The “First Tracks” series highlights the pregnancy, postpartum, and parenting experiences of noteworthy athletes in cross-country skiing in various stages of their professional careers. The sharing of these experiences can benefit athletes in any stage of their career, whether they are an elite or recreational skier, by demonstrating that it is very possible to return to skiing, competition, and an active lifestyle with a growing family. The series will include the physical challenges of being an athlete during and after pregnancy, balancing family life with skiing, and the joy that starting a family can bring. So far, this series has highlighted Kikkan Randall (Part 1 | Part 2) and Holly Brooks (Part 1 | Part 2).
In October, 2018, FasterSkier spoke with Caitlin and Brian Gregg, the Olympian husband and wife dyad of Team Gregg, about the transitions in both of their lives following the PyeongChang Olympics. The couple had also recently announced that they were expecting a baby girl in February of 2019.
At the time of the interview, Caitlin was about 24 weeks pregnant and undergoing treatment for the blood clots that she had experienced early on in the pregnancy. Brian was working full time in finance while completing coursework to become a financial planner, in addition to training. He has since placed second in the 2019 Birkie and passed both the Series 7 and Series 66 exams, certifying him as an investment advisor or securities agent.
In this conversation, Caitlin shared a deeper look into how the blood clots impacted her both physically and emotionally and recounts her training during pregnancy and her recovery postpartum.
For Olympic caliber athletes, conception can include tracking more than just the cycles of mother-to-be; the quadrennial cycle of the Olympics is also taken into account. Caitlin explained that she and Brian had always hoped to have a family of their own. The Greggs have cherished their work as mentors of kids ages 6 – 13 for the In-the-Arena Organization, a nonprofit which connects at-risk youth in their community with elite athlete mentors, as well as their time coaching juniors at the Loppet Foundation. However, before embarking on the journey to create their own family, they wanted to first explore their limits as athletes and also take advantage of the opportunities to race internationally.
“We wanted to see if we could get the training, racing, and travel bug out of our system first,” Caitlin explained in a call. “So after the 2018 Olympics, we decided, ‘Okay, this is when we’re going to try.'”
She elaborated that they were mentally prepared that the conception process might not be simple, based on the experiences of her former Olympic teammate, Holly Brooks, and other friends who had shared their difficulties. While optimistic, the Greggs were open-minded to all possibilities of what “a family” might look like, including adoption or simply continuing to be mentors and role models for lots of children without one of their own.
The Greggs approached the 2018 season with the goal of competing together at the Olympics in PyeongChang and their race performances landed them both on the cusp. However, neither were selected for the team. Caitlin
went on to win her fifth Birkie, then the couple wrapped up their season competing at Canadian Nationals.
While parenting roles can be shared, there is no denying that the creation of a baby takes a much greater role on the mother than the father. In any pregnancy, there are plenty of unknowns, especially in regard to how much training an elite athlete might be able to sustain while gestating. Caitlin explained that while she was eager to have a baby, the idea of being pregnant and putting her athletic goals aside for an indefinite amount of time was daunting.
“Initially, I mentioned to Brian that as soon as we found out about the Olympics [it would be time], meaning if we didn’t make the Olympics, we would start trying. And then I got kind of cold feet and I kept saying, ‘Oh, you know, the Birkie is coming up and I don’t think I want to be pregnant for the Birkie,’ and ‘Oh, there’s Grandma’s Marathon, I’ve always wanted to run a marathon.'”
As she was encroaching on “advanced maternal age”, Brian gently nudged her that they may not want to delay the process for too much longer. They began “trying”, but as the timeline of when she might become pregnant was vague, she continued to train, focusing on marathon-specific road running. Despite not cutting back, Caitlin fell pregnant quickly and the Greggs found out that they were expecting a baby girl just two weeks before the next Birkie.
“We realize that we are really fortunate. I was 37 at the time, training a lot. I had kind of convinced myself it wasn’t going to happen [right away], which maybe then took the pressure off, so that was the caveat to it all.”
The Greggs were “super excited” that they were on their way to a family so quickly. As Grandma’s Marathon in Duluth, MN was imminent and Caitlin was still feeling like herself, she decided to race but switched to the half, finishing in 1:31:38, an average pace of about 7 minutes per mile. A few weeks later, after a long car ride back from Thunder Bay, Ontario where she had cheered for Brian in a rollerski race, Caitlin felt a sharp pain in her calf, which was later diagnosed as a blood clot.
“What I think I’ve learned about pregnancy is that if it isn’t one thing, there’s another thing. Everyone has good and bad experiences. For us, getting pregnant wasn’t a problem, but then I developed blood clots in my left leg, which was really scary for me.”
During the first trimester of pregnancy, women are in a hypercoagulable state as their blood volume increases by 40 to 50 percent to support the growing baby. This change in blood volume also increases cardiac output — essentially how hard the heart is working — and the likelihood of developing a blood clot. A blood clot poses a threat to both the mother and the baby, as the risks include heart attack, stroke, pulmonary embolism, and miscarriage.
Her doctors started her on anti-clotting medications, which she learned to inject into her belly twice each day throughout the pregnancy and for the first six weeks postpartum. She immediately reached out to the ski community, contacting Holly Brooks about her experiences with high-risk pregnancy and Kikkan Randall, who had experienced a blood clot in 2008. She recounted that their support and advice were essential in helping her through the stressful news.
“[Talking to them] was key for me to have a much better experience overall.”
In the few days following the formation of a clot, there is a risk that the clot may dislodge from the blood vessel, which could be life threatening. Because of this, doctors advise avoiding intense activity until the clot hardens enough that the risk of embolism is much lower.
“I went from feeling great and being able to do everything I was doing before and coaching and having fun, to really scared, like ‘Oh my goodness, what does this blood clot mean? I don’t want it to dislodge or embolize or anything like that.’ And my doctors really couldn’t tell me if I should train, if I shouldn’t train, if activity was good – because, in theory, activity helps circulate the blood, but at what point is the clot stabilized? So there were a couple of weeks that were pretty nerve-wracking where I couldn’t get answers and didn’t know what I was supposed to do.”
Caitlin recalled talking with her doctors and reading as much as possible before coming to the decision to take two weeks completely off, during which the clot would stabilize and the medication she was taking would dissolve the clot, though not fully. It was an abrupt change, but for better or worse, the anxiety she felt about her health kept her mind off the training hours.
“For me, those two weeks were a combination of being very scared and anxious about what the blood clot meant, which overrode the, ‘Oh my gosh, I’m not training.’ Then as I started training again, there were a lot of unknowns going forward as to, ‘Okay, what does this mean with the blood thinners?’ And I kept trying to be optimistic about it and say, ‘Oh, I can probably keep doing things and just be conscientious.’ But what the doctors said, ‘You can’t ride a bike. You can’t rollerski.’ And not because of the pregnancy, but because the risk of falling while on blood thinners was so dangerous.”
She explained that it would not be the road rash or scrapes from a fall that would cause problems. Rather, if she took a hard fall on her abdomen or hit her head, there would be a very high risk of internal bleeding.
Though pregnancy and training while pregnant were shaping up much differently than she envisioned, the need to cut back did not take as much of an emotional toll as she thought. It simply required a change in approach.
“When everything was great at the beginning, I was like, ‘I’m going to have this awesome summer of fun adventures while pregnant.’ And all of a sudden it was like, ‘Whoa, I’m going to have to navigate things differently now.'”
Though biking and rollerskiing were cut out, she continued to run and bound. She also sought out a strength training coach, Andrea Claassen, who specializes in working with prenatal athletes to ensure that she was moving in ways that were safe for her changing body.
She also joined Blooma, a group that offers pilates, yoga, and barre classes for expecting and postpartum women in addition to childbirth education classes and body work. Adding new faces to her support system helped prevent Caitlin from feeling as though she was missing out on the training partners she might otherwise be logging hours with.
“That was awesome because all of a sudden I had a new community that I could exercise with,” she said. “And some of the groups that I had been training with here in the twin cities, I could still run and bound with them. So that helped normalize what I was hoping for in my pregnancy.”
As her belly grew and her body changed, Caitlin became conscious of her exercise routine in hopes of avoiding diastasis recti, or the separation of the rectus abdominis muscles. Grateful for the professional athletes who have spoken out about this topic, including professional runner Stephanie Bruce and Olympic Gold Medalist in Triathlon Gwen Jorgensen, Caitlin was aware that strategies and devices existed to reduce the strain on these muscles during exercise.
“One of the strategies I used was the FitSplint to help alleviate that expansion, especially when I’m training and trying to really give my body as much support as I could.”
Designed by Celeste Goodson of ReCORE Fitness, a pre and postnatal trainer who experienced diastasis recti herself, the FitSplint band wraps snugly under and around the belly, lifting gently to relieve some pressure on the bladder and strain on the low back. The band also reduces bouncing and offers structural support, relieving the abdominal muscles from some of the work they would otherwise be responsible for.
Caitlin wore the band daily from 17 weeks onward. She especially felt it benefitted her during running or bounding sessions but used it regardless of the activity. She also explained that she changed the types of exercises she was doing while strength training to avoid moves that heavily recruited the core.
“I really worked with my strength coach to really avoid any ab work that would put strain on those muscles and to sort of let the abs that I had disappear so that there wasn’t that extra force there.”
While reducing training did not have much emotional toll, Caitlin did struggle with the lifestyle change from traveling regularly for training and racing to suddenly needing to stay put in Minneapolis.
“One of the things that was really different for me was that I was unable to travel as much as I had envisioned. That was something I was really excited about – being on the road and supporting Brian while he was racing. That was tough, for sure. I missed that part of our life, for the last twelve years what we’ve been doing together. I had to tell myself that I could do it in the future and be patient.”
She recalled missing Brian while he was away and also the experience of being in different places and taking part in events.
As the weeks ticked by and winter approached, running became more and more uncomfortable for Caitlin. Luckily, in early November, temperatures in the Midwest dropped and snow began to fall. To the week, when Caitlin was ready to retire her running shoes, she was able to slip into ski boots and begin skate skiing on a 400 meter loop.
“I was just on cloud nine. It felt so great to skate ski. I was a little nervous to classic ski because I was unsure with my balance with my belly and kicking, and I just didn’t want to mess around with hitting an oak leaf and falling.”
Because she has spent so much of her life skiing, she and her doctors agreed that it was safe so long as she took it easy and remained confident that she wouldn’t fall.
“The motion was just so perfect and it was nice to mix it up again and be back moving how I love to move.”
Caitlin was thankful that both she and her baby were healthy throughout pregnancy, despite being labeled high-risk because of her age and the blood clot. She explained that blood thinners can sometimes cause babies to have a low birth weight, but at each of the regular growth checks, baby Gregg measured perfectly. Because of the medication she was taking, her doctors advised scheduling an induction at 38.5 weeks. This allowed her medical team to gradually wean her off the blood thinners in time for the delivery without prolonging the amount of time she was without the medication.
“I was really scared about the delivery on the blood thinners,” she recalled.
Most women experience some apprehension about delivery, but Caitlin felt especially concerned since if she went into labor earlier than her induction date, the blood thinners would still be in her system, increasing the likelihood of severe bleeding.
“At that point, I had a lot of friends who were pregnant that [delivered] early, and that was what I was most scared about. What if she decides to come a week or two early?”
Though she had confidence in her doctors and in the advice they provided, that remained her biggest fear. However, as the date of the induction drew near, Caitlin felt no signs of impending labor.
“She wasn’t ready,” she laughed. “She had no intention of coming out, so we went in for a scheduled induction, which was kind of different knowing that you are just going to pack your bags and head to the hospital at a specific time to have a baby. For people who like schedules, that’s great.”
One of the many pregnancy resources Caitlin sought out was a doula who helped her and Brian understand their options for pain management during the birth. Caitlin was apprehensive about getting an epidural, as there is a slightly increased risk of needing a c-section among other risks. She was also concerned about simply having a needle placed in her spine. Ultimately, her priority was delivering a healthy baby and remaining healthy herself throughout the birth.
As she thought about her birth plan, Caitlin found herself reading about the birth experiences of other athletes who had shared their stories, eventually finding an article in Runner’s World by pro runner Lauren Fleshman. Here’s an excerpt:
“My goal was to have a natural labor. Not to be on some moral high ground against the use of medical technology, but because I wanted to know what it felt like. Call it old-fashioned curiosity. Part of my job as a pro athlete is believing in my body’s ability to do amazing things, and I wanted to test its limits. Experiencing a natural birth was a challenge and an opportunity to feel a bond to all the women around the world since the beginning of time. But when talking to my doulas, I made one thing clear: I’m not interested in heroics. If I’m having what’s considered an average birth experience, I want to be coached to persevere, but if things move toward the extreme, I’m open to the help of modern medicine.”
Reading this section helped Caitlin to reflect on her own response to pain and helped her become comfortable with the idea of getting an epidural to help her relax during labor.
“As athletes, we have very strong pelvic floors, and that can be really hard to release,” she explained. “So one of the things I thought a lot about is this concept of, ‘When I feel pain, do I tense up or do I relax?’ And I definitely am someone who when I am racing or training hard, when things get tough, I grit my teeth and try to push through it. That’s just my mentality. So what we talked with our doula about is that childbirth is the opposite. As soon as you feel that pain, you need to relax and let it go.”
When she went in for her induction, her plan was to see how her body responded to the pitocin and to labor, then ask for the epidural when she felt that she needed it.
“As soon as I started getting to the point where every contraction I started fighting it, and I was gritting my teeth and trying to be tough, I knew that it wasn’t going to work, I needed the epidural. And I had no qualms requesting it and I think that was the best decision I made.”
However, there was a chance that she would not be able to have the epidural because of the anti-clotting medication. If the concentration of the blood thinners remaining in her body was above a certain level, it would be unsafe for an epidural to be administered since it could cause a spinal epidural hematoma, a bleed inside the spinal canal which can cause an injury to the spinal cord, potentially resulting in paralysis. Luckily, when the doctors tested her before delivery, the concentration was at a safe level.
“So there were a couple of things that had to come together at the right moment. I couldn’t be too far dilated or too far along. I couldn’t be too anticoagulated. So when they came in and said, ‘Alright, you’re in a good spot. Do you want the epidural?’ And I was like, ‘YES!'”
Because she was able to relax and allow her body to progress through labor comfortably, neither she nor the baby showed any signs of distress. She also expressed that the epidural contributed to a positive overall experience.
“It took away so much anxiety. I had anxiety about the needle and the side effects, but in the moment, it helped me be more present.”
Stay tuned for Part 2 of this conversation in which Caitlin discusses her recovery from pregnancy and birth and Team Gregg’s adventures navigating parenthood, travel, and training.