And welcome to the Far Down Moments podcast.

My name is Christina Fabit, I'm a public four-fluffe out there, and the pleasure in exercise and fighting feet in a mom of the students who have to see it in Cosmetics Hollywood or Please Fighting post-facts or both.

In this podcast, we want to talk about the realities of being a mom who loves to exercise.

Whether you're a recreational exerciser or an athlete, we want to talk about all of the things that we go through as females going into this motherhood journey.

We're going to talk about fertility, pregnancy, and postpartum topics that are relevant to the active individual.

While I am a public floor physical therapist, I am not your public floor physical therapist, and know that this podcast does not substitute medical advice.

All right, come along for this journey with us while we navigate motherhood together.

And I can't wait to get together.

Hello everybody and welcome to the Barbell Mamas podcast.

Christina Freva here, and today we're going to be talking about some controversial truths, maybe about uh return to exercise, exercise in pregnancy and postpartum, and its relationship to pelvic health.

I feel like we have gone through this absolutely massive change in the way that we are approaching exercise and pregnancy and postpartum, but then also in the world of pelvic flora rehabilitation.

In the last, you know, as I said, five to 10 years, there's been a big change.

There has been a lot of individuals who are trying to be more active in pregnancy and postpartum, more research has come out in this space.

And I feel like that's created a much different landscape than we have seen previously.

And so my first controversial truth is that when we are giving uh advice about exercise outside of a complication that you are seeking medical attention for in the pregnant and postpartum space, the question isn't about if you should be working out.

It's about the personalized and individualized how, right?

When we are looking at recommendations in pregnancy and postpartum, again, outside of medical issues that require pelvic rest or close medical monitoring, we should be recommending that pregnant and postpartum individuals stay active.

And I mean that after cesarean delivery, I mean that after vaginal delivery, I mean that when individuals are experiencing pelvic floor dysfunction.

I remember when I was pregnant in postpartum for both of my deliveries, and I have had plenty of people over the years say to me, like, Christina, it must be nice that you are this unicorn who didn't have any issues, and you were able to exercise immediately postpartum, or you were able to exercise to intensity without issues.

And I think this really gets to a fundamental switch that is necessary in medicine because I didn't get to do those things because of the absence of complications or pelvic floor issues or injuries.

I leveraged exercise in order to work through all of these issues.

In medicine, one of the things that drives me absolutely bananas is that we think that we need to earn our exercise, that we need to have low symptom burden, that we can't have any pain, that we have to be able to do X, Y, Z before we allow ourselves to be exercising.

But where the pendulum has to switch and where the change in our philosophy has to be is that exercise is the vehicle.

Exercise is the tool to reduce those symptoms.

That is so fundamentally different.

Because the reason why I got to do all of those things is not because I didn't have symptoms.

Heck, I've had dyspernia, pain with uh sexual activity, I have had incontinence, I have had subjective symptoms of prolapse.

I do have objective signs of prolapse, I've had two vaginal deliveries.

Of course I do.

I have had injuries, I have had issues, but I have leveraged exercise and modified my exercise program to create this bridge to capacity in order to bring my symptom burden down.

Every day in my DMs, I get people who tell me that they have these different pelvic concerns and they are being told to not do exercise that they love, to stop lifting, that they can't run, that they can't do this, that they can't do that.

And, you know, I work with a lot of geriatric clients as well who are facing these um these changes to their body as well in a different way, in an aging capacity versus in a pregnancy postpartum capacity.

And instead of trying to troubleshoot how they can continue moving in a way that they love, the knee-jerk reaction often by their providers and pelvic health physical therapists can actually be really bad about this, about essentially making them gatekeepers, that you have to earn your exercise instead of acknowledging that exercise may help to improve their symptoms in the first place.

They say you can't do this.

You shouldn't do that.

Wait six months before you start high intensity.

Where did that come from?

Who knows?

Right?

These pieces of advice they're well-meaning, but we have to look at the flip of what happens when we decondition individuals.

Do we really think that their symptoms are gonna get better in a body that is weaker?

And I knew that I was gonna start with this one, it was gonna make me all fired up because I think it's really important is that in 2025, going into 2026, what we need to acknowledge is that exercise is a vehicle for improving pelvic fluoride function.

Exercise is a vehicle for feeling better in that vulnerable time in the postpartum period.

Now, I understand that not everybody is going to be able to have a gym that they can bring babies to, that they are gonna have the time to cater or have a full exercise program.

I understand that, absolutely, but it does not take an hour, right?

You can get a lot of work done in five to 10 minutes, and that is going to significantly improve your symptom burden.

And 99.999% of people can do that, right?

They can do that.

I understand being busy, I really do.

And I do know that I scroll doom scroll on Instagram way longer than I should, probably to the detriment of my mental health, if we're being truly honest, right?

We can carve that time away.

And as a pelvic health provider, I need to be that person who is really educating that the use of exercise is going to improve your symptoms, right?

Is going to improve your symptoms.

The next kind of controversial truth, and I've talked about this a lot in my clinical circles, is that every person that you see in healthcare and in pelvic health PT, like kind of putting them under the same umbrella, these individuals have biases.

And especially for mothers in pelvic health PT, the transfer into motherhood is such an astronomically world-shattering experience that what I see a lot of the pipeline in pelvic health PT, and this is not everybody, of course, but many pelvic health physical therapists through their uh pregnancy and postpartum transition, those changes to their body and the need to rehab from their own experience is oftentimes a big driver into getting women, in particular women clinicians, into this profession.

Now, this is not true in other medical fields, sometimes it is, but um, I definitely see a big pipeline of like I had my first kid, I struggle with pelvic floor dysfunction, this became something that I was really passionate about.

I want to bring this information to my community.

I love that.

I think it's really great.

I love how many people are now in the profession, how many people are really enjoying engaging in pelvic health.

And it's really important that if you are a provider or a coach, if you're an exercise professional, a lot of personal trainers get into pregnancy postpartum fitness during their own pregnancy journey and then start classes and things like that.

It is really important to know that your personal experience can cloud your judgment if you are not reflecting on that experience.

How I see this show up in healthcare and in obstetrics is that a lot of times our physicians see the high risk, high fear, right?

The scary stuff in their field, right?

That's why they are there.

They have the specialized training to be able to handle the scary and complicated.

So many people see our most vulnerable 10% of 70-year-olds and don't see how many, you know, thriving 70-year-olds there are.

You know, moms who have never exercised before, or for moms who want to exercise more than I felt comfortable exercising in pregnancy and postpartum.

And sometimes I have to reflect on reflect on is this emotional reaction or is my my response around limiting exercise or how I'm counseling on increasing exercise being clouded by my own thoughts and feelings around movement, or is this rooted in the evidence plus the summation of my clinical experience?

The reason why I say this is that I one, I have a lot of healthcare providers and exercise professionals who are listening to this.

And two, is for some clients who are in my DMs who are talking to me about, you know, where some of this advice is coming from.

Many times it is coming from just clinical experience and not necessarily rooted in the evidence.

And because up until recently we haven't had a lot of evidence, that's kind of been what the clinician has to come from.

And so just kind of acknowledging that emotional side of being in pelvic health.

Um, I think, you know, working in pregnancy and postpartum, being a mother yourself can be a very strong connecting point when you're working in this area.

But we have to make sure that we're not letting our own, you know, experiences with prolapse or our own experience with pelvic florid dysfunction um seep into our treatment.

This kind of comes into my third controversial truth is that we need to acknowledge, and I don't really know how to frame this perfectly, um, but we have an education problem in pregnancy and postpartum.

Many moms go into pregnancy and postpartum, and they understand that they could get stretch marks, they understand that their nipples may not be in the same place pre-conception as after their breastfeeding journeys, but we still have a lot of work to do in understanding and educating on expected changes with postpartum, um, especially in the case of vaginal delivery.

And we have a lot of work to do on the education side around the possibility of birth injury when you come into your postpartum journey and you feel like you've been duped or that you really didn't know how much your body was going to feel different from pregnancy to postpartum, you can feel like the medical system has really let you down.

And I I agree, right?

That there is there's so much benefit that happens in the prevention side around having an understanding and education around what pelvic floor health in the postpartum period can look like.

As like a 3B of this, what can happen is that that education in the postpartum period often happens when we are seeking labels or diagnoses for some of our sensations in the postpartum period.

And it's once we have these diagnoses of diastasis recti or pelvic organ prolapse or incontinence or what have you, but especially diastasis recti and pelvic organ prolapse, many times that's when our education begins.

And we start to recognize that I'm not crazy, or I wasn't wrong in understanding that this deviation from what I was feeling in pregnancy to postpartum is something that has been characterized in the research or does have labels associated with it.

Why I kind of tangle these two things together on the education side is that in our postpartum in particular, in our rehabilitation spaces, in our Euro gynecology spaces, we're having a lot of conversations around overdiagnosis and over-diagnosis because we are just getting now an understanding of normal variability in anthropometrics, body shapes, and sizes, and the urogenital system of women across the lifespan.

For example, we have data that almost 50% of our population, our eight or 30-plus population, has a greater than two centimeter distance between their two rectus muscles on a headlift, which is our diagnostic criteria for having diastasis recti.

And if 50% of individuals have that distance, we're not saying that 50% of our population is dysfunctional.

It means we need to move the buoy on what is a clinically relevant diastasis recti.

When we look at our prolapse data, we see that 40 to 50% of individuals have a grade two, grade one, grade two pelvic organ prolapse, but three to eight percent of them are symptomatic.

We need to move the buoy and say that we have range of motion of the vaginal walls, when, if, and how you're assessing those vaginal walls is going to change our prevalence data tremendously.

So we need to move the buoy.

When I talk clinically about moving our diagnostic criteria, I get a lot of people who are really upset with me because they think I'm gaslighting women.

First of all, these are two separate conversations.

One is talking in a clinical space about our practice guidelines and when we are slapping a label, especially something that is negatively stigmatizing, right?

Like a prolapse diagnosis can really change a person's quality of life and their sense of self and body image.

It's moving the buoy based on new presenting information, not gaslighting how a person is feeling within their body, right?

I wouldn't say that because your MRI didn't show a disc bulge, that your back pain is BS and you're lying and it doesn't exist, right?

I'm gonna treat your back pain.

And all of our new data is saying that there's an over-reliance on this objective image of your MRI, and it actually oftentimes doesn't link up with what we are seeing in a person's symptom presentation.

And there's so many other inputs rather than what this MRI static image shows that is influencing how you're feeling within your own body.

And so, what this controversial truth is, is that we have a lot of work to do in the education space.

And I think we have to come to a consensus on the research area, research space with a combination of our Euros, our maternal fetal medicines, our OBGYNs, and our pelvic floor physical therapists around what is the diagnostic criteria and what truly is normal variation.

And as we are getting, and that is not to dismiss a person's complaints, I am never going to do that, right?

But what you are feeling within your body may not be 100% correlated to this objective finding, and we need to take this zoomed out whole body approach to how like how these sensations are coming within your body.

Why I say that this is a controversial truth, right, is that our system kind of has to change, in my opinion.

Of course, this is just my opinion, right?

Where I feel like we would have so many less women with highly sensitized pelvis pelvises if they had the education on the front end over the last, I would say two or three years in every pregnant client that I see, part of her birth prep is to say, hey, here are these normal variations that you're gonna feel, especially early postpartum, right?

We talk about vaginal wall changes, we talk about the stretch of the opening of your vagina and how that doesn't go back immediately and it may not go back to 100% at all.

Like we talk about this stretch injury that requires recovery.

We talk about the abdominal wall.

And then postpartum, I reiterate that when they say, okay, I'm feeling this.

I was like, Yep, that's exactly what we had talked about in your last pregnancy visit.

Like, that's that sensation that we were alluding to.

And then when there's a deviation outside of that norm, or if their recovery is not happening in a timeline that we would expect, then we're gonna deep dive a little bit further.

But a hesitancy, for example, to give a prolapse diagnosis at six weeks when we know that early postpartum healing, we are like your tissues are gonna shift, and that diagnosis at six weeks probably isn't that helpful, is not me saying that I shouldn't give this diagnosis.

It's being in line with our current best evidence around postpartum physiology and understanding that those diagnoses hold a lot of weight, right?

And so it's not to try and gaslight, it's not to try and not withhold information, it's me truly questioning in the medical space how we are delivering this information.

Like if you delivered vaginally, your cervix is gonna be closer to the vaginal opening in those first six to 12 weeks postpartum.

Why?

Because you pushed really hard to get that baby through your cervix.

And in first delivery, a baby had never of that size, nothing of that size had ever gone through your cervix before.

It had been completely shut, right?

And so we know that there's this moving towards the opening that happens when you push a baby out, and then we see gradual recovery that happens over time.

That cervix approaching close to the opening could give you a diagnosis of an apical prolapse, right?

But I understand that that is your healing physiology, and I'm gonna withhold and not withhold or or make sure I don't give that diagnosis early when you're in your recovery process, and that is a part of vaginal delivery physiology.

And so this is where I think we just have so much we can do on the preemptive education side.

I think we really need to lock shields with our obstetrical providers, maternal fetal medicine, OBGYNs, our midwife, midwives, all of us have to come together and educate without fear, but give empowerment of this is how it is normal for your body to feel.

Um and not to dismiss, but to disclose.

And then that education doesn't have to start with a diagnosis, right?

It has already started so that there isn't this um a kind of visceral reaction that happens when you're you're talking about changing these buoys because then it kind of moves when that education would occur to earlier on in your care pathway.

This is kind of a just random hodgepodge of things that I think a lot about the pregnancy and postpartum space.

I know that some of them are controversial.

I I don't mean any of them with malice, but rather to just kind of think I think about this a lot as a researcher too, around, you know, how do we best show up?

Because like even in research, what has to be acknowledged is that the first idea is often the idea that tries to get replicated, and then it oftentimes gets etched into the gold standard, even if there are, you know, holes in it.

Like an example is like the 12-week return to run, right?

Um, what Tom Goom, Granier, and Emma did was amazing because we had such a huge need for some sort of guidance in the return to run space.

They were the first ones to put anything out there.

And now we haven't had any substantiated evidence that has said you have to wait 12 weeks, and yet that is the prevailing advice is that you wait 12 weeks before return to running.

And again, it it's because the first idea kind of held the most traction.

Um, and it hasn't there hasn't been enough evidence that has looked at anything in the contrary because it just hasn't come out yet.

Um that doesn't mean that the 12 week is right.

It also doesn't mean that the 12 weeks is wrong.

It means that we can't say 12 weeks with confidence until we have evidence that substantiates that claim.

So we just have so much work to do.

And, you know, being a clinical researcher, I just have so much heart and passion in trying to make sure that we answer these questions well and that our profession, my profession as a pelvic floor physiotherapist, is aware of these gaps and acknowledges when our advice can kind of be harmful.

So um, yeah, just kind of random rants, random thoughts, and I think a great way to finish off this month of content.

Um, so if you have any thoughts, questions, concerns, let me know.

Otherwise, I hope you all have a wonderful Thanksgiving if you are in the US.

My family is doing Friendsgiving when we moved back from the US to Canada.

We decided to keep girls uh timelines because Canada's Thanksgiving is in October.

So we do family Thanksgiving in October and Friendsgiving at the end of November.

And so it's been really fun to kind of get to Thanksgiving dinners.

I hope you all have lots of fun with family and friends, and I will talk to you all next week.