The Barbell Mamas Podcast | Pregnancy, Postpartum, Pelvic Health
The times are changing and moms have athletic goals, want to exercise at high-intensity or lift heavy weights, and want to be able to continue with their exercise routines during pregnancy, after baby and with healthcare providers that support them along the way.
In this podcast, we are going to bring you up-to-date health and fitness information about all topics in women's health with a special lens of exercise. With standalone episodes and special guests, we hope to help you feel prepared and supported in your motherhood or pelvic health journey.
The Barbell Mamas Podcast | Pregnancy, Postpartum, Pelvic Health
Understanding Pelvic Floor Changes During Pregnancy
Ever wondered how pregnancy fatigue and vomiting can challenge the pelvic floor? Tune in to the latest episode of the Barbell Mamas podcast, where we unravel the physical complexities of pregnancy. Christina Prevett, a pelvic floor physical therapist, joins co-host Sheena Berman to explore how the tiredness of pregnancy and frequent vomiting can strain the pelvic floor, leading to symptoms like involuntary urine release. With insights from Dr. Jenny LaCrosse, we dive into anatomical variations and the potential hormonal links that might predispose some individuals to pelvic floor issues. This episode promises to shed light on the intricacies of pregnancy that often go unnoticed.
Moving beyond fatigue, we also explore the biomechanical changes that come with pregnancy. As your body adapts to its new passenger, anterior pelvic tilt and lumbar lordosis become part of the norm. Christina discusses the critical role of strength training and debunks myths about weakened muscles during pregnancy. Through a candid conversation, we highlight how modifying exercises instead of eliminating them can sustain core strength and manage symptoms like leaking during activities such as running. The emphasis is on understanding your body's evolving needs and fostering resilience through tailored exercise routines.
Pelvic floor health doesn't stop at understanding; it requires action. Our episode continues with a focus on pelvic floor exercises and therapy, challenging the anti-Kegel sentiment with evidence-based support for pelvic floor strengthening. We emphasize the importance of coordination, relaxation, and strengthening, offering strategies for modifying activities that trigger symptoms. By maintaining strength and avoiding deconditioning, expectant mothers can enhance their postpartum recovery. Join us in this comprehensive discussion that empowers you to navigate the physical demands of pregnancy with confidence and care.
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Hello everyone and welcome to the Barbell Mamas podcast.
Speaker 1:My name is Christina Previtt. I'm a pelvic floor physical therapist, researcher in exercise and pregnancy, and a mom of two who has competed in CrossFit, powerlifting or weightlifting, pregnant, postpartum 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 pelvic floor physical therapist, I am not your pelvic 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 started. Hello everybody and welcome back to the Barbell Mamas podcast. Sheena Berman, here and today, we are going to talk about why your pelvic floor symptoms may get worse during your pregnancy. Before I do that, I wanted to tackle a couple of things. I had had Dr Jonathan Rosner on the show and, since I'm so honored that he's continued to listen, we posted a C-section episode last week and I just wanted to correct one thing that I said was incorrect. I had talked about how we have the horizontal line or scar across the skin and that we do a vertical incision through the linea alba to make sure that we don't cut through the rectus muscles, the six pack muscle, but it is not a vertical incision through the uterus. He said that that was called a classical C-section, which is very rarely done now, and there is a horizontal incision through the uterus. So horizontal across the skin, vertical to spare abdominals and then a horizontal incision across the uterus. Thank you so much for that correction. I really appreciate it and I am never offended or concerned when somebody tries to clarify some of my information. I am not perfect and I am still always or concerned when somebody tries to clarify some of my information. I am not perfect and I am still always learning, and so thank you for that clarification.
Speaker 1:The second thing I must admit to you all is that I am feeling a little heart and mind tired. I am going to keep trying really hard to do these podcast episodes on a regular basis, but if you all follow me on my personal social media, you know that I have been talking about some of the changes and censoring and change of language and allowing a change of language. That's happening through the National Science Foundation and the National Institutes of Health and is making me feel really sad and really devastated. Even though I'm in Canada, my grant funding has not changed. I'm with the Canadian Institutes for Health Research with my work.
Speaker 1:I am out of the University of Alberta, but I am a women's health researcher. I research pregnancy. What you're going to notice if you have listened to any of my podcast episodes is that I try to be very inclusive with my language in all directions. Right, I say pregnant women, I say pregnant people, I say pregnant individuals, I say women and people. Our Society for Obstetricians and Gynecologists of Canada ask us to write in our manuscripts pregnant women and people, to be inclusive and make everybody feel like those recommendations apply to them, and I'm going to continue doing that. But also recognize that it is going to have such astronomical downstream consequences on some of the positive momentum that I feel like we've been having.
Speaker 1:And I said I posted about how it's really dangerous for pregnant person to be a forbidden term and everyone came at me and said it's women. Well, guess what? Like a couple of days later, women and female were also restricted, and a new bill came up into the house of representatives that required your birth certificate and your passport to have the same name, and so it would make it very, very difficult for married women who changed their names. It would be a very big hurdle for them to be able to vote. So I don't think I really was that far off with some of my my thoughts, and I am very pro trans rights and I treat trans individuals and I have worked with them from a public perspective, from an orthopedic perspective. They have told me about some of the struggles that they have just existing, and so I feel really sad.
Speaker 1:I'm probably going to tear up just like thinking about it, because it's just, it's unbelievably disheartening to see the scientific process be so, so bluntly and systematically eroded, and I have collaborators in the U S that their grants are halted and their labs can no longer be funded, um, and it's just really devastating, you know, and so, um, I really don't care what your politics are. Um, I think that you can vote for a representative and not agree with everything that they did, and I actually think that if you did vote for Trump, that your voice, if you don't agree with this is more important than people who did not vote for him, because the way that this is going to impact science for many, many years to come and we are just starting to get some momentum on us even beginning to understand women's specific health problems like PCOS and fibroids, endometriosis, ovarian cysts, complications of pregnancy, menopause and how to handle these things medically Like it's just, it's devastating. It's devastating and so I'm going to keep trying to show up, but I know that I'm not working at 100% capacity here and even as a Canadian, my heart is very heavy. I have a visa to the US, I teach in the US clinician and yeah, there's just there's a lot of downstream consequences that are making me really sad. So we're going to, we're going to finish that there, and I feel very like disingenuous, not or just trying to ignore all this stuff that is happening to. You know, go on business as usual, because it's not business as usual when my colleagues and collaborators are losing their research labs, all right, so why might your pelvic floor symptoms be getting worse during pregnancy?
Speaker 1:When I am kind of talking about pelvic floor symptoms, what am I referring to? It could be abdominal weakness, so some people will call that coning or they'll see coning happen very suddenly across their ab wall. That could be that they are peeing when they don't want to, so either they have to rush to the bathroom, which would be urgent continence, or when they cough, sneeze, exercise, do anything of high intensity or high impact, they are leaking, pee without meaning to. It could be feelings of heaviness or sensations of a ball within the vaginal opening, kind of in line with what we would call pelvic organ prolapse. It could be pain. I talked a little bit about why I think that pain can be so significant, so high, in pregnancy, talking about some of the hormones. So I'm not going to really focus on pelvic girdle pain, as I just talked about that a couple weeks ago. So today what I really want to focus on is the pelvic floor symptoms, so specifically peeing and heaviness around the vaginal opening. That can be getting worse during pregnancy.
Speaker 1:The first thing that I want to say is that if you have noticed an increase in your symptoms, it is okay. I first want you to know it is okay that those symptoms have happened. I do not want you to panic or be really concerned for long-term health outcomes and all those types of things, like you know, just first. I just don't want you to panic or freak out because all of a sudden sensations have changed within your body. These sensations can happen very early on in the first trimester, particularly in subsequent pregnancies. So if you have given birth before, you may feel a bit more sensitive to those sensations early on in a second, third, fourth, fifth pregnancy, and that is okay. So let's kind of talk about it. Because people think, oh my gosh, these symptoms are starting in the first trimester. I have not even gotten that big yet. It's obviously not the way to the baby, because baby is the size of a pea. So what the heck is going on. So let's kind of talk about some of the things that around pregnancy, biomechanics and physiology that could make this a little bit worse In the first trimester.
Speaker 1:The obvious ones that are going to place some amount of strain on the entire body, and then particularly on the pelvic floor, is fatigue and vomiting. So your entire body feels very, very tired. Pregnancy tired is an experience that is like no other. A friend of mine, we were talking and I said, and she agreed, that I would take postpartum tired with a baby that isn't sleeping a million times over compared to pregnancy tired because it feels like, no matter what you do, your body is just walking through mud, like I compare it to wearing a weighted blanket on your body 24 seven. No matter how much you sleep or how much you nap, it does not seem to get any better.
Speaker 1:And when you're having second pregnancies it feels like, oh my gosh, my body's been hit with some sort of tycoon because you have a little one at home that you have to take care of. Plus, you know function as if you were not pregnant, in the workplace or wherever you are and whatever you're doing, and try and continue going on, so that fatigue can make everything feel a little bit worse. And then, additionally, especially if you are also throwing up right, that can put a lot of pressure on the pelvic floor. I will have clients will say things to me like I took an entire two weeks off for having gastro or having some sort of, you know, flu bug and my pelvic floor feels worse, like I just took two weeks off. I'm like, hey, your quads may have taken two weeks off, but trust me when I say your pelvic floor did not.
Speaker 1:And when you are trying to throw up, think about the muscles in your core canister, right Pelvic floor, abdominal wall, muscles in your back, your erectors in your chest wall they all violently and rhythmically contract to create an increase in pressure in your belly in order to expel whatever is in your stomach and that could be because of the hormone changes that we see during pregnancy or because of some sort of bug and the idea is to evacuate the contents from your stomach, and so that contraction has to be very strong in order for us to do that. It's the same with coughing right, you have to increase the pressure around your core canister. That's going to allow your cough to be more productive, for you to be able to get whatever is in your lungs out of it to try and protect yourself, like it's a protective response. But when you are tired, when you already have some pelvic floor issues going on, maybe there are some relative weakness in your pelvic floor or your pelvic floor is just so gassed because of fatigue plus vomiting, it can hit this threshold where, all of a sudden, it cannot contract as hard as it needs to to avoid peeing or letting go of gas or stool. When you are rhythmically having that really strong contraction while you are retching and just like any other muscle, your pelvic floor requires time to recover, right, you're not going to heavy squat every single day because your legs would get tired. Eventually, your legs wouldn't be able to lift as much as they could before and it wouldn't actually lead to long-term like advantages in strength. If you are vomiting every day in your first trimester, you are never giving your pelvic floor a break right Like, and so you may be able to get through a couple of days. However, eventually, if you are vomiting all the time, it can make it really hard for your pelvic floor to respond and recover. And that being said, the fact of the matter is is that our pelvic floor is actually a very resilient muscle group and it recovers relatively quickly. But depending on how often you are vomiting and what your pelvic floor recovery was in between pregnancies, it may make your threshold or your capacity to withstand that vomiting a lot lower and that can make it so that you're starting to pee.
Speaker 1:A colleague of mine her name is Dr Jenny LaCrosse and she's working on the in aging but across the lifespan, around the changes to pelvic floor morphology after giving birth vaginally and what that may do to our body's capacity to withstand that increase in pressure like when we are vomiting. And she said something really profound for me and said that there are certain amounts of pressure that, just based on your anatomy, you may be more likely to vomit and there's nothing that you could do to fix it. Because I was saying to her that one of the things as a pelvic floor physical therapist that I find so hard is I can often help people if they're peeing with coughing, sneezing, running. But sometimes the hardest one to get the full recovery on is if you're throwing up. And you know she was saying, you know just the absolute magnitude of pressure in your belly that's required in order to successfully vomit, based on how your anatomy changes with age, stage, life and delivery can make it, so that you may be one of those persons whose anatomy is just going to make it that if you're throwing up you are peeing. And I thought that was kind of helpful because it kind of just points to the fact that there is variation in all of our anatomy and where things are and that might mean like there's nothing that you can do about it and it's not your fault that this is happening. So in the first trimester, that fatigue, the throwing up, is definitely something. There is probably something to be said with the increase in human chorionic gonadotropin, estrogen and progesterone that happen with that start very early on in that process of becoming pregnant and baby growing. I do not know if there's any close connection between rate of that rise and onset of or worsening of pelvic floor symptoms. I haven't seen any of that in the research, though it stands to reason that you know estrogen influences the ligaments and our muscles and therefore it could influence our pelvic floor. But the jury's still out on that and I'm not really sure where that connection is just yet.
Speaker 1:As you progress through your pregnancy and fetus starts to get bigger and baby starts to develop, then there are biomechanical and musculoskeletal changes that happen during pregnancy that are going to make it so that your pelvic floor has to be stronger the uterus pelvis, not weight of the pelvis, weight of the uterus, placenta and fetal growth and then also subsequently the change in your body mechanics that are working to get used to or accommodate that change in baby. What I mean by that? So? Obviously absolute weight, normal weight gain during pregnancy, 25 to 35 pounds plus or minus, and it depends on what your BMI and body fat percentage et cetera was going into pregnancy and everybody's a little bit different. That is one thing. It's just an absolute amount of weight on the pelvic floor.
Speaker 1:The second part is how your body changes. So outside of the first trimester, so as you get into the second trimester, definitely in the third, the uterus and fetal size is going to increase and your uterus is going to push, pop out of your pelvis and come into your abdominals or into your stomach area, right. If you've ever seen a picture of how much your organs and stuff are displaced as you get into your third trimester, everything gets a little squished. But baby's got lots of room and a couple of things happen to accommodate that. Our ab muscles. They stretch and lengthen, right. This is why diastasis recti and coning is so concerning to people, even though it doesn't have to be. It's this beautiful mechanism that our body goes through in order for us to make room for baby to grow.
Speaker 1:So our belly starts to pop out more, our abdominal walls lengthen and for many they do not feel as strong. I'm not going to say weakened. My postdoc supervisor. I said that our ab walls get weaker and she's like do we know that? Everybody's ab wall gets weaker and I love being a postdoc, because I always get questioned on things that I am making very black and white that are never black and white and so, no, they do not become weak. But we can probably say that they weaken because they're in a lengthened position and if we look at muscle tension relationships, a lengthened position is often not the strongest from a length tension perspective on the ab wall. So that lengthens, our pelvis is going to tilt forward and our low back is going to arch more. So anterior pelvic tilt, lumbar lordosis changes arch more, so anterior pelvic tilt, lumbar lordosis changes and that is to keep our center of mass over our base of support so that basically we maintain our upright balance and our baby doesn't cause us to fall forward, right. So we make those changes to accommodate that and so that kind of changes how our bodies move in space. Now our pregnancy progresses very slowly. Most individuals who are pregnant they will accommodate and change for that.
Speaker 1:If you are active, like if you're a runner, if you're a lifter, like, your body adapts to that very gradually and you make the necessary micro adjustments every single day. You go into the gym and most of the times people like if you were a runner before you could keep running on the treadmill and those types of things. Don't change your balance point too much. It might change your speed, but what we see with that, however, though, if we kind of come back to that core canister, is that it changes the strain on the muscles around the hip and the pelvic floor. Right, our core canister is meant to be in its strongest length tension relationship, which is neutral, so rib cage over pelvis, and it co-contracts together in order for us to move our limbs right. It's our force generator. We contract our core and then we push, pull, reach, lift, against whatever gravity, any activity we're doing in our daily life strength training, whatever that may be and then, as we change speed, for example, that increases even more. Like this is true in even running.
Speaker 1:Right, you may not think that running is lifting, but running is exerting force, this point into the ground in order to propel us forward, and if you've ever been somebody who does, you know, leisurely jogs and then all of a sudden do a sprint workout, you're like dang, my abs are sore the next day, and that's because there's this increase in contraction of all the sides of the core canister. And it's also why, sometimes, if you're having leaking, for example, with running, we start by trying to slow you down to see if we can bring that threshold down or bring you below your threshold of leaking by managing or changing speed. But in pregnancy we have one side of that poor cancer that lengthens and subsequently is weaker than it was before. What we say now, and what I've definitely changed my mind on the last two years, is that I hammer strength training across a person's pregnancy for that reason. Right, never in rehab would we say, oh, your body is under more strain, we need to avoid doing it and have it weaken and decondition further, right? I do not want you to hear that sometimes it can make our pelvic floor muscles have to work harder. The weight of the baby plus the fact that one side of our core cancer is not as strong or contracting maybe as optimally as it was before, can make for a situation where you're feeling symptoms more often. And then some of those change in biomechanics also change how strong our pelvic floor is contracting. We have some like preliminary research, for example, that being too much in an anterior pelvic tilt increases your likelihood of pelvic floor dysfunction.
Speaker 1:And I had somebody. I will never forget this. I was at a gym and a very well-meaning practitioner said well, you have anterior pelvic tilt, you should go see a pelvic floor PT. And so she came up to me and she said hey, I got told that I have this anterior pelvic tilt. Should I come see you? And I said well, are you having any pelvic floor issues? She's like no. I said are you having any pain? And she said no. I was like well, make sure you keep your ribs over your pelvis as you squat heavy like you're going to be fine.
Speaker 1:And when I was pregnant with Quinn and with my second, the only time I had incontinence was if I was like kind of lounging on the couch as I got into my second and third trimester. And so what I would do if you're reclining I'm reclining in a couch right now is your pelvis tucks under and now you're in a posterior pelvic tilt. And if I had to sneeze or cough anytime, especially with a full bladder in my second pregnancy, I knew I was going to leak a little bit. And the reason for that is when you're not in neutral, your muscles of your pelvic floor not extremely, but they're just not in their strongest orientation. It's why when we're strength training, when we're doing lifting, when we're teaching form or technique for many different types of exercise. We kind of stay in that neutral position where our pelvis is a neutral and our rib cage is stacked up on top of it, not because being an anterior or posterior tilt is wrong, and if you are going to be there, I'd likely strengthen you there, for example, with our strongman athletes who are rolling odd objects up their backs into extension, like they're going to have to have a really strong pelvic floor in that anterior pelvic tilt. But what I am going to try and do, especially, you know, when there's extra strain there is, try and put you in the strongest position I can when you have an increase in belly pressure coming. Therefore, my recommendation is is, if you feel like you're going to sneeze, and you can, when you're pregnant, think about the position of your body. Now some people have a short torso and belly has to expand really far out, and so this may be very difficult, especially if you're 37, 38 weeks pregnant. However, I'm trying the best you can and then doing that pre-contraction of the pelvic floor that we call the NAC, which is a squeeze before you sneeze, can be helpful to try and immediately reduce those symptoms. What I'm kind of getting at with this is what the heck do we do about it?
Speaker 1:I kind of mentioned a couple of things already that I want to reiterate. One is don't freak out. It's okay if you have an increase in symptoms. There's a lot that we can do. It is not necessary for you to just wait it out until your postpartum. I have a lot of people who saw me postpartum with their first and then continued to see me when they got pregnant with their second and they said I really wish that I would have seen you when I was pregnant, so you do not need to wait. This is true with pain too. I don't like when providers say that you just have to wait until the baby comes out, because there is a lot that we can do. And if you have pain very early on in pregnancy, um, it can feel very demoralizing and very upsetting because you think I'm just going to be in pain for the next six months. So the first thing is that it is okay, we will help figure this out. Um, the second thing is that it is okay, we will help figure this out. The second thing is your positions, right? I just kind of mentioned that, getting in that neutral as best as you can, given your body shape and size and your stage of pregnancy can help, and then trying to think about that squeeze before you sneeze can be helpful. The next two are going to be true with leaking or with heaviness. I should mention I've been talking a lot about peeing, but this can be true with heaviness as well. So your heaviness tends to be, especially in pregnancy, made worse just with prolonged activity. But the next two things, whether you're having heaviness or leaking, that is a bit worse.
Speaker 1:Pelvic floor physical therapy can help and exercise modification, not elimination. There is a lot of really confusing information on the internet and there's a group of pelvic floor physical therapists who are like kind of becoming very anti Kegel and I really disagree with that sentiment. I've spoken very openly about that. We have Cochrane level evidence that says that in pregnancy doing pelvic floor muscle strengthening can help to prevent or mitigate the impact of urinary incontinence on pregnant individuals and so really important. But I like to expand our definition of pelvic floor muscle training. My clinician hat is on right now, not my researcher hat. My researcher hat says it's just the strengthening, but my clinician hat especially working with active individuals. I actually scratched that not just active individuals, it's everybody is that it should encompass making sure that you're contracting your pelvic floor at the right time. So coordination, strengthening and relaxation. And then that relaxation becomes really important when we're thinking about delivering, especially in the pushing stage of delivery.
Speaker 1:And so if you are having an exacerbation of symptoms, please don't wait. If you have access to pelvic floor PT, I really highly encourage you to go seek out some help, because they can, one, calm your mind, two, figure out kind of where you're at from a pelvic floor strengthening perspective, and then, three, get you on a plan to help at least manage some of your symptoms, hopefully eliminate them as much as we can for as long as possible in your pregnancy. So that can be pelvic floor. The third thing is going to be or I guess, fourth is exercise modification, not elimination. And the reason why I say that and let me be clear, like if you choose that, hey, like this isn't right for me right now, or it doesn't feel very good, like that's not what I mean, but I just don't want the knee jerk reaction of like, oh this, I have a little bit of symptoms with this, you should just stop doing it Right, we see it in our kind of standard orthopedic practice all the time of oh, it hurts to squat because of my knee pain, well then, don't squat. I was like well, how do you get up from toilet? And when things are under more strain, deconditioning them more, making them weaker, isn't the answer right, especially when all of our research is saying that the stronger a part of the body is, the more resilient it is to stress and activity, and we want to keep that, and that includes in pregnancy too.
Speaker 1:So what are things that you can do if you're having symptoms? So the first thing is trying to figure out what are things that you do throughout your day that are aggravating. What are things that you do throughout your day that are aggravating? For some people there's no real connection, but for others it can be. You know if I run over a 5k or if I squat over this weight or if I do a squat workout and I'm fine with a deadlift, for example.
Speaker 1:Trying to figure out what might be your aggravating factors, like what might be making your pelvic floor symptoms worse during your pregnancy, is step one. The second thing is to take a look at your biomechanics first. So before I say, well, then, stop doing it, or before I have a conversation. Maybe we should stop running in pregnancy this oftentimes is a conversation when people are in pain is. Let's take a look at you on the treadmill right. Is your low back firing up because you're trying to slow yourself down? You're already arched in pregnancy and then you're arching more. You've lost some strength around your hips, so now you're stomping. Your impact is higher through your joints and it's flaring you up during running right, for example. So the next thing is to look at how you are changing maybe the way that you're moving during pregnancy and seeing if we can change it back or put you into a better position to bring your symptoms down.
Speaker 1:And then the third thing is that we can change load, speed, volume, impact, range of motion or all of the above to modify the exercise before we have to eliminate it. If you do those things and you're still experiencing symptoms and you're like you know, I don't really love this enough for me to try and problem solve through this. I think I'm just going to parking lot this until I postpartum. That's great, like that is totally fine. Um, however, if it's something that means a lot to you like I know a lot of my runners want to continue running for as much as for as long as they can. A lot of my lifters want to keep up enough strength so that they can get back to things postpartum. Um, for my CrossFitters who like to do gymnastics, they don't want to remove those if they don't have to like those types of things. If they are meaningful to you, then we can work on exercise modification before elimination and to you, then we can work on exercise modification before elimination. And I think the third thing, or I guess the last thing, I don't even know, like I don't even know why I bother with these because I end up doing like one A, one B, one C Additionally, like you know, one of the things that I've been really exploring in my own research and I'm going to have a couple of new research projects that hopefully are going to be announced very shortly we're going through ethics right now is that I want to try and limit the deconditioning of pregnancy as much as possible.
Speaker 1:Right, we're going to get weaker in pregnancy, but it makes it harder to recover when we've lost a significant amount of strength. Right, you're going to hear me say this a lot like being pregnant is hard. Being pregnant deconditioned is harder. Being postpartum is hard. Being postpartum deconditioned is harder. Aging is hard. Aging deconditioned is harder. To give the head nod over to my geriatric rehab PhD right. So we want to think about that and try and hold onto that as much as possible, and I even think about that just to be totally on a soapbox at another side.
Speaker 1:Rant is I think about that in your inter pregnancy window, like if you know that you want to have three kids back to back to back, you're 35, you want three, so you're going to get pregnant really close together. Like I hope that you are aggressively trying to regain that strength in between pregnancies instead of thinking I'll do it after my third pregnancy because that relative deconditioning increases with every follow-up pregnancy that you have in a short window. And I think I would love, love, love, love to have more research that's looking on return to strength from a pelvic floor perspective, yes, but general strength too, and how each follow-up pregnancy goes. So that is kind of totally a rant going on the side, but thinking about you know we don't necessarily always have to have the knee-jerk reaction of stopping exercise when there's a lot of things that we have on our checklist first before you know, the elimination or removing of exercise is where we go, and a lot of times too, like some of these things that we are trying to maybe substitute when we are trying to eliminate, those exercises create a bigger barrier. So I see a lot of providers will say things like, oh well, try and get into the pool or trying to get yoga. I see a lot of providers will say things like, oh well, try and get into the pool or try to get yoga, and the exercise that they were doing was at home in their garage with weights that they had available to them, and they don't have child care, so getting out to a pool is actually impossible, and so we kind of want to explore that too before thinking. You know, my knee jerk reaction is just to go to low impact or low load or what are traditionally kind of seen as pregnancy safe options.
Speaker 1:All right, I hope you found that helpful. I hope you felt seen and heard. If you are in this camp where your pelvic floor symptoms have spiked during pregnancy, know that for many individuals you can see relief in pregnancy and also postpartum. Part of the reason why this advice exists is because it is true that many times we see an improvement in symptoms postpartum. As you know, hormone fluctuations come back and level out a little bit more, and so it's going to be okay, and we have a lot of clinicians who are in our corners. Talk to your obstetrical providers, talk to your rehab team, if you have them, and they can figure out the plan that works best for you. All right, have a wonderful week, everybody. I hope you all are staying strong out there and I will see you all.
