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
Lessons from the Female Athlete Conference
The boundaries of female athleticism are expanding in thrilling ways, yet the research supporting women's unique physiological journeys lags significantly behind. From my recent experience at the Female Athlete Conference in Boston, I've returned brimming with insights about how we're finally beginning to address this disparity.
What makes this biennial gathering extraordinary is the spirit of collaboration. Sports medicine physicians, obstetricians, researchers, physical therapists, nutritionists, and coaches share knowledge freely, recognizing that advancing women's sports medicine requires collective effort rather than competition. This stands in refreshing contrast to the typically siloed approach in both healthcare and academia.
A powerful theme emerged around trusting athletes to tell their own stories. In the shadow of the USA Gymnastics abuse scandal, healthcare providers are recognizing how critical it is to center athletes in their care decisions. This parallels what we need in maternal healthcare – placing the birthing person at the center while providers serve as supportive guides rather than authority figures. The most successful approach appears to be multidisciplinary, as demonstrated by the US rowing team where two athletes had babies three months apart during Olympic training and returned to win medals with comprehensive support.
The conference revealed fascinating nuances about menstrual cycles, with research showing extreme variability in cycle length, ovulation timing, and hormone profiles among athletes. This variability makes generic cycle-syncing workout programs virtually impossible to implement effectively. More concerning were discussions around fertility risks in elite sport, where high training volumes combined with inadequate fueling can lead to anovulatory cycles even when menstruation appears regular.
Perhaps most exciting was the focus on previously neglected populations – particularly masters athletes navigating perimenopause and menopause. With some women transitioning directly from postpartum to perimenopause (especially those having children in their 40s), there's an urgent need for research in this area. Equipment design also emerged as a critical barrier, with revelations about cyclists undergoing labioplasty because bike seats weren't designed for female anatomy.
The most profound reframing questioned why we measure women's sporting advancement by how closely it approaches men's sports. What if instead, we focused on making women's sports the absolute best they can be without male performance as the benchmark? This perspective shift invites us to value women's sport for its unique contributions rather than as a perpetual game of catch-up.
Join me as we continue exploring how these emerging insights can support your journey as an active woman through pregnancy, postpartum, and beyond!
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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:Hello everybody and welcome to the Barbell Mamas podcast, christina Brevitt. Here and today, I want to talk about some of the key themes and the things that we were talking about at Female Athlete Conference. I was not here last week because I was in Boston at this conference and for some of you, you may be asking, christina, what the heck is that and why do we care? Very great question. I'm so glad you asked. Female Athlete Conference is a every two-year conference. I don't know what that term is like, biannual, I never know if it's biannual means every six weeks or six months or twice a year, like you know, whatever, really selling my intelligence right now but every two years there is this conference called Female Athlete Conference and it is a multidisciplinary conference of sports med docs, obstetricians, exercise physiologists, coaches, physiotherapists, researchers. There is just a plethora of nutrition, mental health, counseling, social work, like there's just a plethora of different providers who are coming here into Boston and talking about the new and upcoming research, things that are very relevant to the female athlete, and it's a female athlete across the lifespan.
Speaker 1:So from adolescent athletes to our collegiate athletes, our elite athletes outside of collegiate age, and there was discussion around the rise of the master's female athlete and they were talking about one how do we show up for these athletes? Two what do these athletes need? And over the last two years, what have been? Some big wins, losses, challenges, threats and advancements in a whole variety of different components of female athletes, and I love this conference. And the reason why I love this conference.
Speaker 1:One obviously female athleticism is near and dear to my heart, it is my own history, it is my research, it is so much about myself but, as a person who has gone to a lot of different conferences, this is a conference that truly is so collaborative and I cannot say that about others, and what I mean by that is that there is truly this descending of so many different providers into Boston with the sole objective of collaboration and sharing of ideas, trying to work together, knowing that there is a lack of research in the female athlete space. There is so much work that has to be done that the best way for us to be able to do it is to work together and not have to rework and redo things that other groups have done, but to build upon each other's excellence and build upon each other's knowledge. And that truly is a very unique space to be in because it can be very competitive in sports spaces. It can be very competitive in the academic space and the research space at it. In the academic space, in the research space, I just appreciate so much that it was this coming together and the sharing of resources and knowledge, and that always fills my cup and always makes me feel so, so, so grateful for a lot of particularly there was a lot of women that were just lifting each other up, which is so cool to see. Lot of women that we're just lifting each other up, which is so cool to see. Okay, so, if I kind of you know, take a step back from the conference.
Speaker 1:There was six or seven different things that I think were really relevant to you all who are pregnant, postpartum athletes around. What are things that we want to be mindful of, things that we want to be taking into account when we are, you know, thinking about the next couple of years and what that means in our space. One of the first things that I think was coming up that was really interesting is how we, as healthcare providers, can center the athletes in their own stories. There was a lot of discussion. There was several keynote addresses that were focusing very heavily on the lived experience of elite level athletes.
Speaker 1:This was in the realm of talking a little bit about USA Gymnastics and some of the consequences of Dr Nazar's prolific unfortunate I actually didn't even realize the magnitude of his abuse of over 150 athletes, or up to 500 athletes 150 athletes testified, I think, and 500 were seen to have been abused at some point in his career and use kind of that example of you know what led to this astronomical amount of abuse that happened within the gymnastic system and what can we learn from how that happened? And how it wasn't only his abuse, but there was a lot of complicit adults who were not protecting these female athletes. And over and over and over again, what came up was that the athletes needed to be trusted and that they're not only obviously in the reporting of their own health experiences, but how they're feeling within their own bodies, what they feel like they need as athletes, and it kind of brought about this really big highlight of collaborative work within the healthcare system. We see this so much in pregnancy and postpartum too, and then if you were an athlete navigating pregnancy and postpartum, it can be really challenging, and it's been one of the things that our research group has been really trying to push the healthcare space on is that there is there is no set timeline for when athletes should retire from practice, when athletes should be doing this, when athletes should be doing that, when they should be modifying or scaling back in pregnancy, when they should be coming back postpartum and having the person in the center of that story and working with them, where their background, what their circumstances are, what their wants and needs are, what their competitive drives are. All of those things are going to come into account when you're working with a healthcare team in pregnancy and postpartum to hopefully provide some of that support, and our research as a consequence of that, or as a kind of next step, for that also has to have the athlete into the center of our research. So often we're having these discussions about you know, how can our coaches help to inform these athletes, how can our doctors help support these athletes which is fantastic, and it's what's driving a lot of our research conversations but we also need to make sure that this is something that is so important to our athletes that they want to engage in this research. It is a question that they want answered too, and there is so many keynote addresses at the conference.
Speaker 1:Clara Hughes was one of them. She's a Canadian athlete that I have just followed for so long and just talking about how you need to trust the athlete and you need to allow the athlete to speak their piece and be a safe space for that athlete, and I really think about that in our pregnancy and postpartum space too. I was making so many parallels to what the athletes were talking about with the motherhood journey in general whether you're an athlete or not and having that athlete at the center of the story. And this is true in obstetrics too, where, as a healthcare provider and what we need from our obstetrical providers is that the mother is at the center of the story and we are guiding as their GPS, and sometimes we're a little bit of a backseat driver and we're like hey, like this is a really dangerous situation or this has a very high risk for complications. We really want you to turn left, but ideally that becomes a collaboration and a discussion rather than a big shift in power differentials, and there was a lot of conversation about that with coach dynamics as well.
Speaker 1:So having the athlete at the center of the story was one thing that was really highlighted in this conference as kind of a secondary piece, which is its own item, but also something that kind of goes in tandem with this is that, when it comes to women's health care, a multidisciplinary approach is the answer. We saw panel discussions, for example, from women's tennis, and they were talking about these yearly physicals that all of the women's tennis athletes went through, and it was like eight stations and it was general health nutrition, pelvic health, fertility, injury prevention, psychology and they would go through each of these stations. You would see a specialized provider with their own scope of practice that would essentially help fill out this overall health profile that didn't just focus on the performance of the athlete, but mentally, how they were doing fertility conversations and fertility conservation strategies, if that was something that was relevant. Pelvic health, if they were having incontinence issues. Mental health, how that was impacting them as a person. Their nutrition, if that was supporting their performance or taking away from their performance, supporting their recovery from an injury perspective or taking away from it.
Speaker 1:Primary care, sports medicine bringing it all together. It was incredible. Sports medicine bringing it all together it was incredible. We are always, always, always talking about locking shields with other providers and this conference truly showed examples of when that worked well. They were talking with the US rowing team which, in their quad of four, two of them had had children in the last Olympic trial and they had had them three months apart, and what one athlete needed in their pregnancy and postpartum journey was so different from what another athlete needed in their pregnancy and postpartum journey, and how the whole team had to come around and hug and give love to these athletes as they were transitioning away from sport for delivery and then back into sport in postpartum, and how the dynamic of motherhood shifted the dynamic of the team. And it was just incredible but it was this coming together of multiple health care workers and coaches and the other athletes to help support and lift these athletes up and they won, like they won, an Olympic medal. And it was incredible to see that, one, there was so much support that was needed in motherhood and that, two, when that support was given, these athletes could continue to thrive. And what this really demonstrated was how it's so important to have people on your team and, again making these parallels to motherhood, there's so much benefit to having your obstetrical provider, whether that's a midwife or a doula. If you're in a higher risk, you may be seeing maternal fetal medicine, but then also having your dou, you know, a doula for support, a pelvic floor physical therapist for support, a nutritionist for support, mental health supports for perinatal mood disorders. You know so many of these people can come and be part of your team lactation consultants, like. There's just so many things that was paralleled in the athlete space to the athlete and motherhood spaces and how, when those opportunities for that crosstalk between providers to come and hug on that mother and hug on that athlete, how it just allows them to thrive and feel so supported in this big transition journey, and so I thought that was really neat.
Speaker 1:Other things that kind of came out of the conference speaking to, you know, working with female athletes and big buzz discussions was around the menstrual cycle. You know there has been a lot of discourse online. It's kind of really confusing and I have said, you know, that so much of our clinical work has shown that for some people, especially around their period, they feel worse and their symptoms can get worse. They can be a little bit more sensitive to things during their cycle. They don't feel like they're as strong or as capable. Their rating of perceived exertion for something that would be a five is like a million on certain parts of their cycle. But our evidence shows that from a performance perspective, if we don't consider premenstrual cycles and things like that, that our output of our bodies, like the force that we can generate, the strength that we have, there is maybe small, negligible differences, but it doesn't seem to be, you know, clinically meaningful. Despite that, there's still a lot of discussion about the menstrual cycle because it can have such a big influence on one. How female athletes feel within their own bodies, right Like if you are feeling super bloated and your belly hurts and you're having a couple days of anxiety before your period and all those other things like that is going to influence how you feel.
Speaker 1:And then Dr Kristen Pope came up and also talked about how what we're seeing in female athletes is this huge amount of variability in their cycle. That makes taking this information and getting this data a lot more difficult than people think. You know, which also makes me think so much about these cycle syncing workouts. So she was kind of you know, saying how, look like. She kind of put up a graph and she said here is six athletes where they took urine every single day to figure out where their luteinizing hormone was and where all of their blood markers and sex markers or sex hormone markers were, and mapped it across the cycle. And you know we had some people who had a 25 day cycles and some that had a 31, and some people ovulated and some people didn't, and the timing of their ovulation was kind of all over the place. And she said because of this, you know, even if they're having their period, they may not be ovulating, and so there was a lot of things that kind of come into how we take this data and it's kind of expensive and it's pretty labor intensive on the side of the athlete, like you have to take blood urine samples every day and maybe blood and all of these things.
Speaker 1:That it makes this really complicated and I really appreciated her kind of breaking down some of that complexity, because I think in social media we talk so much in short snippets like clickbaity, types of ways of consuming information and I which is why I love this podcast I really struggle with that because so much of it is very nuanced and you know where I see this and kind of the clinical connection that I make is one. Again, we have to use this personalized approach. The thing that they didn't mention is that a lot of our research is showing that you know how you feel around your period and how your symptoms are around your period is a way bigger tell on what and how it influences how you feel with exercise. Even then your hormones and your hormones may be guiding how those perceived symptoms are, but the truly telling story is your symptoms. And one thing that drove me crazy was they talked about your premenstrual symptoms as perceived symptoms, and that was such a horrible choice of words because it's not perceived anything.
Speaker 1:It's how you're feeling within your body and it was interesting to see just some of that variability. And with that it means that there's just no way that a lot of these cycle syncing workouts could work, because your luteal phase may be 10 days and another person's luteal phase is 12. That a lot of. There's just no way that a lot of these cycle-syncing workouts could work, because your luteal phase may be 10 days and another person's luteal phase is 12. Or you may have a 21-day cycle and another person will have a 35-day cycle, and what that means is that it's almost impossible to set a workout routine, not only to be cycle-syncing workouts not work and they're not based in the evidence, but it would be impossible to individualize that when we have so much variability in cycles. And then that's not even adding in if you have other things going on, like endometriosis, ovarian cysts, fibroids, pcos, that are going to be another layer that influences a person's menstrual cycle.
Speaker 1:And while that might be really confusing for a lot of people, the other thing that I think this does for me as a clinician is that I'm going to be able to allow for variability with my athletes, with my moms and their perceptions of you know how they feel. Their performance changes in their outputs it matters and then we're going to take their physical symptoms and layer into that. And then we're going to take their medical history and we're going to layer into that and you, some of these things that we were talking about. It was really helpful to see the doctors who are working with Olympic teams and the physiotherapists that were working with Olympic teams that were mirroring this message and saying, yeah, it is messy. We're getting all of this research. It's super helpful. And we're going to take the athlete that's in front of us and we're going to make an individualized approach for them based on what we see in the research, but then also what this athlete is telling us and what this athlete needs from us in that time, and so it was really neat to kind of see this come very full circle from the research space to the clinical lens.
Speaker 1:Building on that with the menstrual cycle conversation was the topic of pregnancy, postpartum, but in particular, fertility was a big one, and this is something that I kind of had on the fringe of my thought process, but it was definitely something that was very front and center at this conference and I think it was super interesting was the potential risks to fertility of being in elite or high-intensity sport. The way that we are talking about this I'm very, very mindful of, because I never want the messaging to be that you shouldn't participate in sport if you ever want to have children or that your fertility may be permanently damaged, and I want to be mindful of the risks or the potential risks to some athletes who are working at very high intensity and what that could mean for their future fertility. As we start to learn more, what some of the research was starting to show was that athletes that have a very high training volume there are many of them who have more anovulatory cycles, even if they are bleeding at the end of the month. So just because you are regularly bleeding does not mean you are always ovulating, and what we are seeing is that these athletes that have high training volume are at a higher risk of having anovulatory cycles and losing their period risk of having anovulatory cycles and losing their period. This kind of goes into the conversation of relative energy deficiency in sport, which is under-fueling for the demands of your body. This is something that women are more sensitive to than men, though men can also have this concern, and women tend to be more sensitive to low-fueling than men are. It takes men longer and a bigger deficit before they start to notice changes within their physiology, and it happens sooner and, unfortunately, more readily in women.
Speaker 1:What we are starting to see is that this is the link between high training volume and low fueling is a very big issue at the elite level, and as we are learning more and more about REDS, as we are refining how we are able to capture information about the menstrual cycle and we're getting more data on our athletes and their fertility journeys. As female athletes, their competitive journeys and careers are extending longer, because we are seeing so many examples of people who do have pregnancies in the middle of their athletic career and go back to sport at the postpartum phase of that journey, we are starting to see that this low energy availability and this ability to naturally cycle every month is something that is impaired in a lot of athletes and is something that needs to be focused on. This needs to be focused on from a nutrition lens. There was a lot of incredible speakers who were nutritionists and registered dietitians who worked with eating disorders, worked with athletes who had lost their period, were working with athletes who were having a hard time recovering from injury because of low fueling and then having issues with fertility because of that low fueling and overtraining. And we are seeing that there does seem to be this overlap. And is it purely the low energy availability? Is there an overtraining component to it?
Speaker 1:We don't know, but it was definitely highlighted that more evidence is emerging of this potential issue in the elite sport category and definitely something that we want to be making changes and allowing our athletes to speak up about, so that when or if they decide that children are part of their story and their timeline, that hopefully there are going to be no fertility concerns, and when it comes to that type of thing, it's really important that we frame this up in the right way, because it is very easy, like I've been at other conferences where they say, okay, well, women are having all these issues with leaking while they're running. Why are women running? And that was a female urologist who came up in front of 300 people and said, like why are we telling women to run then? And you know that can sometimes be the unfortunate way that this is interpreted is well, maybe women shouldn't be performing at a high level, and that is not. It is that we need to support women so that their bodies can healthily be able to perform at that level and that they're not risking their downstream health or their later health when it comes to their participation.
Speaker 1:And we see this in injuries too, right, like how many people were athletes up until college, university, and then we see them in their 50s and 60s and they have some cranky joints from some of the hits or the injuries that they've taken in earlier life. And so this is another extension of that, or an expression of that, where we want to try and keep our athletes healthy, not just during their career, but thinking about their life outside of that career. And I think that is where we want to have a lot more conversations. And I think over the next couple of years we're going to be having a lot more conversation around fertility in high level or elite level sport Because, as I mentioned, we're seeing this extending of the female career as more people are still competing in their 20s and their 30s. Another conversation that came up a lot that obviously is near and dear to me is the master's athlete. And how are we going to support our peri and postmenopausal athletes who are still engaging in sport? I love this so much. My work, my PhD work, was in aging, specifically working with individuals over the age of 65, 70. But this is really taking this lifespan approach to sports and athleticism and I freaking love it.
Speaker 1:We had one speaker that was talking about nutritional demands and needs for women as they were trying to engage in sport while experiencing the changes in their body with perimenopause, and I freaking love that. Right, I've done menopause podcasts on here with the Barbell Mamas, because what we're seeing is that some individuals can go right from being postpartum to perimenopausal, as we see more women who are having babies in their early to mid 40s, and what that means is is that they're going to have unique needs, that they're going to be, you know, recovering postpartum but also transitioning into this different life phase. And how do we come and support these athletes? And the fueling piece is important because oftentimes, as individuals, estrogen comes down in that perimenopausal to postmenopausal transition, their body composition changes and they try to fight that body composition change by restricting, and then what we do is. We get into this low fueling issue again in the menopausal era and that has big influences on our brain fog, our heart, our bone, and they're already experiencing changes because of that switch over in menopause.
Speaker 1:And so the highlighted need and when I tell you like our evidence in master's athletes is almost predominantly in men, I am not lying. We have very, very, very little. I can think of one cross-sectional study that focused specifically on female master's weightlifters and that was by Marian Hubner. I'm sorry if I spelled the last name wrong, but that is the only one that comes to mind. Most of our master's endurance work has been done in our 70-plus-year year old men, and some of that is because with female athleticism, we're just getting these athletes who were allowed to compete in sport with the change in Title IX that gave access to female athletes, we're just seeing them get into their 50s and 60s, so getting into this area where they're still competing in sport with that change in legislation in the United States. And so there is a big call and a big need for work in this space as well, which I think is very cool and so, so desperately needed.
Speaker 1:The last thing that I kind of wanted to speak about that was a big highlight of this conference was gear, and my goodness, again, this is such a relevant conversation to our moms. But they were talking about things like sports bras and compression garments, bike seats for our women, and this came with one of the keynote speakers talking about getting a labioplasty and changing the way her external genitalia was because it would hurt on the bike seat and how, instead of creating a bike seat that worked with women's genitals, women were getting surgeries to fit onto the male bike seats and it was just gosh, my goodness. It's frustrating. And you know how so many endurance athletes, their sport kits for their sport, never included sports bras and that sports bras weren't fitted right, and you know. And then you go into pregnancy and postpartum and you're thinking about nursing sports bras and compression garments to support postpartum healing and how there is just such a need for these garments that are going to help active women active women who are not pregnant, active women who are pregnant, active women who are postpartum getting back into movement, helping them feel supported in their body as their body changes, as their body grows from adolescence through puberty right Into our collegiate athletes, into our mature athletes, and how much need there is for that.
Speaker 1:Again, I was thinking about the menopausal athlete and how sometimes we have joint changes. That makes it hard to put on a sports bra if you don't have the range of motion in your shoulders. That's what some of my older athletes are struggling with and, my goodness, there's just such a need and they were talking about. You know the different organizations that have come up that have tried to offer sports bras to athletes, and sizing of sports bras to athletes, and how the supply never is meeting the demand and how we need to be thinking and doing research on. You know how to support breast tissue during sport and how to support, you know, the again like the genitals with bike seats and all these different scenarios where so often women's bodies are just trying to fit into male molds and where it just doesn't work and it makes it a barrier or it makes a performance detriment to our female athletes who are trying to work within male equipment spaces.
Speaker 1:And so the last thing that I'm going to kind of finish off with obviously, this conference is so near and dear to my heart and I just. There are so many things. It made me laugh, it made me cry, it made me think, it made me excited. It gave me so many ideas for my research. It made me want to share it with all of you. But there was a lot of conversation about how many of the sports conversations were about bringing female sports up to the level of male sports.
Speaker 1:And the reframe that was really big in the conference and I want to leave this with you all is what if that isn't the goal? What if we want to make women's sports better, to make women's performance better, without the caveat or the comparison to the male sport? Right, our male colleagues are amazing and I love watching them play. But why do we have to anchor our performance on what our performance is as women relative to men? And gosh was that powerful and I don't think I've ever truly thought about it. You know, because we talk about, you know, the viewership compared to the male side. We compare the relative performance between males and females and in some spaces that's needed, form is between males and females and in some spaces that's needed, but in others, instead of thinking, oh, like you know, catering our males gear to females, for example, why don't we just make female specific stuff because we want to support women's sport and that reframe of just starting with the female, like I think about our bracing literature and you know, women who pee in sport. Obviously that's a big thing for me and my research, and I'm extrapolating all of our bracing data from men to women a lot, unless it's pelvic floor specific or you're pregnant, and I was like, oh my gosh, if we could figure out this bracing stuff, not only would it help women not pee more, but it's going to help our men. And so what if the entry was this is just going to help women in sport and then maybe it'll help our men too, rather than making this comparison of trying to level up quote unquote our women to our men? And so I hope that you all enjoy this. It does make me really excited.
Speaker 1:There was a lot of positivity, even though I've talked about how there are challenges right now in the US with funding changes et cetera.
Speaker 1:Despite that, there was an acknowledgement of that, but also a coming together of hope and resiliency that we're still going to make this a priority, even if our funding has changed, and I really appreciated that, and what that means is that there is just so much more to come in this space.
Speaker 1:There's so much more to come from me. There's so much more to come from so many other researchers, and I just I hope that you all see that these struggles, these problems that you just wish that there were answers to, they are coming and we are working on it, and there is a lot of incredibly smart humans, most of them being women not all of them we had some of our males there that were there and incredible too, but, my goodness, it's coming, and so I'm going to leave with that message of hope and excitement and then in two years, by every double year, duology. I don't know that there's just going to be even more information and I'm going to be able to share it with you All. Right, I hope you all had a wonderful week. If you are in North America, happy Father's Day coming up this weekend we're going to spoil Nick and otherwise have an incredible week, and we will see you all next time.
