S7E03 Pregnancy and early parenthood with MS with neuro physio Becca Mullin

Becca Mullin  00:00

Everybody when they’re pregnant or becomes pregnant, generally thinks, what can I do? Often, people will eat a bit healthier than they would do previously, or they start thinking about, what can I do for baby and myself as part of that so eating well, prioritizing sleep and being active and working out what active, what being active, and what being active and staying active would work for what would look like for them?

 

Overcoming MS  00:28

Welcome to Living well with MS this show comes to you from Overcoming MS, the world’s leading multiple sclerosis, healthy lifestyle charity which helps people live a full and healthy life through the Overcoming MS program. We interview a range of experts and people with multiple sclerosis. Please remember all opinions expressed are their own. Don’t forget to subscribe to Living Well with MS on your favorite podcast platform so you never miss an episode. And now let’s meet our guest.

 

Geoff Allix  01:02

Welcome to the latest edition of the Living Well with MS podcast. Joining me today is Becca Mullin, who is a specialist neuro physiotherapist. So we’ve got lots of interesting questions to ask, because I think this is an area that many people with MS have concerns. We’re interested in what the differences are with normal physios and so on. And there’s lots of questions going to ask. So welcome to the podcast, Becca.

 

Becca Mullin  01:27

Thank you so much for having me.

 

Geoff Allix  01:29

And could I start off with saying, could you introduce yourself, your work, what you do, and your interest in helping people with MS?

 

Becca Mullin  01:36

Of course. So hi, my name is Becca. I’m an almost 20 years qualified neurophysio, and I can’t believe that’s happened. I am a mum to two young boys, a six and a nine year old, and we all live with my partner, who’s up in Chester, which is in the northwest of England. Since moving up here in 2022 I have been working for myself so that I can manage the mum juggle a bit better. But before that, I worked in a large central London teaching hospital, and was there for 15 years. My whole career. I first saw somebody with MS when I was a student. So yeah, good while ago. And all the work the way along the way I’ve been drawn toward working with people with neuro conditions. So whether that was as in patients, whether it was in people’s homes and in the outpatient service that I ran for, it was 12 years in the end. But yeah, I teach when I taught on MS at the King’s College London, and I’m, as part of my rehab, I’m always very keen to stay evidence based. So always go to conferences. And I went to the MS Frontiers Conference over the summer, which is where I met some of your team. And that’s why I’m I’m here today.

 

Geoff Allix  02:57

And so you mentioned a neuro physio. So what’s what is a neuro physio, and how is that different from a regular physiotherapist?

 

Becca Mullin  03:08

When people think of a regular physiotherapist, they’re thinking of people who work in outpatient departments and work with people who’ve got back pain or knee joint problems or ligaments muscles. But in reality, there’s a wide array of different types of physios and their specialisms and their expertise. So there are people who specialize with children. There’s people who specialize in Respiratory Care and working in intensive care units. Even more so. So neuro physios are people who work primarily with people who have neuro conditions, and that is their area of expertise. And how we differ, I guess, is that we’re more holistic. We’re we don’t generally, people aren’t referred to see us for a particular problem. There may be something that’s going on, but generally we’re looking at the whole body and the whole mind, body and soul, rather than a knee joint or a back pain. So I guess that’s the difference, and that’s what I love about it, because you really get to know people and really get to embed within their lives as well.

 

Geoff Allix  04:17

I have more of a close relationship with my neuro physio than I do with any other medical professional.

 

Becca Mullin  04:24

That’s good to know. Yeah. So yeah. And why do you why do you think that?

 

Geoff Allix  04:28

Well, I have a weekly we have a they call a neuro active gym session. They’ve got a local gym that’s kindly sort of donated time, basically, for all of us to go along. And so it means we’re doing regular gym sessions, but also it means we can ask questions. So it’s not just about that. It’s also saying, I’ve noticed this thing, or.

 

Becca Mullin  04:54

You can touch base, can’t you? And just, you know, approach things. But rather than waiting until you’ve going to see someone every six to months to a year, you can, kind of just sound out, is this way? Is this something? That’s the relationship we like to build. That’s good. And

 

Geoff Allix  05:13

So there’s another service I’ve seen you offer called Pregnancy Plus people with neurological conditions. I’m guessing the clue somewhat in the name, but what? It’s probably not for me. What does that entail? So where did the idea of that come from?

 

Becca Mullin  05:31

So I guess that is often the case. It was when I when I was pregnant with my first born. So he is now nine years old, and whilst I was pregnant with him, I started to see the world more through pregnant eyes, and I as somebody who is deeply embedded in the world of neuro I was working in a neuro outpatient service. I saw lots and lots of people with different neuro conditions, and we worked opposite the pelvic health team, which is often a team that supports people during pregnancy, if they get back pains or pelvic girdle pains associated with their pregnancy. And what I would say is that people that if people had pre existing neuro symptoms and then became pregnant and their body started to change, they kind of slipped through the cracks a bit, because a lot of people didn’t understand. A lot of people who typically support people with with pregnancy related issues that develop aren’t so well well informed about the neuro symptoms. And myself, as somebody who’s well informed about the neuro symptoms, wasn’t so confident in how I would manage pregnancy because we develop our expertise and then go into different different areas. And so I was able to support people if they, for example, were less active so developed a foot drop, or if they, if they had a problem with an arm that wasn’t working so well, and they needed to practice tasks like learning how to do an change a nappy thing one handed then. So I could do all of those things in the moment, but I thought that there was more that could be done proactively to help people to have a better experience of their pregnancy. And so whilst I was working at the time and pregnant and then going off on mat leave, there wasn’t really space for me to develop it and grow it, and to develop my skills, to be able to understand more about pregnancy and how to manage and support people with their general exercise and activity during pregnancy. And so it’s only really been whilst I’ve when I left the NHS and set up my own business in in 2022 that I’ve had the time to be able to go and do more training, to be able to then link in with the right people, so that I can create something which fills that gap, so that people can remain as active as possible and feel confident that they’ve got the skills before they need them during that pathway.

 

Geoff Allix  08:08

So we’ll come back to pregnancy in a bit, but, but firstly, Overcoming MS recommends both strength training as well as cardio. So firstly, I was gonna ask whether you agree with that, and secondly, what would be the benefits if you do agree with that of an active lifestyle when you have MS?

 

Becca Mullin  08:27

So yeah, so I am 100% on board with being active with with a diagnosis of MS, it’s so helpful for so many different reasons, and there’s a lot of research to back it up. So from a psychological point of view, whether it’s because it improves your sleep, whether it’s because of mastery, whether it’s because of the lovely endorphins that are released whilst you’re exercising, all together, all of those things make you feel good. So it’s great from a psychological perspective, from a physical perspective too. It is also great. It’s great for improving fatigue experience.

 

Geoff Allix  09:07

Short term, I would say, my MS, symptoms are worse if I’ve really pushed it at the gym, but then in the medium to long term, they’re better. So certainly. So sometimes I so the gym sessions I have at lunchtimes, but, if I’m doing my own workouts, tend to leave them till quite late in the day, because they know, like worst case scenario, I can then just slump down sofa and watch TV.

 

Becca Mullin  09:33

 You don’t have to make a journey home, or you don’t have to cook dinner.

 

Geoff Allix  09:36

I’ve done all the things that need doing, and then I’m like, Okay, I guess it’s because neurological is, it’s not just about the muscles, is it?

 

Becca Mullin  09:44

Exactly. And I guess what we’re wanting to do is to help people to get to the ceiling of potential. So if you’re, if you have pushed it and are doing, you know, you found where, what you’re pushing to. Boards, and you’re, you’re still fine tuned, tweaking like that’s, you know, you’re still seeing benefits, but it takes more effort to kind of get there than when you’re less active. And what often becomes the case is people are more deconditioned than their, than their, than their, MS.

 

Geoff Allix  10:25

I certainly am less active than I was, but I was very active, but yeah, I’m less active now, and therefore I’m weaker, and because I’m weaker then, then the neurological bit is so it’s compounded, so you sort of like, I can’t really get and it varies before because I haven’t got the ability to do what I did before.

 

Becca Mullin  10:48

It’s finding the right balance. And Ms fluctuates so much as well, doesn’t it? That it’s yeah, what is achievable one day might not be the next day, but it’s, but then it might be another day. So it’s just having to become your own best expert and fine tweak around with things to get, to get you to be at your your best.

 

Geoff Allix  11:12

 Yeah, so pregnancy, though. So what be some of the benefits, specifically of an active pregnancy, if you’ve got a neurological condition.

 

Becca Mullin  11:21

Yeah, there’s, so many benefits for people who aren’t pregnant, and including all of those things like physically and also strength and walking and all of those sorts of things when somebody becomes pregnant. Then historically, not that too far distant history, it used to be the idea that someone’s pregnant or get them to sit down, don’t worry, we’ll look after them.

 

Geoff Allix  11:45

That was the same with MS as well. Because that’s so my dad had MS the back, and this back in the sort of 80s-90s Yeah, he was discouraged from doing too much.

 

Becca Mullin  11:54

Absolutely. Yeah, they didn’t. They thought they would make spasticity worse.

 

Geoff Allix  11:59

Women used to be, you know, you sort of see these old dramas, and they were basically locked up

 

Becca Mullin  12:07

But we know, for both individually and together, that that being active is good. And so I know that Overcoming MS is an international charity. And so I guess I focus a bit more on the research, which is in the UK, and the recommendations in the UK, but there are similar across the world. So an active pregnancy is a good pregnancy. And I’m going to read a few things from from my notes here, just to make sure I’ve got the information absolutely accurately for you. The recommendation is aiming for 150 minutes of moderate intensity exercise or activity every week during pregnancy, which is quite a lot, isn’t it. The aim is to control weight gain, to reduce blood pressure, to prevent diabetes, to reduce risk of pregnancy associated back and pelvic girdle pains, and to improve fitness, sleep and mood and that in the UK, the chief medical officer has produced this great infographic which I can share with you, and you can share onwards, if that, if that could work. And so, yeah, so there’s, there’s this great infographic which essentially gives you the the main messages. One is, don’t bump the bump, so you don’t want to be doing any activity which is like combat, so things like rugby, or things where there’s a high risk of falls, or, you know, scuba diving. There are certain activities and sports that you don’t want to be doing during pregnancy, for risk to mom and baby. But there is a lot that you can do. And the message is, if you’re already active, keep going. If you’re not so active, it’s actually a good time to stop, take note and think, Okay, I’m going to, I’m going to push myself a little bit more to for me and for the baby. And so if you’re starting something fresh then start slowly and just finding the right types of activities for you. There are things like water based activities, so swimming, walking, Pilates, yoga, dancing, playing with children, whatever you can do and whatever your body is allowing you to do that day. You can you can tweak to be more active, and it’s it, again, is a similar message strength training, so exercise which help get allows your muscles to develop and grow, and also cardiovascular training. So again, it completely aligns with the Overcoming MS recommendations and guidance too. So I guess the second bit about being pregnant with a neuro condition and how that’s important, we already know on the baseline that if you have MS, then it’s important to be active. And so if you are less active with MS, then your body, you’re not giving your body the opportunity to get to that, that ceiling of potential. And there’s lots of reasons why people can’t and don’t, and it’s tricky. So it’s, you know, it’s not black and white. But then if you add on that, your body’s changing, but there’s more demand on the body with pregnancy. The body’s the center of gravity changes, which can mean that the balance can be affected a bit more. There are things. Your ligaments can get looser, which is part of the body’s adaptations to allow mum to give birth. But as these things happen, you know, if you’ve got a pre existing neuro condition, which means that there are some areas of weakness that can make that more apparent, so the stronger you are, and the more active you are, and finding that balance to to navigate the fatigue as well is really important. And so yeah, being active is good, but it’s finding the right stuff.

 

Geoff Allix  16:04

So what barriers do you see from people who want to be more active, specifically for people with MS or generally, I mean, so we’ve said getting more active, but and is there sort of ways of overcoming those barriers?

 

Becca Mullin  16:20

There are for everybody. If we start at everybody, and then go to people with MS and your conditions, and then pregnancy, like for everybody, there’s so many barriers. Life is so busy. Everyone is juggling so much like and particularly if you’re a parent, working things like that, then a lot of your time is actually not your own. And you know, you’re trying to squeeze in activity and exercise as best you can, like, you know, a lot of people struggle with that. If you then add in having a neuro condition like MS, if you’ve then got barriers like fatigue, you’ve got your symptoms have fluctuated a bit more that day there may be, there may be financial restrictions. You know, there’s that exercise going to gyms and classes and swimming pools can be expensive, travel. Yeah, I guess was there anything else more that I wanted to say on that? No, I mean, there’s so many different barriers. And then, as someone who’s pregnant with a neuro condition, there’s, you know, there’s, you’ve also got the additional things, someone may have more nausea, somebody may again, their fatigue may be worse than it, than it was before they were pregnant. So though, you know, there are lots of different things that come into the into the melting pot to make it a bit more of a challenge.  I know Same with me, like this. You know, this week there’s lots, lots going on, and I, you know, I haven’t been able to do my it’s a problem that everybody’s kind of

 

Geoff Allix  17:43

I think the sort of priorities as well. Because I think there’s pressures on on time if you work. I mean, so I’m still working, so, there is that you have limited time because of that. And then I think the first thing that drops off, typically on the Overcoming MS program, would be mindfulness. So if you haven’t got enough time in a day, the mindfulness probably gets dropped first. And then number two would be exercise. And then you’ll say you sort of, most people like, Okay, I keep with the diet. So well, yeah, that’s you’ve just changed your diet, but you’re still going to eat because that’s kind of quite high priority on your list of things. You’re going to and you’re going to get some sleep. It was good or bad sleep, you are still going to so those sort of things are kind of built into your lifestyle, but you can very easily the mindfulness, very easy to drop that. So I did half hour, and then, and then the equally the exercise, if I’m busy, when there’s a gym class and because of a work meeting or something, then that would be dropped.  Because I saw in my work diary, actually have my weekly gym class because it’s just in my lunch time anyway. Yeah, it’s not that I’m taking extra time off, but I just have it. But now, because it’s locked out in my calendar, people don’t book meetings at that time. Just thinking, because I can move my lunch time around, that’s fine. They know they could book a meeting at one because I just haven’t. You know, I work from home, so I just have lunch earlier or later. But now locked it’s like, then it does. That doesn’t happen so much. So, yeah, I think you do need to sort of take a little bit of ownership as well, if possible.

 

Becca Mullin  19:26

Oh, 100% and there’s, there’s little tips that you can do. So if your class is going out to a class, you can put your get your kit ready the night before, so it’s by the front door, so it takes away that potential barrier for it. Or you can put your clothes on that you’re going to be exercising in. Or, as a woman, do your uniform like you know you can. You can do things that just take away any reason why you you wouldn’t do it.

 

Geoff Allix  19:54

On Tuesday I’m wearing gym kit from first when I get up in boarding, I literally get up. That’s why I put on it after that.

 

Becca Mullin  20:00

Well, that’s it. And then you kind of, you’ve made that commitment to yourself, haven’t you? Yeah, but there’s other things that you can do to make it it it hard, and it’s not so much it harder to to not do it, but it just makes you want to do it more. So I guess when you’re seeing changes that you know that that’s a motivator, if it’s something you enjoy, that you know that is a motivator, because you’re looking forward to doing it, if it’s something that doesn’t take a lot of lot of effort, like swimming, for me, is a tricky one. I love it. Once I’m in the pool, I love it. But you’ve got to get there, you’ve got to get change, you’ve got to earmark a much larger chunk of time to be able to do it. But when you do it, it’s great. And so it’s trying to find ways of fitting things in in a way that is flexible around you. But also, you know you, you can, make yourself wanting to do it a bit more.

 

Geoff Allix  21:01

And so to come back to the pregnancy side of things, you also run a neuronatal Pilates session. So can you tell us a bit about that, what it is, how it works, and benefits that you get from that?

 

Becca Mullin  21:16

Of course. So, so this was, this is the the activity session that I run for people who are pregnant and also have a neuro condition. They’re virtual classes, so they’re online, so no having to go out into the outdoors and see what to get to get yourself there. No travel time, no energy spent on travel. It’s all just, you know, in your own home, the mindset here was for those people who they didn’t have access. So when I was pregnant myself, I enjoyed an active pregnancy, and I benefited from that. I was able to I would swim and I would walk. Those were my things I would do for exercise. And I went to a pregnancy yoga class where I met my mum friends. But I saw that people who were less able bodied than myself weren’t able to access particularly things like classes, because they couldn’t get on and off the floor by themselves, or fatigue was too much. They couldn’t manage an hour’s activity, or they were just, they just didn’t want, they felt they didn’t want to be the odd one out in the class who needed adjustments to everything. So this class is is made to take all of those factors into account and make somewhere which is really inclusive and makes people feel like they’re meeting they’re meeting people on a similar level to them, people who have similar difficulties, who understand their neuro symptoms and understand the extra that’s pregnancy, plus it’s the extra things that People have to navigate when you have a neuro condition too. So people who there’s a group where there’s people who use a wheelchair, so the activities that they’re doing in a class are different to people who are able to walk around and then people who are just it’s more of a fatigue problem, but people are grouped with similar people to themselves, so that they feel like they understand each other and they can share parenting hacks too. It’s done in blocks of six, so people come to the classes, which are held virtually at midday, and so that they can do exercise, and then it’s very much adapted to the needs of the group. So pacing is often a key component. So it’s something that people do to be really in tune with their energy levels, the right types of Pilates exercises. So there’s a section which is more pure Pilates, as I describe it, but very much focused on the core, smooth, controlled movements, gentle, but involving the muscles which help to support bump and baby.

 

Geoff Allix  24:16

Can I ask a really basic question, what is Pilates?

 

Becca Mullin  24:20

Yeah? So, so Pilates is named after the person who who launched it, a guy called Joseph Pilates. If you’ve done yoga before, it’s not too dissimilar. A lot of it, how I differentiate the two? A lot of the movements, when you’re doing yoga, you’re being you’re moving mindfully into positions where stretch towards the end to see kind of how far you can go. Whereas Pilates is more about control within the movements and a bit more about doing repetitions in and the very core part of it is engaging the core, the muscles, which are the pelvic floor muscles at the bottom, the deep abdominal muscles, which help to wrap around and support baby, and the diaphragm, which helps to create this muscular box around about baby, but also around your back and your, your internal organs too, and helps you with posture. So there’s, there’s different things that you focus on. You focus on breathing in Pilates, a lot of the movements are controlled and through ranges that feel right for you. If you’re doing Pilates, there’s, there’s a whole array of different types of Pilates, and you’ll probably see people who look more like gymnasts doing these kind of exercises. But it’s, you know, it can be tweaked in every which direction, and a lot of my classes are mostly done in sitting so but with different kind of tweaks to them to make sure that people are testing themselves at the right level.

 

Geoff Allix  26:03

It’s quite a useful, useful activity. Regards to the pregnancy side of it.

 

Becca Mullin  26:10

100% Yeah. And Pilates is having a real boom at the moment. It’s it’s become incredibly popular. You’re probably hearing it banded around an awful lot. And there are lots of neuro Pilates classes that people can go to, and so, yeah, absolutely recommended for people, if they if that, if that is something that they want to explore, it’s really good for control, it’s good for balance. It’s good for if you’ve got one side of the body isn’t as strong as the other, or one limb isn’t as strong as the other. It’s really good for for maintaining the control for through each of them, and being really targeted in terms of, yeah, how you’re how you’re doing the exercises. There are some it’s really good for Neuro conditions. And I’ve been using it for 13-14, years in my neuro clinical practice, but I’ve also done because there’s specifications that you need to do for someone who’s pregnant. And so there’s, there’s a whole world of antenatal Pilates classes, which is open to a wide range of different people, but I’m just bringing the two together and making sure that people are receiving the right types of exercise, taking into account both their neuro symptoms and their their pregnancy, changing bodies, bringing it both together so that people are getting just the right stuff. So at the end of classes, we do so it’s very much broken up with pacing. At the end of class, we have a mindfulness section so people can get that mindfulness time in so that just they can go on with the rest of the day feeling lighter emotionally as well. And then at the end of the session, we do a an optional shared lunch, which most people do choose to join in with, so that they can they can connect and become friends and become the people who support each other at two o’clock in the morning when they’re sending messages to each other who are just struggling to do different tasks when baby arrives. So yeah, that’s that’s my package

 

Geoff Allix  28:12

Overall, and this is from a physiotherapist. Yeah, background, would you recommend someone who’s got, MS, if they thought, would you recommend if they’re thinking about having a baby or if they’re already pregnant, is it?

 

Becca Mullin  28:26

Yeah, well, I mean the recommendation so there was, there are some recommendations, some research recommendations for for people who are pregnant with a neuro condition. There’s some guidelines in 2019 that say that people pregnant, people with MS should be following the standard guidance, the standard guidance for women who are pregnant, which but specifically including pelvic floor exercises, not smoking, and vitamin D and so, and the vitamin supplements. So I guess the the main things that I would recommend with that in mind, and also from a physical therapy perspective, if somebody is thinking about becoming pregnant or is already pregnant, I guess just think, just thinking ahead and thinking, Are there any things that I’m worried about that I might struggle with? There’s somebody some people who I have met along the way, they they were in a wheelchair, and they wondered how they were going to manage when baby came along, and particularly when they started walking, how they were going to navigate that. There’s the lady who was concerned about how she would change a nappy, with one hand. There’s people who have pre existing difficulties with continence, you know, they’re needing to get to the loo really quickly before they before becoming pregnant. So. There are symptoms there, and there are things that actually we can do stuff about earlier. It doesn’t have to wait to be in when things are big problems that we can deal with. So firstly, try and get a pelvic health physio review if you do have any continence related difficulties. And in that sense, you can see whether, yeah, if there are any exercises you can get started with before baby starts is growing, and then pressing down on the pelvic floor too. So that would be one thing. Thinking about everybody when they’re pregnant or becomes pregnant, generally thinks, what can I do? Often, people will eat a bit healthier than they would do previously, or they start thinking about, what can I do for baby and myself as part of that? So eating well, prioritizing sleep, being active and working out what active, what being active and what being active and staying active would work for, what would look like for them. So it might be different. Some people being active might be being able to go for a short walk. Some people might find a chair based Pilates exercise class would be better. You know, it’s finding the right thing for them that’s going to be motivating for them. And they can keep it up because it’s, it’s the dose. It’s doing it with regularity, the way you get the where you really get the magic. So, so yeah, and if, if they are struggling with any of those things, or they don’t know the answers, or when they’re going to their their midwives, their obstetricians, their their neuro team, they don’t, no one’s really giving them the answers, then you know, I’ve got some services that you can get in touch with me. That’s what I love to do.

 

Geoff Allix  31:44

Okay, and and so to wrap up, is there anything else that you think is useful to to raise to our audience?

 

Becca Mullin  31:54

I don’t know. I mean, I love the Overcoming MS, way. I love the focus, the holistic focus. So it’s just something to really support. I, you know, big advocate for everything that you’re doing. And it’s it is hard to find the time. It really can be. But if you find things that you enjoy, or if you start to feel like you’re dropping off with things, yeah, just regularly have a check in with yourself. And if you feel like you are dropping off with things, then set yourself some goals. Put some time in your diary to try and get back on the get back on the roller because it’s hard, it’s it’s hard, and particularly with a condition which fluctuates. It can be hard to keep things up, but when you do, it’s magic. So yeah, keep it up. And know if you do become pregnant, you know where I am.

 

Geoff Allix  32:47

And so where can people find out more about you and and services you do offer?

 

Becca Mullin  32:54

So I Yeah, so I’ve got a website, so it’s Upton neurophysio.com I’m also on Instagram and Facebook, under Upton, underscore neuro, underscore physio and pregnancy plus underscore physio, if they want to see more, which is directed about the pregnancy plus stuff.

 

Geoff Allix  33:15

And we’ll add in the show notes, so have a look. There’ll be the links available there. So with that, thank you very much for joining us. Becca Mullin.

 

Becca Mullin  33:30

yeah, no, it’s lovely. Thank you so much. It’s been really nice to chat with you. Thank you.

 

Overcoming MS  33:36

Thank you for listening to this episode of Living Well with MS. Please check out this episode’s show notes at overcoming ms.org/podcast you’ll find useful links and bonus information there. Don’t forget to subscribe to the podcast so you never miss an episode, and please rate and review the show to help others find us. This show is made possible by the Overcoming MS community. Our theme music is by Claire and Nev Dean. Our host is Geoff Allix. Our videos are edited by Lorna Greenwood and I’m the producer Regina Beach. Have questions or ideas to share, email us at podcast, at overcoming ms.org we’d love to hear from you. The Living Well with MS Podcast is for private, non commercial use, and exists to educate and inspire our community of listeners. We do not offer medical advice. For medical advice, please contact your doctor or other licensed healthcare professional.