88: Pregnancy Exercise, Diastasis, and Pelvic Floor Health with Lorraine Scapens 88: Pregnancy Exercise, Diastasis, and Pelvic Floor Health with Lorraine Scapens

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Katie: Hi, and welcome to the Healthy Moms Podcast. I’m Katie from wellnessmama.com, and I am here today with Lorraine Scapens, who has been in the fitness industry for over 20 years. And her focus has always been on pre and postnatal exercise. So given that a lot of you listening are moms in various phases of motherhood, I figured she would be an incredible guest to learn from. She’s been a personal trainer for more than 15 years, and she has an online company catered to women with pregnancy and postnatal exercise called pregnancyexercise.co.nz. And I’ve used some of her programs, both while pregnant and after having a baby. It’s got a ton of expert information and, like I said, lots of great exercise programs that you can use. And she’s a working mom as well. She knows just how hard it is to juggle kids and family time, and she’s a mom of three. So welcome, Lorraine, thanks for being here.

Lorraine: Thank you, Katie. That’s a lovely welcome. It’s great to be here.

Katie: I was saying right before we started recording, I love your accent. It’s always fun to talk to people with an accent. This’ll be a great interview, and I want to jump right in, because you are a wealth of knowledge. So, to start off, I feel like there is a whole lot of misinformation surrounding pregnancy and exercise, and is it safe, and what kind, and what you can and cannot do. So, to start off, is exercise safe during your entire pregnancy, and what’s the reasoning there?

Lorraine: Yeah, you know, for sure, and it is hard for moms who want to exercise or for moms who, you know, have maybe not exercised at all, and now that they find they’re pregnant, and they do actually want to do something. But there’s just so much various information out there it just leaves them to being unsure of what actually to do. And it’s definitely safe to exercise right through an entire pregnancy unless there is, of course, any medical complications with that. But there’s just so many benefits for mom and baby, you know. The benefits for mom are that it increases energy, decreases the pregnancy fatigue. It can improve posture, also baby positioning as well. And it helps moms to carry a pregnancy a lot more efficiently, reduce back and hip pain, pregnancy discomforts. You know, there’s just so many reasons for mom why it’s beneficial.

But then we also forget that there’s a lot of benefits for baby also. You know, if moms can exercise throughout the first trimester, which some moms can’t because they’re sick and fatigued. But if you can exercise during the first trimester, this can increase the size of the placenta, which means more nutrients are being fed to baby, and babies generally respond better to the demands of labor and birth, because they’re also getting used to those higher heart rates when mom’s exercising. So there’s many benefits. It’s not just for mom as well. When women are exercising, and a lot of people, I think, are looking at women who are exercising when they’re pregnant think that they may be a little bit selfish and doing it for themselves, which is really hard for moms, but it’s not. You know, exercising during pregnancy is beneficial for both mom and baby, and should definitely be encouraged. And that’s what the latest research is suggesting now, you know, we need to encourage moms to move during their pregnancy, and around 20 to 30 minutes every single day.

Katie: It makes sense with the increased blood load of pregnancy, and the increased, you know, need for circulation, and need for a movement. It makes sense that even just a few minutes of movement like that, 20 or 30 minutes could make a big difference. And I would guess there probably are some cautions as far as like movement is great, but you would wanna avoid maybe like contact sports or anything that was gonna obviously bump your stomach area, is that right?

Lorraine: Yeah, that’s right. I, mean, we’ve got to look at that danger factor, anything that’s gonna put you at risk, you know, of a fall, getting bumped. A lot of exercise is…Most exercise is okay during that first trimester. But I mean, again, we have to assess everything to the individual person, but definitely contact sports, you know, rock climbing. For me personally, and I’m not sure for yourself, you know, where you’ve exercised through pregnancy, you know why I skip road cycling, even though it’s perfectly fine to cycle through a pregnancy, I just didn’t want the added pressure or stress on myself out on the roads where friends have been being knocked over. There is a higher chance of an increase of injury. So, I took that out. So everybody’s a little bit different in how they view their sort of danger factor of their exercise, I would think. You know, I mean, be very cautious. I mean, look at skiing, you know. Again, you may still be able to ski in that first trimester. Some women want to, you know, ski, and it’s that risk factor, what you’re taking responsibility for yourself. That exercise might not be deemed at risk of anything for health complications, for baby, but the risk of falling definitely surpasses those other risks. And that’s up to, you know, females if they want to take that risk, again with horse riding. So I’d say horse riding, skiing, rock climbing. We want to stay away from scuba diving when we’re pregnant, are definitely high risk factors and sports that should really be avoided after that first trimester.

Katie: That’s a great rule of thumb. What about just exercises that are more physically demanding or more endurance, so like a marathon, or like lifting really heavy weights? If a woman’s been doing that before pregnancy, is there a concern there?

Lorraine: It’s really interesting that you bring that up at the moment because we’ve got a couple of top class athletes. We’ve got Serena Williams, who’s just recently announced she’s pregnant, you know, and she wants to certainly keep up those high physical demands of her, you know, of the tennis. We’ve got Gwen Jorgensen, who’s a world-famous triathlete, and who is also competing. Now, personally, when I’ve coached, because I’ve coached triathlon, I was a triathlon coach. And I know how long it takes for somebody who’s not pregnant to recover from a marathon. It can take four to six weeks to physically and mentally recover from a marathon. So why would you do that when you’re pregnant, you know, when you’ve got that fatigue factor anyway, and regardless, you know, definitely we’re talking after the second trimester. Why would you put yourself through that unless, of course, you are somebody of an athlete of that top caliber who’s probably running marathons once a month with training and the body’s got used to that. I just think women have to be very cautious during their pregnancy that they don’t get too competitive, and address the reasons why they might be wanting to race during their pregnancy. You know, it’s okay if you can pace yourself, and you’re not gonna increase that fatigue after a race. You know, marathon’s a long time. You know, for some women who are not good runners, it’s gonna take anything over three and a half to five hours. And that’s a long time to be doing something whilst you’re pregnant. And during that time we’re increasing fatigue, reducing nutrients, and nutrient supplies to the baby, and it takes a much longer time to recover. So, I would say for those top class athletes, those women, can do a lot more than what, you know, the general public can do, and perhaps can manage higher intensity exercises. But for many of us, you know, pregnancy is certainly not a time to compete. If you wanna go and do, you know, a 5 and 10k fun run, fine, by all means do that. But just make sure you are listening to your body, and you’re not getting carried away by the event or by the music in your iPod because then that can lead to increased fatigue.

Katie: That makes so much sense. So on the flip side, the other extreme, which is probably more common, rather than women who are trying to run marathons, is I hear a lot of women who use pregnancy as an excuse not to exercise and to take it easy. And like you just said, it is important to make sure you’re nurturing yourself and to make sure you’re resting when you’re pregnant, because there is more fatigue. But also, like you said, at the beginning, it’s important to be moving, because there’s a lot of benefits for baby. So, what exercises are the most optimal for pregnancy and that you most often recommend?

Lorraine: All moms, you know, as we’ve just mentioned, Katie, should be moving. We need to encourage movement. But moms really need to focus on, first and foremost, good core and glute exercises, because by improving pregnancy core strength and your glute strength is gonna prevent lower back and hip pain, it’s gonna help to improve posture. Again, as we’ve said, you know, if women can carry a pregnancy and feel comfortable and can move right up until the day they give birth, they’ve enjoyed that pregnancy. And that’s what these types of exercises can help achieve. And also we wanna look at functional types of exercise, so including squats and lunges and step ups. We’ve got cardio exercise, you know, from walking to running. And mainly what women have to do is because exercising can be quite hard during pregnancy, is to do an exercise that they enjoy, and just to educate themselves if that exercise is okay, you know. Follow people like myself who can help if they’ve got any questions about particular types of exercise, but if women really focus on the core and glute strength and that functional type of exercise, and perhaps do those type of exercises two to three times a week with some cardio exercise in as well, that’s gonna get them to achieve all those benefits for themselves and for baby during the pregnancy.

Katie: That makes sense. So let’s talk a little bit about another phase that women will go through. Obviously, you mentioned that exercising while pregnant can help delivery, it can help the baby and the baby’s health, but also there are benefits to post-pregnancy recovery as well, both benefits to exercising while you’re pregnant to improve your recovery, but also benefits to exercising at the right times after having a baby. So, what exercises do you recommend after a baby’s born to help with that recovery process?

Lorraine: Yeah, that’s definitely right. We know that women who have exercised during their pregnancy will definitely have a faster recovery, regardless of the type of birth that they have, and they’re more also, more inclined to want to start exercising soon after they’ve had baby. So the exercises that we want to do, for all women to do, Katie, are exercises that promote recovery and wellness. So we need to, everybody regardless of what exercise they’ve actually done during their pregnancy, and no matter how fit women think they are, we all need to learn to reconnect with the core and pelvic floor muscles first. That’s absolute paramount. And we can do that soon after baby’s born. You know, we can start to do that straight away, is these connective exercises, just learning to connect with the pelvic floor muscles to see if we can contract them, looking at the transverse abdominal muscles, which are the two muscles that are part of your important core. We have four muscles which make up the core system. We’ve got the diaphragm that sits at the top, underneath the rib cage. The pelvic floor muscles are at the bottom. Transverse abdominals wrapped around the middle and the center, and then we’ve got multifidus at the back. And they’re the four main core muscles. That’s your core muscles, and they act as a nice pressure system. So once baby’s in there and we’re pregnant, everything is stretched, and the brain loses the ability to connect with those muscles efficiently during pregnancy, again regardless of the exercise we’ve done. So once baby’s out, there’s minimal support there. So that’s why it’s important for all women to learn to reconnect. Once we’ve done that, we can start to move on to different types of core exercises, glute exercises, and then we need to bring the functional exercises and walking. And again, it’s really important that all the exercise we do in that fourth trimester is promoting optimal recovery and wellness. And I think what’s happened in the past is when we say exercise to, you know, to anybody, we tend to think as sweaty, you know, working out in the gym, you know, lunges classes, but all exercise is is movement. Movement is exercise. So your pelvic floor muscle exercises, you’re thinking about how you’re contracting your core muscles and your glutes. Post-natal is exercise. And that’s what we want to be looking at doing.

Katie: Great. Okay, so there’s also…you I believe have five fundamentals that really help with recovery as well, so obviously movement and exercise is important. What are the other four?

Lorraine: When we’re pregnant, you know, also we’re thinking about really, especially with the first pregnancy, is the pregnancy. We’re not actually thinking about recovery afterwards. And it’s actually very important that we get the recovery right, just as much as the focus is on our pregnancy, you know, we lose the focus on recovery for mom, because we now have this little newborn that we’re looking after, and it’s taking up all our demand and focus. And we tend to forget about ourselves, and yet, unfortunately, if we’re not the…you know, if we’re sick or we get run down or depressed, you know, a lot of women are suffering from postnatal depression, then we can’t look after baby 100%. So women need to make sure that they are looking at the five fundamentals for optimal recovery, which as we’ve mentioned is movement. We’ve got rest, which, you know, some of us may laugh at, what, because it can be quite hard to rest with a newborn, but we have to. We have to get that rest in. And I try to say to moms is that last feed before a baby goes to bed is generally when they sleep the most time. So if you can get to bed when baby goes to sleep at that seven or eight o’clock feed, then that could be your couple of hours of straight sleep, which is really good for you. So rest is definitely really important. Then we’ve got hydration, really ensuring that you stay hydrated. If you keep hydrated, it’s gonna help to reduce fatigue, and it’s also gonna help moms produce the breast milk. We’ve also got nutrition, again which is often overlooked because we’re just thinking more about baby. And that’s a case of having good snacks on hand, you know, your protein, your fat. You know, I find hard-boiled eggs are one of the best things. You can put them on in the morning and then just pop them in the fridge, and then women can just grab them as and when they think about it. And then lastly, similar to rest is you time. And this is for mom to, you know, not be walking out…walking is a great exercise for women. If they can get out, it can help them to relax, a little bit of vitamin D. We know that exercise can help prevent postnatal depression and certainly reduce the factors of it. But women actually need that time to themselves. And I try and say to new moms especially, 10 minutes. It doesn’t seem that much, but we might not get that throughout the day, Katie. And that’s away from baby where we’re not having to think about changing, feeding, so whether that’s, you know, your husband takes baby before the last feed, and you just go and get a 10-minute shower, put your feet up with a magazine, forget about the housework. It’s really important to take that you time. And I think if moms put these five fundamentals together after each pregnancy, it can start to help the long-term effects of postnatal depletion. We really need to get this recovery right within the first 12 months postnatal. And I really try and get that help to get that through to moms on the website and on our social media sites, because we do unfortunately forget that. And especially for those of us who are looking at having pregnancies quite quickly, if we’ve got pregnant, you know, later on in our 30s, and we wanna try and get two or three out by the time we’re 35 or 40, then pregnancy is gonna start to, and the recovery process will have a much longer term effect if we don’t get this initial recovery right.

Katie: Absolutely, and I think there’s so much wisdom to, you hear people talk about thinking of at least the three months and if not, the year after pregnancy as like the fourth trimester, and giving yourself that space and that grace to recover and to rest and not to listen to the media idea that by six weeks we should all be back to the exact same size and feel exactly like we did before we had a baby, because when you’re not sleeping, that’s just not realistic to begin with.

Lorraine: Yeah. You know, that’s totally right. And we’ve got to look at, not both the physical side, but the mental side as well. And I think what is forgotten about is after the pregnancy, after you’ve given birth, there’s quite a few things there what we need to recover from straight away. We need to recover from the pregnancy. We’re being pregnant for nine months. It’s taken nine months for the body to change. So that’s big enough. And then we’ve got the trauma of birth, regardless if we have, you know, easy birth. Birth can be quite long. So when I spoke before, when I did a lot of my athlete coach, and I know how long it takes to recover after a marathon. It takes four to six weeks. So if you’ve been in labor for 24 hours, then that in itself is gonna take time to recover. But on top of that, we have a new baby to look after, which can be quite demanding. We’ve got breast feeding. And then we’ve also got sleep deprivation. But then what can really affect moms is the pressure on new moms and that mental side of, you know, whether they were disappointed with the birth, things aren’t going right. You know, it’s not what we expected, looking after a newborn. So all those challenges are what we tend to forget about. And then we’ve got the media saying, as you said, “You need to be back where you are in six weeks’ time or these body shapes,” and we just can’t do it. You know, even though women may look at social media and look at these women and think they’ve recovered, they actually don’t know if they’ve recovered internally, you know, if their pelvic floor muscle’s okay, if their diets are strict, which I know we’re gonna get into and talk to, and mentally if they’ve actually recovered as well. So that’s something, again what we do need to look at, and just help women through their pregnancy and to maybe educate them a little bit more throughout their pregnancies on what’s to be expected in those 12 months postnatal. And then, you know, we could get pregnant soon after baby as well. So, there’s lots of things, what women have to sort of cope with.

Katie: Absolutely. I think even just having the conversation and letting women know that all of that is normal, like you’re doing, is super helpful. But you mentioned a term that I really do wanna deep dive into, and that’s the diastasis recti, which I get a lot of questions about. I’ve written about it a couple times, but I know that you have a lot of experience with helping people through it. So, first of all, define what that is, and how common do you think this is?

Lorraine: Yes, diastasis recti, a very, very popular subject at the moment. Lots of people are talking about it. And now because we are becoming more aware of it, there is starting to get more research done on diastasis recti. So what this is, is when the abdominal muscles start to separate during pregnancy. And it’s normal. This is what should happen during a pregnancy to accommodate a baby and a growing uterus. So what’s actually happening for everybody to try and understand it, it’s not the abdominals that are separated. So if we think about our middle like a bar of chocolate, okay? So we’ve got those six pack muscles on each side. Now, down the middle is the linea alba. And that’s …it’s a connective tissue, and if we can try and think about it as a thick piece of nice, tense sponge running down the middle. Now what happens is, during pregnancy, it’s that that starts to separate, and it starts to thin out. And that gives the impression that the abdominals are starting to separate. And an analogy I like to use is for moms to sort of really think about that connective tissue and what leads to diastasis is if you think about your workout pants, you know, when you get a nice pair of new workout pants, they’re nice and tight, and they’re nice and taut, and they give you a little bit of support. You know, they’ll lift up your butt a little bit, which is fantastic. But then I think we’ve both seen that person in the gym or out on the street when you think, “Oh, they really need to change their exercise pants,” because you can see through at the back when they bend over. And that see-through tight is very similar to what’s happened to the connective tissue at the end of pregnancy, you know, the connective tissue has got quite thin. For some people, it’s very, very thin. And again, we’ll talk about that. So that’s a great analogy for women how to think about it. So it’s not offering any support anymore, it’s quite saggy. Perfect for our exercise, where, you know, we can go and change it and get the support back. But it’s not that easy for a diastasis. But the thing is, for moms is that diastasis recti is nothing to fear. We don’t want to be scared of it. The more we can educate ourselves and know what to do during our pregnancy to help prevent a large diastasis occurring, and then to start to try and heal it. Postnatal is the education we need so we don’t fear the diastasis from happening, because it’s not. We know that there is research done in Australia that pretty much 100% of females at the end of the pregnancy will have some degree of abdominal muscle separation. Postnatal, we need to start to assess. And again, the latest research suggests if there is still diastasis at eight weeks, then we need corrective exercise, good posture management, good nutrition, to help bring those muscles back together, because it should also naturally heal. And then there’s different factors as well during pregnancy that can sort of increase the chances of a larger separation occurring. And it’s a larger separation what we do want to try and prevent, because that can be more problematic long term, and harder to heal.

Katie: Is it something that only affects pregnant women, or can it affect others as well?

Lorraine: No, it can affect other people as well. We look at different types of exercise, people who have been overweight. If you have a look at pictures of bodybuilders, they may have some degree of abdominal separation from over doing certain types of abdominal exercises, whether that’s crunches, and this is, we’re talking hundreds and hundreds of them over time, can actually cause that abdominal separation. So it doesn’t just happen to pregnant women, but that’s where the focus is at the moment, and that’s where, you know, that’s where it my focus definitely is. But it’s not just pregnant women. It can happen to other people as well.

Katie: Okay. So what are some of the symptoms, and how would someone know if they have it or not?

Lorraine: During the pregnancy, for women who are not aware of that, I think one of their first things, what women say, is when they sit up, they’ll see sort of a poking out of, which looks quite alien, like an alien type bump of their abdominal muscles, which can start to make them notice if there are changes happening there in the linea alba. Through pregnancy, it’s actually quite hard to say when and how a diastasis is happening, because there might not be any symptoms to it. We can get all the way through a pregnancy without back pain, pelvic floor muscles, and then after birth, we find out, we have this separation because we’ve not really been made to be aware of it during pregnancy. What I like to suggest to our members is just to continually check yourselves throughout your pregnancy. We can’t assess perfectly through pregnancy because the babies, they’re in the way, baby bump’s growing, so we can’t assess the true depth of the situation. But we can certainly manage it, and I think the protruding belly button, the shape of the abdominals, we can start to see a gap. If you’ve got a t-shirt on, you can look. You can actually start to visually see during pregnancy that abdominal muscle starting to separate. And if women who are pregnant, who are listening, one of the first things what I get them to do is just to sit up and just to start to feel across their bump, and start to feel if any of that tissue is becoming thinner. And you can feel those changes in the linea alba during pregnancy. And I like to test women on their side during pregnancy, especially after 20 weeks, to check for that diastasis. And then we can put in place and start to manage it, because if, again, we’re trying to prevent, and I believe we can prevent, a widening diastasis, based on the experience I’ve had with all my members and the years’ experience is that we can reduce it during pregnancy with good posture management, the right exercise, and the right nutrition as well.

Katie: What about for someone who definitely…who’s already had a baby and already has it? What are the ways to fix it?

Lorraine: Well, what we need to do is it’s exercise, good exercise, posture, and nutrition. And first and foremost, definitely assessing that diastasis correctly postnatal. And what I like to do is if women, they can follow the video guides on our website, I know you’ve got them up on your site, is about two to three weeks after birth, which is the best time to assess. If we test too early, the uterus can still be in the way. We can still be a little bit sore, fluid, so we’re not gonna get that accurate test, what we need. And women need to test the whole way down from the linea alba, and then we need to look, again, three to four measurements. We need to know what the vertical measurement is of the diastasis, the width. But then the next two important ones are the depth that the separation is, and how the connective tissue feels underneath the fingers. So the thinner the connective tissue is and the deeper the separation, women know that it’s gonna take longer to heal. So that’s a really good feedback. If they’re testing and it’s say perhaps a good four finger width diastasis, and the fingers are sinking into the first and second knuckles, which can happen, you know, and can be…you know, a lot of women can be affected by quite a deep diastasis, then the nutrition and the right type of exercise is very, very important for that person. So I’ll just explain, Katie, if it’s okay about that connective tissue. When you can test for a steak, so when you’re cooking, to see if a steak’s at whatever level you want it, whether that’s rare, medium, or well done, if you use your finger…in between your finger and thumb, you’ve got that piece of skin there, and if you just hold the first bit, that’s when you know your steak is rare. And that’s what the connective tissue may feel like within that fourth trimester after giving birth. So it might feel quite thin. And what we actually want, if we move across the hand, where we know the steak will be well done, that’s the tension that we want that linea alba to eventually be, that tension right along through the diastasis and right through the middle. So that tension comes back, so we’ve got perfect function of the abdominal wall and the core system again.

Katie: That’s a great visual to understand it.

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Katie: So you have exercise programs that I’ll make sure to link to, because those are the ones I use after having a baby to help bring all those muscles back to where they’re supposed to be. But are there people who aren’t able to reverse this just through exercise? In other words, are there really serious cases that require something more like surgery?

Lorraine: Yes, there are. And at the moment, only 5% in the recent studies actually need surgery, which is fantastic for women to hear that. You know, that’s really good, because what a lot of women find is that they go to the doctor or go online, and they hear that the only way that this can be healed…Or, some people are actually told it can’t be healed. It can be healed, and it is only 5% that needs surgery. And to assess that, if you think you may need surgery, what you actually have to do is work on trying to close it for 12 months, and to see if you can get that tension back, because what happens is is for the women who do need surgery, they just can’t generate any tension back of that linea alba. It’s just too thin, the brain can’t connect with anything. So those women do need surgery, but it’s only 5% of moms, so that’s really good to hear.

Katie: That is really encouraging. And I get the question quite often on my blog posts about it. What about someone who definitely has a serious one, but also wants to have more children? Is it worth doing the surgery if you’re going to have another pregnancy, or would it be better to wait till you’re done having children before you have the surgery if you did need it?

Lorraine: That’s an interesting question. That’s a good question. You would have to ask your surgeon on that, because quite a large diastasis can be very problematic during the pregnancy. You know, we look at the positioning of baby, and a large diastasis will encourage and can encourage very, very poor positioning, which can result in C-sections, increased medical intervention, problems for baby coming out, maybe distress for baby. So we have to weigh everything up. What would be better and what is often suggested is I’ve had women work with me to manage that large diastasis through a next pregnancy and then go ahead and have surgery, because if you’re having surgery and then go through a pregnancy, it’s just gonna stress that surgery. You know, it can increase the scar tissue again. So for moms really if they are in that position, it’s probably better to go, what I believe, through the pregnancy, under assessment, and manage it throughout, go through birth, and then have it fixed.

Katie: That’s really helpful, I’m sure to women who have that question. So another common problem after pregnancy, and a question I get a lot is to do with pelvic floor health and also pelvic floor prolapse. So you have experience with this as well. So what is that, and how does it happen?

Lorraine: Again, this is an issue which is very rarely discussed during pregnancy and postnatal. So women tend to not hear about it until they’ve gone to the doctors themselves and are suffering with it. So pelvic organ prolapse, or POP, people will see it wrote as POP, occurs when one or more of the pelvic organs have started to descend downwards or actually outwards through your vagina. So it can be the bladder, the uterus, the vagina, or the rectum. And this occurs when the pelvic floor muscles have become weak or damaged, and they’re no longer functioning as they should be. And we’ve got certain degrees of prolapse. So we can have a mild prolapse, which is numbers zero to two. And if women have a mild prolapse, they can still follow our birth to fit mom program, which is the post natal program, and manage it, and improve. But for women who have got stage three to four prolapse, and that is where you can probably visually see something coming out down is where we definitely need to be working alongside a women’s health physiotherapist first and foremost, and then work with the physiotherapist, and then start to come down and work with our programs so they can improve it. What the symptoms of…it’s very, very hard for prolapse. Women need to be aware of prolapse within the first 6 to 12 months after giving birth, because it can be asymptomatic. We don’t know that we could be prone to it after birth. And what can happen at, and especially with subsequent pregnancies, is if we think about we go back to that core system, what I sort of painted a picture of before, that nice cylinder, that strength, is our core. We’ve got that perfect core system. And when it’s functioning well, it holds up those internal organs. It holds everything in a nice place. So once it’s weakened, and baby’s out there, we can think a bit about a little bit saggy. So maybe it’s not supporting those internal organs up anymore, which is really important for moms, again, as we mentioned, to get back into that core strength exercise soon after birth, to help get that strength back. So what can happen is, is women go about their general duties, you know, four to six months, and the core system’s getting weaker and weaker without them realizing it. The pelvic organs can be starting to drop down, but they’re still feeling fine. And then six months later, they feel, “Right, I think we should be going back to the gym. I feel fine.” They go back to the gym, start to skip, pick up a weight, and there we go. All of a sudden we feel very heavy down within our vagina, and something can actually feel like it’s gonna fall out. So women are at risk of prolapsing after postnatal. And it’s something, again, that we need to be aware of which is not often addressed and told about during our pregnancies, which is very frustrating for women.

Katie: Is this something that like a doctor or midwife would be screening for postnatally, or how would a woman know if she had some, especially a more severe version of this?

Lorraine: This is what’s quite hard, because we don’t go through any screening postnatal. And it’s something what I’ve talked about, and we talk about to other experts and physiotherapists online is, if women have had quite a traumatic birth, a lot of medical implications, if they’re over the ages of 34, they’ve given birth to quite a large baby, then these women should probably have ultrasounds within those first six weeks, because that’s the only way we can really have a look at the internal organs and to check the risk factors by that. And this is not done by obstetricians at the moment and your general doctors. It needs to be done by specialist women’s health physiotherapists, who can do that ultrasound and to assess. And at the moment, it’s up to women educating themselves throughout their pregnancies and postnatal to try and find out that information, unfortunately. But what I suggest to our members, again if you do find yourself in that position, post birth, and you know it’s been quite stressful, maybe you’ve been pushing for a long time, if you’ve pushed over and upwards of two hours, again that’s another risk factor. Then, four to six weeks later, you should be getting yourself off to a recommended women’s health physiotherapist for an internal to check.

Katie: That’s great advice, and I think, hopefully there will be more awareness about these kind of issues that can crop up and especially ways like what you’re educating women of how to help reduce your chances of those. I love to ask toward the end of an interview, what are a few things about your area of expertise that people have misunderstandings about, maybe they don’t understand, or that just are not common knowledge, and how do you answer those?

Lorraine: I think women, we tend to put up with a lot of things, Katie. And one of those things is that women believe that back and pelvic pain during pregnancy are normal, and leaking post birth is also normal as well. And it’s actually, you know, you don’t have to suffer any back or hip pain during your pregnancy. With the right exercise, again with the right posture, good management, back pain can be reduced, and completely minimalized during the pregnancy. And we can post birth, and I don’t know whether this is just, you know, something from many years, women just think, again, “It’s normal,” and that we should just be able to put up with it, and suffer with it, and get on with our lives, and we don’t need to. Eighty percent and upwards of any leaking, which is sudden urine incontinence, SUI, and it’s that coughing, you know, when we cough or sneeze or laugh, that we, you know, pee our pants a little bit, and again when we exercise, and we don’t need to. Again, with the right management, with exercise, we can reduce this. And what I want for moms is, and what I say to moms is, is that I want all women to be able to run round, keep up with the kids, pain-free, feel strong, healthy, and confident, and not worry that if you’re gonna skip with your kids or go on the trampoline that you’re gonna leak, or your insides are gonna fall out. That doesn’t have to be the case. We don’t need to worry about that. You know, we should be able to go and laugh with our friends without putting any pads on because we’re leaking. You know, 80 to 90% of leaking issues, postnatal, can be addressed through good posture and exercise management. So that’s definitely one thing that women aren’t aware of.

And I think the second one, which we’ve sort of touched on, is this when to exercise post natal. And there’s a lot of confusion around it, because we’ve got, on one hand, a lot of women around the world wait for the six-week checkup by the doctor before they’ve done anything, and then the doctor says to them, without testing, without assessing, perhaps the diastasis recti, without perhaps assessing pelvic floor muscle function, and the posture, and say, “Yeah, you’re good enough to go.” And women see that as the green light to go back into their exercise program and what they were doing pre pregnancy. Whereas what women should be doing is, soon after birth, they should be starting to start with those exercises that promote optimal recovery and wellness, because what we forget is how demanding looking after babies are. You know, you might have had someone or hear someone say, “Don’t lift any weights up,” you know, in those first couple of weeks after having baby. Well, your baby might be 4 or 5 kgs. Your pram, your pusher, is 10 kgs. Your washing basket is 10 kgs. And someone saying, you know, “Don’t lift any weights, don’t do any exercise,” well, women need to really make sure that we can pick up those washing baskets, we can pick up the pods and the carriers, put them in the car, without doing ourselves any more damage. So we actually need to make sure that we’re activating our abdominal muscles and core muscles correctly soon in that, you know, initial period, postnatal because it is so demanding. So, that is definitely one of the most confusing subjects, I think, which I address very, very frequently throughout the website, and through our social media sites.

And the last one, again, is what we’ve touched on, Katie, is the diastasis recti, the abdominal separation. There’s just so much confusion around this. And unfortunately, there’s a lot of people suggesting perhaps the wrong and incorrect things, because they know it’s probably a good area to start to draw women into to help sell programs very, very quickly, because women are perhaps vulnerable over this diastasis, because of how it’s making them fear. And again, as I said before, you know, for your listeners, don’t fear diastasis recti. You know, educate yourselves, good exercise, nutrition, and movement, and that’s really, you know, that’s it. We don’t need to make it too hard, and just make sure you know everything you can about this subject from a reputable trainer and somebody who’s very well educated.

Katie: Yeah, and on that note, will you talk about your programs, because you actually have systems for each of these phases. So talk about the systems you have and what they entail for women.

Lorraine: Yeah. So, the website now, pregnancyexercise.co.nz, I started the website six years ago, because as a personal trainer, I had all this knowledge, and I just wanted to get it out there, because I could see what was missing. And I wanted to reach out to many more women across the world, and to make my programs and the experience available to everybody. So we have the pregnancy program that women can join at any stage during their pregnancy, which is “Fit2BirthMum.” And this is a great versatile program. There’s exercises that moms can do at home, with or without weights, take to the gym. And the focus on the “Fit2BirthMum” program is to improve pregnancy, fitness, and strength, to reduce back pain, to prevent a widening diastasis, to get moms fit for birth, and then to recover postnatal, and to enjoy their exercise. You know, everything is in that program to help them achieve that fit and healthy program. And it’s also suitable for busy mums as well. You know, if you’ve got two or three kids, we’ve got different time plans. And that’s also then if you look at our postnatal program, which is the most popular program, which is the “Birth2FitMum” program. Now that can be started soon after baby’s born, you know, 7 to 10 days after a normal vaginal delivery. And it can also be started two to three weeks post a C-section. And the programs are all recommended by, endorsed by physiotherapists and obstetricians. And that 12-week program will help moms optimally recover, both physically and mentally, postnatal. And they can do it at their own time. Even though it’s a 12-week program, most women can take, you know, anywhere from four to six months, because once they join our programs, women get to keep the programs forever. And they also have me there as well as support and backup and to ask any questions if they’re not sure of. And the programs, like I mentioned before, are very, very flexible. And it helps women to feel better about themselves, get in shape, a speed what they want to, feel confident with their body, help heal their diastasis, help improve that pelvic floor muscle function. And then we do also offer an advanced program after that, an advanced postnatal, which is really focusing on healthy mums to get back into the gym, get back into that advanced type of exercise. And then we also run a couple of challenges as well for moms. The one that is very popular is the “No More Mummy Tummy Challenge,” which, it sounds a bit, “Ahh! No More Mummy Tummy Challenge.” But what it is, I set it up after watching online these 30-day ab challenges, which promote often the wrong type of exercises for women. So this is why I created this two-week challenge was to give mums the tools and to educate them on to basically change their lives to help them to reconnect actually with the true core muscles. And there’s no crunches in that program. So it gives women so many alternative exercises, as opposed to crunches, and certain other exercises which can put a lot of pressure on the pelvic floor, can stress a diastasis and prevent it from healing properly as well. So all the exercises throughout the programs bear that in mind, you know, whether it’s preventing or healing the diastasis recti, improving pelvic floor muscle function, improving posture, and just helping women to feel that they can achieve the exercise and the level that they want to, you know, during and beyond pregnancy, because as you know, it’s such a special time. And women want to feel safe and confident in whatever they’re doing. And we need to encourage this increase in energy and internal strength, because I believe that’s what can help us as mothers and be better parents for our kids. I think it all comes down to this health and wellness and inner strength, what we have, Katie.

Katie: I agree, and I’ll echo what you said, that I feel like all your programs are very doable and don’t take a lot of time or any crazy equipment. So they’re really doable for moms at any stage. I’ll make sure to link to them in the show notes as well. But, Lorraine, thank you so much for your time. I know with our time difference, you had to get up early on a weekend to be here, and I appreciate it so much.

Lorraine: Thank you, Katie, it’s being great. I really hope all your listeners enjoyed the interview. It’s been wonderful.

Katie: It has. And like I said, the links will be in the show notes for anyone listening, so you can find Lorraine and all of her programs. And thanks to all of you for listening. I’ll see you next time on the “Healthy Moms Podcast.”
If you’re enjoying these interviews, would you please take two minutes to leave a rating or review on iTunes for me? Doing this helps more people to find the podcast, which means even more moms and families could benefit from the information. I really appreciate your time, and thanks as always for listening.

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