Morning sickness? Why not try your bike!

Research reveals obstacles to cycling to work during pregnancy
By Davara Bennett

More people than ever are commuting to work by bicycle in London: according to 2011 census data, the city saw a 144% increase in cycle-commuting over the previous decade. This has considerable public health benefits, including among pregnant women. Frequently, however, women who become pregnant stop cycling, following a decision-making process we know surprisingly little about.

My mother, formerly a midwife working with young mothers in a London borough, cycled to and from home visits. Following in her footsteps, or tire tracks, I’ve cycled to and from school, then work, since the age of sixteen. My bike is close to my heart, and I care about women’s informed-decision making during pregnancy, whatever the decision, without judgment.

It is in this context that I’ve observed changes in the city’s cycling infrastructure, hopeful that it would lead more people, in particular women, from all backgrounds, to rock the rust off their chains, and bring their bikes out from under the stairs and into the light. My MSc research project at the London School of Hygiene and Tropical Medicine, and my recent article in the Journal of Transport & Health were rooted in this hope, aiming to tease out why women do – and don’t – cycle to work when they’re pregnant.

Bumps and bicycles

Cycle-commuting is usually actively encouraged – it yields benefits for individual and public health. Exercise during pregnancy can help alleviate common discomforts such as nausea and back pain, prevent excessive weight gain, gestational diabetes and high blood pressure, and may also contribute towards women’s improved mood. Meanwhile, the cycling gender gap appears to be narrowing with the increase in bike journeys overall – more women are choosing to cycle-commute as a means of embedding physical activity in their daily lives.

But during pregnancy, cycle-commuting becomes fraught with uncertainties, despite the potential health benefits to mother and baby. There is little explicit information on the topic in the literature, and what is available is generally framed negatively – for example, the advice, ‘continuing a moderate course of exercise during pregnancy is not associated with adverse outcomes’.

Cycle-commuters who become pregnant will inevitably choose whether to keep up or forego their cycle-commute. We are deeply ignorant of the ways in which women navigate this grey area, of the factors shaping, helping, or hindering their choices, and of their experiences of quitting or continuing. I wanted to understand what affects women’s decisions about cycle-commuting during pregnancy and shine a light on the grey area, to find out how best to support women in their own resolutions.

It turns out that, when considering whether to continue or cease cycle-commuting during pregnancy, there are several important factors at play: physical comfort on the bike, the type of bicycle, the degree of social support, and the ways in which pregnant women perceive and manage concepts of risk. Notably, the nature of the medical advice women receive also exerts influence, which means that midwives, doctors and guidelines may affect whether women benefit from cycling during pregnancy.

To cycle or not to cycle

To gather information about how women decide whether to continue cycle-commuting, I conducted three individual interviews and held three focus group discussions: with a group of women who had stopped cycling early, a group that had carried on into later pregnancy and a mixed group. I recorded and transcribed all of them, and analyzed the transcripts line-by-line to develop themes.

An obvious physical factor affecting women’s decisions is the pregnant body itself: some women stopped cycle-commuting because of the physical obstacle of the growing belly, while others found cycling to be a relief from bodily discomfort. The participants deemed ‘women’s bikes’, in particular Dutch-style, upright designs with a low crossbar and a wide, supportive seat, most accommodating to their growing bodies.

Women’s background perceptions of pregnancy tended to polarize their positions: some left their bike behind as part of entering into a conventionally more tranquil state of expectant motherhood. Others cleaved to the bike as a touchstone to the more ‘authentic’ self, chafing against the perceived expectation of greater passivity during pregnancy.

Either way, women tended to change their cycling practices to minimize risk, even if they questioned their own reasons for doing so. External factors had an impact too: partners’ support or concern – generally implied – factored into women’s decisions. And despite some positive encounters with health professionals, women felt medical advice to be noncommittal, if not risk-averse.

Understanding the obstacles to women cycling during pregnancy can support the development of more appropriate cycling infrastructure and informed medical advice, giving more women the opportunity to benefit from a more active commute. By addressing some of the more socially prohibitive public discussions on this topic, I hope my research will have a greater impact, not just on women’s informed decision-making, but on the kind of guidance that health professionals provide.

Dr. Magdalena Harris probably won't even remember inspiring the research question – I was randomly assigned to her during a drop-in qualitative brainstorming session, and I thank my lucky stars. Professor Judith Green gave me valuable advice when I approached her with questions about the study’s evolving methodology, and took to twitter on my account. Dr. Alex Mold read, and made thoughtful comments, on a draft of the project. Above all, my sincere thanks to the women who gave up their time to take part in the study. I sought to do justice to their thoughts and experiences.

Davara Bennett

Born in Papua New Guinea, Davara lived in Canada, Vanuatu, France and China before settling in London, more or less. She was fortunate enough to attend the Lycée Francais Charles de Gaulle before completing an undergraduate degree in English at the University of Cambridge. She left a career at a literary agency to pursue an MSc in Public Health at the London School of Hygiene of Tropical Medicine, like her mother before her and her sister afterwards. She’s now proud to be working for young people at a Centrepoint hostel, commuting to the residence by bicycle.