Author: Emma Brockwell et al and FIFPRO
Journal: British Journal of Sports Medicine (2026)

Over the past decade, professional women’s football has evolved rapidly — yet postpartum return-to-play remains an underdeveloped area of practice. Traditionally, pregnancy and childbirth marked the end of an athlete’s career. However, global policy changes — such as FIFA’s 2024 Maternity Regulations and FIFPRO’s Postpartum Return to Play Guide — now require clubs to provide structured, evidence-based support for players returning after childbirth.

Recognising a major gap between research, policy, and practical application, Brockwell et al. (2026) developed the FIFA “Stepping into Play” Decision Aid. This tool provides an athlete-centred, evidence‑informed pathway to help players safely and confidently return to football — from grassroots to elite levels.

Purpose

To empower postpartum football players and their multidisciplinary teams (MDTs) — including medical, coaching, and performance staff — to make high‑quality, individualized decisions about training and match participation.

Framework and Methods

The tool was developed using the Knowledge‑to‑Action (KTA) cycle, an implementation science framework that bridges research into real‑world practice. The process involved:

• Review of current research on postpartum rehabilitation and return-to-sport.
• Identification of barriers and enablers to athletic participation after childbirth.
• Creation and validation of a step‑wise, user‑friendly decision aid through international expert consultation (32 respondents from 12 countries).

The resulting framework integrates medical screening, psychosocial evaluation, training progression, and structured communication between all members of the MDT.

Core Components

1. Contraindication Screening

Every postpartum player should first be screened for medical conditions that require clearance before engaging in exercise or contact sport.
The decision aid aligns with FIFA’s and CSEP’s Get Active Questionnaire for Postpartum screening standards.

2. Biopsychosocial Assessment

Acknowledging that postpartum recovery involves far more than physical readiness, the tool embeds validated questionnaires for:

• Mental health: Edinburgh Postnatal Depression Scale (EPDS)
• Fear of movement: Fear‑Avoidance Beliefs Questionnaire (FABQ‑PA)
• Pelvic floor function: PFD‑Sentinel Tool

These allow practitioners to identify issues affecting performance, recovery, or wellbeing and enable appropriate referral (e.g., pelvic health physiotherapy or psychological support).

3. Seven‑Stage “Stepping into Play” Progression

The training roadmap follows clear progression and regression criteria, helping players transition safely from initial rehabilitation to full match intensity.
Each stage includes goals, sample activities, and monitoring checkpoints, ensuring transparent communication within the MDT and with the athlete.

4. Postpartum Medical & Performance Debrief Form

A documentation and reflection tool that records key decisions, adaptations, and athlete feedback. This promotes accountability, consistent follow‑up, and shared decision‑making — echoing FIFPRO’s emphasis on player empowerment and ongoing dialogue between athlete and club.

Key Principles for Practitioners

From FIFPRO and FIFA Guidance:

• Player‑centred: The athlete’s voice drives the process. Participation decisions should respect her physical, mental, and emotional readiness.
• Team‑supported: Collaboration between doctors, physios, performance coaches, and coaches is vital.
• Flexible and individualised: Postpartum trajectories vary; timelines should adapt to each player’s health, delivery type, symptoms, and personal goals.
• Holistic care: Address recovery, breastfeeding, sleep, nutrition, and psychological wellbeing — all of which influence performance outcomes.
• Transparent communication: Documentation using the debrief form ensures medical, performance, and coaching decisions align.

Practical Application in Clubs

1. Integrate the decision aid into club return‑to‑play protocols.
2. Educate medical and coaching staff on postpartum physiology, screening tools, and communication strategies.
3. Build MDT capacity: Ensure coordination between medical support, strength & conditioning staff, mental health professionals, and the player.
4. Prioritise health over timelines: Avoid one‑size‑fits‑all prescriptions. Functional readiness, not weeks postpartum, should determine progression.
5. Monitor and evaluate: Document each training phase, noting symptoms such as pelvic discomfort, fatigue, or mood changes.

Research Insights

• The decision aid received 97% approval for usability and 100% endorsement of its seven‑stage progression framework from professional stakeholders.
• Respondents in a usability trial correctly applied the tool 93% of the time, confirming its intuitive, practical design.
• Ongoing implementation and evaluation are underway across global football environments.

Take‑Home Message

The FIFA Stepping into Play Decision Aid operationalizes the postpartum policies championed by FIFA and FIFPRO — moving from “what should be done” to “how to do it”.
It helps practitioners bridge the gap between theory and day‑to‑day professional football environments, ensuring that postpartum athletes are supported physically, psychologically, and professionally as they return to the pitch.

Ultimately, it reframes postpartum recovery not as career interruption but as another phase in athletic development.

Note: This summary was generated with the assistance of Claude Opus 4.1 based on the original paper and the FIFPRO article, with the aim of translating the research into practical insights for coaches and practitioners.