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
Navigating Medical Realities for Active Moms
Step into a heartfelt conversation about the challenges and victories faced by mothers who strive to maintain their physical health amidst the overwhelming journey of pregnancy and postpartum experiences. In this episode, Christina Prevett, a pelvic floor physical therapist and devoted mom, opens up about her personal experiences with vulnerability in healthcare. We dive deep into the emotional struggles surrounding pregnancy loss, the importance of empathy in obstetrical care, and how sharing personal narratives can create a robust support network for mothers.
Christina shares the rollercoaster of her own fertility journey, navigating moments of heart-wrenching loss and the subsequent medical care that made her feel both supported and vulnerable. This episode challenges the clinical detachment often observed in healthcare settings by emphasizing the necessity of nurturing emotional connections between providers and patients. As Christina reflects on her experiences, listeners are invited to consider their own feelings of vulnerability and the need for authentic communication during times of upheaval.
By daring to address these sensitive topics openly, we hope to foster a conversation that uplifts and connects moms—reminding them that they're not alone and that sharing their journeys is vital in creating community. Join us as we explore the depths of motherhood, the impact of emotional experiences, and the ways we can support each other through the complexities of life's journeys. Be sure to share this episode, subscribe, and leave a review to help others discover this essential conversation!
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Hello everyone and welcome to the Barbell Mamas podcast. 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.
Speaker 1:Welcome back to the Barbell Mamas podcast, christine Krupp. Here and today, instead of kind of a content area around education, I feel like I want to have more of like a fireside chat about some of my own experiences. But then I've been kind of noodling on and thinking about within obstetrical care and so I want to talk today about vulnerability and vulnerability in obstetrical care and kind of loop in some of my own more recent experiences and then just kind of reflect. These are all going to be my own thoughts, feelings and beliefs, and I know that not everybody is going to have the same experiences. I am not saying that I am right in any way, but I have had a lot of people, as I've talked about my own journey, that have reached out and said that it's been helpful for them to hear not only someone else's perspective but maybe somebody's perspective who has gone through something similar, and so I kind of want to acknowledge that right now I am not doing this episode in the research as a clinician or researcher. I am doing this very much as a mom who wants to be a mom again, who's been interacting a lot with the medical system lately.
Speaker 1:If you have heard me talk, I say a lot about how, as rehab providers, we need to lock shields with medicine, and that means that sometimes we have to do a better job in both directions rehab to medicine, medicine to rehab of acknowledging our own strengths and weaknesses and then leaning on each other to fill in those gaps. Right Like an example is when I'm thinking about postoperative guidelines many of my surgeons they've never rehabbed a person after their own surgeries. So I think they should lean on me for their rehab guidelines, not give me their blanket protocol outside of maybe early healing stages, and then I'm not going to tell them how to do their surgeries and I'm going to trust that they've done everything in the operating room. Similar we kind of see this in the rehab space and pregnancy and postpartum. It is not the provider's fault that their recommendations around exercise are very vague. It's just not where a lot of their education has come right, like they're looking for all of these complications and all of these you know, other things that could affect the life of mom and baby, and I think that they should do the handoff into rehab around how to progress exercise and how to assess function of the pelvic floor. And so I want to first kind of say that as I'm talking about this, I recognize that this is very multifaceted. This is very intense, talking about being a patient and being vulnerable and what that means in rehab and medicine.
Speaker 1:I've talked to you all a lot about how I have had I've had two non-epidural vaginal deliveries in hospital. I've talked a lot about that. But then recently I've also talked about my journey through miscarriage and loss. I talked about kind of my early like having bleeding and they found a heartbeat and then I had a subchorionic hematoma and then they were mapping my HCG. I've been a little bit more quiet about it lately and I think a lot of people rightfully so probably thought that it was because I was on the other side of my miscarriage and I was no longer being followed by medicine. Um, but that is not true. Um, I was told that I had a fetal loss mid November, like somewhere between November 14th and 16th. Honestly, it's a bit hazy now. Um, those are really sad days but they.
Speaker 1:My doctor, my family doctor, who has been following me, is absolutely incredible and she was having me do follow-up blood work just to track that my HCG was coming down from its peak at 72,000 to non-pregnant, which is essentially zero, and it was coming down fine. So it was really eyeopening how long it took for my HCG to go down. But it was trending in the right direction and so I was kind of in the wait and see natural course of miscarriage. There was no real reason for me to have a DNC, which is a surgical finishing of miscarriage, and retained products or use the drug like mesopristol. I never pronounce that right but the men management for miscarriage or abortion, and so that was kind of happening. So I was kind of tracking down.
Speaker 1:But what happened with me was that, um, after the beginning of January, I had been away and we are, my family, had gone on vacation. So it had been a couple of weeks and my doctor wanted to finish up, make sure everything was good, by doing another intravaginal ultrasound. I'm in Canada, so I'm kind of talking about, you know, within our public healthcare system, um, and they wanted me also to have a final beta done. She was getting worried because it had been taking a while. It was still trending down, so we weren't in the intervention or need for additional intervention stage, but we were definitely not in the low risk or low like do nothing stage either. We were still in that monitor.
Speaker 1:So we're kind of in these yellow flags and I was truly I had stopped bleeding, like I kind of thought I was on the other side. My fitness, like my heart rate and stuff, the cramping when I was running was going down. I'd run half marathon distance and was doing well with that. So I was truly like, oh well, everything's going to be back now. I just have to kind of wait until I get another menstrual cycle. But that was not the case. In a month my HCG had gone from 200 to 100 or just under 100. It was like 95, which was not great. It should not have trended that slowly and it should have been at zero.
Speaker 1:And then my real big like punch to the gut where I was still trying to process a lot of my emotions was that I assumed that my intravaginal um uh ultrasound would be fine, but that was not the case. There was some sort of retained product there and I didn't know if it was vascular or avascular. And my doctors have been really great and really upfront about where their concerns are, what their level of of threat or concern is, to make sure that I had informed consent, which it has been amazing and has been really helpful for me, and I am so thankful it has been amazing and has been really helpful for me and I am so thankful you know I've said this before but in particular my family doctor and now the resident who's been following my care. They have been absolutely amazing, just kind and thorough and like just they've been top notch. They've been amazing. So my doc calls me.
Speaker 1:It was like there's actually something that's still there and, um, things that I I understood but not really um or had never really thought of, was what that retained product could mean. Like I was getting phone calls from my doctor and she kept asking, you know, like, are you feeling any lightheadedness or feverish, or you know, just those signs of infection? And so I knew that those were things that I was looking out for. But now it had been a while and there seems to be something sticking around. So she did an emergency obstetrical consult to the early fetal loss space and so I got followed up with with an OBGYN resident who was being followed, obviously, or who was working with an attending OBGYN. So I go in and when there is product again, this is me talking as a patient from what I have learned, not talking about the guidelines or anything like that. I'm talking as a patient.
Speaker 1:What they were worried about was something called a molar pregnancy and individuals with a molar pregnancy. They have a heightened risk for a certain type of cancer, and what that would have meant was that they wait X number of months. For me it was. They were going to wait a year for my husband and I to try again for baby three when I heard that that was probably one like this has been a very emotional process. But having to have that forced weight and, of course, like I do not want to have a heightened risk for cancer it has nothing to do with my medical team but in that moment I felt probably one of the biggest waves of sadness and grief I had had. Like I've kind of gone through those waves of you know what you plan with baby three and the distance between my three kids and all this kind of stuff. But having to wait.
Speaker 1:That year I'm 35. I was going to be 36 when I delivered, pushing that another year my children would be older, that gap between them would be bigger, the idea of going back into diapers would be different and I would be older, which not to say that you can't get pregnant older. But for me, I had this in my head about when my fertility window, or our reproductive window my husband's and mine in terms of expanding our family was going to close and we're kind of encroaching on what I had had in my mind when I was thinking about my family planning and my fertility journey. And so if that had been the case the molar pregnancy then my husband and I had decided that we were going to close this door or close this chapter on trying to have a third child. We have an incredible family.
Speaker 1:My kids are amazing, but there was like that grief process there where it almost felt like it was a decision being taken away from me process there where it almost felt like it was a decision being taken away from me and that's not really fair. But I know that there's a lot of clients of mine that are going through infertility that also feel like this is just completely outside of their control and there's a grief process to that. There's a sadness to that. It ended up getting ruled out because I did have a gestational heartbeat but they weren't 100% sure if it was a partial molar pregnancy. That gestational heartbeat wouldn't have completely excluded the idea that there could have been a partial molar and because of that I had my consult with the OBGYN resident and they laid out a couple of different options. One was to wait an additional week and see if I had had any more bleeding. The other was to put me on the list for a DNC to take a swab or take the retained tissue for testing, and those were kind of the two that were front and center, at least in my first initial consult when she started going through the DNC process.
Speaker 1:This was when I probably had my biggest fear ah factor, like this light bulb moment in my own sadness about the vulnerability of being a patient. I talk about this a lot in my courses in geriatrics because our older adults are in a very vulnerable time when they're sick and in hospital. This is true for anybody, but we have a lot more hospitalizations that happen in our people over 65. And that can be said a lot in pregnancy and delivery in particular as well. Right, Pregnancy is probably the time when individuals are interacting, especially, you know, otherwise healthy individuals who don't have any chronic disease or any medical conditions are interacting with medicine or interacting with a healthcare provider, whether that's a midwife or family doctor, ob or OB or high risk maternal field medicine, whichever provider you're kind of going down the care pathway with. But it's probably one of the first big interactions with medicine and labor and delivery can make individuals feel so vulnerable. Right, where you know, we can acknowledge that, especially if you did not want a cesarean you were not planned or prepped for a cesarean going from a birthing center or a hospital bed to a sterile surgical suite in a high stress situation. That level of vulnerability is intense. I experienced this as she was very kindly and thoroughly going through my informed consent for a DNC and so the way that it is working right now in Ontario and so I'm kind of context specific.
Speaker 1:I am in Canada, in the province of Ontario. It is seen as a low risk or low priority triage surgery. When there's no signs of infection, it's a class C I believe Again, this is not my area of expertise where if there is higher triage, like life threatening surgeries, I could get bumped and so you would fast the day before, you would stop taking in any fluids and then in the morning of based on the board and the different classes of risk based on their triage for a surgery room, they would call you and say, yeah, you're going to come in for your surgery operations day or not, and then she kind of went through where or how this would happen. So you're going to go into the sterile suite and you are going to be put under and then the procedure will be done and I am a medical provider, I'm not a physician, but I am around health care, I am also a researcher in pregnancy and so I feel like I know a lot about the procedures. I have a very good understanding of them. The procedures I have a very good understanding of them and even despite that, I was in this room and it was probably the only time I kind of teared up the entire time, like going through that grief process.
Speaker 1:Yes, but all I thought was what a freaking vulnerable place to be where I am unconscious. I am unconscious, naked from the waist down. I'll be draped or whatever, but in a cold space with a bunch of strangers I don't know, while somebody is scraping the side of my uterus and it sounds very cold and it has to be right, like what I want to acknowledge is that we want to reduce infection risk and we want to. I understand all those things, but the emotion as a mom who has been struggling with a very stressful experience, as a person who is kind of interacting with this, it felt so cold and I've never felt more vulnerable in my life and I wasn't even in the sweet of it but or like kind of it wasn't even happening in that moment, but even just and she was going through an amazing informed consent process, but even like the thought of going through that it. It chilled me and it made me feel very vulnerable. It made me feel very scared and it made me understand that the clinical nature of our healthcare system can make those feelings sometimes worse.
Speaker 1:Right, like when we are thinking about, like even I think about my physio training. Right, you learn so much about shoulder assessment and it is shoulder pain, shoulder pain, shoulder pain. And then you become a clinician and you can step back from it and it's like no, this is a person with shoulder pain, but you start to become desensitized to it. Right, because you see a lot of people in chronic pain, you see a lot of people who have pain for a long time, and eventually you put these boundaries and these walls up as clinicians so that you don't even have too much like empathy burnout. And you have to find this balance between catering to the emotional side of being in pain for a long time and the clinical, calculated, strategic nature of your job.
Speaker 1:And when I was thinking about this and you know, the physician again was so wonderful and she's like you are in good hands, like we do this all the time, and that's true, but it was just I can see how sometimes there's this pull away from medicine because, in its inherent nature to reduce risk, there's a coldness, a calculation and a distance that happens between the medical provider and the person receiving care and there's been a big push and move away from trying to create this power differential though that power differential will never go away to try and ease some of that vulnerability. But when you have, for example, a home birth, those types of feelings don't come in as often and I've seen a big shift away. Whether I agree or not that in all cases, especially that a home birth should happen, I can sometimes understand if someone was in a very high risk or clinical, like very clinical, sterile environment, that those feelings and emotions are high in those scenarios. And what ended up happening for me is that thankfully I, they, we had another conversation and my HCG had come down another 10 points, or no, 30 points, and because of that they kind of consulted and they said you know, if I wanted to do because my, my job has me traveling a lot, I'm in clinic. It's hard to have this, this variability of like it could be Monday, it could be Tuesday, it could be Wednesday, it could be Thursday that I'm having this surgery.
Speaker 1:The DNC. They were like well, you know, you have the gestational heartbeat. Risk of partial molar is low. Let's, let's use medication. And then this next informed content, like this next informed consent, happened.
Speaker 1:And you know, when you're taking the mesoprostol I think that's how you pronounce it Um, he's a person. I don't even remember the name, my, my brain is not really functioning that well right now but, um, the meso, you know you put in the tablets intervaginally. And then you know they said to pre pregame essentially with Tylenol, ibuprofen and Gravol, because you can start getting the flu, the cramping is intense, you're going to start passing clots like, and again, like it. Just it sounds so horrible and nothing about fetal loss is nice. But again, I was just struck with. You know, this really freaking sucks. Like this is horrible, like there's this like real, that's, like it's not. And I keep like repeating that over and over and over again, like, oh my gosh, this nightmare is going on forever.
Speaker 1:And you know, you think about that with traumatic birth to where, oh my gosh, like this isn't fair, like this isn't fair, this isn't what I wanted, this is not the birth experience that I wanted, and it's just it feels like so much of it is out of your control when you become that patient. And there's always this joke that healthcare providers make awful patients. Because I said to my OBGYN, the resident, I said I must tell you that I live the healthiest, the healthiest life possible. Not that I don't have respect for medicine, but I want to avoid you guys as much as possible Take as many like conservative oh my gosh, conservative methods as I can to not have to interact with medicine for as long as I possibly can, because this vulnerability that comes up and that feeling of vulnerability and lack of control, and you know it just it feels so hard.
Speaker 1:It was probably the you know there's been a couple of times in my life I'm only 35, that I felt truly vulnerable and I talked to my patients all the time that postpartum is one of them where it's the first time that you don't feel that in, especially for me who was a strength athlete, who was so used to feeling so strong that you don't feel strong and that's a little bit scary. Um, but this was the first time that I felt very vulnerable and sad and uncertain and unsure in a medical scenario not uncertain with my physicians at all. It wasn't that, it was the, the feeling of something so, so cold feeling or that I don't know in a medical interaction and I had to reflect on. You know, it was the procedure, not the person. It was very easy to do because there was a lot of kindness exuding from the resident that I was working with. But I could see how those feelings, when you're not reflecting on them and you're kind of reflecting on your overall healthcare experience as a whole, they can get a little jumbled up and how easy it would be for that transference from the person to the scenario, especially if there's an issue with the connection between the provider and the person, whether that is bedside manner issues like not everybody in healthcare there's the good, the bad and the ugly, and I think it's important for us to acknowledge our flaws, including, you know, in rehab as well or a lack of connection. You're a stranger If you're a person that didn't come in, that wasn't originally part of your team, like there's just so many reasons why that connection or that feeling of stress, sadness or negativity can transfer onto the provider.
Speaker 1:And so where my thoughts, feelings, beliefs and things have come from is that I think having these conversations about the lived experience of the patient is something that I am reflecting on as a person that works with patients and how can I reflect on my own behavior as a provider who works with really vulnerable people, because I work in pregnancy and postpartum and then I work in a 65 plus, like those are kind of my two buckets, based on my PhD and my postpartum or my postdoctoral research. That kind of translates into my clinical practice because people know me for those two things. How can I reflect on that experience and how can I take that feeling and that sensation to one, have a very well-rounded conversation with some of my people, especially those in that obstetrical space, about you know those thoughts, feelings, concerns, but how can I help to make them feel just a little bit less vulnerable, understanding that there are certain things that are the way they are in medicine and healthcare to ensure safety and a lack of adverse outcomes. And so some of the things that I was thinking about was holding space for people in my life circle, but also as a provider, when we think about how we show up around pregnancy and postpartum, miscarriage and loss. You know we we kind of say that the standard things you know of, like I'm really sorry for your loss and those are helpful I some but what I noticed is that the way that a person says that to me is going to stay with me in a very different way. And so what I mean is, like you know, some people can be like, oh my gosh, I'm so sorry for your loss, and there's other people that look me in the eye and give me like a little smile or like a held eye contact and they say I'm really sorry for your loss, and those two ways of saying that are different. And the people that hold that the second way it almost feels like it holds space for that person where they sit with you in that moment and they are okay with those emotions coming up and that vulnerability being there. Now, if I have people who say that to me in the wrong moment and I start to cry, it's very hard to keep myself together. But I think about you. Know how can I put that care even into my voice when I am talking to people who are going through hard times, and then I can keep the minute or two or I can ask that, ask those questions or hold that space for individuals so that we have a couple of minutes to be able to hold space and have those conversations again in my healthcare interactions and in my personal life.
Speaker 1:I remember I had a client who was coming to me for prevention because he had just got diagnosed with Parkinson's. He was in his sixties and I asked him and I said, first of all, I said how are you doing? Which is like the standard ask, and he kind of fluffed me off and he's like, yeah, I'm okay, like whatever. And then I turned to him and I said no, like how are you really doing, like having this type of diagnosis? Yes, there's a lot that we can do. Yes, we have a very positive lean that we can have it in Parkinson's, because our research is very good around exercise, especially at appropriate intensity, slowing down its progression. But it's still a diagnosis that you are not expecting and so how are you really doing? And I will never forget him breaking down and crying in my office about how, like this wasn't the retirement that he wanted and this was not what he was expecting, that he was going to be dealing with and he had a lot of plans and now he's worried that those plans aren't going to shake out the way that he wanted to. And holding that space he told me later was very healing. But then also I had the opportunity to then provide resources for him on the grief and on the space to have those conversations and maybe seek help or seek professional help or help him to have those conversations with loved ones, and so I think that that can be helpful for you all who are listening to this If you've had similar experiences to lean into people.
Speaker 1:I've been very open about this online. Not everybody wants to share it publicly. I get a lot of healing from sharing my journey and having people reach out to me that have had that journey in return. But that may not be your style, but having and leaning in and opening up those conversations everybody is very busy and so I've had to, in my own circles, get rid of this thought or this feeling that I am bugging somebody by bringing up the fact that I am struggling. Like this is just not a good mental health day. You know, I felt this grief in waves. Like I feel this grief now that you know I'm going to finish this podcast, I'm going to have dinner with my family and then it's like a scheduled pain that I'm going to take the medication for getting rid of this retained tissue and that feels kind of messed up to me, but it is what it is and I'm not the only one to experience this and I know that people are listening. It's not only me, it's lots of people and so I have to also lean into my networks and recognize that I am not bothering anybody, and if they have to wait a couple of hours because they're busy, they will, but the people that love me are hoping that I'm going to reach out when I need them and they can't read my mind and so, leaning into that vulnerability, it has been very healing for me. I'm vulnerable online, but obviously my family and my close friends, like they, understand a bit more about you know the ins and outs of that emotional journey, but I think there's a lot to be said to.
Speaker 1:As a provider is to take time, not all the time, but to make sure that I'm reflecting on my own practice and that I don't stray too far from that acknowledgement, because I'm busy and what I feel very proud of in some ways not proud of the other is that when you have me one on one, like I, you have a meeting with me, you got me, you got my attention. Sometimes I'm hard to get a hold of in other ways, like with emails and my Instagram DMs or the wild wild west. So, like I, I'm always apologizing that sometimes, like things get lost Cause there's just, you know, there's a lot of people that are contacting you in a day with work and family and life and whatever, um, but you know, in those moments, in those face-to-face connections, um, I'm a person that leans into that vulnerability and my husband we used to own a clinic together for five years Um and I'm I'm not in practice full time anymore, but he used to always joke that people cried a lot in my office and I was always not proud of that, because that sounds a women's health continuum, that there is a big emotional component to it and care is multifactorial and sometimes what I'm doing is not for the body, even as a physical therapist, but for the mind and for the heart and for the soul. So that's kind of a little bit about me.
Speaker 1:I wanted to post this because I've been a little bit less consistent and it was because I have been struggling in moments talking about pregnancy. As I'm going through pregnancy loss, it comes in waves. I'm obviously still a researcher in pregnancy and I love everything that I do, um, but sometimes it's hard. So, um, yeah, that's me. I will hopefully be back in this, like I am obviously still going to be doing the podcast, but I feel like my pizzazz will be back and, uh, they'll keep up with all the educational content. So, um, let me know if you have any other thoughts, questions, concerns. Know that, again, this was not I'm not an expert in anything around miscarriage and loss. I have learned a lot being the patient and, yeah, these are kind of just my own reflections. Have a wonderful week, everybody, and I'll talk to you soon.
