Women’s Health Education Network (WHEN) : when.org.au/

Hannah:
Welcome to the Burn Pod, listeners. We’re really excited to get stuck into today’s episode. And as 99% of you are women, we’ve been fortunate enough to steal some time with our special guest, Peta Titter, from Women’s Health Education Network. Now, Peta is the founder of WHEN and head of health education. And WHEN is a women’s health organisation working to educate and empower all women across Australia to live and age well through exercise and movement, and pretty cool it’s based in Hobart, Tasmania. So welcome Peta.

Peta:
Hi, how are you?

Hannah:
Good, thank you. Thanks so much for joining us.

Peta:
Thanks for having me.

Hannah:
So our listeners get to know you a little bit more, tell us a bit about yourself. So what got you started in this area? You know, what your background is and what are your passions?

Peta:
Okay. So my background is that I’m a nurse. I worked in adult and paediatric intensive care and always would slouch when I was looking after patients. So I was always looking over patients and I ended up getting a sore back. And I tried Pilates when we were living in Europe and it made my back better and I continue to nurse. And then we moved to Holland because I married a Dutch man, and my Dutch wasn’t good enough to work in intensive care. So I decided I needed a change, I was a bit burnt out and I decided to do some Pilates. And I did sort of a lot of Pilates while I was there and found out that I really loved it and wanted to leave nursing, was desperate to leave nursing. Then we came back to Australia and realised I sill needed to nurse to make a bit of money. So I was working between the hospital and working at the body studio.

Peta:
And so most of the women knew I was a nurse. I didn’t keep it a secret. But one of the things that I was finding was that women were telling me things that they weren’t telling the other instructors. And I was young and hadn’t had babies at that stage. And the things they were telling me I was very shocked at. And so they were saying, “oh yes, when I sneeze I leak urine, but that’s normal. I’ve had three babies. And if I do a sit up, I leak a bit of urine, but you know, you’ve got to expect this.” And I was extremely taken aback because I did not know that that could happen, let alone that it was normal.So I retrained as a continence nurse and found out I don’t like to use the word normal because it does happen and it can happen. But it’s something that is not something that we should be expecting or expect.

Peta:
And so we started… I have my own Pilates studio and we started to really use this information when we were teaching. But then what I found was I got pregnant late in life. So I got pregnant at 38 and 40, two different pregnancies, and was really, really taken aback at what happened to my body. Even though I knew everything that was going to happen, I was still shocked that it happened. And one of the things that happened, which is very bad for me, but great for my practise, is that I got a pelvic floor injury on the first baby. And I was really, really disgusted and shocked at how I was treated in hospital. I was just told, “well, at least you’ll know where to get cheap pads.” And that was pretty much my education.

Peta:
And so, if I wasn’t a very forceful person or a continence nurse, I knew that this was not acceptable. You know, is that happening to other women? Did they just treat me like that because they knew I was a continence nurse? But the more I looked into it, the more I’m seeing that that’s how other women are being treated. So got very angry, kicked the obstetrician out and asked for a different one. And did a lot of my own work myself, like went and saw continence physio, worked really hard on it. Now in saying that, I’m really open about saying that I’m incontinent, but lots of women aren’t and it does have a stigma attached to it. But for me, it’s not been the best thing cause it’s horrible, but it’s been the best thing to open my eyes to see that there is so much that we can do to help women and educate them about this.

Peta:
And then I went on to decide to have my other baby pretty quickly because I wanted to get it all done by 40. And I’m one of those people who’s a real stickler and has to follow exercise guidelines or any sort of guidelines. And so I followed the exercise guidelines to a T that were released. And what happened was I leaked urine continuously whenever I exercised, my pelvis gave me pain, and my diastasis opened up earlier in the wrong way than it should. In saying that, a diastasis is a healthy thing, but it wasn’t working in a healthy way. And I was really, really shocked because I was like, but I am following the guidelines, why is this not working? And after I had Emma, my last baby, I went back to uni and did my research specifically around the exercise guidelines and was absolutely dumbfounded when I found out that all the exercise guidelines that we’re currently working on, are only about keeping the baby safe.

Hannah:
Not thinking about the actual mother.

Peta:
No. So we’re still seen as vessels, which is disgusting. And so, people will say to you… There’s two trains of thought on running, but a lot of people will say to you that running is safe in pregnancy and running is safe in pregnancy for your baby. But it is not safe for the woman. But we’re not thinking about the woman. We’re valuing the baby more than the woman, which is unacceptable in this day and age.

Peta:
So that was quite an eye-opener for me. And the other thing that I found out was that there’s lots and lots of long lasting impacts in pregnancy that we don’t talk about, ever. And we’re like, “yep, you have the baby, okay, move on and get your body back. And you’re fine.” But if you look at the statistics, women, who’ve had a baby are more likely to have a hip or knee replacements. That’s a big one. If you look at the statistics-

Hannah:
Is that due to the release of the relaxins?

Peta:
Well, no. So relaxin is a big… Everyone thinks that it’s the big hormone that we should be looking after. It’s actually… We actually don’t know because no one will do research on women. Well, not no one. That’s a big statement. Research on women is very unproportional to research on men. No one really wants to research pregnant woman. That’s a fact for a few reasons. Because no one wants to get sued 20 years later when the baby comes up and says, “that research could have affected my learning development,” along those lines.

Peta:
But the other reason is because women have been having babies forever. We’ve just gotten to the point where we’re just accepting that these conditions will occur after we have the baby. And so, the statistics around incontinence… I don’t think incontinence is increasing, I just think women are a little bit more comfortable about talking about it now, so that’s why the numbers are on the rise. So if you look at it, one in three people in Australia will be incontinent, but 80% of those will be women. And there is some suggestion that if you’ve had a baby, it could be more two in three women will be incontinent and especially after menopause. But in saying that, you don’t have to have a baby to be incontinent. And women don’t get talked to about their pelvic floor if they don’t get pregnant.

Peta:
So there’s lots of issues around that area that we need to talk to women about. But I got very angry after I had my second baby and found this out and started yelling at the computer a lot. Got on Instagram, saw all these women doing the splits when they were pregnant, saying, “no, it’s perfectly safe. The guidelines say it’s safe.” And my husband got really annoyed that I was yelling at the computer. And he actually was the one who started WHEN. Which was really nice to have men involved in women’s health, because I think one of the things is we need men to be our allies and to be yelling about women’s health, because that’s why we’re going to change it.

Peta:
And so initially we started off being around pregnancy and childbirth. And then the more we started doing research, the more we looked into it, the more we feel that women are not taught about the changes in their body and that our bodies change as we age. And if we learn about these changes, we can age a lot better. And we want all women to know about their bodies changing and that they have power. And we’re over the word empowerment because every person is putting out, “I want to empower you to get your bikini body back.” That is actually not empowering women. What we want to do is give them power to make their own choices and their own decisions and have the facts. And then if they still want to run when they’re pregnant, that’s perfectly fine. But they need to know that if they’re running when they’re pregnant, they’re going to put lots of strain on their ligaments and joints. Their pelvic floor is going to alter. They may give themselves some knee and calf damage, but they can still run. But they need to know that information, not just being told it is safe to run.

Hannah:
It is or it isn’t. So is this where WHEN comes in? So you had this experience and then saw that women actually don’t have enough information to be able to, I’m going to use the word empower, or understand their changes as they grow, as they age. So this is where WHEN came in?

Peta:
Yeah, that’s totally what WHEN is about. We have a full board and that’s the message we’re trying to get out there, that women need to know how their bodies are changing. And then once they understand the changes in their body, they can make their own decisions. They can have power back. They know, “I don’t want to do that or yes, I do want to do that. I know that consequences of my actions.”

Hannah:
Mm, exactly. And we think it’s really important that we have more conversations and there’s easily accessible education to support women’s health at every different age. I wonder if we could walk through the different ages and when WHEN has found all the key areas of focus, concern that WHEN focus on, or you have found even in your experience, at each stage of life. And I’m sure I’m going to be missing a couple here. So I’ve just, it’s a very general stages. We’ll walk through if that’s okay, but I guess let’s start with teenagers. What are the sort of key areas of focuses, as we go through that awkward teenager stage that you find?

Peta:
Well, I think a few things are really important and we are actually trying to get teen pelvic floor education into all high schools. But one of the things that I think we really need to be aware of, is when you become a teenager or when you go through puberty, you get oestrogen and your whole body changes. So I liked to… I’m very blunt. [Inaudible 00:11:06] I like to point out with my two girls, which they may hate this when they’re older because they’re eight and ten. When they cough and sneeze, they fart, and think it is the funniest thing in the world. And it’s fine for them to do that because they haven’t got oestrogen in their body. And our pelvic floor is oestrogen-dependent and our muscles are oestrogen-dependent. But if you and I are farting and… Or coughing and then farting, we need to go and see someone, or we need to think about doing something about it.

Peta:
And so girls are going into teenage hood and their bodies are really changing. And this is one of the phases that is very dramatic. So they’re getting oestrogen, their shape is changing, they’re getting a waist, they’re getting breasts, and they’re getting hips, and they’re getting their period. And we’re not very supportive around women and periods. And we make it out that we all have periods, and that you can just toughen up and get through. But there are certain times in your periods, you shouldn’t be pushing your body around exercise. And we’re finding that there’s lots of teenagers at the moment who are ending up at physios really young, because they’re pushing their bodies in sport. And we would really like girls to be educated on, you don’t have to push your body that hard, you have to work smarter with your body when you’re exercising.

Peta:
And you need to know about things like your pelvic floor, because it’s the base of your core. And if you’re thrashing your body or bearing down, you’re going to change things that happen in your body. But there’s some amazing research coming out of Sydney, or that’s come out of Sydney, around netballing and pelvic floor, and how playing in netball can increase your risk of pelvic floor injury or leaking urine or incontinence. In saying that, we don’t want them to stop playing netball. We want them to know that there are things that they should be aware of. So if they are leaking urine, they should be seeing someone, or maybe they just need to do some pelvic floor exercises before they go on the court. And it’s not just netball, it’s any sort of stop-start sport. [crosstalk 00:13:10]

Hannah:
…Area, this idea of… your period cycle and the different ways that we need to look after our body, or things that we need to do to maybe ease back or rest, depending on the stage that you’re in, in your cycle. And I’ve come across it a number of times the saying that women aren’t small men, and we need to learn to we need to recognise and understand how to use our periods cycles in a way that’s… work with them in a way that’s going to be most beneficial to our health and our wellbeing longterm.

Peta:
Yeah, totally. So one of the things that… I use this word, and if any of your listeners can think of a better word, I hate this word. I really hate that word, but it’s the most commonly used word, when people use this phrase. When you’re feeling fragile when you have your period, there is a reason you are feeling this way. It is because you have low oestrogen levels. So it is not that you are a fragile flower. It is that you don’t have the same hormones that you normally have. And so if you don’t have that hormone that is running through your body, that you need, you are going to put yourself at risk of injury and you are not going to feel as strong as you do two days later. So maybe don’t go for that run that day, just hold off, do some weight training or something else, or just have a day off. And then once you get over that period of not feeling as strong, then you do the harder exercise.

Peta:
And so I think we should be educating younger girls on the impact that exercise is going to have on their body, if they do it incorrectly and movement. And even carrying a backpack, the way they texting a lot more, they’re always in a downward… their head is always in a downward position. These are things that I need to know about. So that’s probably what we find in teenage hood.

Hannah:
Yeah. Wow. And I guess the next stage is the young adult or the… could you call it the pre-pregnancy years? The sort of early twenties, mid twenties generally. And I assume this is usually when we’re at our fittest and healthiest during our lives. So what do you see as the main concerns and focus areas here? Are they sort of similar to the teenage?

Peta:
Well, I think one of the biggest things here is that women, and this is not about women. This is about people in that age group, that feel that they can do anything and they’re infallible. And they’ve got that sort of, “there’ll be no consequences for what I do,” sort of, you know… And I did it, like I travelled around Europe, I did dumb things. I jumped off the top of boats, and jumped off the top of waterfalls, and did things that at that age, I didn’t think that there would ever be any consequences for them. And I think we want people to live their lives, but we also want them to know that if they look after their bodies really early, and that does not mean wrapping yourself in cotton wool, they’re going to have… They’re going to age better, and everyone wants to age well.

Hannah:
You just don’t think about it at the time though, when you’re 22 and backpacking, like I was doing, that’s the last thing on your mind, isn’t it?

Peta:
No. Like I carried a 20 kilo backpack. How stupid is that? Do you know what I mean? I did not meet all of that stuff by the way. But I carried that round for like two years and the extra weight that I was putting through my joints and pelvic floor, I didn’t need that. In saying that, I was really strong at that point, but… I think that all women should know about their pelvic floor and their vagina, because it gives them more power in general. The more we know about it, the more we are in control of ourselves. And these are things that I don’t think… This is what women should be learning pre-pregnancy because you fall pregnant, and then all of a sudden, the first time you were ever told about it you were probably 12, really? And you’re already at your first pregnancy, you’re in a high, like this pregnancy high, so you’ve got so much information being thrown at you, and then you get trained, oh, that’s just how people work.

Peta:
And it’s hard. It’s not easy. It’s not… It’s easier for menstrual pelvic floor with some women, we’ve got three breaches and a baby’s head fits through one of them. It’s not an easy thing to learn. And then you got this extra weight and the hormones on board. And then you’ve got a whole generation of women who are choosing or are unable to have babies, and they never get spoken to about their pelvic floor. And they should be knowing about these in their teens. And the other thing, and we don’t actually bring this up if we do this at school.

Peta:
But the other thing that they need to know is it’s the [inaudible 00:17:47] And there’s no reason that women should not be told that. When I first started doing pelvic floor talks, if I spoke to a man, it was the first thing I ever said, because I knew as soon as I [inaudible 00:17:59] pelvic floor work. But with women, I always talked about continence and childbirth and everything like that first. And it’s taken me a while to realise that our sexual sex life is just as important as a man. And it’s really important that we encourage women to do pelvic floor work for that reason as well.

Hannah:
And I guess the next stage for many women is the big buck we’ve already started talking about is pregnancy. And we’ll definitely get into that in the next podcast, listeners, so don’t worry please, we’re going to skip that for now. But we get into that perimenopausal age, late thirties, sort of forties. And we were actually lucky enough to have some guest speakers from the Perry project join us a few podcasts earlier. So listeners, if you wanted to dive into this topic a little bit more, just jump back a few episodes to the Perry project.

Hannah:
But Peta, in your experience in WHEN, what are your key focus areas and educational support focused around this stage of a woman’s life?

Peta:
Well, I think this stage of the woman’s life is just as big a shock to a woman as being pregnant and as going through puberty. So if you look at all of those three stages, one of the key factors that happens in all those three stages is our hormone levels change. And oestrogen is one of our biggest hormones and it’s a female-defining characteristic. And one of the big things that you’ll hear lots of women talk about first is, “oh my goodness, I can still get the pants on that I wore last winter, but I just can’t do them up around my belly. I just can’t get rid of this belly fat.” And it’s not always belly fat. A lot of the time, what is happening is your oestrogen levels are waning. And if you think about oestrogen, that is a female-defining characteristic and it gives you your waist. So your waist is thickening. And it happens really quickly. Like it happens in a season, and it’s a bit of a shock, and it can change the way we move as well, because your waist thickens.

Peta:
So their bodies visually are changing, and shape wise are changing. And that is really hard, as women, we seem to get our bodies between 16 and 24 and decide that’s what our bodies should be like forever. And we try and make our bodies work that way forever. We try and make them work like a 16 to 24 year old body. And if we could learn that our bodies have been through massive changes and we need to work differently with them, we could still have this amazingly working body, which is really bad English. Sorry about that. We’ll have a really functioning body.

Peta:
It’s like, not that I run, I hate running. I just want to put that out there. I’ve never been a runner, but since I’ve had my pelvic floor injury, I’m very angry that I can’t run. Not that I would run. But I get angry that that’s been taken away from me. If I ran at 16, I wouldn’t have to stretch. I could just get up and run and I would recover really well. At 26, I’d probably have to do a few stretches. At 30, I’d have to do a lot more things to make sure my knees didn’t break down my feet and break down. At 40, I have to do a lot more. It doesn’t mean I have to stop running, but I need to look after my body around that. And when we go through perimenopause, I think that women are still clinging onto the fact that they don’t have to do these things. They don’t want to change their routine, because then they see that they’re getting older.

Hannah:
And it’s an interesting way of looking at it. I think we… It’s a major one that we hear, “I’m hitting that perimenopausal stage, I’m putting on weight.” And it’s kind of a nice way to sort of change that frame of looking at your body and going well, you’re not putting on weight, your body’s just changing. As you said, your hips are… you’re losing your waistline. It’s not necessarily that you’re just putting on weight, it’s, things are changing. Your body is changing. It’s kind of… I quite like that actually, kind of takes the pressure off. You’re trying to desperately hold on, like you said, to this 20 year old’s body when it’s not going to happen.

Peta:
And there’s lots of amazing thing about an older body, and we should be embracing that. But the other thing that I find really hilarious is, our whole lives, we try and lose weight off our thighs. That’s our biggest aim in life, to have skinny thighs. But then after you go through menopause, your quad muscles waste. And if you look at older women, one of the reasons they fall is that their legs aren’t strong enough. So after menopause, we should be pushing our legs to get stronger. We should be embracing thighs. We should be loving thighs. You know, the bigger, the thighs, the stronger the thighs. That’s what I say.

Peta:
And we’ve got this whole body image thing that we have to have tiny thighs, but really, what we want is really strong, big legs that are going to look out for us when we’re older so we don’t have falls. So we don’t end up in nursing homes, things like that. So we need to change the narrative. And just by, love your thighs. Like I’ve spent a lot of money on my butt and thighs and wine and cheese. That’s how I see it. This mention my future.

Hannah:
And then finally, we reach perimenopause, menopause, and then post-menopausal age. What are the key health focus areas or concerns during this stage of our life?

Peta:
So one of the things that we have had to learn, and this is through focus groups, is post-menopausal is a very, very tiny, short period. And what we’ve now decided to do is drop post-menopausal and we call it peri-menopause menopausal, or over 65. The reason we’ve dropped it is because if you look at women over 65, if they went through menopause at 45, they’re going to class themselves as postmenopausal now. That was so long ago that they are just like, “oh, I have no idea what… That has no impact on me at all now.” And so we look at it as over 65.

Peta:
And there is so much… We were looking for pictures in stock photos the other day, and we were absolutely shocked at the way women over 65 are portrayed. They’re either portrayed very Botox-y and made to look so young that it’s ridiculous, or they’re portrayed as, like my Nana from the 1980s with a set and curl pin, and a twin set. And it’s just this group of women are portrayed so badly and the amount of stock photos when you’re looking for it, there’s hardly any. So it’s like we pretend that people don’t get old, where we should be embracing them, and we should be learning from them, and we should be supporting them. One of the big things at WHEN is we want generations to support each other, but in both directions. So there’s lots of information that younger women will ask, but older women won’t. And that’s for us to tell them about. But there’s lots of information they know that we can learn from.

Hannah:
And pass down. Exactly. Thanks for coming on the pod, Peta. It’s been a very insightful and educational conversation, and we really appreciate your time. Now, listeners, we’ll be diving a little bit deeper into the pregnancy and post-pregnancy topics on the following podcast, and join us on the next one.

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