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
New Research Challenges Old Rules
Traditional postpartum exercise guidelines are being dramatically rewritten thanks to groundbreaking new research. As someone who contributed to this international Delphi study, I'm buzzing with excitement about what these findings mean for new mothers everywhere.
The study's most revolutionary conclusion? For typical postpartum recovery, there are no absolute contraindications to returning to exercise. That mandatory six-week wait for medical clearance—the one that keeps countless new mothers sidelined while their bodies decondition—may not be necessary after all. This shifts our entire approach from restriction-based to empowerment-focused.
Equally significant is the study's position on pelvic floor sensations. Those feelings of heaviness, pressure, or even mild leaking that many experience postpartum aren't red flags requiring medical intervention before exercise resumes. They're expected parts of recovery, similar to how we'd approach rehabilitation for any other body part. Just as I'd encourage someone recovering from a shoulder injury to work through some discomfort to rebuild strength, postpartum bodies benefit from gradually challenging those healing tissues.
The research has led to the development of a new screening tool—the GAQ Postpartum questionnaire—which fitness professionals can use to guide appropriate return to activity. This represents a shift from arbitrary timelines to individualized guidance, giving women "navigational buoys" instead of blanket restrictions.
For those interested in diving deeper, the paper is available as open access on the British Journal of Sports Medicine website (published March 7th). And stay tuned for comprehensive return-to-exercise guidelines coming in April, which will further transform maternal healthcare approaches.
This research validates what many of us have observed clinically—that women's bodies are incredibly resilient, and with the right support, they can safely return to movement earlier than previously thought. How might your postpartum journey have been different with these evidence-informed guidelines?
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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. And welcome back to the Barbell Mamas podcast, christina Brevitt.
Speaker 1:Here and today, I wanted to talk to you all a little bit about a new paper that I feel so honored to be a small part of. I was one of the listed authors, but I was definitely not the brains behind this study at all, but I wanted to share with you all a little bit about a study that we just published about postpartum return to exercise. Before we do that, I just wanted to give you all a little bit of an update on me. If you've noticed, I've missed the odd episode. I've been trying really hard to be consistent and I want to make it relevant with some of the new research and stuff that's going on, but, to be completely honest, it has been a really tough, really couple of years, but definitely a couple of months I have been open about the fact that I have been going through a miscarriage, I think right at the tail end of that management, which has been hard enough. But less than a year ago I lost my godmother, who is very, very close to me and was very, very close to my parents, and that loss has been very crippling. And then last week I found out that my mom has a very advanced stage of lung cancer. She is 61. She is very young. We still don't know if it's stage three or stage four, but lung cancer is particularly brutal and she's very sick. And so that was not on my bingo card either.
Speaker 1:And so, um, I appreciate you all, um, if we miss the odd episode or if we're a little bit more sporadic with our posting. That is why, um, life is just lifing. And then you have two kids at home and I travel a lot and teach in the U? S and you know it's just. It's been a lot, and so I am trying my best over here, just like taking a day by day. But life is life, but I try and take these very small glimpses right now of happiness and I try and be grateful for things every single day to continue moving forward in the background of stress and grief.
Speaker 1:So this paper is definitely a bright light and so I want to do it justice. So this was an international Delphi study. So what that means is when we have areas in research where we acknowledge that there isn't a ton or a very big body of evidence, we look to our clinicians and our experts in an area of practice, in combination with the little research we do have, when we think about evidence-informed practice. So when you are interacting with healthcare, ideally your clinicians are working as evidence-informed clinicians. So what that means is there are three things that matter when we are talking about making decisions about your health. One is your personal preferences. When we are educating or we are deciding on plan of care, you are. We have it as part of the triangle, but really you're at the center right and your desires and wishes matter. The second thing is our research and our evidence. That is always changing, that is always evolving. What we used to recommend five years ago we are definitely not recommending now. I've talked a lot about that within pelvic health and pregnancy exercise. So this growing body of research and staying up to date with the research that's coming out.
Speaker 1:The third thing is our clinical experience. Sometimes, when I'm teaching courses in geriatric practice and when I'm teaching about pelvic health, I always joke that I have my research hat and my clinician hat, and my research hat is standardization and protocols and this is the way that we do this step one, step two, step three. And then my clinician hat always comes in and creates a little bit of wiggle room in that, saying that we cannot make blanket statements for everybody. We are looking at averages and when we are working with humans that you know have thoughts, feelings, experiences, different injuries, all those types of things, then your pregnancy situation, scenarios, social supports, all of these things there's always a little bit of wiggle room and that clinical experience matters. And then, in areas that are growing and evolving, like five years ago when we started talking about lifting heavy in pregnancy, when we had no research to go by. Then we have to rely on clinical experience and what patterns we have seen as providers whether we're OBs or midwives or physical therapists that allow us to try and make informed choices. What Delphi is trying to do is, where this research base isn't there, instead of relying on only one clinical opinion, we try and pool a lot of people's clinical opinions and try and gain consensus around what we think is necessary for a specific area that we are trying to do a Delphi about. And so this Delphi study.
Speaker 1:What we tried to do was to get an idea about what's basically our traffic light for returning to exercise postpartum. What do I mean by that? Red lights are contraindications, things that, in the presence of these issues, we do not recommend returning to exercise. It is a red light Do not pass go. Our yellow lights are relative contraindications, so proceeding with caution, maybe requiring medical screening, or you cannot proceed until you've seen a doctor or a physical therapist in injuries or things like that. And then our green lights are yep, you're good to go. What we try to figure out is one do we have good research on what this traffic light is? And when there isn't, what do our experts say about what should be screened or cleared or what provider should be being seen in order to clear you for exercise? You see your doctor, your midwife, your OB at that six-week postpartum mark.
Speaker 1:Now, of course, if you have been listening to the podcast, you know that I adamantly disagree with that right and what this Delphi consensus was kind of going along that same vein. And so the first question that it was trying to ask is if we're looking for medical clearance, what are we looking for medical clearance from? And in this consensus, what they said is specific to postpartum. I mean what happens to your body with a C-section or vaginal delivery outside of early wound healing like stitches or glue popping, early C-section or stitches around the opening of the vagina, around the perineum, outside of that early protective phase. That there were no absolute contraindications specific to postpartum that were there. So there were no red lights to returning postpartum.
Speaker 1:Now what that does not mean is, if you had a complication in the postpartum period, that we're going to ignore that. That's not what this was saying at all. It was saying that for individuals with typical postpartum or cesarean considerations postpartum, that there are no red lights to returning to exercise. Now, if you had, for example, postpartum preeclampsia exercise Now, if you had, for example, postpartum preeclampsia, it would be the preeclampsia that requires considerations from your doctor for returning to exercise, but it is not the postpartum piece, it's the preeclampsia piece. Was one triggered by the other? Yes, but we are treating the exercise considerations of the preeclampsia so that already in and of itself is a big finding right, that in the postpartum period, outside of any complications and that early wound healing, we don't have any red lights.
Speaker 1:Number one the second thing that we were wondering about was relative contraindications, and this is where a lot of conversation was being had. Right, we had over a hundred providers, about 60% of them were physical therapists, about 40% were physicians, ish, and there was a lot of conversations around the pelvic floor and the belly and those sensations as potentially yellow lights to exercise. What they included was like leaking or heaviness or pain around the vulva or around the belly, and are those reasons to say whoa, whoa, whoa, not to say that you can't exercise. But we need more medical clearance. When we took a look at what our experts were saying in combination with what the research was saying, the conclusion of this Delphi, was that pelvic floor considerations were not considered relative contraindications to exercise.
Speaker 1:However, if you had pelvic floor complaints that were, once you were returning to exercise, being made worse from exercise, then maybe that is a reason for us to scream. Now. Why did we do that? A couple of reasons. Number one is it is unreasonable to expect that you are not going to have heightened sensations or early leaking returning to activities postpartum right. Early leaking, returning to activities postpartum right.
Speaker 1:You have heard me relate many of our thoughts around pregnancy and postpartum, especially postpartum healing, to different orthopedic conditions and how ridiculous our expectations are of new moms who are already trying to figure new stuff out about how they're going to feel within their body, especially early on postpartum right. If you hurt your shoulder right and you had some stiffness and tightness and pain overhead, I would encourage you to push into a little bit of that discomfort so that we can strengthen and gain that range of motion up overhead. I have to get you to push into a little bit of your symptoms. Range of motion up overhead. I have to get you to push into a little bit of your symptoms. That is true postpartum as well.
Speaker 1:Right, having those sensations of heaviness around a stretch injury in your pelvic floor is not a sign of failure in the postpartum period. It's actually something that I expect that you are going to have, especially as I'm pushing your fitness, that you are going to have, especially as I'm pushing your fitness, and so saying that that is a contraindication in any way, absolute or relative, is unfair, because it is expected that you are going to have some sensations around your perineum after you pushed a baby out. You are going to have sensations around your scar when you are stretching it after a cesarean section, and so saying that this is something that we need to be mindful of as a reason to stop exercise is difficult for us to say and is not necessarily true. Right? Additionally, pushing through some of those sensations not completely ignoring them, I'm not saying that but pushing or edging into them and recovering edging into them and recovering we are going to see many people, as they continue to heal, from initially postpartum to the first year and beyond, that those symptoms are going to improve, and that can happen even without medical intervention for some individuals, whether that's physicians or physios. Right, naturally, with healing and with returned activity and re-strengthening of those muscles without physios, getting fitter, is going to help those symptoms. Now, if they're really significant or they're really interrupting your exercise routine or you're really not feeling comfortable again, that is a reason to screen, but it is not a reason or we cannot give a blanket statement rather that nobody with those sensations of heaviness. They require medical clearance.
Speaker 1:The third thing there is that this Delphi study helped create a new screening tool for returning to exercise, or exercise readiness, postpartum, and so that questionnaire, that GAQ postpartum, is going to be published through the Canadian Society of Exercise Physiologists in a couple of days, very soon, which is so fantastic and it's going to help you, if you're a personal trainer or an exercise professional, getting individuals to take this screen for you to evaluate. You know how fast or how slow should I go with this person based on how they're feeling within their body in that postpartum period. So these are three very, very big findings. The final one that was concluded by this Delphi and it is very, very kind of research, shattering right and we're going to need to do more research in this space. But the conclusions of our author group was that it is not necessary or should not be a requirement that medical clearance happens at six weeks for individuals to return to exercise postpartum, which, like, makes me so excited. I told you all that I've been like, bound by confidentiality for a lot of things, but the reason why that recommendation was given is that we don't want individuals to decondition even more early in the postpartum period.
Speaker 1:That first six weeks, number one. Number two right, we have a lot of individuals, especially in the United States, where there is no maternity leave policies, that are going back to work. So getting weaker and not using fitness to try and improve your feelings around your body postpartum is doing a big disservice to the people in our care. And then, third, is that we didn't have any absolute, relative contraindications to exercise. That would be a barrier, or would be a reason to institute a barrier, to returning to exercise postpartum, and so, therefore, we should remove that medical clearance requirement and say you know, in our early education postpartum, here would be a reason for you to stop exercising, here would be a reason for you to seek medical attention, whether that's physio or physician-led intervention, as you are returning to exercise postpartum, and I love this.
Speaker 1:I love this especially because, unfortunately, what I am seeing more and more is that this is not true with midwives. This has been more true in my experience with primary care docs who are doing the postpartum visits is that they're not even checking your vulva anyway. Right, this is not all. I'm not saying this is all, but I'm definitely seeing it more and more that, unless there is a reason, like individuals are talking about uncommon or incredible amounts of pain, feeling like there's a retained stitch continuing to bleed after the six week mark, or you know some other consideration I have had I don't want to say how many, but definitely not one, and it's not rare individuals saying that they don't need to check and and it's just to talk about birth control, not to say we don't want to talk about birth control.
Speaker 1:Postpartum, we do, but that's not the only reason for a postpartum visit. Okay, now, if they were waiting for six weeks and then you didn't even get your vulva checked at six weeks, then they're probably thinking you know if you're probably thinking WTF, why did I wait the six weeks? And then what does that mean for exercise? And so what the goal or hope of this paper is is to start questioning some of the long held beliefs around returning to exercise in the postpartum period. And you know, as I talk about, a lot is how do we give individuals navigational buoys saying, hey, like these are signs that you're pushing your body too hard, too fast, versus making these blanket statements that you do not do X, y, z until six weeks postpartum unless it's warranted, right. And we're seeing this in other areas of practice too, like, for example, if you've had pelvic surgery right, there's a lot of lifting restrictions that get put on sometimes if you've had surgery for your pelvic floor and our research is showing that they're not actually that helpful. And when we say, other than, do not insert anything into the vagina if you've had surgery in the vaginal walls for six weeks, here are the buoys as you return to exercise post-surgery. Those individuals who get more liberal restrictions do better, and so this has been such an incredible paper to be working on. It has such widespread applications and implications, hopefully, for medicine.
Speaker 1:What I am hoping is that this is going to prompt more individuals to be doing research on return, early return to movement, postpartum and rates of pelvic floor dysfunction. We do see we had some studies that were done by Janet Shaw and Ingrid Nygaard, two researchers that I absolutely have research crushes on out of Utah, and they have been consistently showing as well that early return to exercise doesn't seem to exacerbate rates of pelvic floor dysfunction up to a year postpartum, which is great, and so we are in line with some of their findings. And so we are in line with some of their findings and so exciting. This is kind of one of the lead ups to a very big project that's going to be coming out in the next couple of weeks, which I will be talking about on this podcast as well, which is our return to exercise and physical activity guidelines that are going to be published in early April, and that was. I was not a part of that project, but my lab group has been and my supervisor is leading the charge as the incredible role model and mentor that she is in postpartum so pregnancy and postpartum movement and so I will keep you all abreast of those guidelines as they come out, because I think 2025 is going to be a very big, challenging year in a good way, like we're going to be challenging some of our thoughts and opinions around um, around the exercise or return to exercise considerations for mamas in the postpartum period.
Speaker 1:If you are looking for that paper, if you're nerdy like me, if you go to the BGSM website so the British Journal of Sports Medicine. Under latest content, it was published March 7th and it is open access, which means that you have, you can click on the link and you can download that paper. And there was also the link in the caption of the figure in that paper for the GAQ postpartum outcome measure. If you are looking for a screen for your postpartum, mom is getting back into activity. So let me know if you have any questions. It is so exciting to. I am going on Thursday to give an obstetrical grand rounds for my local university, which I am super excited about, and you best believe I'm gonna be bringing all of this research forward and I'm just so excited, right? This is how this influence starts to spread and change.
Speaker 1:It's you all listening to this podcast me connecting with our physicians, locking shields with them, locking shields with our midwives, locking shields with our doulas, so that we can have our patients in the center of our care and then allow them to make the decisions that work for them about exercise in the pregnant postpartum period. I hope you all have a wonderful week in the pregnant postpartum period. I hope you all have a wonderful week. Thank you for being understanding, as some of our, if some of our podcasts are a little bit later delayed. I appreciate you all and I will talk to you all very, very soon. Have a wonderful week and I'll talk to you next time.
