Sound Living
In this podcast, Dr Helen finds doctors and other health experts from around the world to bring you reliable information, based on facts and research, to inspire and support you to improve your health and wellbeing. Dr Helen Lawal is an NHS GP and a Regional Director for the British Society of Lifestyle Medicine. The BSLM is a registered charity dedicated to promoting Lifestyle as Medicine.
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Sound Living
Pregnancy: Mental health, exercise, sleep and lockdown
In this episode about pregnancy, Dr Helen Lawal interviews Dr Julie Gray. Julie is an NHS GP and currently 35 weeks pregnant. Helen is bringing up a new-born baby in lockdown. The pair share their experience as mums and explore: benefits of exercise in pregnancy and what precautions to take; how to maintain good emotional wellbeing and mental health during pregnancy; and practical tips to improve sleep both during and outside of pregnancy.
Hello and welcome to another episode of the BSLM podcast. And today we're going to be talking about pregnancy. So pregnancy, it's quite a big topic. So really, we're going to be focusing on three main areas and that's exercise in pregnancy, mental health and wellbeing, and sleep. And as someone who's recently gone through the journey of pregnancy myself, having just given birth to a baby boy, I can definitely vouch and say that pregnancy is a time of great change, physical change and emotional change as well. And I'm joined by a very special guest today who is on that pregnancy journey at the moment. She's 35 weeks pregnant. And that's Dr. Julie Gray. Julie, thank you for joining us today.
Dr Julie Gray :You're most welcome. Nice to be here.
Dr Helen Lawal :And congratulations.
Dr Julie Gray :I was just away to say the same to you. Congratulations for you.
Dr Helen Lawal :Thank you. So you're 35 weeks pregnant now?
Dr Julie Gray :I am indeed. Yes. Yep. It's getting close.
Dr Helen Lawal :And are you well into the swing of maternity leave?
Dr Julie Gray :I just started this week, so starting to nest as much as I can with a toddler running around the house in lockdown, but it's going okay so far.
Dr Helen Lawal :And normally when you're not on maternity leave, you are of course a GP and one of our fellow regional directors for the BSLM and you're based in Aberdeen.
Dr Julie Gray :That's correct. Yeah. So I work in quite a big busy city centre practice in Aberdeen, and have been a partner there for about eight/nine years now. And since having a little boy I do six sessions a week and then some out of hours. And yeah, I have a special interest in lifestyle medicine. So find myself in that role up in the northeast of Scotland.
Dr Helen Lawal :And I feel like if there's anyone who practices what they preach that's you. You're normally very, very physically active, aren't you? And you've come from a very sporty background. Tell us more about that.
Dr Julie Gray :So I've always been into sports, historically, my main sport was swimming. And then throughout my teens and then University years, I just, I guess, dabbled a bit in gym work and things like that. But I think my main interest laterally has been triathlon. That's really just come about in the last probably two to three years. And inspired by my husband who got into it about four years ago, and I was getting dragged around the world actually watching him do lots of events and helping him with his training and that I sometimes had to drop him off pick him up, when his bike broke. After a while, I thought 'You know what? Im going to give this a bash as well. So I gave it a shot. I had a lot of personal reasons for doing it as well as a few difficult things had happened. A few tragedies in life. And I was trying to find an outlet for that sort of energy and a coping strategy. And for me, it was channelling that energy into endurance sports, and it's just, I've absolutely fallen in love with it. So yeah, so I've been competing now for a couple of years and in the last year, I've completed two half Ironman and absolutely love it.
Dr Helen Lawal :But tell us a bit about the Iron Man for anyone listening that doesn't know what it is.
Dr Julie Gray :So an Iron Man, well a half distance Ironman consists of, it's a triathlon, so it's still a swim, bike and run. The swim component is about 1.2 kilometres and most of the events are open water so it's out in the sea. The cycling component is 90 kilometres when you come out the water you have to strip off your wet suit, get on the bike and do however long it takes you to complete that. And then once you finish the cycle, you then have to run a half marathon.
Dr Helen Lawal :That sounds full on.
Dr Julie Gray :Yes. And I've not had the guts to do a full distance yet, hopefully one day. But my husband does so and I've seen the pain he's gone through for that. So I haven't quite mustered up the courage for the full distance yet. But I've done half ones and really enjoyed it. But it's been parked for now because of baby number two on the way!
Dr Helen Lawal :And I'm guessing you've had to wind things down. And I guess that's a good place to start really with, you know, is it safe to continue exercising in pregnancy for women who are already quite physically active as you are?
Dr Julie Gray :Absolutely. And I think that's one of the important things for people to know is that you don't have to stop everything abruptly. You can keep going and there's so much evidence to show that that is beneficial for both the mother and for the baby from so many different aspects, not just your physical health. It helps minimise complications of pregnancy. And it's also great for your mental health during the pregnancy as well. So, if you're already doing it, the answer is yes. But you do have to make some modifications, for sure. Things that you would have to modify would be from a safety aspect. So for example, I would have previously done a lot of road biking, and I made the decision once I found out I was pregnant, that I wasn't going to go back out on the road and that's just a safety aspect. But there's adaptations you can make like training in your garage you know, if you've got a turbo trainer, things like that. And the second thing is, is to I guess, have a bit of acceptance that especially if you're into endurance sports, you quite like numbers. You quite like charting things, you quite like monitoring things, just accepting that that's going to change. Your fitness is going to change. You know, your physiology is changing, your joints and your ligaments are getting more lacs. So you might find that things get a bit more uncomfortable. So still keep going. But listen to your body, pull it back a little bit. And yeah, just try and keep as active as you can.
Dr Helen Lawal :That's a really important message, isn't it? Listen to your body. And I guess life gets really busy and we forget to do this in general, whether we're pregnant or not, but especially in pregnancy, it's really important to listen to your body and if something doesn' t feel right, physically, or you just don't feel comfortable, then to ease off most definitely.
Dr Julie Gray :Absolutely.
Dr Helen Lawal :And is there anything during pregnancy, so again, we're talking about women who were already physically fit, that they should definitely avoid doing?
Dr Julie Gray :Any high risk sports that would potentially result in trauma. So for example, I made the decision to stop going on the road bike, because, I know that sadly cars are not always that supportive of cyclists on the road. So you just don't take any risks of you know, a situation where you could fall off a bike. So that obviously applies to even more extreme sports where you could fall, hurt yourself, traumatise the baby, traumatise yourself. So yeah, you do need to sort of rein it in a little bit with for example snow sports. We know also as well from a physiological point of view things like scuba diving, that can pose a bit of a risk from your cardiovascular system so, so any high risk sports you do need to rein it in, tailor it, adapt it. Certainly from a safety point of view. But most strength conditioning and moderate intensity cardiovascular exercises are safe to continue.
Dr Helen Lawal :And if a pregnant lady is hoping to start to become physically active during her pregnancy. So perhaps she's feeling more motivated than ever, you know, it's a time for change. It's an extra reason to try and get healthier. What's the advice for somebody starting exercise for the first time during their pregnancy?
Dr Julie Gray :One of the first things that I would recommend for ladies who are completely starting from scratch is either do a bit of background reading or get some advice if you don't know where to start. But I would also reassure them that it's very, very safe. And there's lots of evidence to support that this one of the best times to actually start and initiate getting into exercise. You really need to start off slowly, as you would with any kind of new physical activity, start off slowly and build it up. So have realistic expectations that that first day that you participate in it, you may not be able to go for very long or you may feel like you haven't achieved much, but that little bit is just the first rung of the ladder. And then you can build on it and build on and build on it. So probably just starting off with something maybe two to three times a week for perhaps 20 or 30 minutes, and enough to just get that heart rate up a little bit. And that's what we are often referring to when we're talking about moderate intensity. It's about still being able to hold a conversation but getting that heart beating faster. And one of the things I often tell people is to actually think about the talk test or the song test, sometimes, referring to where your heart is maybe beating enough, your breathing is heavy enough that you can still maintain our conversation, but you might not be able to belt out one of your favourite tunes without a few interruptions. So that's often a good indication that you're working a bit harder than what you would be at rest.
Dr Helen Lawal :And of course, as your pregnancy progresses and the bump becomes bigger and you know, everything changes in the body, you might find that something at the beginning of your pregnancy that didn't get you out of breath then really does begin to make you out of breath. So, you know, you spoke there about building up exercise gradually and it can just be 10 minutes here and there. Even just carrying heavy shopping bags. And for me towards the end of my pregnancy, that would get me really short of breath or pottering around in the garden, or just walking down the street even. Something before I wouldn't have even thought twice about ,at that time for me would get me short of breath. And you know, so I think that's an important message as well to to get across.
Dr Julie Gray :Absolutely. And again, that goes back to listening to your body and knowing your limitations. Listening to your body doesn't always have to be a negative thing and think, 'Oh, I have to stop', because you know, pregnancy is a wonderful time to become really tuned into your body, tuned into that baby that's growing inside you. So just having a bit of respect for it and yeah, just being realistic with your expectations again with regards to when you experience these symptoms. It's not you failing, it's not you being unfit. It is that that wonderful baby you're growing inside you is just taking a lot out of you that particular day.
Dr Helen Lawal :And you've mentioned there about starting gradually, building up slowly if you're not already physically active or if you are maybe avoiding certain things. And how many minutes of exercise should we be aiming for during pregnancy to get all the physical and mental health benefits?
Dr Julie Gray :There, certainly, there's a lot of different evidence out there and there will be a lot of different pieces of advice you find. In general, for good health, for anybody, and this applies for pregnancy and non-pregnant. What we want to be aiming to do is about two and a half hours a week of moderate intensity exercise to try and get that heart beating. Things working a bit hard in our body. That's generally a good amount to aim for. So that's exercising, if you want to divide it up, maybe five times a week at just half an hour a day. But if that doesn't work with your routine, you can maybe do it less frequently for longer periods. Again, once you've managed to get that stamina up a wee bit.
Dr Helen Lawal :And let's talk specifically about some of the benefits. So I know that mental health is one of those you know. We know that exercise outside of pregnancy can be great at improving our mood, boosting our mood, does the same apply during pregnancy?
Dr Julie Gray :Definitely, it still has the same benefits in that the kind of hormones and endorphins that it releases have a positive effect on your mental health. Exercise will help with things like your ability to sleep better. Also we know from regular exercise that it has a kind of chain reaction on your appetite and your desire for certain foods. So you're gonna then be more inclined to eat healthier when you incorporate exercise into your day to day kind of journey throughout your pregnancy. So it encompasses all these things for sure. And generally people feel good about themselves after doing it too. They, they feel they have achieved something and they perhaps enjoy it. And it can be used as an opportunity as well to get that timeout from everything else that's going on. You know, most women are still working through their pregnancies and can be quite stressed, have other things going on. So just a few minutes, half an hour, hour, here or there just gives you that time to distract yourself and engage in something else, and feel much better when you when you finish it. You very, very rarely hear anybody say that they regretted doing any exercise session. They all feel good afterwards.
Dr Helen Lawal :And I think the topic of mental health during pregnancy, it's a funny one because actually it's the time where there's often that pressure to feel really happy, you know, and about being pregnant. But often, especially in the first trimester, it can be really difficult. So first of all, you're meant to keep it a secret, you're not allowed to share it with anyone, which can be really difficult. And then there's the morning sickness. And so you've got to keep that to yourself and manage that quietly whilst carrying on with with your job or looking after, you know, other children that you might have. And everything changes, doesn't it, hormones are changing, your body's physically starting to change. And I think it can be a really difficult time. And it can be a time of vulnerability, I would say, from a mental health point of view.
Dr Julie Gray :I would completely agree with that, especially due to the fact that there is just a culture to not tell anybody about it. So you can feel quite isolated. And many people have a partner that's going through that journey with them, but you know, they often know even less, they don't know how to comfort you, they're not experiencing what you're going through. So, so it can be quite terrifying from that point of view. And for all the reasons that you've mentioned, you can feel absolutely ghastly with morning sickness. Your sleep can be disrupted, but yet you've got to soldier on and try and act as everything were completely normal. And then you've got the anxiety of, especially if it's a first time pregnancy, of is it gonna be okay, you know. I mean, there's so many women that have had bad experiences. I'm one of those myself where I have, you know, had miscarriages and things and subsequent pregnancies then became quite overwhelming in the first trimester because it was that what if, what if, what if. There's also so many different rules of what you should and shouldn't do. And how am I going to get through that night out and pretend that I'm drinking and people don't second guess it? So yeah, there's so many emotions and then yeah, you're contending with the hormones as well. And boy, they're hard sometimes. You cannot control those.
Dr Helen Lawal :Yeah, it's a bit of a roller coaster, isn't it?
Dr Julie Gray :It is indeed. Yes.
Dr Helen Lawal :And also, it's not just about being emotional or being hormonal, you know. Depression can occur during pregnancy, antenatal depression affects one in 10 women during pregnancy and I was one of those women. And I found that exercise really helped me. But what else can women turn to during that time to help support their mental well being?
Dr Julie Gray :You've got lots of different resources that you can use in general anyway for anxiety, low mood, any of these sort of things and these apply both to during and out with pregnancy. But if you do feel that it is perhaps very much orientated around your pregnancy, and you know a lot of your mood, your anxieties and your fears are very, very much focused on that, then getting in touch with people like your midwife would be one of the most important first points of calls to make. We know that we can make a booking visit quite early on with them. They generally encourage that about eight to 10 weeks, but if you were really struggling, they will engage with you earlier. So using your midwife or your GP and just telling them how you feel. Because although you can't shout it from the rooftops, that you're pregnant, you can engage with these health professionals who know what you're going through to a point that they have a knowledge about it. And it's confidential. So they would be probably the most sensible people to go to. But at the same time, if you're familiar with other resources, whether they're online or they're counsellors you've used in the past, you can certainly go back to them as well for that generic support on your mental health.
Dr Helen Lawal :And actually, as we're recording this podcast, we're doing so in lockdown. So I mean, this adds an additional layer of stress to women who are pregnant at the moment. You know, a lot of us are isolated from friends and family, we don't have the same support mechanisms and coping mechanisms of being able to, to be sociable and be around friends and family. So have you got any advice for women like yourself who are pregnant during this, these unprecedented times? And during this really difficult, challenging time that we're all facing?
Dr Julie Gray :I do. Yeah. I mean, the important things to remember are that you're not alone. Every pregnant women in in the UK anyway (obviously, different countries are doing differently) are all going through the same. So first of all, think about how you can maybe connect with them. Now, I always am a bit hesitant and cautious about promoting using social media platforms to a point. But there are some good resources out there. There are some good say, Facebook groups. So use these with caution to connect with other people, perhaps use that to maybe connect with other people locally. Other things to remember are: Whilst one of the anxiety provoking things for ladies is that the antenatal care is, some feel it's being withdrawn slightly, it isn't. It just is that perhaps some of the appointments are now being done more remotely via telephone call. And perhaps a risk assessment has been done and someone who was meant to get several scans have had those reduced slightly. So you can feel a bit neglected in that sense, but remember that your midwife is still there, they're still on the end of a phone. And you may not be able to always have that face to face consultation with your midwife, your GP, but they are still there for you. So contact them if you're still struggling, because many of them are set up to talk to you through videos or through telephones. Some areas are still running antenatal classes, again through videos. So use those resources as well. If you want one really good resource just now, is the NHS Inform website. (https://www.nhsinform.scot/) If you actually go onto that website, there are so many links to different self help programmes and access to online CBT, which is cognitive behavioural therapy for anyone who's not familiar with it. There are so many different resources and you can pick one that's tailored to what difficulties you're going through. And then also use technology. You know, it's quite daunting for many people, but a lot of people are getting the hang of it now. You know, FaceTime, Zoom calls and, and my 95 year old granny is doing it now, it's great.
Dr Helen Lawal :That is impressive!
Dr Julie Gray :Absolutely. So use all these things to still stay in touch with the rest of the world. You don't have to lock yourself away in your four walls. Yeah, we might not be able to get in our cars and drive to see people, but we can still communicate with people, and you can still confide and tell them how you're feeling through these different mediums.
Dr Helen Lawal :Yeah, staying connected is more important now than ever.
Dr Julie Gray :Yep, absolutely.
Dr Helen Lawal :And also thinking beyond pregnancy once baby arrives, you know, you're going to want and need that support. And I started my antenatal classes outside of lockdown. And we now have a Whatsapp group with the other parents. And that's a really great source of support and we have regular Zoom calls and I think it's important to put the things in place now that you'll need to support you once baby arrives as well. So thinking slightly ahead as well.
Dr Julie Gray :Definitely. One thing I always recall was having a Whatsapp group with my antenatal group from when I had my little boy. And that was fantastic when you were up feeding at three in the morning because if you text somebody, guaranteed there was someone else sitting there.
Dr Helen Lawal :There's always someone else awake.
Dr Julie Gray :Yeah. And it just makes you feel a little bit better. Like 'Well, I'm not the only one sitting up in the middle of the night, feeling desperate for sleep'. So it's just that that solidarity of knowing that you're not on your own and other people are going through what you're going through.
Dr Helen Lawal :Absolutely. Now I think it's important that we move on to talk about sleep because that's a biggie. I mean, it's a biggie anyway in health in general, isn't it? Insomnia and sleeping problems, but pregnancy, it's next level. I know that I, towards the end of my pregnancy, you're 35 weeks, from around 35 weeks, I was waking every one to two hours by the time you know, baby arrived. It can be really really tough. Why is sleep affected so much during pregnancy?
Dr Julie Gray :So I always like to think of it as three different areas that have an impact on your sleep during pregnancy. So we've got the psychological side of things, which is just similar to what we've been speaking about. Anxiety and adjusting to, you know, what your body is going through. And the 'What will happen?', you know, the fear of 'I am going to become a parent'. But you've also got the hormonal side of things, which has a really big impact on your body. And then there's the physical discomfort. And that changes throughout each trimester for sure, you know. The physical side of things you've got, perhaps, say breast tenderness and things like that in the first trimester. And, you know, I certainly am a front sleeper, and that became a pain in the neck because I couldn't lie on my front. So, and then as the pregnancy progresses, you've got the bump and trying to roll over in bed is uncomfortable. You get a lot of ligaments and muscle laxity, so you can get pelvic and back pain. And then you can also get a lot of fluid retention caused by that the higher levels of oestrogen in your body. So that causes a bit of restless legs. Some ladies get carpal tunnel syndrome, some people get really itchy. There's those aspects as well. And then the last one that I mentioned was the hormonal side of things. We know that just some of the hormones that are produced just have an effect on the normal sleep cycle. And that's not something that you can control actually. Also the hormones in your body relax smooth muscle. So as a consequence, we need to pee lots. So that can often disrupt people, some people can be up several times a night because of it. And then it can even be some smaller aspects where as, again, it's the fluid retention, some ladies have problems breathing through their nose through the night. And one other hormonal bit which I've always found with both my pregnancies and interestingly, found other ladies get, is the hormones seem to cause an irritation towards your partner when you're sleeping in bed with them? I don't know why that comes about. I'm not sure they mentioned that in the medical text books, do they? They don't! But you speak to a lot of ladies, they find that their partners breathing, or something like that, gets quite irritating. So there are so many different levels from that, you know, the absolute discomfort to just the effect that the hormones are having on you.
Dr Helen Lawal :So what can be done practically to overcome some of these? Some of them can't be overcome, it's a case of hanging on in there. But is there anything practical that can be done?
Dr Julie Gray :Yeah, there's lots of things that you can do. You can preempt some of these things. And one of the biggest bits of advice that I would advise from a physical point of view is to invest in a really good pillow. And these don't have to be expensive, they can be bought quite cheaply. And if you can't afford to do that, then you know just, you know, even maybe just get a couple of pillows and sew yourself a big pillow case. So you have a nice long pillow that you can use to wrap around your bump, support your back or in between your legs during sleep. So that's one of the big things that I would recommend from a physical point of view. There are so many other things that you can think about sleep that apply to anybody and as well as in pregnancy. Get into a routine. And that's the most important thing you know, yes, your life is changing and it's overwhelming. But keep a routine, go to your bed at a similar time every night, set an alarm to force yourself to get up at the same time. So your body clock still follows that rhythm and just try and fight the kind of changes to your sleep cycle. Keep physically active, that'll tire you out. Be mindful of what you're eating and drinking as well. So again, if you're well hydrated, we know that that helps sleep. Avoid heavy meals right before bed. That's something all people should do for good sleep but particularly in pregnancy when you might be more likely to have reflux or more discomfort in your stomach because of less room. So be mindful of that sort of thing. Have breakfast in the mornings. Not only is that a good habit to have for various different reasons, but again, our bodies are tuned into that and we naturally start to wake ourselves up shortly before the timing of us normally eating. And then it goes without saying avoid things like caffeine and alcohol, which most pregnant ladies do anyway. And then again, attend to your mental health. Try to find a way to wind down. Try to find a way to switch off from that anxiety and that is a very, very individual. Because there's a lot of people, a lot of resources will quote, don't watch TV before bed, but some people find that does work for them. Read a book, some people find that overstimulates their mind, so find something that helps relax you before bed. And one other thing is about thinking about your body temperature as well. So having things like warm baths, warm drinks, caffeine free, obviously, that can help because it warms up your peripheries but cools down your body core, which we know is really really important for good quality restorative sleep.
Dr Helen Lawal :Those are fabulous!
Dr Julie Gray :They're just a few tips that I give people in general for sleep.
Dr Helen Lawal :I think it's really, really useful. Thank you for sharing those. I think that that's the biggest thing, isn't it? Just knowing that there's practical things that you can do during the different stages of pregnancy to get you through. Because each of the different trimesters you're faced with new and different changes, and it's just nice to know that you've got a toolbox of things to fall back on to help help get you through and help support you during this time.
Dr Julie Gray :Absolutely.
Dr Helen Lawal :Have you got any final words of encouragement for any listeners that might be pregnant?
Dr Julie Gray :Again, it's just about remembering that you're not alone. And I know it's a scary time and we don't know today when lockdown is going to lift, but it is not going to go on forever. I know a lot of ladies are feeling a little bit cheated just now because they may be losing their nesting time. I can completely relate to that because I should be on maternity leave while my little boys in nursery but he is here all the time. Love him to bits but I'm not getting that five hours a day of Netflix that I had planned to do. And I know that a lot of ladies are feeling cheated from the postnatal side of things. You know, meeting up with other moms, enjoying, you know, walks in the park with their babies, enjoying family visitors. It is difficult, but you are not alone is the most important thing that I would say and this will not go on forever. And you know, this child that we're bringing into the world, yes, these few weeks that we're experiencing lockdown is sort of overshadowing what you're going through. This child is hopefully for life, and we've got many, many, many, many, many fun years to come beyond COVID. And hopefully it will be something of the past and it will be something that we'll be able to tell our children about when they're of an age that you can tell them stories and remind them of the difficulties that you go through. I'm hoping that a lot of people will take a lot of appreciation lessons from the experience that we're going through just now. Perhaps moving forward in life, there'll be things that we don't take for granted and it might actually help nurture the lives of our children in the future. So, so I guess just trying to think of the positive spin on it the best that you can.
Dr Helen Lawal :Yeah, absolutely. I'm really glad that we're ending on a positive note because it can feel quite overwhelming. My little boy's four months now, as someone who's bringing up a baby in lockdown, they are the light aren't they? They are the bright shining light amongst the darkness and, for women that are listening who are pregnant, just hang on in there because once you see a little baby, it will all be worth it. And it will give you a new perspective on life. They are they're going to be a very special generation of babies, aren't they? Who were born into lockdown and yeah, very unique and special.
Dr Julie Gray :Definitely. Definitely.
Dr Helen Lawal :So Julie, thank you very much for your time today. And best of luck for the rest of your pregnancy.
Dr Julie Gray :Thank you very much, Helen.