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

Hannah:
Welcome back to the Burn Pod listeners. Now, if you haven’t already jumped on back to our previous episode, well, we had the pleasure of special guests, Peta Titter from Women’s Health Education Network. In that episode, we introduced WHEN and reviewed the different stages of a woman’s life and the health focus or potential concerns that we generally see at that stage. Now, I’m really excited to expand on this topic in more detail with a specific focus on women’s health during pregnancy and post-pregnancy with Peta. So welcome back.

Peta:
Thank you so much for having me.

Hannah:
What are the key areas WHEN focus on when it comes to pregnancy education?

Peta:
Well, I think one of the biggest areas that I like to focus on is giving women information. And one of the things is on how your body changes, and we don’t focus on how her body changes for her. We focus on how it changes for the baby. And I think that this is something that we need to stop, and we need to start talking to women about their bodies as well, not just your body is doing this to accommodate the baby, because if they don’t understand the changes when they’re trying to exercise, it won’t make sense to them. And then when they’re trying postnatally to exercise or even just get through life with this new baby, they will get frustrated and not understand that there’s a reason this is happening.

Peta:
So just a few examples. When you get pregnant, your rib cage can expand by up to seven centimetres. Now, this doesn’t just happen from the mechanics. So it doesn’t wait till you’re 40 weeks pregnant and then just pops out. It can start happening in the first six to 12 weeks because all your hormones are kicking in. With that expansion, there’s a whole heap of stuff that can impact women for life. So, your ribcage doesn’t just pop back after you’ve had this baby. You have to work on it in the health industry. So I do own Pilates studio. So I feel quite comfortable about talking about this sort of stuff. If I’m saying something negative about the fitness industry, I mean it. But we talk about, if someone’s rib cage is popping with a funnel, we’ll pull your ribcage back. But if they’re doing that, they’re bearing down on pelvic floor.

Peta:
But we don’t want that to happen. So we need to teach them about this rib cage, how to correct the rib cage in the long run, because what happens is women’s ribs get really sticky after their rib cage has expanded, and they stay in this sort of [inaudible 00:03:01] rib cage. Then they’re pushing open their stomach muscles. So their diastasis, they’re holding it open. So, one thing. And then the other thing is, as you get older, if you think about all the women when they fall, and this is going to sound a bit mean, but if they break a hip or wrist, all of that is very fixable. But if they’ve got these really hard sticky rib pages, which is what happens after pregnancy unless we teach them to move it more, they’re going to fracture a rib, and that fractured rib is going to give them pneumonia. And that’s the thing that is going to debilitate them more than anything else.

Peta:
So with pregnancy, women need to understand that their rib cage is challenging, and it can be super painful. You’re getting this rib cage to move when it’s never moved. And there are ways around it. There are small little exercises that you can do that can alleviate that discomfort. So that’s one thing that we like to tell women. The other thing is… One of the biggest things I like to tell women is a diastasis is not the end of the world. It’s actually a really good thing. So a diastasis is a separation of your stomach muscles. If you look at a lot of social media or Google doctor, you’ll see that people really want to fix their diastasis. So they’re devastated when they get a diastasis when they’re pregnant.

Peta:
But the option is you’ve got three options when you’re pregnant. You are growing a human. It has to go somewhere. You’ve got a normal shaped body, and then all of a sudden you’re trying to put a whole human in there. The options are that you can rupture your diaphragm, which no one ever wants to do because you will die. So that’s out. [crosstalk 00:04:38] muscles in our body. It’s not going to happen to anyone. So then the next two options are your pelvic floor or your stomach muscles. Now, pelvic floor is really hard to rehab. It is really hard to sort out once there’s any sort of damage to it. There are options, and there are things they can do, but it’s hard work.

Peta:
Stomach muscles are a lot easier to sort out. So you’ve got to have a space for your baby to grow. So it’s not a bad thing, but what we want to teach women to do is how to support that separation. That makes sense?

Hannah:
That does make sense. So if we’re looking at those physical changes that occur during pregnancy, what do we need to watch out for when it comes to exercise? So, you’re someone that’s been doing, regular exercise, and then these changes start to happen. These physical changes start to happen in your body as well as all the hormones and stuff that go on. So what is it that we really need to be careful of when we’re continuing to exercise or we want to continue to exercise once pregnant?

Peta:
Well, I think everyone should exercise while pregnant. You should be doing 150 minutes of cardiovascular work, and you should be doing some strengthening work. So I would never advocate for anyone to stop exercising, but I think one of the biggest myths about exercise, and it’s really perpetuated in the fitness industry, is if you were doing it before, you can do it now. So one of the things that you need to understand is your body is changing dramatically overnight. You’ll see women… And I did it to myself. I was ironing, which is very, very unusual. But I actually ironed my stomach because it was in the way. It changed that quickly. I didn’t ironed the whole stomach, but I hit it with the iron.

Peta:
And I remember when I was pregnant, one day I could fit through, the next day I couldn’t. So they are huge changes. This is the fastest your body, apart from when you give birth, will ever change in your life. Your centre of gravity is changing. Your pelvis is changing, and we really underwrite that, and it’s something that I feel very strongly about that we should be paying more attention, that pelvis is not just [inaudible 00:06:48]. And then we’re telling women, well, if you did it before, you’re perfectly safe to do it now. But she’s in a totally different body, and it’s changed overnight, so she hasn’t learned how to use it.

Peta:
So what I would say is be conservative. There’s always ways around exercises. You want to give yourself the best chance to recover from this pregnancy. You also need to understand that what you choose to do during your pregnancy will impact you for the rest of your life. So you may not feel it straight after pregnancy or in the first couple of years, but when you go through menopause, it’s going to come back. So you want to exercise, but you want to do safely. Do it safely.

Hannah:
And moving on from that, with exercising during pregnancy, what are the benefits? What’s [inaudible 00:07:37] safely?

Peta:
There are so many benefits I don’t even know where to start.

Hannah:
Top three. [inaudible 00:07:45] top three.

Peta:
Okay. The top three is mental health. One of the biggest ones, and you’ll find that even women who don’t particularly like exercise, just getting out and going for a walk, everything is so confusing and changing when you’re pregnant. Maybe not on your third pregnancy, but on your first pregnancy, it’s very overwhelming. So I think exercising for mental health. Cardiovascularly, you need to have cardiovascular health, but I think women are too hard on themselves because if you think about the anatomy of a pregnancy, when you get pregnant, your blood volume doubles. And what that means is more weight. It also means that [inaudible 00:08:24] doubles is your white blood cell count, which doesn’t have any oxygen carrying capacity at all. And your red blood cells only go up between 18 and 20%. So all your red blood cells… Not all your red blood cells. A big portion of your red blood cells are being shunted off to grow this baby.

Peta:
And then you’ve got all this extra fluid [inaudible 00:08:45], and then you’re expecting to be able to exercise really hard, or not really hard, but at a rigorous way. And you’re getting short of breath. You’re getting short of breath going upstairs, and that’s because you have the same amount of oxygen available to you as you did before you were pregnant. So you want to keep cardiovascularly fit, but you want to be realistic. And the other thing, one of the biggest things that I think we underestimate when we’re pregnant is remembering there’s not much research on pregnancy. So we’ve extrapolated this from obesity research. Now, you are not obese when you’re pregnant, but you put on a lot of body weight. So if you put on 20% body weight, which most women do nowadays, and it’s a really interesting thing that we’ve gone up two kilos in the last 10 years compared to what we used to be.

Peta:
So if you put on 20% of your body weight, you’re putting 100% more force through those joints below that body weight. So think about your pelvic floor, it has joints around it. Your pelvis, your hips, your knees, your feet. So your arches can drop by up to one centimetre in your first pregnancy. You’ll hear people say, “Oh, get your leg strengthening to give birth.” No, nothing’s going to help you give birth apart from your pelvic floor and your uterus. What you need to do leg strengthening for is to ward off all the impact [inaudible 00:10:09] for weight is having on your knees, feet and hips. So the stronger your legs, the better off you are.

Hannah:
Once again, cheese. One. Or maybe not.

Peta:
[crosstalk 00:10:20]

Hannah:
[crosstalk 00:10:20] cheese. Or chocolate maybe.

Peta:
[crosstalk 00:10:26] Yeah. You can use it with other things. So it’s really about just being strong. And you’ve got to remember, after you have this baby, you’re going to have to care for it. You’re going to have to hold this baby for 12 weeks with no neck control. Your arms are going to get exhausted. So you want to be as strong as possible after this pregnancy so you can get through the postnatal period. I’d like to point out the postnatal period can get monster going on. [inaudible 00:10:50] 10 and eight year old. You are exhausted. You’re not [inaudible 00:10:55], and your body doesn’t recover within three months.

Hannah:
Which is, I think, a lot of us expect just to bounce back straight away and get back into their standard normal exercise routine within 12 weeks.

Peta:
Yes.

Hannah:
Yeah. Yeah. So how do you know when is the right time for you to return to exercise once your baby is here?

Peta:
If I’m honest, you should be exercising even after your baby’s here, but a different form of exercise.

Hannah:
[crosstalk 00:11:23].

Peta:
Yeah. You need to be exercising. I’m actually doing my PhD in postnatal information given to women in the postnatal period, which is not enough. It’s all about the baby, and I want it to be more about women. But you need to know that your body has done this massive dramatic change again. More than even being pregnant. You’ve expelled a huge amount of weight in, let’s say, 48 hours, depending on how long your labour is, but your body has had a dramatic change. And the thing that has happened is you have gone from stretching your body to its maximum capacity, literally to its maximum capacity where muscles have separated, tendons and ligaments have stretched to then going, okay, so the weight isn’t there, but I’m back together and I’m strong. I want to be strong. I want to get going.

Peta:
You want to be kind to your body. You’ve just gotten rid of all that weight. One of the things that we see lots of women who have strapped their babies to their body and going for hikes in the first three months, and then they come in with heaviness in their vagina, and they’ve basically given themselves a prolapse, which is when one of your organs moves, whether it’s your vagina, your… Not your vagina. Your bowel, your bladder or your uterus. It doesn’t mean it hanging out of your vagina, but it has dropped slightly. And so there’s lots of workaround to strap your baby to your body and exercise. Don’t. Get rid of your baby. Do something for yourself. Put the baby on the ground. If it cries, it’s going to cry. Your baby’s going to be crying for their whole life.

Peta:
Obviously don’t neglect your baby, but give yourself some time to work your body. You’ve just gotten rid of that weight. Your pelvic floor has just had a break. You don’t want to baby strapped to it, putting more weight to your pelvic floor. And this baby now has free will. It had free will beforehand because it kicked, but it has free will, and it’s moving at times [inaudible 00:13:21], and it’s making it harder for you. And people talk about that it’s really good for bonding. You don’t need to bond with your baby while you’re exercising. You need to make you a priority. And it’s really important that you start with gentle walking, that you’re doing pelvic floor exercises, that you get your pelvic floor fit, that you start gentle breathing is the best thing for a diastasis. Working on that sort of breathing to reconnect, get both sides of the stomach knowing that they’re supposed to be talking to each other, or your muscles.

Peta:
Be careful with stretching after having a baby because everything has been stretched to the max. You want to pull everything in and get everything stronger. And you want to be kind to your body. If you’re breastfeeding, your oestrogen levels can be as well as the postmenopausal woman. So you want to be careful, because oestrogen can help our muscles contract and help them heal. And so you’re putting yourself at a disadvantage if you want to start running. It’s fine if you want to start running. Just understand that you may put yourself at risk of a calf injury. If you look after yourself in this postnatal period, you are going to have a better recovery, and you’re going to have a better long term outcome from ageing and having babies.

Hannah:
Yeah. Yeah. And for those that are listening, how can you start strengthening your pelvic floor? Is there some really basic, simple exercise or activities you can do from home?

Peta:
Well, it’s a really interesting concept because I’m a [inaudible 00:14:57] and I advocate pelvic floor work all the time, but the best thing you can do is get [inaudible 00:15:03]. But not everyone can afford it. It’s a very expensive task. When you want to do that, it’s not cheap. And the wait list in Hobart is two years. If there’s something happening with you, if you just want to… That’s publicly. Privately, you don’t need a referral. You can go and see a continence physiotherapist or women’s health physiotherapist, or you can say your obstetrician, or your gynaecologist. But what I think women first need to do is learn about their pelvic floor. They need to get educated on things that are going to impact them, how to go to the toilet properly, how to sit on the toilet, about not bearing down, about learning that…

Peta:
Everyone talks about your vagina when they talk about pelvic floor, but if you think about your vagina, it basically is designed to fit a head through. So it is very mobile. Where we should be looking at holes in your bottom and things like that. So your anus has two [inaudible 00:16:00] which we have control over one. And that will give us more ability to contract our pelvic floor. That’s not a full pelvic floor contraction, but we need to stop… I don’t know how to say this. We need to think about getting the right education at it because a lot of people will tell you that you only need to do functional pelvic floor work, which is squatting, which is not true. You need to do standalone pelvic floor work, but you need to be taught by a professional properly. We do not do pelvic floor at all in our Pilates studio because every woman’s pelvic floor is different.

Peta:
And so if I’m cuing, say, you and then cuing someone else, and you’ve got a tight public floor and someone else has a looser pelvic floor, and I’m giving you the same cue, I’m doing more damage than good. If you look at the average woman, they can only hold their pelvic floor up for one to three seconds, unless they’ve done some serious pelvic floor training. And if you’re asking them in a fitness class to hold their pelvic floor up for a full set of repetition of 10 or whatever you’re teaching, then they’re not going to be able to do it, or they’re gripping, or they’re just giving up, and they’re going to get really disheartened.

Peta:
So I think you need to find someone who can educate you on how to use your pelvic floor correctly because it’s probably the best investment you can make in your life because if you look at nursing homes, 70% of people in nursing homes are incontinent. And I’m pretty sure when they were our age, they wouldn’t have gone, “Oh, I’m going to end up in a nursing home incontinent. It was off their radar. And so with women, and especially with exercising, if you’re going into a class, you’re going to have 10 to 20 women with very different pelvic floors. And so you cannot compare yourself to the woman standing next to you because she might not have had a baby, or she may have had 10… Well, hopefully not 10 babies, but she may have had three babies and a difficult birth and had a full [inaudible 00:17:59]. And so her pelvic floor will be more damaged.

Peta:
So it’s very individualised, and you should be doing pelvic floor work outside of any exercise you do. Every woman should be.

Hannah:
[inaudible 00:18:09] by the sounds of it.

Peta:
Yeah. I think women should know about their pelvic floor from when they can understand it. My little girls know about it. Oh my goodness. My little girl, when she was in kinder, asked her kinder teacher if she was doing pelvic floor work, because we have pelvises all around house here. And I’m like, “Oh my God.” [crosstalk 00:18:32] she knew what I did, and she was like [inaudible 00:18:34]. But yeah. So I think every girl should know about this sort of information, but I think there’s a lot of bad… One of the things people say, if you can stop peeing mid stream, you’ve got a strong pelvic floor. It doesn’t mean anything. It means you can stop peeing mid stream. That’s all it means. There’s lots of things that people perpetuate, and they’re pelvic floor myths.

Hannah:
Yeah. So, where you can, go talk to a professional and seek out information that’s based on your particular pelvic floor and your needs.

Peta:
Yeah. Try and always go to someone who has education in this, who hasn’t just done a one by course in it. So someone like a continence nurse or a physiotherapist or a doctor. In the fitness profession, there’s lots of people talking about pelvic floor at the moment, but a lot of what they’re teaching is incorrect, and it can impact on you longterm. And it can… Like with the Pilates studio, you’ll hear people say, go to Pilates to fix your pelvic floor. Pilates doesn’t fix pelvic floor. Basically, you’ve got to be doing standalone pelvic floor exercises. Then when you go into Pilates, it will strengthen it, but then if you do boxing, it will strengthen it. But if you’re doing Pilates or yoga incorrectly or boxing or sit-ups, you can [inaudible 00:19:55] and you can make your pelvic floor work.

Hannah:
Yeah. Anything done incorrectly can kind of damage it. Exactly. Yeah. So, speaking about educating ourselves, if our listeners want to find out more about WHEN and your educational workshops, how do they do this?

Peta:
So we have a website. We have an Instagram page. We also have Facebook. We’re trying to actually go very digital at the moment. So we’re trying to get as many of our workshop digitally available as possible. We are a non-for-profit, so we’re not funded, and all of our medical staff and nurses and doctors and physios volunteer their time. So we are trying to get there as fast as possible, but we’re very slow moving because obviously money helps. But we do do workshops on request. So we have lots of different workshops that we do. So we do a pelvic floor workshop. One of the things that we do do is we run… If you want to come to WHEN in the evening, and you can bring your own wine, we supply wine glasses, and we do talk about pelvic floor.

Peta:
So you can book a group of your friends and then go out afterwards. We try and make it as relaxed as possible, and we just give you as much attention as we can in the hour, and then you’ve got something to think about when you’re going out dancing. So we offer things like that. We offer pregnancy education one-on-one and postnatal education, all about what is safe, what movement is safe and what you want to do with your body. So it’s very personalised. So you can tell us what’s happening with your body. And then we say, “Well, this, this and this is going to work for you, but you still have choices.” One of things we’re really aware of, there’s so much information at the moment with people telling you what to do. We want to not tell you what to do. We want to give you the information, then you can make your own choices.

Hannah:
Yeah. Yeah. Exactly. Well, thank you so much for joining us, Peta. It’s been an absolute pleasure having you on the Pod. And I’m sure it’s a topic that a lot of us… I mean I’ve already got about four other topics I want to chat to you about just from this conversation, but providing just that starts for people to start thinking about and providing a bit of education for many of our listeners. So I really appreciate your time. Thank you so much.

Peta:
Oh, you’re welcome, and I’m sorry if I talked too fast because I do talk fast.

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