Q&A; Back Pain and Diastasis Surgery, The Perfect Exercise Plan And How Fear of Childbirth Affects the Labour Process

This week I'm doing a littlew Q&A as it's been a while.

First I talk about how diastasis recti surgery (tummy tuck) can help ease post-partum back pain. How does it work? What the issue is, Who might need it etc. etc.

Secondly I go over an email I had from a listener, and HPNB member, who wanted to cancel the program because it's not right for her. MY advice is always the same in this case; Cancel it! Don't pay a penny for something that you can't stick to :)

And finally I go over this study , sent to me in August, which raises some interesting points about how "Fear of Childbirth" can negatively impact the whole labour process, and what we should do about it.

As always; HPNB still only has 5 billing cycles.

So this means that you not only get 3 months FREE access, no obligation!

BUT, if you decide you want to do the rest of the program, after only 5 months of paying $10/£8 a month you now get FREE LIFE TIME ACCESS! That's $50 max spend, in case you were wondering.

Though I'm not terribly active on  Instagram and Facebook you can follow us there. I am however active on Threads so find me there!

And, of course, you can always find us on our YouTube channel if you like your podcast in video form :)

Visit healthypostnatalbody.com and get 3 months completely FREE access. No sales, no commitment, no BS.

Email peter@healthypostnatalbody.com if you have any questions, comments or want to suggest a guest/topic

Playing us out this week; "Nobody" by Ellisay.

Chapters

• 0:00 Fresh Q&A And What’s Ahead
• 3:30 Diastasis And Postpartum Back Pain
• 8:50 When Surgery Helps And Why
• 12:30 Real Email: Program Doesn’t Fit
• 16:30 Do What You’ll Actually Stick To
• 19:50 Study: Fear Of Childbirth
• 25:30 Empowerment And Antenatal Prep
• 31:40 Coming Up And Sign-Off

Transcript

Peter: 0:00

Hey, welcome to the Healthy Postnatal Body Podcast of your Postnatal expert Peterlap that, as always, would be me. This is a Q ⁇ A. This is a fresh Q ⁇ A. There's no guests on. We're doing a QA. We're doing guests again in two weeks' time. Um, this is a QA because I haven't done a QA in a long time. I am talking about uh a couple of things because it's a QA, but it's also a couple of things that I've had on my radar for a long time. Um, questions about uh diastasis surgery and back pain. Um, someone who uh emailed me um asking about Tommy Tox and whether that helps for um for like dull backache and all that type of stuff, postpartum backache. I'm talking about what to do if you don't like the HP and B program. I had an email about this, which I think highlights very nicely where I am on this sort of stuff. Email from someone who said they can stick to the program and you know, send me an email about that. And finally, I'm talking about a study that came out um a while ago, 14th of August. I've had this in my inbox since 14th of August from Robert Gordon University in Aberdeen, Aberdeen. Um, that is my um you know impression of an Aberdeen accent, um, in Scotland about fear of giving birth and how that leads to negative birth um experiences and how positive um mental health prep can help with that, so how staying positive ahead of giving birth can can make it a bit easier. Um, I had a one or two issues with the study, but it's a fascinating one nonetheless. So without further ado, here we go. Hey everybody, this is the podcast for what is it, the 19th of October 2025. And it's been a long time since I've done one of these off the cuff type things because you know I pretend to be more professional than that these days. Uh ever since I moved on to, as as as you'll know, as I moved on to only doing a new episode once every couple of weeks, and then bringing one from the vaults back in in the intermediate weeks, I've had a lot more prep time and people have had uh chance to work on it and do what needed to be done. So I hope you're enjoying that transition to you know, I would argue, better quality guests and um just better conversations, better production value, and all that sort of thing. Peter at healthypostnatalbody.com. If you disagree with any of that, by the way, if you think it's all still terrible, send me an email because you know there's people we're paying for this stuff now. Um I hope you're well. Like I said, I haven't spoken to you live in a in in a little uh in a little while, and I miss it a little bit. I like these off the cuff sort of I don't know where I'm going with it, sort of things. To be honest, I'm I'm I like to shoot the shit, um, so to speak, as everybody who knows me will tell you. We are doing a little Q ⁇ A, um in a slightly different way. So I'm going to start with um diastasis surgery and back pain. I had an email from somebody who said um that they had experienced back pain ever since uh they'd given birth to their second child. The first one was apparently okay. Um and then they figured and then they found out they had uh they had really terrible diastasis recti, and then they had a tummy talk, and immediately the the the button and the and the correction of of the uh uh diastasis fixed as as they as they said it, and all the dull pain instantly disappeared. And they're they asked basically, is is there a link between the two? Now I've written about this extensively, and I've spoken about this extensively. There is a clear link between diastasis recti and postpartum back pain. And it's significantly more than just yeah, it's postpartum back pain because you gave birth, and that's why you have diastasis, and therefore, no, there is a clear, and I would argue, causal link between the two. Um, I had someone on the show a while ago, three or so years ago, um, who said that there is no link, there's no evidence, and I've I have so much evidence of this now that it's absolutely scary, more than anecdotal uh evidence. Um they were wrong, and I was right. But basically, if your core muscles at the front of your body don't really do what they're supposed to do, other muscles start to kick in and start to correct, and that's where the postpartum back pain comes in. Especially if you combine this with um pushing a pram, carrying babies and toddlers and all that type of stuff. Um pushing any sort of heavy object, lifting any sort of heavy object. If you if you're and and this is where this this is where I am different in that have different opinion from a lot of postpartum, um postpartum people, that I think part of diastasis rectile has to be the non-functioning of the core. So you might not have the gap anymore, but the core uh isn't isn't necessarily doing what it's supposed to do. The core muscles aren't working when they're supposed to be working, you don't have that activation. If that activation isn't happening, and that could well be because the gap is huge, right? Um your lower back will often compensate for the tremendous amount of movements, and that leads to lower back pain. This is an absolute, absolute, I'm getting a bit uh passionate and need to rein that in a little bit. It's an absolute no-brainer. It's an absolute no-brainer. If one part of your muscles, uh one part of your body isn't that is supposed to be helping during emotion, isn't doing what it's supposed to do, but you still complete the motion, that means another part is doing too much. End of discussion. That is just the way it is. There is nobody there is nobody that thinks that that isn't the way it is. Let me relate this to bicep curls. If your bicep isn't doing most of the work, during a bicep curl, that means something else is. And you usually see that with momentum, right? People start to move their backs and all the sort of stuff. So that means your glutes are working, your back is working, everything is working except the biceps. You're flinging the weight up. That is what's happening. And if you do that repeatedly, not using the right muscles, that means other muscles start to overwork, and those muscles also have their own jobs to do, and then they get tired and they get achy. That is just that is just the way it is, and especially if you then have, let's say, postpartum duties, which involve a lot of um uh heavy lifting and and all that type of stuff. It's an absolute no-brainer that like pushing a pram, how often? How often outside being postpartum do you push something ahead of you like heavy? Unless you're a maleman, right? And I don't think they do it anymore. But you you just don't for hours a day. Whenever you go out on a walk, you push this little pram in front of you, right? The little buggy. Uphills, downhills, chug it. Right? That that's how how often, unless you're postpartum again, right? How often do you carry 15-20 kilos of travel equipment with you wherever you go? Right? The the the postpartum stages, the let's call them the early years of postpartum, uh, postpartum life, so say five, six years. When you have toddlers and all this other stuff, and you have to carry all their favorite toys and and the buggy and the and the go bag and and and and the formula and the blah blah blah blah blah blah blah, all the stuff that you need to take wherever you go with your little one. How often in life are you gonna have that? You don't have that when you have teenagers, you don't have that when you don't have kids, right? You only have that during the postpartum years for for most people. Um, so you know that is the time when your core is not necessarily recovered, but the demands of your daily life are such that you're actually supposed to ask it to do a tremendous amount of work, and that's when it's not working, so your back is kicking it. This is it is so remarkably straightforward that it's that is frightening that people are still denying the causal link between the correct dish and definition of diastasis recti, if we apply that, right? And the non-functioning, uh the not functioning properly of the core muscles of that diastasis recti and lower back pain. It's a no-brainer. So, yes, then if you have surgery, so you have a reasonable core, you've you've you've done the work, but you still have a gap, and therefore the core can't function quite quite properly, uh, quite as well as it should, because the muscles aren't in the right place. When you get that repaired, yeah, your back pain goes. It's remarkable, it's an absolute no-brainer. It really is. This is the most straightforward A to B sort of thing that there is in the world, in the world, as Jeremy Clarkson would say. So, yes. Diastasis rectal surgery, assuming you have decent uh muscle function as in everything is is is is working, right? Um, then yeah, that will eliminate um uh tummy talk will eliminate back pain. And I don't see any problem with with saying that. Some people will need to go food out. Now most people don't. Most people can resolve diastys with exercise. However, you know, some people just uh just can't. It's a bit too much, and therefore, you should really um you should really just get the surgery if you can, if you can swing it, because it's about 5,000 pounds, it's not cheap. Um, if you're in the UK, it's about five grand. I'm sure in America it's like $15,000 or something stupid like that. Um, anyways, get the surgery if you need it. And if the exercises don't work for you. Speaking of exercises that don't work for you, I had an email from someone a while ago. Dear Peter, I purchased your plan after listening to your podcast because at 18 months postpartum, despite getting the whole clear from my health insurance pelvic PT, I am still experiencing neck and back pain. I was fairly active pre-pregnancy, uh capoeira and climbing, uh, total three, four times a week. So very active in a fair amount of walking. So, you know, in shape. Moderately through my pregnancy, you know, start to put the brakes on a little bit, uh, and she's back to capoeira and climbing once a week, but consent, she only is a fraction of her former strength, um, breastfeeding a low iron and all that type of stuff. Right. All so far, so standard, right? I've been struggling a lot with compliance, only did the exercises won't, and same thing with my health insurance PT because stopping constantly to look at my screen is challenging, and I get now. Um, and I got supremely bored with the format of the exercises. Yeah, yeah, me too. I will walk, Clim, climb, what climb? Walk, climb, dance, even run. Anything that allows me to read some flow mental release, but following exercise on the webpage, the exercise sheet is mentally very challenging. Suspect there's no magical solution, but did want to ask for your advice before I end my subscription. Many thanks. Um, and I love emails like this. I genuinely do. I like people that just say, hey, listen, I'm not gonna stick to this. I'm just not, because that is fine, right? There is nothing wrong, and and I told the the lady to, you know, no big deal. What I would do in this case, because you get three months free, you copy-paste the first three months of of the thing as I hit the microphone with my glasses. Um, you copy-paste the first three months of the program, so the bit that you get for free, you copy that into a Word document. The links are two YouTube clips, right? That I already have, so you have that for free, and then you cancel the thing. Don't pay me. Just hand me no money, it's not gonna work for you. Hand me no money. All you need if you are good at being active, right? So, and and you know, she's gone back to capoeira and climbing. She's just not as strong. No, after after six, seven months of of not training, you're going to lose a bit of strength. But the strength will come back.

unknown: 13:31

Right?

Peter: 13:31

So that's a no-brainer. You just keep doing those exercises that you enjoy and you will get stronger, especially things like climbing and all that type of stuff, right? So you will get stronger. That is that's automatic. Then all you need to do for diastasis at least is sort your breathing, which is covered in the first three months of the program. The three months I give away for free, as part of the healthy postnatal body uh program, is a full you go your way, do the thing you want to do, postpartum recovery program. That three months is it, right? That is what you pay Mutu a hundred pounds for. What you pay. I'm not gonna list all this. That's what you pay everybody else a hundred pounds for. That's what I give away for free. That's the whole point. The HPMB, postpartum care, should be freely available to absolutely everybody. That is why I set up HPMB. So I have no problem with people canceling saying, I'm not gonna stick to it. Okay, then don't stick to it. Just so I responded to this lady saying, okay, here are the basic things that I'd like you to do. Integrate these exercises into your capoeira training and and and your climbing training, and then ignore it. Don't give me any money. You don't need to. If you're not gonna stick to it, there is absolutely no point in paying money for a subscription that you're not gonna use. If I never watch Netflix or Apple TV, I'm not gonna pay for that. Right? HBNB is the same. I don't need loads of people that don't use the program. Uh, we're doing okay. We're doing okay. I mean, I'm eating my shorts every time, every every year. But we're doing okay. I don't need your 50 bucks or eight, eight pounds a month for 40, 40 pounds, whatever it is. Right? It's all good. All you need for to get you on your way is do that three months. Try to find time to do that first three months. Like I said, copy paste it into a Word document. Right? You don't need to log on to the HPMB website once you've reached that stage. Copy paste it, you go click on the YouTube links, right? Um, you can then just you know integrate the breathing, get the breathing right. If you find your back and neck pain, uh neck pain especially, it's usually uh it's quite often a posture thing postpartum, right? Because of breastfeeding and all that type of stuff. Um, right during breastfeeding, uh I've gone over this, but during breastfeeding, your shoulder falls forward and all that sort of stuff. A lot of people have issues with that. So do your scapular wall slides. They're in there somewhere. I'm not sure which month they're in. I'm guessing month one or two. Um, and that's when you do them. So before you then go do your rock climbing, for which you need to activate those muscles a bit, anyways. Do your scapular wall slides and make your climbing better. It helps helps your strength get back quicker, and then boom, you're there. Your back and neck pain, your back and neck pain will go away the more you strengthen up with decent, uh, what they call decent posture with uh once all the muscles are doing what they're supposed to be doing. Right? So go do that. Don't, don't, don't stick to exercises that you're not don't don't pay for stuff you're not gonna use. And this is key with exercise. Uh one of the one of the things I get asked the most is what's the most effective way uh to exercise? And it can be cardiovascular exercise or or weight loss or just strength training. Doing what you can stick to, that is the most effective form of exercise. And if you can go do capoeira once a week, and you can do rock climbing once a week, but you can't do anything else, then that's what you do. And ideally, you'll go back to doing it a bit more often. The capoeira and the rock climbing. The the the the you don't have to do any form of exercise, right? You don't have to do any rowing. If you don't like rowing but you like running, then go run. Right? This is something that a lot of personal trainers and and coaches still miss the point on. The good ones don't, the good ones know. That's you know, if if your favorite form of exercise is not the most optimal form for whatever your goal is, that is okay. You're not trying to be an athlete. Right? You're not going to compete at the world championships or Olympics. Why worry? Just just do what you enjoy doing. Get fitter, get stronger. Your way. Doesn't have to be my way. My way is just there to say, hey, the first three months um that I'm giving away, that will help with diastasis rectile and help relieve your uh back and neck pain a little bit if you stick to doing these exercises. And if you're like, yeah, Pete, I'm not gonna do it, okay, then it's not gonna work. But then then why would you pay me? Right? It's not gonna work if you never do them. But you can learn from this stuff, and you can take one or two exercises and just integrate them. It's really it's a no-brainer. Um, I half ex half think that this lady half expected me to say, you know, please don't cancel, stick with it. No, don't stick with it. If you hate it, you don't stick with it. It's it's exercise, it's it's you're already exercising, you're doing the things you want to do. So just like I said, she will walk, climb, dance, run, capoeira, climbing. You don't need my exercise program for any of the other stuff. You don't need to do lunges if you don't want to. It's fine, you don't need to do squats. Right? You don't have to do these things. Your rock climbing and your capoeira covers most of that stuff, anyways. So why on earth would you would would I tell you to stick with me? Right? So don't. So I told that lady, cancel your subscription. Don't don't don't don't pay me. Don't don't pay anyone money for for that type of stuff. Right. Finally, finally, uh I can't even well we're 20 minutes in, so this is going alright. This is actually going roughly according to schedule. Robert Gordon University, uh David Proctor, send me an email. Uh Doctor, Dr. David Proctor, um Dr. Katarina Forbes Mkay from Robert Gordon University, Aberdeen, and um did a um did a study about the um let's say the fear around giving birth and and the impact that has on um on the woman and the child and all that sort of especially on the woman um during pregnancy and what the pregnancy outcomes of of that are. Um what the so and they basically said, you know, we we and this is a very preliminary thing, and they say that themselves, loads and loads more research needs to be done into this, because as you can imagine, the numbers just aren't really uh there yet to have um to have a really solid opinion on on what come out of that, but you know, there there's some interesting stuff to come out. So I just want to quickly highlight one or two things from the study. Um so basically how how it worked, they where where did I just have it? Uh Jesus peep. There we go. So I have it here. So you know, again, back to the unprofessionalism, right? So the study is called, and I will link to this, it was published in the Journal of Psychosomatic Obstruction uh obstetrics and gynecology. Um, predicting fear of childbirth during pregnancy, the positive role of self-advocacy and mental well-being, a cross-sectional study. Um, like I said, by um Dr. Katrina Forrest Mackay. My cat wheezes in in the background for some reason. I'm not editing that out, I'm telling you what's happening, right? So we know that uh, for instance, there is uh uh the negative impact of fear of childbirth. Childbirth is what it's times. We know birth can it's negatively correlated, fear of childbirth is negatively correlated with mental well-being, um childbirth self-efficacy expectancy, and all that type of stuff, and basically can be lead to longer labor and and and all that sort of thing. Um now the numbers here are very wide-ranging. This is one of the issues with the study and why this needs to be studied more. I'm not slagging off the studies, right, at all. I am a firm believer, firm believer in uh in this type of uh type of thing. Um but I I want to highlight why these studies need a lot more funding, right? So, introduction, and this this highlights it already, because this is my biggest problem with the study. Between 10 and 60 percent of pregnant women experience a fear of childbirth. Oh, 10 and 60 percent that's a lot, right? That's a wide range, is what I'm saying. Although prevalence rates vary depending on definition, measurement tool and sample use, the prevalence of having a fear of childbirth at uh so FOC at severe clinical level is reported between 2.5 and 14.7 percent. Again, huge, huge margin, right? A global prevalence rate of 16% for severe fear of childbirth and studies. Again, to you you just went from two and a half to sixteen percent. So this is a bit of an issue, right? We don't have numbers to say to to really nail this down as in one in five, and just go, yeah, it's anywhere from two and a half percent, which is a huge number, but you know, relatively speaking, and I don't mean to crap all over this, not that a significant a number of of people, um percentage of people, a significant number, but not a percent percentage, to an astonishing number, which is 16%, which is one in six. That's a phenomenal number. One in six women experience severe fear of childbirth, which again matters because of all the negative um side effects, negative uh after effects of it, uh effects associated with it. It's not a side effect, of course. Um, right. So, what they basically did, they they they took uh a group of women, um, they invited 240 women or something like that in the third uh in the third trimester. They got 91 responses, and then they had to rule out some uh some people. So they took people in, like I said, in their um third trimester, so 28 weeks, uh they had to be 16 or over, read and write to understand English. Women were excluded, and this is interesting if they had a mental health issue requiring medication or did not meet inclusion criteria. So you're the study was effectively done on women without mental health issues, or at least that mental health issues that required medication. And this matters because you can kind of deduce from this, from excluding that, and still hitting these numbers, that for people who are on mental health uh medication, antidepressants and the anxiety meds and all that sort of stuff, right? If you're on cetilepram and all that type of thing, right, the consequences of uh fear of childbirth are likely significantly worse. The worse, the impact of it is likely significantly worse. So this is just in I'll airquote this. I know that we can't see it, but I'll air quote this and I'll stipulate that I air quote this healthy women, right? Air quote it. Don't come at me for using that term. I couldn't think of a different one on top of my head. Basically, so they ended up working with uh 57. I want to say 57 women, um, which is about right, right? That's that's fine. Um and and they they they came they they came with um they had a they had a long look at the the fear of childbirth, uh the percentage that they had, and then most importantly for this study, the um they tried like an empowering um technique. So the the basically they said they they tried to educate women as much about childbirth as they could. So give to give them all the knowledge of the things that can go right, the things that can go wrong, basically, those are stuff that I've discussed on this podcast with many, many experts that will tell you the same thing. The more you are prepared for this, the less, even though you experience the fear, the less negative consequences you have, because you're I say familiar with the fear. That's kind of what comes comes out of this. Um and what the authors are saying, and and this matters, because like I said, the studies like the the numbers the number swings are huge, the margins are massive, so we can't really rely on uh on on the numbers. Um we just know that fear of childbirth has negative effects and and that it affects quite a few um people, right? So what this shows is that during the anti-NATO classes that almost all of you are going to, a large bit more time, let me put it that way, and I sigh deeply there, more time should probably be spent not just on the process of childbirth and the possible outcomes of childbirth, but on empowering women and potentially couples. Um, because again, that would be a different study, right? Um showing the effect of having a supportive and well-informed partner in the childbirth, uh during the childbirth and the pregnancy, what impact that has on recovery and the actual childbirth and actual labor experience. Different study, but I I think it's almost again, it's almost a feel it feels like a no-brainer, right? That this stuff should be included. This study kind of shows that within huge, absolutely huge, like I said, margins. Um that teaching women to advocate for themselves, teaching giving women the knowledge that they need about childbirth removes a lot of the fear and therefore removes a lot of the negative uh effects of the fear, and teaching them, empowering them to advocate for themselves. So you give them knowledge, you give people knowledge, and you teach them to advocate and stand up for themselves, has a really overwhelmingly positive out uh outcome on um at least, it seems to be, because again, this study shows, like I said, many caveats with this particularly very early study. This needs to be studied more, but it's fascinating nonetheless, and I think it's fascinating at a okay. There's a study about this now, but it almost feels like a no-brainer that this is what your you know your your antenatal classes should be doing, anyways. It should be giving you all the knowledge, it should be telling you to advocate for yourself, it should empower you. You you will be okay. It should really inform you about the risks associated with childbirth and how what the actual risk is versus what you think the actual risk is, right? Lot of people have a fear that is not based on actual numbers. Um and and that matters. And I think we should probably discuss as part of the antenatal classes that there are different health outcomes that are not dependent on uh not biologically dependent on the race of the parent. But they are the the race of the parent does affect the outcome. As in we see medical bias, we see this all the time with black people and people of color and all that uh all that type of stuff that they have significantly worse outcome, uh health outcomes uh in in maternity care. And I was going to do an episode about this, I can't remember what happened with that. I'll need to go for my emails uh because I had someone lined up to talk about this. But, anyways, we know for a fact that there are huge, hugely negative uh medical biases towards uh black people, especially um in especially in America, um but in in in the UK as well. So that sort of thing needs to be addressed during your antenatal class because it allows the woman and the and and the and the partner, uh again seems a no-brainer to me, to be much better prepared for when that situation occurs, so that you can advocate for yourself, so that you feel empowered to advocate for yourself, and that will make your labor easier, will make your the whole process will be easier, and therefore by definition, will make your postpartum recovery easier. And I'm not talking about like diastasis recta, but the fewer complications you have during your labor, the easier postpartum recovery is. That's a no-brainer, right? That makes sense to everybody. Oops, as I just pulled my headphones out. I'm sorry, this is what happens when I don't sit still for five minutes and and and don't do an interview. And as I will link to that study, it's it's a fascinating little thing. Um like I said, it's mainly one of those studies that says a lot more research will need to be done. Like I said, the numbers are the the margins of the numbers are are are are huge, two and a half to sixteen percent. Yeah, okay, that's not that's not what we can work with, right? It's you can't have uh you can't multiply it as a factor of six and expect it all to to be in the in the right ballpark, right? Um but it matters because even two and a half percent is a is a is in absolute numbers, it's a huge number, right? Um so we need to narrow that down a bit and we need to fund that properly. Anyway, so the link to that it's half an hour. My time is up. I'm going to edit next week's episode as well, and the week after I have an interview, um which is actually a fascinating one about a um I have an interview with a couple of ladies, um, Robin and uh Linda, about um their um close apartment recovery facility in uh America, right? And why I think that's interesting and all that type of stuff, uh what they're doing there, and why I think it's interesting and why they agree with me that you know these things shouldn't have to exist in a commercial environment uh as a commercial entity. But if we spread these things out more, we can bring the cost of these things down and and they should they should exist. Let me put it that way. So that will be in two weeks' time. Next week is from the vault of that I haven't picked yet, because I'm still to work on that, anyways. Peter at halfypostnatalbody.com. You take care of yourself, and I'll be back next week. Bye now.

unknown: 34:07

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