Career Clarity with Athletes: A 2ndwind Podcast with Ryan Gonsalves

168: Dr Lamia Zafrani - What No One Tells Women in Sport About Pregnancy, Performance, and Recovery

• Ryan Gonsalves

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Dr. Lamia Zafrani saw firsthand what the system lacked and built a new way forward. A powerlifter, an OB-GYN, and a passionate advocate for female athletes, Lamia sits at the intersection of performance and pregnancy, challenging outdated norms that have sidelined women for far too long.

In this episode, we go deep into her journey. From being the one who gets called when nobody else knows what to do, to creating a model of care that truly supports elite female athletes through pregnancy and postpartum. She does not just talk about the science. She brings the nuance, the humanity, and the stories of women who have felt unseen and unheard in medical spaces.

If you are an athlete thinking about family planning, a coach supporting women, or someone navigating your own physical transitions, this conversation is the permission slip, the blueprint, and the fire you did not know you needed.


What You'll Hear:

  • Why elite athletes are still being told to “just stop training” when pregnant
  • The emotional and identity shifts women face during pregnancy and after birth
  • Why preconception care is more than a checklist and when to start thinking about it
  • How Lamia is helping build policy changes for female athletes, not just temporary fixes
  • The real stories behind training while pregnant, including PBs that shocked everyone
  • How Lamia blends strength coaching with clinical expertise to support recovery
  • Why postpartum plans need to be built around the athlete, not the average woman
  • How high performance women are redefining what is possible after motherhood


💎 GOLDEN NUGGET:

“No two pregnancies are the same, not even for the same woman. If we are serious about supporting female athletes, we cannot use cookie cutter care plans. We need systems built around the real bodies and real lives of women who perform.”


This episode will challenge you to think differently about strength, identity, and the seasons of life. 


Need Career Clarity or Transition Support? 

If you are navigating what is next in sport or beyond, visit www.2ndwind.io
to learn more or book a consult.

SPEAKER_01:

I'm interested in who you sort of typically work with and what their ranges of athleticism are. And then I want to just talk a little bit more about how. But if you help me understand that that who piece, what do they look like?

SPEAKER_00:

So a lot of the sort of consulting work I did was with sort of MMA, Brazilian Jiu Jitsu, CrossFit, athletes, basketball. And people would usually ask, well, how can you work across sports? And my argument is always, well, if you understand the biomechanics and you understand the physiology, those things don't change very much from sport to sport. All that changes is if you understand the physiology and the biomechanics, what you can do is you can break each sport down into its basic movement patterns. What is it that the athlete needs to be good at to excel in that sport? And then look at the aspects of that sport that they are not safe to continue with potentially during their pregnancy.

SPEAKER_01:

Hi, I'm Ryan Gonçalves and welcome to a Second Wind Academy podcast. A show all about career transition through the lens of elite athletes. Each week, I invite a guest to the show who shares their unique sporting story. Please join me to delve into the thoughts and actions of athletes through a series of conversations. Don't worry, there's plenty to learn from those of you that aren't particularly sporty. Elite athletes are still people afterwards. Let's be inspired by the stories of others. Lamia, great to have you on the show with me today. Thanks for joining.

SPEAKER_00:

Thanks for having me.

SPEAKER_01:

Now, I my cliche that everyone tells me is that I'm always so excited and happy to have people on the show. And it is true, I am happy, and I am really glad to have you on today because well, look, you're going to bring something that, well, you know, I know very little about, but I'm so I'm really excited to learn a lot about your perspective and what you see with elite athletes.

SPEAKER_00:

Yeah, I'm happy to share all of that. And like I said, I can talk and talk and talk. So you might have to uh stop me at points.

SPEAKER_01:

Just a perfect kind of guess. It's like I'm just gonna sit back. I've got my drink and uh we'll we'll just take it from there. Now, Lamia, for those who don't know who you are, please can you just give us the introduction, who you are, and what you're up to nowadays?

SPEAKER_00:

Yeah, so I am Dr. Lamia Zafrani. I'm an obstetrician and gynecologist from the UK. I'm also a specialist in elite athlete health. So I work with athletes and their organizations to help them through any women's health issues that are affecting their performance, everything from menstrual, so period problems through pregnancy, through their postpartum return, all the way through to menopause if they're still sort of in their athletic careers at that point. And in some sports, they might be.

SPEAKER_01:

Yes, yeah, I guess they will be.

SPEAKER_00:

Now I've seen menopause indeed.

SPEAKER_01:

Yes, yeah. Well, look, well, what already amazes me is the fact that I've not met many doctors like yourself who focus in that elite female athlete uh perspective. And as I see the professionalism of the game come up, we're starting to learn so much more about it. You know, as a coach, as a you know, football coach coaching young women, you start to change things in terms of intensity of training based on different cycles. There's so much more knowledge that's out there. But I'm guessing from a female body perspective, let me ask the simple question first. Nothing's really changed over the past 50, 60 years of doing sport.

SPEAKER_00:

No, not really. I think what's changing is, well, if we go back sort of history of it, just generally in women's health, so not even sort of sports gynecology, but just in women's health in general, women have been excluded from sort of being sort of participants in medical research. There's a lack of funding in medical research into women's health. And then if you were to add athletes, sort of athletes and athlete health into that, we're even further behind. So whilst female physiology hasn't changed, the science hasn't changed, what we know about the science, what we know about the physiology is ever changing. And sort of as we speak, there are more and more studies being released now on the benefits of exercise and pregnancy, resistance training in pregnancy, sort of how to exercise around IVF cycles, egg freezing, and all of these are you, you know, if you're in the sphere, you might actually come across one particular research group in Canada that is doing a lot of good work in that field. But for those of us that have kind of been working in the realms with female athletes and in female athlete health, some of it is in what we call empirical. So we see it in practice, we're already doing it. We kind of need the data to back what we're doing and what we can see in practice already. And that's where we're lacking, and thankfully we're starting to catch up. Well, we are very behind, just generally.

SPEAKER_01:

As in, so when you say we're behind, we're as in the empirical research on women's health in sport is behind, or is it more specific to either country or sport in the code?

SPEAKER_00:

No, I I think it is quite general across the board, and um, and I guess a lot of that is to do with because we do do quite well in speaking to you know, when we when we look at research, it's usually global. If there's a good piece of research, it's out in the global sphere. So it's it's actually a worldwide problem. The US is always a bit better just because they have more money and funding available, but essentially still looking throughout, you know, we're only now looking at football players and their injury and ACL uh injury risks around their cycles. Now, the athletes, when they reach out to me, they're saying, my coach doesn't quite understand when I say to them, I get more injuries when I'm training in this part of my cycle. And they're like, oh, okay. And but the the athletes are noticing, and now we're coming back with some research to say, actually, you it's not in your head, you're not crazy, you're right. There is there is some links between your cycle, the hormones, and then an injury risk. So, but the conversations are now happening. The athletes are feeling a bit more empowered to have those conversations with their coaches. The coaches are getting more educated to say, okay, yeah, I'm seeing some research coming out on this. I think it's FIFA that's doing a really good women's health project at the moment. And part, one of the parts of that is looking directly at ACL injury rates and whether there's any difference with the menstrual cycle. But there is so much more that we need to know. And those of us that are working in the field will say, you know, we we know that there's something, but we haven't got the power of uh research. So empirical, i.e., I'm working with an athlete or a number of athletes, I can see that there's some sort of pattern emerging. But I'm still only working with one, 10, 20 athletes. That's still not enough to for me to say, to make a generalization across all female athletes. And it's only when those of us that are working and work with the researchers to put all that information together, that's when we can get powerful research that can then be generalized and used. And I think that's where the problem is. That requires time, that requires funding, both of which we haven't been given. So, which is changing, which is always good.

SPEAKER_01:

So, let me I'm interested then. What is it that interested you in elite sport, in working with female athletes? You know, was that something you'd always intended to do, or did it happen just by chance?

SPEAKER_00:

So, my background is I have been powerlifting since I was in my early 20s. I'm now 38, so it's been a while. Um, I wasn't a competitive powerlifter, recreational athlete, I would call myself. But this was at the same time that I was medical school, and then I graduated from medical school. But one thing I realized was medical school didn't really teach us nutrition, didn't teach us about exercise, you know, maybe a lecture here and there. And, you know, I don't think it's changed very much. So everything that I went and learned around nutrition, exercise, physiology, all of those things were because of my hobby and my interests, and it was somewhere where I felt that there was a gap. Then I started my residency in obstetrics and gynecology, and I think I remember the day it actually dawned on me that there was such a big gap, and actually I wanted to try and fill that gap as much as I could. I remember being in my antenatal clinic, and I had a CrossFit athlete who'd was 32 weeks pregnant, and she came in and I don't know how we got onto the conversation, and she started telling me about how she's still training CrossFit. I asked her if she was making any modifications, and I mean and bear in mind, this is like 15 plus years ago, and she's telling me, no, I'm not making any modifications. She wasn't asking my permission as her doctor to be like, should I be doing this? She was just like, Yeah, I'm doing this already, and yeah, I'm great, it's fine. I was really impressed. And then I thought, but hang on, is this okay? I I don't actually know. I don't know the answer. I'm her obstetrician. She's not asking me, but I should know about this. Like, what should I be advising her about the safety and long-term effects? And and then I thought, I'm powerlifting, and one day, hopefully, I'm I want to have children. I don't, and I want to carry on doing whatever I'm, you know, the training, etc., through my pregnancy, but I want to have the evidence and know that I'm giving the right advice and know that I'm being safe. And then that kind of took me down this rabbit hole of trying to find the research. Surprise, surprise, there wasn't much. So then I thought, right, I'm gonna start finding people to I guess just on that.

SPEAKER_01:

So, you know, it's interesting as you're coming through medical school, this this level of uh, I guess, focus on, like you say, the sport and that physiology, that wasn't something that that became part of it. Chance conversation just gets you thinking about your own experience and like, hey, I you you don't know what the answers are. So I'm interested then in what made you want to figure out more and and then and what did you what did you do first? Because there's going to be people there listening who say, Oh, yeah, I'm interested in sport, but go down, you know, they're doing whatever that field is. You did something that started to get you focused, a bit more focused in this area. Just talk to me about what that process was.

SPEAKER_00:

And it was a very non-traditional approach, because as doctors or uh as medical students or as medical trainees, the the medical field itself is very, it's very hierarchical, it's very traditional. There's very much pathways set in place for how you go and learn and how you train, etc. But there wasn't one for sports gynecology, and there still isn't. There isn't. I'm trained as an obstetrician and gynecology consultant that I followed the traditional route and went through all the hurdles, the exams, everything and practicing. And the sports side, yes, there are qualifications in sports medicine, masters, etc., that I could do, but I wasn't, I wasn't really interested in doing the whole of sports medicine because I know there's great colleagues that are doing all the musculoskeletal, all of the orthopedic, you know, all of the other things. I was specifically interested in a very specific part, and that was the female athletes, pregnancy and postpartum. And then obviously, as I started going down that rabbit hole, I then came across other conditions that affect female athletes more so than the general population, and it all kind of came together. But it was very much the pregnancy and postpartum and training where the gap I felt was that I was interested in. So what I did do is I looked to the US where there was more research, more funding, more people already working in the spaces that I was interested in. And I then went about gaining a um coaching qualification in pregnancy and postpartum athleticism and became a pregnancy and postpartum athlete coach. So I was able to coach women, yes.

SPEAKER_01:

Question There's a coaching qualification for training pregnant women.

SPEAKER_00:

There is. There is. It's um in what? In what? So Brianna Battles, that's who whose coaching qualification that I did. She essentially, I think her background was very much S and C coach, CrossFit athlete, had two children, realized during that time she had no idea what she should and shouldn't be doing, kind of made it up as she went along. It was after that that she realized that the gap in the market. And then she went down her own journey of then getting qualified in sort of um pelvic health physiotherapy, working with pelvic health physios, working with people like me, and essentially put all of that information together into a qualification that looks at every aspect of the female athlete. And she doesn't sort of discriminate against athletes being elite level and recreational. She says any woman who wants to do any element of physical activity through their pregnancy and postpartum is an athlete, and that's how we work, and they're just different levels of athletes, and that's what I loved. So, yes, there is a qualification, and it's a it's a proper qualification with the right uh qualified professionals giving the information up about the different aspects of the course itself. So, not an influencer, not someone who's had a pregnancy trained through pregnancy, and then thought she can tell you how to do it. But you've got doctors, physios, SNC coaches who are all collaborating together.

SPEAKER_01:

Right. Okay, and so for you then, this this piqued your interest, started getting you going down this path of researching more about exercise in and around pregnancy. And I guess I'm fascinated because of the coaching qualification. That isn't something that I I knew before we were talking. So I was like, wow, okay. So this actually gets quite structured. So talk to me then a little bit about the types of women that you work with from this sort of sports perspective.

SPEAKER_00:

Well, I'll go backwards a bit to go forwards to say how to kind of explain how I work. So even though I did the coaching qualification, I knew that there were so many good fitness coaches in that sphere that it I didn't need to be another fitness coach. I knew that I had something else that I could offer. And for me, it was the I could, I'm the obstetrician and gynecologist that is offering the obstetric and gynecology oversight. That's what's lacking. So actually, what I did was I then worked with fitness coaches and was basically working on a consulting basis. So if they had athletes that were pregnant or postpartum, struggling with any issues, etc., they would then come to me for sort of advice and advisory around their pregnancies, et cetera. So I wasn't necessarily doing the day-to-day, week-to-week sort of coaching as such, although I'm able to and I can have an understanding. What we do is we would look over their sort of training plans, their nutrition, etc. But where I was coming in with an individual and unique perspective was, okay, what's actually going on in their obstetrics? What's their own what's their OB telling them? What's their obstetrician? What's their gynecologist saying? Because what would normally happen is as soon as they developed any form of complication as such, they were being told by their obstetrician, rightly so, if you're unexperienced, if you're not experienced in something, you just say, I don't know, speak to your performance coach. The performance coach would say, I'm not an obstetrician, and the poor athletes get bounced around and they're saying, I'm being told to go see this person, this person's saying I'm not qualified, this person's saying I'm not qualified, and then they were left in the middle. So I was basically that person in the middle that actually joins the dots, and that's predominantly how I work.

SPEAKER_01:

Right. And you and sort of I'm piecing in my picture now what it is that you're doing. I'm interested in who you sort of typically work with and what their ranges of athleticism are. And then I want to just talk a little bit more about how. But if you help me understand that that who piece, what do they look like?

SPEAKER_00:

So a lot of the sort of consulting work I did was with sort of MMA, Brazilian Jiu-Jitsu, CrossFit athletes, basketball. And people would usually ask, well, how can you work across sports? And my argument is always, well, if you understand the biomechanics and you understand the physiology, those things don't change very much from sport to sport. All that changes is if you understand the physiology and the biomechanics, what you can do is you can break each sport down into its basic movement patterns. What is it that the athlete needs to be good at to excel in that sport? And then look at the aspects of that sport that they are not safe to continue with potentially during their pregnancy. And then how can we actually train them to get to the end goal, which is to still maintain those movement patterns or get better at whatever it is, skill that they need for that sport without actually adding extra pressure, extra tension, extra load, and extra injury risk, really? And that's kind of what that type of athlete with.

SPEAKER_01:

Who is now you've you've touched on some great sports. So I've got a whole load of very basic and simple questions to start asking you. But I'm gonna ask this one first. Who is your customer in this regard? Because you mentioned their injury risk, which makes me think it's the expectant mother. But before we even started this conversation, I was like thinking, it must be all about the baby. What can the baby take? What sort of movement and impact and things can can they sustain? But you're on about injury risk. And I'm like, ACLs, come on, surely it's about the baby.

SPEAKER_00:

Babies are very resilient. And you know what, in obstetrics, and we joke and we say, oh, you know, your baby's actually like a parasite. It will take what it needs from the mum, it will survive, usually, you know, it's built to survive essentially. So even with now there's research coming out into uh sort of combat sports and collision sports, and actually we're finding the women that continue to work to train in collision and combat sports, even though the official advice is not to after 12 weeks of pregnancy, you can't stop someone from doing what they're going to do, they have making an informed decision and doing it anyway. What we can then do is watch them and see what happens. And actually, from what we call observational studies, we're watching them, we're seeing what happens. And what we found is nothing bad generally happens. So actually, we need more data, but we're not seeing that there was any what we call adverse reaction. So basically, what that means in simple terms is women who still continue to do even things like collision in combat sports after 12 weeks of pregnancy, nothing bad happened to their babies, essentially.

SPEAKER_01:

So their babies still now now I know this isn't, you know, we're not on this empirical, and you're not giving it, you're not giving advice on this particular show, but because you you mentioned perhaps three areas. So I I go straight to so you mentioned MMA or anything where you're in a ring and you're you're you're fighting collision. So I'm jumping to rugby, or I go to things like uh a rugby or anything else where you get you're getting hit, and then basketball, because you're literally jumping up and down. So you've you've I think for me, you've hit this perfect trio of sports where well, how was my eldest? My eldest normally is 17. So 17 years ago, I probably just fattened my wife up, probably won't like me saying that. Um, by feeding her and trying to follow everything in the book and like, right, you need to eat all of these things, you know, to obviously protect him. Now, here you're you know, combat.

SPEAKER_00:

You still need to do that. I mean, you still need to eat well, and that's a different part of the story as well, and very important one as well. Yeah.

SPEAKER_01:

Yeah.

SPEAKER_00:

But just looking at the training side, yeah.

SPEAKER_01:

So yeah, go on and well, that's it. So we're talking about the training, and that's kind of why I'm trying to figure out some of the who's in in terms of the um, is someone who is, I'll say 24 weeks pregnant getting into a ring and having a full having a an official fight at that time, or are we talking more about managing a training aspect?

SPEAKER_00:

We wouldn't we wouldn't be recommending, and I don't think I've met as yet anyone who actually wants to get into a ring for a competition at whilst they're pregnant. When you're pregnant, the usual advice that we're giving, and we're all usually singing from the same hymn sheet, is it's not pregnancy is not the time to be breaking records. Although there's research coming out to say challenging that notion. Anyway, we'll stick to what I know for now. And I am more than happy to update my knowledge as more research comes out. But essentially, up till now, pregnancy is not the time to be breaking records, taking risks, etc. We usually look at it as a time when you want to essentially be at maintenance. You want to maintain your strength, your skill, your speed, etc. And essentially that's what we want to be looking at, the nine months of pregnancy, 10, nine, 10 months of pregnancy, and then the time postpartum to rebuild that. So essentially, what you want to do is try and uh sort of preserve the strength, the speed and things as much as you can, so that when you come out the other end, you are in a better condition. And actually, what I find with a lot of athletes is and their performance teams is they usually think more is better. So they'll start to worry if they've got first trimester, nausea, vomiting, and they're really sick and they actually just feel awful and can't get out of bed. Obviously, they can't train, they're not in a state to train. My usual advice is this is temporary, it's fine. You don't need to train, you know, as you would have expected. You just have to manage the symptoms you've got. It's temporary, but nothing bad's gonna happen to your fitness levels because the very fact of being pregnant, the amount of pressure it puts on your heart, your lungs, etc., if we were to do VO2 max testing, hate heart rate variability and things like that, now with wearables and things, we know that even the average woman comes out a lot fitter potentially out after pregnancy just by looking at their heart rate metrics. So an athlete who is already looking into these things is much, much fitter to start with. I always try and reassure them nothing bad's going to happen. You know, you've you've just got to be intentional about your training and we have to work around all the symptoms that you're getting. It is temporary, don't panic. Now, in an ideal world, people would get pregnant, sort of away from a competition cycle, an Olympic cycle, etc. But that doesn't always happen. But that that's the best plan. And this is another point that I love having these conversations with athletes. If you can plan your family planning, preconception counseling is one of the biggest things I do, which is speaking to athletes before pregnancy about their options. And I think that is a big missing piece in in sport as well. But that's a that's a topic we can also touch on. But essentially, pregnancy is not the time to necessarily be pushing yourself, although we're getting new research that might prove me wrong. And I'm more than happy that when that research comes out, I'll have you change what I do.

SPEAKER_01:

Well, that's well, we'll you we'll come back on and we'll we'll educate again. So then one of the words you've used a lot is continue. So, you know, in terms of those who you consult with, you've spoken, you've you've used the word continue rather than start or sort of ramp up. So this also is as much about that continuation of training patterns and adjustments rather than perhaps kicking off someone new. But you know, that's just what I'm hearing, I think.

SPEAKER_00:

Yeah, and there's and this is kind of this touches on a lot of myths around training in pregnancy. So one of the myths is that you can't start something new in pregnancy, and actually that that is a myth. Now, looking at an athlete, they're not likely well, no, they may have to start something new. So, for example, if we're looking at an athlete who essentially hasn't incorporated strength training into their training for their sport because they're just training sport specific, one of the main recommendations we make is actually, if you can't do, for example, you can't, I don't say that you can't get in the ring. You can get in the ring, but it has to be with the same training partner, you know, someone you know, trust, you can train in a specific way, but it's not sort of competition, it's not getting in the ring for a fight. You can still continue training as long as it's with the same partner, they understand you, you trust them. There's lots of different caveats around that. But essentially, we would break down what that fighter needs to be good at for their sport, and usually every sport I find can be broken down into starting strength training if you're not already doing it as part of your uh um as part of your training for your sport. So if you're not already doing strength training in some capacity, that is something that we recommend starting. And that's a myth that you can't start something new. Obviously, if you're starting something new, you're not going just like if you were starting any new sport, you're not going to jump straight to you know high level. You're gonna get on there. Yeah. And yeah, there is no reason that you can't start something new in pregnancy. And I say this to my non-athlete average patients in the NHS as well. You know, what sport, what what exercise do you do? And if they say none, I'll say, Well, what do you want? What do you enjoy doing? Because it's really beneficial for your pregnancy. So let's get you started. And that's usually a refreshing perspective for them because they're usually told you can't start something new, you can just continue what you're already doing. And that's a bit of a myth, amongst lots of other myths.

SPEAKER_01:

Wonderful. Keep let's keep breaking these myths. This is fine. I'll keep honestly, I'm I am I'm fascinated. So my my mum, as I grew up, she's she's a nurse, and so she's been a nurse as far as I know all my life and um work works now in neonatals, but on neonates, but has been a midwife as well. So I always it's always fascinating as I because I've grown up with midwifery books on the kitchen table and sort of all these views, and it so I'm I'm always asking questions in and around this area. So it is wonderful to have you to have you join me today as well, Lamir. So now I guess I'm getting this picture of who these athletes are, the types of sports or what it is that they are doing. Now, you you sort of introduced earlier that you work alongside perhaps their the club or their fitness trainer. So now I'm just picking a couple, an example and just talking about how you support and you know, sort of the types of guidance that you would take somebody through.

SPEAKER_00:

So, in an ideal sense, it would be as soon as they find out they're pregnant, essentially they need they need to, we we need to start certain screening processes. So they need to have a pelvic floor screening, they need to have essentially just general screening for their fitness levels, etc. And essentially a lot of it is finding out from the athlete what they want to achieve and then working with them and their expectations. And sort of sometimes it's you know, if the athlete's like, I want to carry on training, but actually they've developed a condition where their pelvis is unstable and they get pain, their training's gonna need to change to accommodate that, even though they've wanted to do something. So essentially the first part of it is screening. So you start screening them for things like hypermobility. So are they at increased risk of having these unstable pelvis and pain syndromes and things? Are they at high risk of getting, you know, a lot of women will think that if they're very fit and active, that that means they're not going to get a problem in pregnancy. And unfortunately, that is not the case. You could be very fit, very healthy, but you know, there are certain things that happen in obstetrics, which is why I'm paid to be on call 24-7, because you know, you could have an amazing pregnancy but still have a complication during the delivery, or you could have you'd be very fit, but you'd still develop, say, symphysis pubis dysfunction, which is where your pelvis becomes hypermobile. And to be fair, I see that in athletes a lot. I think the things that make them very good at being an athlete, potentially they get hypermobility, that increases their risk of getting um what we call SPD, where their pelvis starts to uh essentially become hypermobile and then they get pain. So so, yes, screening and then it's basically.

SPEAKER_01:

I was just gonna say something like that must be really challenging because well, didn't Serena Williams win a grand slam while she was in the early stages of pregnancy? And I'm thinking you're gonna have loads of female athletes, a lot loads of athlete female athletes who who are training and but don't realize that they're pregnant for a certain certain few weeks, if not months.

SPEAKER_00:

Yeah. I mean, usually this is the thing, you've touched on a really, really important point. Every pregnancy is individual, each so even the same athlete getting pregnant more than once can have complete two completely different experiences. So each pregnancy is is different, so each athlete needs to be treated as an individual. So whereas I get asked a lot, oh, can you not just write a program or something and we can just cookie-cut her and just put it across her? And you really can't, because you know, even each sport is different, but each patient, each person is different, each athlete is different, each of their own pregnancies will be different. And actually, what we need to do is essentially not be sort of you have to be proactive in certain things, but you also have to be reactive in other things. You have to be proactive in managing expectations, certain things that you know are going to occur in pregnancy, but also to an extent, they don't always happen to everybody. So you have to be reactive as well, in the sense that week by week, I'd be having meetings with the athlete and check-ins essentially with the athlete, their performance teams, at least monthly to address any changes that are happening and to basically provide that oversight. But yes, it has to be individualized and literally it has to be very dynamic. So the coaching and the advice and everything that we do, what we call in a multidisciplinary team setting, it needs to basically the plans could be changing every week. And that doesn't normally happen outside of pregnancy because usually you'll get a program and you know you're following it for a certain amount of time, etc. But in pregnancy, things can change so quickly that we have to be prepared to make those changes reactively as and when they're happening in real time. So that's a bit of a mindset shift, both with the athlete and the performance teams as well.

SPEAKER_01:

Yes. And so we were we were going through how, in a in a perfect world, what that routine would look like. So when so it's are you do you find yourself, your consultations are more with or just as much with the the athlete as they are with their performance team or their coach? And is it like a three way meeting that? Takes starts to take place.

SPEAKER_00:

I mean, in an ideal world, there's it's a multi what we call a multidisciplinary approach. So, you know, everybody in the same room or online together, but essentially in the same place, having a discussion together with the athlete there. Then I also have check-ins with the athlete themselves because there'll be certain things that are medical that they may not want to necessarily speak to the whole team about, but their or their obstetrician. So I'm not necessarily delivering their babies as well. That's you know, they have their own obstetricians to do that, but essentially their obstetricians might be adding information, etc. And essentially I'm then explaining how that relates to their performance goals or how that relates to what they're doing in terms of the performance side of things. And one of the main things I found from working with athletes is they usually find that their obstetrician, midwife, is very much looking at their pregnancy, their performance team is very much looking at their performance. And I've had a couple of them say to me, Nobody's even asked me how I am. They're like, How's the baby? How's the pregnancy? Yes. How's your training? They're like, I'm vomiting all the time. I haven't slept properly for a few days. Nobody's asked me how I am, and they're still expecting me to carry on training. And to an extent, I end up being that advocate for the athlete themselves, as that middle person that says, Look, you know, I don't think this week's a good week. Don't worry about we can work around this, we can work around this. And and essentially, yes, being an advocate for the for the athlete themselves as well. And taking that mental load off them, because a lot of the other athletes I've spoken to, let's say they've gone through a pregnancy without sort of this sort of support, they've usually said, I've had to do X, Y, Z myself, I had to figure it out on my own, I had to be the advocate for myself, and that took a huge toll on my mental health. But actually, I would rather give that to someone who I trust who knows what they're doing. And that's a big another big part of what I do.

SPEAKER_01:

So, yeah, and it's helping them the mental load, help them from the mental side of things, the physical aspect. And we touched on earlier to do with the nutrition, me fattening my wife up for the first pregnancy, the other two, we were she was we were good, we were good. So when it comes to that nutrition side, how does that sort of play a role in in your work?

SPEAKER_00:

So, in an ideal world, and this doesn't happen even without them being pregnant and sort of me being involved, you know, you'd ideally want a dietitian, nutritionist involved with athlet with female athletes, because it brings up another issue that exists outside and even before of pregnancy in something called red S or Reds, which is essentially a fancy term for not eating or not fueling yourself enough for the amount of output or the amount of work that you're doing, which then results in gynecological problems, like your body starts shutting down your periods, your bone density goes down, etc. Now you're more at risk of sort of that kind of underfueling pattern happening in pregnancy because A, sometimes the athletes are not eating enough even outside of pregnancy. We don't really know what each individual person, let alone athlete's nutritional requirements are in pregnancy. We have this figure that we're told 300 extra calories in the third trimester. But that's looking very generally, not look taking what, not taking athletes into account firstly, and not even taking into account that each individual athlete is going to have a different output based on what their training, what their sport is. So at best, it's still a bit of guesswork, but it's very important because actually we know that they need to be eating more, but to just to support A, their pregnancy and B their output from their training, but actually now you're battling with sickness, now you're battling with feeling sick, actually being sick, etc. How are we managing that? And you know, in some cases, the sickness can last the whole of the nine months, or they can have some complications such as hyperemesis, where you actually start losing body weight and it's and it's quite an awful condition. So if an athlete ends up with that, or just the nausea and vomiting, but it's lasting a long time, then actually we need a dietitian or a nutritionist so that they can have strategies that can help them as well. Um, otherwise, yes, you risk underfueling, and essentially we we know that underfueling, essentially your baby is still, I say like a parasite, it will take what it needs from you. It's the mum, it's the mum, you know, iron level, drop, anemia levels, vitamin D levels, all of these things, which are not going to put the woman in the right sort of nutritional status for when she wants to come back to training postnatally. And then you're adding breastfeeding potentially into that mix if they're choosing to breastfeed as well.

SPEAKER_01:

So let's come to that, you know, I guess the post-pregnancy piece, the labour. Well, it sounds like there is this individualised plan. And you mentioned this multidisciplinary approach, which actually reminds me of batch tested, Kevin Brown. She joined me on the show a year ago, and she was talking a lot about that multidisciplinary approach needed because she comes at it from a sports pharmacy aspect, and so thinking not just about eating, but then also about any supplements and things like that that might be needed to be taken during this period as well. And I mean, is that you know, sorry, that's just coming to me as is that something that you would touch on as part of that multidisciplinary approach?

SPEAKER_00:

Yeah, if I'm honest, and I'm I'm learning more about this as I work with um sort of researchers and clinicians who are in the anti-doping space, even something as simple as folic acid, which everybody, every woman needs to take, you know, ideally three months before pregnancy, before she becomes pregnant, and definitely in the first three months of pregnancy. But standard folic acid is not batch tested. So essentially, I'd recommend you take it now, but I can't guarantee that you know it's not never has up till now, but essentially it's not batch tested. So, from an anti-doping perspective, we need to do better if we're, you know, these women, we are getting more athletes that are choosing to get pregnant through their careers, not waiting till retirement. So, you know, I was speaking to someone who works in anti-doping and talking about, you know, can we get supplement companies on board that can batch test things like the basic things that all pregnant women need? So the athletes definitely need your iron, your folic acid, your vitamin D, etc. Essentially what ends up happening is the athletes take the pregnant care, they take the folic acid, and they take a risk. And then nothing has happened as a result of that, but you know, these things are not bad.

SPEAKER_01:

No, well, I guess off the back of this, I better drop Karen a note and see what she thinks. Um, well that yeah.

SPEAKER_00:

Well I think from company's perspectives, what I was told is how many athletes do we have really in the world that would use this? Is it essentially for them? Is it worth business perspective? I mean, I don't know the answer to that.

SPEAKER_01:

No, no, we don't. And I guess this comes down to that, you know, the evidence base that needs to be built around female athlete and pregnancy. And you did mention it there on, you know, planning, so planning, family planning in and around that competitive period, and therefore having appropriate batch tested, I guess, supplements becomes more and more important.

SPEAKER_00:

And honestly, if I'm honest, more than the work I do in pregnancy and postpartum return, more of the work that I do with athletes is actually in the preconception and fertility sphere. So I'm definitely getting asked to do more and more in that sphere. So they're coming to me before they're pregnant, which is a great, you know, I love preconception counseling, which is if every woman could plan their pregnancy, come and get advice, optimize their health. And not just women, the partners as well. And because they make up 50% of the of the DNA. So optimizing the people, the parents, is honestly that that would be what I would advocate for. So, yeah, so athletes are usually coming to me and saying, Look, can I just get a well-woman like screening? Can you do my tests and blood tests and panels and things? Basically, just look over me and tell me what I need to know about my own fertility. And it's you know, it's really hard to give someone a concrete answer of yes, you should be fine, or no, you're gonna run into trouble because we don't we don't have that kind of information or that kind of sort of crystal ball. But asking the right questions, having the right conversations is key because a lot of what I find with the athletes is they've never had the opportunity to have these conversations, so a lot of them are waiting till they retire, and you know, careers are longer now, so you know, because we know sports science is improving, so careers are longer, women are waiting, female athletes are waiting till retirement. And for example, in netball, their league is sort of 16 to um 30 or 41. You know, they're waiting till potentially 40, 41, but nobody has told them that fertility starts to decline from sort of well, it starts to decline from 35 onwards, but you run into trouble, you're more likely to run into trouble from 40 onwards. But nobody's told them this, and they usually come to me saying, Had I known, I may have made different decisions. And that's the sad part, because actually we should be having these conversations. So, you know, there'll be athletes that do still wait till they're retired to have a family, and that's fine, but that decision is informed, whereas it saddens me when they have those conversations and now they feel like they may have done things differently had they known. And that's a lot of the work I do is actually in that area, more so. And I'm, you know, I kind of fell into that more from what the athletes were asking from me as a gynecologist.

SPEAKER_01:

Yes, yeah, interesting. I mean, I I I kind of thought it was going to be in the post, but but it's actually the the early stage, that planning stage. It's and it's being informed, it's getting that information early. And I think, well, the theme that I would I would say comes across not just this podcast, but the whole show or what it is that I've what I've learned along this um podcast journey is very much the the power of planning and getting that information early gives you then, I guess, the power to be able to make decisions and and feel like you're as informed as you possibly can be.

SPEAKER_00:

Yeah. And I mean, the governing bodies are trying to do the right things and trying to help in that regard. Because I know, at least in the US, that offering cryo, so egg freezing and IVF is part of certain um certain governing bodies and certain sports organizations contracting their athletes. I don't know. I've we've had a couple of conversations with colleagues and and people in the area in sort of the in the sphere. It sounds like a great initiative, right? You know, you're offering athletes a way to still preserve their fertility. But when you scratch below the surface, it does make me think, but what are you really? What's the messaging? You're giving them the message that, oh, don't get pregnant whilst you're training with us whilst you're playing for us or training for us. Just wait till you're retired. But guess what? In case you run into trouble, we'll give you some egg freezing whilst you're younger. Nobody's telling them that egg freezing is not a guarantee. It's not even, it's an insurance policy at best, not one that might even pay out. But as long as you know that, then again, you're making a decision saying, well, I froze my eggs when I was sort of mid to late 20s. There's no guarantee that that will work when I put them back, you know, during IVF. But at least I have those and I'm happy with that. That's fine. But if the messaging from the organizations is that I'm gonna give you egg freezing and IVF, but don't get pregnant until you've retired, and that's why I'm giving it to you. I'm very much of the opinion that actually the work that I do in pregnancy and postpartum is mostly to show athletes and their organizations that getting pregnant is not the end of your career. So you don't have to look at it as that. It's hard to come back after pregnancy. I'm not saying it's easy, but with the right support, it's definitely doable. And we should be encouraging the athletes who want to pursue pregnancy, infertility, and family planning during their careers to do that rather than making them feel like they have to wait till they're retired or taking early retirement. That's actually worse for the organizations. You're losing. I think the last time I checked, ballpark figure, you're losing up to two million if an athlete retires three years early from whichever sport it is. You want to see the higher paying ones more, lower paying ones less. But you know, it's a big chunk of money for the organizations if they're just even from a business perspective.

SPEAKER_01:

Yes, yeah. Yeah, you're you're right. I guess that sort of final question in this sort of phase is what we spoke about the support, that pre-planning support, the pregnancy support. What's the type of support that athletes should should look for? What type of support would you be offering for those who come back from pregnancy to get back to where they were?

SPEAKER_00:

Honestly, that is actually the most important part because that's the time when actually they, you know, you your athlete themselves are going to be like rearing to go and but their body's not quite recovered. Their mind might be telling them, right, you're ready to go, but their body's lagging behind. And actually, I'd argue getting the postnatal part right is the most important. So the people that you need to be looking after an athlete postnatally is your pelvic floor physio. You need one of, I'd argue you need one of those throughout the pregnancy because any problems in the pelvic floor and the abdomen and the deep muscles that you can address throughout the pregnancy will benefit you postnatally. And things change postnatally as well. Depends on how you delivered, what your recovery from that delivery type is. You know, a pelvic floor physio needs to be holding your hand through that, and essentially a strength and conditioning coach, again, a dietitian or nutritionist, because your nutritional requirements are going to change again. We again we say breastfeeding takes you know an extra 500 calories. That's still a guest, you know, it's a ballpark figure. We're not even taking athletes' output into that, but they need to be eating more. Then there's the mental side of it, body image. You've gained weight in pregnancy, which is completely normal. There'll be an expectation on certain athletes from themselves as well as possibly their teams or wider public to lose the weight, sounds back and that. And actually, you know, you're not sleeping well. So that's gonna throw trying to go into a deficit out the window. You're not probably not eating and drinking properly. If I know what my postpartum was like, you know, you've got a baby and you've got a baby to keep alive. We forget that there's now an actual living baby that needs to be kept alive. So, you know, the organizations need to put things in place. If we want women to be coming back after pregnancy, there needs to be the medical support. So the pelvic floor physios, the dietitians, the strengthing coaches. You need to essentially spend the first six weeks is just recovery. Then from six weeks to six months is the rebuild, or that's how I kind of term it. So you're rebuilding all the movement patterns again that you've sort of changed or sort of not neglected, but have to step back from. And then you're only really going to start looking at sort of making plans for competitions or breaking sort of records and things, really, six to nine months plus. And obviously, not all athletes have time scale, and we know that. So, I mean, my sort of ideal is that the organizations understand what the time frame really should look like. But really, what we do in practices is look at the athlete, we see what time frame they've been given, and we work within that. So that's kind of how, but yes, but organizations need to think about breastfeeding spaces, spaces where they can bring their babies to practice. Because actually, what a lot of athletes struggle with is yeah, you know, it's great, they're telling me to come and train. Who's going to breastfeed? You know, I need to breastfeed every two hours, I need the baby here. So these are all logistical and practical things that we need to be thinking about as well.

SPEAKER_01:

Yeah, so as we see that, you know, and that's good advice, I think, for clubs, for the organizations, associations to be able to work towards that. I guess I've got two sort of more burning questions. But one is what about the coaches? What, you know, you speak about that performance staff, but what about the club coaches and and managers? What kind of education journey do they need to go on and how?

SPEAKER_00:

I mean, I think the sort of education journey they need to go on is to realize the time frame of how long it takes for female physiology to return back to pre-pregnancy levels. And it is, it's something like 18 months to two years if we're looking at literally being back to pre-pregnancy levels. Now, athletes are very rarely given that amount of time on their contract, on their sponsorships, etc. We're not given that kind of time. You know, even the guidelines that are written by certain uh sort of organizations are looking at six months and nine months before you're, you know, you're already making plans for whether you're competing in the next Olympics or whatever, um, or next, etc. So it's already nowhere near that. But then I appreciate the athletes are not going to want to wait two years either. But you know, finding a happy medium that respects the the body and the physiology, but essentially otherwise, what you run into is the risk of injury, the risk of injury and not returning back or not returning back to a point at which you feel that you've reached your potential, and that's one of the things that I speak to athletes when they've not had the support, they said, I know I could have done better, but I couldn't reach that that medal or whatever, and that's the risk, and that's the risk of rushing things. I've never spoken to an athlete who has said, Oh, I really regret taking my time, but I speak to athletes who regret rushing things.

SPEAKER_01:

Yes. And so I guess my last question really is on that guidance for athletes. And I don't know, is it different between the partners? But what guidance would you give an athlete who is who even has a dream of one being an a top athlete or athletically you know active and also has desires of having a family?

SPEAKER_00:

I think get find find your find out your options. So ask the questions, find out your options, get empowered with information. So see, you know, see a sports gynecologist. I I mean, I say that we just plug for me, really. I'm joking.

SPEAKER_01:

Well, that's all good.

SPEAKER_00:

We'll find a gynecologist at the very least. It doesn't need to be a sports gynecologist, but you know, ask the questions, find out you know, what your hormones are doing, look at your training, look at your nutrition. Because I the way I always look at my athletes who come preconception is you're in the middle of a competition cycle, for example. What I'm giving you is the best, better, and good enough. And actually, right now we might just say good enough, but if you know what best and better looks like, then you can make that decision. Well, okay, when I'm not competing in the next season, etc., I can start looking at optimizing X, Y, Z. But again, it's just it's information and having someone that sort of understands your lifestyle and what your goals are, and doesn't say, oh, sorry, if you're doing this, you've got no chance. Because actually, there is, you just have to work around things, and it's about giving that information. So get information, see someone, get empowered, and preconception counselling. You know, what you the best pregnancies are the ones that are wanted and are planned.

SPEAKER_01:

Yes, that's yeah, there you go. You've ended up very nicely, wanted and planned. And I think for the athletes, like you say, it is going and finding. And, you know, this this is but this show is very much for athletes in this respect, because but actually, do you know? I'm gonna take that back. Probably like every episode I do, it is relevant to everybody out there because here it is that you know, planned and wanted pregnancy. But then it's also about well, seeking the best guidance on that. If you are athletically minded, and and you said it in joking, but it I think it's true. If you're an athlete, go and see a gynecologist who specializes in athletes because they will be doing the research as scant as it may well be, but growing, but they will go away and do the research so they can be at least give you the best information possible so you can make an even better decision.

SPEAKER_00:

Yeah, yeah, 100%. You've said it exactly perfectly.

SPEAKER_01:

Yeah, wonderful. So, well, thank you for bringing your knowledge, your perspective, educating me, and hopefully those who are listening and watching as well. But I I'm certainly coming away with a lot more information and probably even more questions, to be honest. But you said you could talk from England, but I ought to let you um take some rest at least. But I've got to say thank you. Now, if people are interested in finding you, in getting in contact to ask questions or further their knowledge, what's the best way to find you?

SPEAKER_00:

Um, so you I'm happy for people to email me. So dr lamiazefrani at gmail.com. And I have a website which has um information on there as well as sort of how to reach out and um and and I do offer consultations virtually because a lot of the things we talk about, they don't necessarily need a physical examination, but they need discussion. We can put care plans together, it doesn't matter where in the world you are, you can get the bloods and things done and we can interpret the results together. So being not in the UK doesn't limit you from having access to the kind of information. And my website is dr lamiazefrani.com.

SPEAKER_01:

Lamia, thank you once again. Really enjoyed this conversation.

SPEAKER_00:

And and I've enjoyed having it as well.

SPEAKER_01:

Thank you for listening to the Second Win podcast. We hope you enjoyed hearing insights from today's athlete on transitioning out of competitive careers. If you're looking for career clarity for your next step, make sure you check out secondwin.io for more information or to book a consultation with me. I'd like to thank Claire from Betty Book Design, Nancy from Savvy Podcast Solutions, and Cerise from Copying Content by Lola for their help in putting this podcast together. That's all from me, take it easy until next time.

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