The Guild held a successful conference for professionals and exercise professionals on Saturday 30th September 2000 to explore 'POSTNATAL PARTNERSHIPS' - working together to support the postnatal mother. It was a great chance for members to meet and hear what other health professionals thought. Gillian Fletcher chaired the day and there were contributions from:-

For those of you that missed the day and would like to read the text of the Chair's address it is set out in full below and tells you a little about the history of the Guild.

The Chair for the Day, Gillian Fletcher, opened the presentations by explaining a little about the origins of the Guild.

Back in 1987 she had been asked by the NCT to join a working group to look at who was running the, then ad hoc, postnatal classes and what training could be offered. She herself had trained as a physiotherapist and as a National Childbirth Trust antenatal teacher and had run  postnatal classes for many years. 

Eventually, Gillian and Marion Grant, another physiotherapist, were asked to develop a postnatal teacher training programme. The first NCT training course was run in 1989 and between then and 1999 they ran twelve teacher training courses which included postnatal exercise, as well as discussion. 

In 1998 the NCT undertook a major review of services and decided  that it could no longer financially support postnatal exercise training.

The PNEX tutors felt very strongly that the provision of these classes by specialist trained teachers was very important and so the Guild was founded by a small group of enthusiastic teachers.

The Guild was set up as a non profit-making organization whose mission statement was, and is:-

To promote the development and organisation of specialised exercises courses that meet the needs of mothers during the childbearing years and to offer support and training to exercise teachers.

In her talk Gillian reminded us of the well-documented benefits of exercise and the effects on blood pressure, cardiovascular fitness and prevention of coronary artery disease. The benefits to women with gestational diabetes as well as prevention of Type II diabetes, obesity, breast cancer and osteoporosis and more recently studies investigating the possible beneficial effects on stress and depression. 

Her main focus, however, was on motivation and barriers to exercise and physical activity for young women in the childbearing age range. The opportunities we have for encouraging women in this category to adopt healthier lifestyles that may influence the next generation and the challenges we face. 

The Allied Dunbar National Fitness survey was published in 1992, surveyed 6,000 randomly selected adults. The findings indicated that in the group young women 16- 24 years of age

Only one third achieved the recommended amount of moderate intensity physical activity (5 times a week x 30 mins)

One fifth of women were sedentary (take less than 30 mins activity per week)

27% of young women were unable to sustain uphill walking (at 5% gradient) at 3.0 mph.

Over half felt they were not getting enough exercise.

Public apathy about physical education and the glitzy distraction of commercialised sports in mass media, sometimes hide the basic fact that physical activity is a public health resource for millions of girls as well as their families said The President’s Council on Physical Fitness & Sports.

Gillian asked us “What motivates people to adopt a lifestyle that includes appropriate levels of physical activity and what are the barriers to taking part.”

Which of the following do you think were the top reasons why people said they took part in physical activity?

   To meet new people,

   To seek adventure and excitement

   To look good,

   To feel in good shape physically,

   To improve or maintain health,

   To feel a sense of achievement,

When asked what the benefits of exercise and physical activity were for them, their answers were:-

   To learn new things

   To feel independent,

   To control or lose weight,

   To get out of doors,

   To have fun,

   To relax

And what were the reasons people gave for not exercising enough?

   I’m too fat

   I don’t enjoy it

   I haven’t got the time

24% of men and 38% of women were put off exercise because they do not regard themselves as “sporty”

Other factors given by women were:-

   Shyness

   Feeling overweight

   Lack of energy

This highlights people’s perception about exercise

Feminist researchers have shown how women’s leisure opportunities are structured by their distinctive position and role in society.  

Sheila Scraton’s work in Liverpool in the 1980’s explored why adolescent girls are so resistant to PE. She talks about the notion of ‘good practice in PE centering round discipline, neatness, good behaviour and appearance’

Interestingly in the HEA Active for Life campaign which focused on young women in 1998… those asked said ‘they did not want directive nannying advice on what activity they should be doing – most of them already knew. They wanted support and encouragement, fun and socializing and the opportunity to try something new and exciting.’ 

Scraton further explores the physical and biological changes that adolescent girls go through and ways in which they respond to these changes. Clearly puberty brings with it dramatic changes in body functioning and shape. She discusses the social construction placed on womens’ biology and expectations about how they should be responding to these changes. She suggests it is the Social and Ideological pressures linked to sexuality and body physique that produce the inhibition rather than a biologically determined physical restriction on movement. 

If we think about it the cultural expectation of young women is that of passivity and inactivity. Young women are not expected to ‘get dirty and sweaty and run around’.  Peer pressure is also important. She found that options lists in the PE department often showed names erased because the best friend did not want to take part.

Deems research on 168 young women randomly selected from 5 areas in a new town found that hardly any young adult women continued with sport or physical activity once they had left school, with the exception of swimming. 

Gillian asked us where all this research information left us? 

We are dealing with these same young women a few years on. Women now faced with another huge change in circumstance at the birth of their first baby, accompanied by many physical changes too. 

We are probably all well aware of the enormous demands on these women both social and emotional, mental and physical. If these are overlaid on the inhibitions about physical activity and possibly tied up with feelings about one’s body and the ‘out of control changes it is subject to’. How do we go about motivating postnatal women that physical activity can be fun and provide opportunities for socializing as well as laying the foundations for good health and not just for them but hopefully for the whole family in years to come. 

But herein lies a dilemma.

The pressures to get back into shape are all around. Only yesterday she was asked to comment on a local radio station about the Guardian article on Madonna getting back into shape so quickly. Young women may feel that they are being told what to do to get fit, perceive that getting fit involves donning skimpy leotards and leaping around at an aerobics session or pumping iron in the gym like the Cindy Crawfords and Posh Spices of this world. This may well conflict with their current reality of exhaustion and bodily changes as well as their feelings about physical activity.

Remembering that ‘I don’t have time’ was the most common reason for not exercising in the Allied Dunbar survey how on earth is a new mum going ‘to find time’. There may also now be the added element of the equation of ‘Can I afford it?’ now that I have given up work. 

Studies of the spending patterns of households have shown that being a member of a low income family may in itself limit leisure activities but even within such families it’s members are not seen as equally entitled to spend money on leisure activities outside the home. For many women access to money to spend on leisure is limited or non-existent. 

How do we encourage young women to take time for themselves and to become more physically active even when they are on a low income?

Well we need to be clear about the benefits of moderate activity including ordinary everyday activities such as brisk walking or dancing around the living room.

HEA defines brisk walking and energetic dancing as moderate physical activity making the participant feel warm and breathe more heavily. Going for a brisk walk with the baby in a buggy and a friend can be very beneficial. Walking is a very efficient activity in terms of energy expenditure and so to be beneficial we do need it to be brisk. As a rough guide you should be breathless not speechless. In other words be able to carry on a conversation.

Activities, which do not allow you to carry on a conversation, are classed as vigorous. Start slowly and build up gradually is the clear message for those who are currently leading a very sedentary lifestyle.

For those offering classes – the practical considerations are:-

   Crèche facilities

   Venue

   Time of class

   Cost

   Time management – passing on tips from others about how to make time for yourself

   Being sensitive to personal feelings about being overweight, feeling unwelcome and self-conscious.

Research challenges us all – let’s ask young postnatal women what they want. Let’s find out why they don’t attend classes and try to provide what they need.

Midwives could re-examine their own attitudes to exercise in pregnancy and the influence they may be having on pregnant women. Do they put people off by being anxious that they don’t overexert themselves or attend potentially hazardous classes.

Health Visitors can ask themselves – is the main focus on the baby? How do they support the mothers and encourage them to take time for themselves? Do they discuss their physical and emotional needs?

The recently published NCT postnatal survey reporting on the trends 11 – 30 days after birth found that:-

Half of the women surveyed felt the need for additional support and care.

One in six said they received little or no care during this period.

One in five felt they had received little or no information,  and a quarter believed they had not been offered emotional support. 

A woman who is struggling to meet the demands of a new baby and who feels her emotional, informational and support needs are not being met is probably not in a position to think about her long term physical well being. 

Physiotherapists – do you focus too much on education , and on the bits that can go wrong such as abdominal separation and stress incontinence? Or do you encourage and motivate?

Exercise teachers – when you get the women through the door are you thinking about their possible inhibitions about exercising and are you sensitive to their feelings about their bodies? Finally, do we do all we can to make sure we don’t fulfil their worst fears about exercise classes?

Following Gillian’s talk we then divided into groups looked together at the challenges we face. 

References:-

Allied Dunbar Fitness Survey – 1992 HEA

Sociology of Leisure – 1999 C Cricher, P Bramham, A Tomlinson

Exercise England – March/April 1998

Fit Pro – April/May 1998 Research Update

Women’s Health Research November 1998 Volume 1 Number 1