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
Battling the Silence: Postpartum Depression and Exercise
Fear nearly kept me from motherhood. Growing up watching my mother battle severe mental health challenges that began in her postpartum period with twins left me terrified that history might repeat itself. That deeply personal story opens our candid exploration of postpartum depression and anxiety—conditions that affect countless women who suffer in silence.
What exactly distinguishes normal "baby blues" from actual mood disorders requiring intervention? When does typical new-parent worry cross the line into clinical anxiety? These questions remain frustratingly difficult to answer, particularly with postpartum anxiety, which lacks the research attention and screening tools that depression has received. Many high-achieving women dismiss their symptoms as merely being "type A" or having "perfectionist tendencies," missing opportunities for early intervention.
The most exciting development in this field comes from emerging research showing that exercise—specifically accumulating 120 minutes weekly of moderate activity—provides significant protection against postpartum mood disorders. This evidence helped transform international guidelines away from mandatory six-week exercise restrictions. When you're in a vulnerable low-estrogen state that predisposes you to depression, movement becomes more than physical rehabilitation—it's mental health medicine.
For mothers struggling with depression symptoms who can barely get out of bed, the standard exercise prescription can feel impossible. That's where "movement snacks" prove transformative—just 5-10 minutes of activity can provide immediate mood benefits. Starting small and building gradually creates momentum when traditional workouts seem overwhelming.
Most importantly, we must normalize asking for help. The cultural expectation that mothers should silently shoulder their burdens does immeasurable harm. As one poignant quote reminds us: "I want you to bother me." Your friends want to support you through difficult times, not just celebrate the happy moments. They want to sit with you in vulnerability without judgment.
Ready to break the silence around maternal mental health? Share this episode with someone who might need permission to reach out. Remember that no matter where you are in your motherhood journey, you never need to face these challenges alone.
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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. Hello everyone and welcome to the Barbell Mamas podcast, christina Previtt. Here and today, we're going to be talking a little bit about postpartum depression and anxiety and the importance for us to continue talking about mental health disorders and to be having open dialogue and discussions about how so many women and individuals in the postpartum period just struggle so much in silence. Where I put the medical disclaimer at the beginning of this podcast. But I want to kind of make sure that I mention this again I am a researcher and a physiotherapist. I am not a physician or a psychiatrist or a psychologist and so I'm not going to be really getting into the weeds of treatment options and if or when to go on medications et cetera. I'm going to be taking very broad strokes around that component. But where I really want to try and create an argument is with some of our new research that's coming out in the role of exercise in the management and prevention of perinatal mood disorders, because I think that is super relevant and definitely a big motivating factor for me in my life and has definitely been something that is really coming up in the research, which is exciting. It's just kind of a bias confirmed, definitely on my side To get started in this podcast episode.
Speaker 1:I wanted to talk about a personal story and then kind of get into the weeds of some of the research that is coming out and what we know and what we don't know. I almost didn't have kids and I remember when Nick and I met. It's funny because Nick was 21 and I was 24 when we met, so he is younger than me or I was 25, because he's almost four years younger and he was very certain about what he wanted. He wanted kids and a family, like even at 21,. He knew that that was something that he wanted. When we started dating I knew almost immediately that he was my forever person, if we could kind of align on a lot of things. But I was still very unsure, and I think it was because one I hadn't met my forever person. So you know, when I met Nick, it definitely brought forward a lot of those desires or the thoughts of what I wanted my family life to look like.
Speaker 1:But the very big and very overarching reason was because my mom has struggled with mental health issues her entire life and up until very recently. Now we have a little bit more clarification on her story, but it had always been told to me that my mom had had postpartum depression and it had caused a lot of challenges for her in her life and not to get too much into my mother's story or anything like that, but I had learned my mom got postpartum depression and now my mom struggles with mental health challenges and she can talk now that it had probably started before. It definitely got exacerbated, being postpartum with twins, but my mom was in and out of hospital needing very, you know, advanced care for mental health issues throughout my early childhood. She, you know, struggled with some of the medications you know now we're talking 30 years ago. It caused her to have issues with her metabolism and weight gain and then that was a struggle for her body image, wise Like. There was a lot of of circumstances or a lot of stories or areas in my childhood where this idea or this theme of mental health issues was very prominent. And I had an amazing childhood and I'm so close to my mom. This is by no means a way of saying that my childhood was awful I had an incredible childhood but it was definitely a predominant theme around protecting mental health and ensuring mental health was solid and that was a big theme and because of that I went through my early 20s and I hadn't had any issues with my mental health.
Speaker 1:I met this young stud when I was 25 and my mom had struggled with her first major depressive episode at 26, when she had had me and I didn't know and I don't think for me it was a lack of desire, but, to be frank, I was terrified. I had seen how much my mom had struggled. I knew that there was a genetic component there, component there. I understood how prevalent and how much of an issue postpartum depression and anxiety can be and I was scared. And I think you know there's a lot of people who maybe have had anxiety and depression early in their life where they think about going through this major life event which could cause them to have another episode of depression or more severity of depression, and it's terrifying. And so there was a lot of conversations that Nick and I had when we first started our relationship about what that family life could look like and what some of my very real concerns were. That family life could look like and what some of my very real concerns were.
Speaker 1:But you find your forever person and you start building this life together and I started to be aware very quickly that being a mom and having a child with Nick was definitely something that was a desire for me, and when I got pregnant I was very much in the health and wellness space. We owned a gym, a physiotherapy gym at the time, and it became something that now I was trying to figure out. What am I going to do? So I was an athlete so that athlete identifier right. I was competing nationally in weightlifting at the time and I was not an Olympic contender or anything like that, but that was a part of who I was and I loved that and I was afraid that I was going to lose that part of my identity and then I was going to have problems with my mental health right. So I was very active in my pregnancy, loved that, did well, and then postpartum I started exercising very early because you know, at that time six or seven years ago we didn't have the same strength of our evidence that we did now. But in our general population, in, you know, all of our lifespan data, we're seeing a protective effect of exercise for mood disorders.
Speaker 1:And I did an undergrad course that was looking at exercise and mental health and that really solidified a lot of beliefs for me and I started exercising. And it's funny because I posted about my journey and I alluded a little bit on the mental health side of things but so many people were so concerned with my pelvic floor and what my body was doing and how my body was responding postpartum but so few people were thinking potentially about my why. And of course I had the athletic piece in my mind about having that identifier as an athlete and really not wanting to take that extended time away, that six weeks away. But a big part for me was that I knew that when I moved my body, my body felt better, and when I moved my body, my mind felt better. And in a time where, you know, baby blues and anxiety and being uncertain about how to take care of this little tiny human was present, I was definitely thinking, okay, I need to be exercising, and I don't know if I would have had a mood disorder if I waited or I wasn't active or did exercise truly protect me.
Speaker 1:But in my mind and of course some of this is like it's confirming my own bias is, I felt, a very protective effect of exercising, and I've spoken about this as well in very stressful times in my life, like I have been running for the last year I'm still lifting, just not as often, and I'm getting outside with my lab and running. I've done a couple of half marathons in the last year and it's been an incredible experience, one because I don't have any comparisons to past performance that I'm looking at, to past performance that I'm looking at, but also getting outside, getting into a new environment, getting outdoors and exercising at a higher aerobic intensity for prolonged periods of time. I truly believed it saved my mental health when my mom got diagnosed with cancer and my godmother died and I went through a miscarriage. And then you're also really busy with work, and work is stressful, like there is just. It was just such a positive coping strategy. And now you know, fast forward, you know six, seven years in the future and our evidence is becoming a lot stronger.
Speaker 1:And so the first thing that I think is a really important part of postpartum management whether you are a mom going through your own postpartum journey or you are a coach or a therapist listening to this episode is that we need to be asking how you're doing, and I don't mean in the knee-jerk oh how are you? Kind of way Like, like I always joke that I hate the small talk. I want to get into the deep stuff. Like I want to know all your deepest desires and expectations. I am here for the messy conversations and so often I think in early motherhood there is this perception, especially with social media comparison games, that we have it all figured out and that everybody goes through this. So I shouldn't or couldn't or should not be talking about how I am struggling and you know, I think even some of our thoughts around, you know, some of those baby blues are normal.
Speaker 1:What we haven't done a very good job in and I am not the expert to be doing this work but we haven't done a very good job in helping moms identify when it's not normal fluctuations, when it's not just sleep deprivation, when it is so much more than that, when it's time for us to seek help. And I don't even think, especially on the anxiety side, that we have this figured out. On the depression side, we do a little bit more around some of the prolonged low mood turning into suicidal ideation or thinking that your family would be better off without you there. Right, when we start going from you know we're in the green lights to, hey, we're in some of these yellow lights, we should proceed with caution. Something might be going on here until, like, we're in mental health crisis. But on the anxiety side, I don't think that we have really talked a lot about what is kind of normal adjustment to being a new parent, to this is something that we should seek help for. Even thinking back on my first postpartum journey, I definitely think that I was flirting with the line on the anxiety side, of trying to show like I was just, you know, putting that baby under my arm when I was acting and producing at the same amount from a work perspective and a life perspective, but adding the slice of motherhood into the pie of who I was and, you know, trying to smooth out and make it seem like you know, all these other parts of me that were, you know, in my personal life changing, just they weren't reflecting in my output or how productive I was at work, and so I see that reflecting back, but when you're in it, I see that reflecting back, but when you're in it, one.
Speaker 1:We have very little evidence on postpartum anxiety. We don't have any outcome measures or screens that are universally accepted as a way for us to identify moms who may be in anxiety crisis and, further from that, we don't have a lot of educational resources, at least that I am aware of, and I could be completely wrong about this. So if you're listening to this and you have something that's really epic, please let me know, because I would love to see it. We don't have anything like that that, I think, allows moms to realize oh, this, this is not normal anxiety or I'm not just being type A right, when we're looking at some of our postpartum anxiety, a lot of these overachieving stereotypes, you know, eldest daughter, type A, perfectionist tendencies, like those may be real, like I'm not saying that they're not real, but we use those as a justification for our anxiety. And you know that's just who I am versus. This is something that I might need help with and I think it's a hard line because we don't really know and it's blurry and it's always changing and there are so many reasons why that experience of anxiety may change.
Speaker 1:And what is considered persistent? What is a normal feeling of grief or sadness versus when does it flip to depression? What is normal stress, like you're responding to a very stressful circumstance, versus your response is not in line with what you are trying to or what you are currently experiencing, and I think we don't really know. And then add in some of these I'm going to say these fringe, because they're not even discussed about like postpartum rage, where you just want to throw the baby around the room, or you're having intrusive thoughts, like about, you know, getting into a car accident or putting a pillow over the baby's face when the baby won't stop crying, all of those things that maybe make you recoil a little bit, even listening to me saying those words. Moms are having those fleeting thoughts going through their minds and everybody has intrusive thoughts that come into and out of their mind. It's when those intrusive thoughts become persistent and you are actively or working hard mentally to block out what you know are thoughts that are not productive or are not I don't want to say accepted, because that's not the word that I want to use, but you know what I mean, where they're not actions that you know in your heart that you do not want to act on, I should say. And in those spaces we're just starting to kind of identify how many moms, especially on the rage side I see this in menopause and I see this in postpartum is that rage sentiment and that resentment spike that can happen in the postpartum period and the menopausal period. That may have very real reasons why it's there, but it is also very amplified being in those states, and both of them happen to be low estrogen states. So we have a lot that we still need to learn in these spaces when it comes to having these conversations.
Speaker 1:As I said, more of our research is in postpartum depression than postpartum anxiety and for our medical colleagues who are listening, if you are in medicine, we do have outcome measures and screens that I think are really important for us to have in our back pocket on top of asking you know our friends and family how they're doing. The one that is most often used in the postpartum space is the Edinburgh Postnatal Depression Scale, the EPDS, and it asks about in the past seven days, have you been able to laugh and see the funny side of things? Look forward with enjoyment to certain things? Have blamed yourself unnecessarily when things have gone wrong? Have been anxious or worried for no good reason? Have felt scared or panicky for no good reasons? Things have been getting on top of me. I have been so unhappy that I've had difficulty sleeping. I have felt scared or panicky for no good reasons. Things have been getting on top of me. I have been so unhappy that I've had difficulty sleeping. I have felt sad or miserable. I have been so unhappy that I have been crying and the thought of harming myself has occurred to me. And these are questions that we ask in order for us to get an idea if individuals may be struggling with postpartum depression, knowing that some people may reduce their numbers or lie on these outcome measures, but it does have very good reliability. And on that last question about self-harm, it's considered a red flag for immediate discussion, treatment, et cetera. And so we have those.
Speaker 1:Now, on the treatment side of things, when we are looking at our guidelines, psychotherapy right talk therapies is considered the first line in gold standard treatment in most of our published guidelines, with pharmaceutical treatment being second, with the discussion around breastfeeding, breastfeeding desires, wishes on what and how from a medication perspective, things are prescribed, knowing that there are medications that allow the continuation of breastfeeding while on those medications which is good news and then understanding your thoughts and desires around being medicated, having conversations around is this medication a permanent thing? Is this a temporary thing? How do we get on and off these medications? And then our medication management in all mood disorders is a trial and error. Management in all mood disorders is a trial and error. It is a ramping up and coming down because of the way that our antidepressants need to work on the receptors rather than the availability of the neurotransmitters in our brains, and so there is, you know, sometimes a delayed effect for you know, when we are starting these medications, and then some of the trial and error. So those are the big two buckets.
Speaker 1:What hasn't been talked about a lot in our guidelines, especially in our medical spaces, and where I am definitely going to be putting my advocacy hat on is around the role of exercise. I've talked a lot about our new postpartum exercise guidelines and our international Delphi that moved away from requiring the six-week clearance and if you listened to those episodes, one of the arguments and justifications that was made in our article and one of the things that I think is important to think about is when you have this period of time you know that early postpartum period where women are really vulnerable to mood disorders. They're in a low estrogen state that does predispose or does link to depression and we have this stimulus of exercise that is really important for us to use as an immediate mood booster. Are we being net helpful or net harmful of saying to not do any exercise? Now, of course, we're going to take this ramping up of exercise. We are going to talk about gradual return to movement. We are going to give these buoys of what your body is ready for versus what your body isn't.
Speaker 1:But one of the big justifications that our group is talking about is this protective effect of exercise in the postpartum period. And what we saw, you know, in my cross-sectional work looking at CrossFitters who returned to lifting postpartum, is that our rates of perinatal mood disorders was very low compared to general populations. And one of the systematic reviews that was published that informed the exercise guideline, the physical activity guideline postpartum, was on the protective effect of exercise in the postnatal period, and what it showed was is that accumulating 120 minutes of moderate intensity exercise, so slightly below our general exercise guidelines, is a potent stimulus and has a protective effect on the mood of the postpartum mother, the mood of the postpartum mother. And so I think it's important for us to be thinking about not just healing postpartum but also the mind of the mother and how much it can help with the very real stress of transitioning into this role of mother or mother again, transitioning into this role of mother or mother again. And how do we remove barriers to exercise in the postpartum period?
Speaker 1:And now I can totally understand, right, when you are dealing with postpartum health issues. So that may be postpartum pelvic floor dysfunction. You're healing from a belly birth where trying to get into exercise, you're a single parent. You don't have to go to work four weeks postpartum, you're not getting paid maternity leave, you don't have any family nearby, that there are very real barriers. If you are working with your physician or your midwife or your physical therapist, your coach, you are following individuals online. What that looks like for you is going to be so different, but knowing that doing something is better than doing nothing, and if we can engage in movement with baby there, so much the better.
Speaker 1:I think that is such an important thing for us to be bringing front of mind. I think that is such an important thing for us to be bringing front of mind. And so, for example, like find exercise classes where you can bring the baby, do gentle work at home. I'm always giving home exercise programs to my postpartum moms. That is a baby-free or with baby option, right, so you know you can do a squat and hold on to baby. With baby option, right, so you know you can do a squat and hold on to baby. Or you can do exercise on your own without baby, if baby is able to be held by someone else in the family or it doesn't immediately need you for nursing or something like that. And so, acknowledging one, that exercise is super protective for postpartum mood disorders but two, that there are very real barriers, especially in that early postpartum period, that can make exercise really challenging and exploring what those very real barriers are, and then you know brainstorming and problem solving and figuring out the way that movement fits for you.
Speaker 1:The final piece that you know is important for us to acknowledge is that when you are in the throes of high anxiety and high depression and you're having a hard time getting out of bed and your baby's not sleeping and you're exhausted, and that sleep deprivation is exacerbating or making that mood disorder worse, if I come up to you all sing-songy and smiling and saying, hey, you should probably exercise more, I know you're going to want to slam the door in my face or maybe hit me or both right, and I think it's important for us to extend that hand and talk about how to make it approachable, because 120 minutes for a person who's having a hard time getting out of bed seems like a completely insurmountable hill, and so in some of this is not in our postpartum work, but this is what we're seeing in some of our older adult literature is that these movement snacks of you know, 10 minutes can instantaneously boost mood and so saying well, we might get there to 120 minutes. I want you to get there. I think it's important for you to try and get there for your own goals and health. But if we can get you to do something over doing nothing, if we can get you to do five minutes and then eight minutes and then 10 minutes and then 10 minutes multiple times per week and then boost that to 15 minutes, that is going to be super, super helpful. And the effect of exercise, especially if we can get your heart rate up, is almost instantaneous especially if we can get your heart rate up is almost instantaneous. And so trying to create that connection where we don't have this all or nothing phenomenon because that can be like the really big challenge especially, I would say for my first time, moms, because they're so used to having that protected time to exercise and then all of a sudden it's taken away and it can be really hard to adjust those expectations but trying to work together to set you know this is our minimum, what I want you to do, and then everything else. If you get above this, five or 10 minutes is just bonus exercise over and above what we were trying to get in that day. Those types of flips in mindset can be really helpful.
Speaker 1:And finally, I think where I have moved in my communication and education is, and in this entire podcast, what you'll notice is that none of the things that I talked about had anything to do with body composition, and I think that's important, especially early where losing the weight and trying to bounce back I'm air quoting here and all of those things is not front of mind, right. It's making sure that your body feels strong and supported, that we're taking into account any issues with baby sleep that may be influencing how you're feeling in your body fatigue, et cetera, helping your body feel recovered from either your cesarean or your vaginal delivery, and then making sure that we're using exercise as a preventative or mitigating intervention to help with how your mind is feeling in that postpartum period, and so I hope that that was, you know, kind of a very over like big overview. But if you are in this period and you're thinking I don't know if this is normal, sad, I don't know if this is normal sad, normal grief, normal anxiety, normal obsessive thoughts about like baby bottles being clean or other things as you've transitioned into motherhood, I hope you reach out to somebody that you really trust and at first. It doesn't have to be a doctor, right?
Speaker 1:There was a Instagram influencer and I really love him. He's so funny, but he was talking about how so often and I'm going to leave with this how so often in our lives we silo or isolate ourselves because we don't want to be a bother. Talk about how you know well, I am struggling but, like my other friends are busy with their kids and I don't want to be a bother. I want you to bother me and I want you to know that your friends want you to bother them. And he was talking in this reel and he's like if I brought you into my circle and you are one of my friends, even if we haven't talked in a while. I want you to bother me, like I'm not here for just the good times and the brunch, mimosas and all of those happy times. I'm here for the struggles. I'm here for the struggles. I'm here for the grief. I'm here to sit with you in those vulnerable moments. I am here to not judge you, but to come alongside you. And I want you to bother me.
Speaker 1:And I have thought about that reel.
Speaker 1:It literally kind of brings tears to my eyes every time I think about it because I think in our culture, where we're expected to bring on all of this hardship of motherhood which is so beautiful, right but it's also so hard that we expect or we think that we have to carry those burdens alone.
Speaker 1:And I hope that you know if it is something that requires medical intervention, that you feel that you are safe enough to talk to your medical provider.
Speaker 1:I know that I try and open up that conversation with all my clients in my physio practice and to help with resources as necessary. But also I hope that you reach out to your friends if you are listening to this or maybe it's not something that's relevant to you, but you think it might be relevant to someone else and just say I want you to bother me, let's talk about it and you can fall apart. I'm here to help you. I will hold you up because I know that if it was reversed or when I struggle not if when that you're going to be there to hold me up too, and when we can do that and maybe, like it's taking a walk together whilst talking about those things, it's going to be very healing. That is how these conversations become very open and it becomes a lot easier. The burden becomes a lot easier to handle. The burden becomes a lot easier to handle. All right, have a wonderful rest of your week. Everyone Know that I want you to bother me and we will talk to you all next time.
