment, I used humour to try to mask my nerves. Despite this, I was not feeling light-hearted and jovial. I was feeling like I had wrecked my body and I craved reassurance that this was not the case. Our words and actions matter, and clients may be hyper-alert to even the slightest flinch, the faintest grimace or the most silent, internally muttered ‘uh-oh’ from their trainer or physio. This was an incredibly powerful learning experience for me, which has prompted me to be much more careful about the language I use with my clients.

2. We don’t need to rush in with a fix.

As I lay on that plinth I could see whispered conversations between attendees, possibly discussions about tweaks they would make to help me to better manage intra-abdominal pressure. Again, I think this came from a good place. We see something ‘dysfunctional’, and we want to make it better. We know so much that can help the client. We are often time poor. But are we at risk of missing a big piece of the puzzle if we rush in? Antony essentially paused the practical part of the assessment and took the time to reassure me that what was happening was ok. It didn’t mean I had damaged myself. It didn’t dictate that my postnatal journey was going to be fraught with obstacles. That, actually, was what I needed most at that time, not a bunch of cues about my respiration or my pelvic floor or my ribcage. There is a lot of power in listening (as in really listening, not just looking at the other person and nodding and lining up the next thing you are going to say or do). If we actively listen, we can maybe better judge what the client needs most at that time. Again, a powerful learning experience which has prompted me to try to listen more and talk less in sessions with my clients.

Interestingly, when we did resume the practical part of the assessment, I was able to achieve the best control when I relaxed and stopped over-thinking cues that I had been committed to in the past (exhale, lift pelvic floor, draw ribs together, spread bellybutton). Antony has written a really interesting blog on cues, and whether our cues are holding our clients back which is well worth a read.

3. As practitioners working with pregnant and postnatal athletes, we need to try to rebalance the pendulum with regard to DRA.

When I had my last baby, in 2014, I had barely heard of DRA, if at all. Now there is a huge amount of information about this condition floating about on the internet, and on social media in particular. In part the mismatch between my 2014 exposure and what I see now is accounted for by my career change. Being a trainer working with pregnant and postnatal women, rather than a lawyer, this information is on my radar in a way it wasn’t before. But I know from interactions with clients and from others working in this space that the career change doesn’t account for all of the difference. The pendulum seems to have swung from lack of/limited awareness about DRA to panic/hysteria.

Antony describes diastasis during pregnancy as ‘a useful adaptation, not an injury’. Basically, we would struggle to accommodate our babies without some stretching/thinning of the linea alba. That is the kind of thing that my brain needs to hear right now (not gasps of shock and ‘uh-ohs’, to link back to point 1). That is not to say that I am carrying on through my pregnancy with zero regard for my DRA. I am monitoring symptoms. I am modifying movements accordingly. I am managing intraabdominal pressure as best I can. As Brianna Battles would say, I am controlling the controllables. Perhaps we can all unite in a mission to rebalance the situation and calm the hysteria, to empower and inform without piling on guilt.

Thanks, Antony, for such an enriching learning experience. And for making me feel like this is going to be ok.

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