Podcast: Play in new window | Download
Reaching your postpartum fitness goals can be intricately linked to your new identity as a mother, your personal health, and even your mental health. But how to get there without causing injury or finding the time within your busy and constantly changing schedule as a person caring for new life, is the challenging part.
Fortunately for all of us mom’s out there, we have people like Dr. Carrie Pagliano. With over 2 decades of experience in orthopedic and pelvic health physical therapy, she can guide, support, and teach you everything you need to know in order to reach your goals in a sustainable and realistic way.
Postpartum fitness looks different for each and every mom, because the circumstances of your birth, labor, genetics, and previous injuries will all influence your postpartum fitness program.
Want to find a postpartum fitness path that fits your life, your body, and your new and evolving identity as a mother? Watch the video or listen to the podcast today!
Dr. Carrie J. Pagliano has been a dynamic leader in the areas of women’s/pelvic health for nearly 25 years. Dr. Pagliano received her Masters in Physical Therapy from the University of the Sciences in Philadelphia in 1999 and Doctor of Physical Therapy from University of St. Augustine for Health Sciences in 2007. Dr. Pagliano is a double Board Certified Clinical Specialist in Orthopaedics and Women’s Health.
Dr. Pagliano served for 7 years on the Executive Board of the Academy of Pelvic Health Physical Therapy, a component of the American Physical Therapy Association (APTA), completing her term as President in 2020 and as Past President in 2021.
She is an adjunct professor at Marymount University in Arlington, VA. She also served as Instructor of Clinical Rehabilitation Medicine at Georgetown University School of Medicine. She is an appointed Advisory Board member to the Pelvic Floor Disorders Network: National Institutes of Health, Eunice Kennedy Shriver National, Institute of Child Health and Human Development.
Dr. Pagliano is a Certified Running Coach through the Road Runners Club of America as well as a Level 1(O) CrossFit Certified Coach.
Dr. Pagliano speaks internationally in the areas of postpartum return to sport and integrative models of practice in pelvic physical therapy. She is a national media spokesperson for the APTA. Dr. Pagliano is the founder of Carrie Pagliano Physical Therapy, LLC in Arlington, Virginia & The Real Moms’ Guide to Postpartum Digital course series for moms & postpartum professionals as well as the host of Active Mom Postpartum Podcast. When she’s not kid wrangling or bringing pelvic health to the world, Carrie is an avid runner, yogi & crossfitter.
0:00 Dr. Ginger Garner: Hi, everyone, and welcome back. I am here with a very special guest today, Dr. Carrie Pagliano, and I can’t wait to talk about our topic today. I want to fist pump, but I’ll probably knock something over, so I’m just going to just nod. Welcome, Carrie.
Dr. Carrie Pagliano: Thanks for having me on.
0:25 Dr. Ginger Garner: Yeah, I’m so glad you’re here. I want to brag on you just a little bit before we get started. Dr. Carrie is quite the leader in clinical care and education in both ortho and pelvic health for nearly two decades. She got her master’s in physical therapy from the University of Sciences in Philadelphia in ‘99. One year, one year right after me. We were back to back. And her doctor of physical therapy from the University of St. Augustine for health sciences in 2007. She is double board certified because overachiever.
1:03 Carrie Pagliano: And 4 kids.
1:04 Dr. Ginger Garner: Oh gosh, that is so loaded. We’re going to talk about that.
1:08 Dr. Carrie Pagliano: I know that’s why I said it.
1:10 Dr. Ginger Garner: And in women’s health too, and also holds manual therapy certification, as well. She is the owner of Carrie Pagliano PT, LLC. She has been a leader for over 10 years, founder for Pelvic Physical Therapy Clinical Program Residency at MedStar Georgetown University in DC, and she’s quite active in APTA, that is the American Physical Therapy Association, and is a past president of the American Academy of Pelvic Health. Welcome.
1:44 Dr. Carrie Pagliano: Thank you. I’m tired just listening to that.
1:50 Dr. Ginger Garner: Yeah, that, that is, that is the perpetual state of being a female and particularly being a mom. But you’ve accomplished so much that it’s worth a pause. I think that this is a good place to jump off because as women, and as women who are entrepreneurs, we often will beat ourselves up over woulda, shoulda, coulda. I could be doing this. I should be doing that. But if you just take that moment and listen to your bio get read, you’re like, I’ve done stuff.
2:26 Dr. Carrie Pagliano: I’m glad I did a lot before I had kids.
2:32 Dr. Ginger Garner: Yeah, yeah, that and that is very true. And I think that is a great segue into what we’re talking about today, which is how moms get back to activity, movement, taking care of themselves, plugging into their self-care, which is a word that’s thrown around so much. And oftentimes it’s like mindfulness, right? A few years ago, the word got tossed around so much that you begin to wonder if it means anything at all, or if it’s just this word that’s reserved for people who can afford it. [Right.]
So our topic today is moms: What do you do to get back to yourself and your new identity in the postpartum?
There are a lot of challenges that have been identified. Some casually, some in the literature, like formally, these are the obstacles for moms getting back to postpartum health, to being active again. So what do you have to say about that? What are those barriers?
3:36 Dr. Carrie Pagliano: That’s such a huge question. Because if you’re a mom, you understand that going into thinking about being a parent, being pregnant, you have this idea, this expectation, and then you walk through this magic portal that you cannot understand what it’s like until you get to the other side of the portal. You can hear the exact same words, but they’re very, very different.
I mean, there’s so much, I joke that, you know, the second that you conceive is when you start to lose control. And for so many of us who are older moms, in the DC area where I live, my average pregnant postpartum client is in their late thirties. I had my first at 34 and my second at 36. And I feel like I was young for around here.
We like to control things and you think that you can control all that and you have this plan set on how things are supposed to go. And most of the time, it’s going to be different from what you had planned. And it’s probably one of the first times that you don’t have active control over what that looks like, unless you have unlimited resources.
And some of it can be with you, some of it can be with your kids, some of it can be with family, spouse, like, it’s so many things that kind of come to a head. Plus, oh, by the way, you’re trying to find who you once were while you’re becoming this other person/role. And you have fluids coming out of every orifice of your body, you’re sleep deprived, not sure what to eat, constipated, like, oh, by the way, all of that.
So, I think you can logically understand it if you haven’t gone through it. Like, Oh, this will be hard. But if you have gone through that, you understand that in a visceral way that will probably make your nipples kind of retracted a little bit. So when I’m talking to women who are thinking of getting pregnant or they’re already pregnant, we start that conversation early and I talk about the portal. I was like, look, you’re going to hear things from me right now. And you’d be like, yep. And some of it, you’re going to be like, she’s full of shit. My situation isn’t going to be like that. I’ll do better. I said the same thing. And then other things you’ll hear in the same way on the other side.
And so I think the first thing is just whatever timeline you have figured out, assume it’s going to be different. Whatever map you have figured out, make it loose because it’s going to be different. And some of those things you can control and some of them you can’t. And the sooner you learn to be flexible and open to change, and a dear friend of mine, Cecily DeStefano, once said that, you know, you have these balls and some of them are glass and some of them are rubber. and don’t drop the glass ones.
And I said that to somebody recently, oh, maybe it was you. And you were like, it was you. If you’re like, well, I’m planning on dropping some rubber ones. And I’m like, go you. Wait, that was you. And so I think the sooner you kind of get your head around to that idea, the easier it can be. But the first setup that we do it ourselves is we set up these expectations about a situation that we have no sense of what that possibly will be for our end of one.
7:32 Dr. Ginger Garner: Yeah, yeah. And I think that one of the things is like we have these personal expectations. And then we’re shouldering societal expectations. I was very similar in that I had my first at 32 and my last at 37. So and then one in between that is a wild thing and it took a while to figure out whether I was going to have a third or not. But the thing is you’re shouldering everything that you mentioned. And then I think it’s worth teasing out that societal and cultural pressure and expectation that I recently read and I hope that I get this right.
This was and I believe, the holistic psychologist was on Instagram. She does some great things. And she was talking about really hinting at trauma was what I was talking about. But she said, you know, it wasn’t specific to postpartum, it was specific to mental health and women though. And talking about labeling women with these mental health conditions when really we should actually be labeling the societal problem that’s fueling it. And instead, we end up labeling ourselves. Oh, I just need to do A, B, C, and D, and it will be fixed.
But if we pull back and go, well, what if society stopped pressuring moms to think that they can just bounce back? What if society actually supported moms instead of, and this is another thing that we should talk about, the single six-week postpartum visit, and then saying, okay, you’re ready to run, right? Like I saw one of your Instagram posts, which is it’s funny, not funny, right? That’s got to be a hashtag funny, not funny.
Where it was the giraffe trying to walk? When your OB clears you, you know, to return to whatever your activity is and you can really, you’re just stumbling in and out of the office. So I think that it’s worth a pause to say to moms, hey, look, by the way, you’re laboring, literally, you’re laboring under expectations that no one could thrive under because we don’t have the support system yet. And one of those is the single six week visit thing.
09:46 Dr. Carrie Pagliano: Yeah. And I mean, the other thing too, is, you know, you talk about societal expectations, We want to wrap our arms around some of them. We want to wrap our arms around, I’m a strong pregnant mom, not realizing that strong in pregnancy isn’t remotely close to strong in postpartum because you’re in literally a different body.
And it’s, I think that, again, I think that’s where we set ourselves up is, you know, even if we are active in pregnancy, that doesn’t equate to you pick up and where you left off in pre-pregnancy, like there’s so much to be done. And really where you almost have to put yourself back in that place of, you know, post-surgical or post-injury or something along those lines. But you know, another societal expectation, “Oh, by the way, now you’re supposed to, you know, be a Lady Di and, and, you know, walk out the door and be in a cute dress and pre-pregnancy jeans. And we are rewarded for having our baby at the gym and showing how we’re working out. We’re showing them, you know, we’re a great example and we’re doing all this stuff. Meanwhile, we’re sleep deprived and constipated and our nipples are hamburger and all that other stuff. So it’s this weird juxtaposition of we wanna be these things But I think we’re also being sold like you and I are the generation of that you can have it all and that you should. And then the Instagram generation came up and said, this is what perfect looks like. And, you know, Sheryl Sandberg, lean in. OK, the hustle is sexy. Like, no, this shit is ugly.
11:29 Dr. Ginger Garner: It is. It’s a freaking recipe for burnout.
11:33 Dr. Carrie Pagliano: It’s hard. And it’s and again, that’s why I go back to these time expectations and things like that is like, let’s be realistic about what one or two weeks looks like when you, it’s your first kid, let’s be realistic about what it looks like if you have unexpected birth trauma or your kids in the NICU, or, you know, that can look a lot of different ways. And okay, it can look like going out for a walk and doing these things, but it also, I very much remember two weeks postpartum, if I could get out the door by myself, there was crying involved. There was like maybe two blocks down the street, you know. And I bring attention to that because, I felt like an utter freaking failure when damn girl, if you got out of the house and good for you.
12:26 Dr. Ginger Garner: Yeah. Yeah. I’m remembering back to when I had my second and, you know how friends will have a meal train and they’ll bring some food over or whatnot. A well-meaning set of friends, unbeknownst to them, brought over food that gave us food poisoning. Uh-huh. Food poisoning is bad when you haven’t pushed something out of a small opening.
12:52 Dr. Carrie Pagliano: You’re freaking me out because you literally just reminded me I need to make food for the mom across the street. She just had her baby a month ago. So I was like, no food poisoning.
13:00 Dr. Ginger Garner: That’s right. It was awful. There were multiple adults passed out in hallways. [Oh my God!] Yeah, because the adults that were trying to caregive me, like, literally got so sick, they blacked out in the hallway. So, you know, your postpartum can look really different. And I wasn’t laughing because, you know, of course, I got it too, which was awful, awful. It was the double awful. You don’t want anything coming out of there. And then you got food poisoning on top of it. So I’m really deeply empathizing with moms and what you said about just being able to get out the door.
I was just trying to like, you know, get out of the bed, you know, in the first two weeks, having to have a neighbor who I just met, like show up. She’s not a rando anymore, but she was completely a random person. I had no one, I had no one in town, no one to lean on. She came in and was bringing William, my second, to my bedside just so I could nurse him and she’d take him away again because I was too sick to get out of bed. It was fun times. All you moms out there, it can look all different ways, but you can plan tight, but definitely run loose.
14:20 Dr. Carrie Pagliano: Yeah, definitely. Definitely.
14:22 Dr. Ginger Garner: So that’s another point I wanted to make in talking to you about, you know, what you do with helping moms get back to activity postpartum. And that is to, it’s like a mantra, like stop asking if you’re doing it right. You know, there’s no right or perfect way. And I know you talk about that a lot, so.
14:43 Dr. Carrie Pagliano: Yeah. I mean, it’s, and this is the other point I want to make. You know, there’s, there’s times that I feel like, you know, both of us, our kids are older and people are like, oh, this is just something that you learn. It’s just for when you have newborns or toddlers or things like that. No, no, this is a skill set. If you learn this now, you’re going to use it later. Trust me. I mean, there’s no right. And there’s no promise or promissory note that you sign that says, if you do X, Y, and Z, you’re promised this thing or this perfection.
And I don’t know who keeps perpetuating this idea. And that’s where again, like we have these conversations in pregnancy about, you know, the research says that if you are active in pregnancy, you’ll have an easier delivery and your baby will be healthier. What if you can’t? What if you have placenta previa? What if you have issues that medically leave you unable to do this? Does this automatically mean that you and your baby are screwed?
No. And I think that’s one of the first things to start to think is, yes, we all would like the most boring pregnancy delivery and postpartum ever, like, definitely. But there may be things that come up that you have to do the best you can with what you have. And you have to also be aware that you’re going to make the best decisions that you have at the time with the information that you are given.
Like, if I had to do pregnancy postpartum over again, I would totally do it incredibly differently. I don’t ever want to, I’m good. We’re 10 and 13 years out, totally done. Like I don’t need to be right that much, but still like I think about that and I’m like, no, there’s still so many things that I can’t control.
And so when I talk to women in pregnancy, that’s one of the things that I bring up is like, here’s our best case scenario. I am here for you. If, you know, red flags, yellow flags come up, we’ll talk about it. We’ll process it. We’ll work through it. the closer we get towards the end, we’ll start planning delivery. We’ll also start planning for postpartum because your brain is shot the second you walk out of the hospital or have the baby, because you’ve got so much stuff going on.
I like to do pre-planning to say, “Hey, in those first couple of weeks, you’re going to get your head above water and then you’re going to come in.”
And this is where, you know, unfortunately I’m seeing this falling off. In 2018 ACOG put out their fourth trimester guidelines about earlier access to care. And I think COVID screwed it up because I think we just have a mass exodus from healthcare right now and there’s not enough physicians to float around. And I’m not getting moms that are getting that two to four week check-in, virtual or in person.
So that’s where I really double down and I’m like, look, there’s so much that we can help you with at that point. Resources, get you a lactation consultant, get somebody to help you with feeding, sleeping, all of that stuff. We can talk about nursing positions. There’s so much stuff that we can do there, but we can also troubleshoot. Hey, you’ve got some tearing, let’s keep an eye on that scar, especially if nobody else is.
If it’s C-section, let’s make sure all the right things are covered. You know, how to get out of bed. You’re not counting pills. I definitely counted pills my first time, the little things like that. And then here’s some basic exercises that just will help you find yourself in your body again, find coordination. And that’s where I think there’s such a huge benefit to early rehab, that we appreciate in orthopedic post-surgical care, that I don’t know how this all gets missed in postpartum. But my patients are so much better off at that six week mark. If they’ve been doing a little bit of moving and this is beyond just walking. Like walking is in there, house care, baby care is in there, but like a couple minutes to find breath and to find coordination and to reconnect with your abs. That has changed zip codes a couple of times here.
And then they have their six week [appointment] and I let them understand this is what you should expect out of your six week [appointment]. Birth control, make sure things aren’t outside of your body that should be in your body, and make sure that you’re not going to kill yourself. That’s basically their job and fawn over your baby in about seven minutes. Anything beyond that, you should not necessarily be expecting.
If you need, you know, somebody to check out your exercise program and clear you to go back, they don’t have the time/skill set for that. They’re basically checking that nothing’s flying out of your body. You’re not dead. You can go. That’s basically what they’re saying, but [at this time you are only] at 75% soft tissue healing. So we’re not even like full soft tissue healing and like, yep, [we’re often told that we’re] totally good to go with no understanding of what that might look like.
And so, and we’ll do a check again at that six week mark and it’s interesting we just got Return to Run Guidelines in 2019 from the UK from Emma Brockwell, Tom Goom and Gráinne Donnelly. And I’ve been using them for return to anything at this point, because it’s one of the few things that we have that organizes understanding balance, what’s your balance look like? Because Lord knows that changes with your center of mass. Understanding hip strength, core strengths, impact. Understanding impact, because I don’t care if you’re not a runner, but you’re going to have to run across a playground after some toddler at some point. You do not want to feel things coming out of your body, trust me.
So why don’t we start to incorporate that? Much less if you want to go back to orange theory or, you know, whatever. So when I kind of spell that out to be like, okay, then we’re going to see kind of what deficits do we truly have. And then let’s look at what your expectations are.
And I go further than that. I go, “Hey, let’s get your maternity leave program set up because that’s going to be good.” But where people miss the boat is they don’t continue on to return to work. And that’s where the ball gets dropped like crazy. So that’s also the other question I ask in pregnancy is like, okay, what’s your childcare plan? Cause around here, the order of operations is get childcare and then get pregnant. Um, and then also you should sign up for a pool, but that’s just here. So once we know your childcare plan, then we can start to figure out where exercise is going to fit. And I really encourage moms, like if you have the luxury, you know, pick your kid up 30 minutes late. So your time that they’re in childcare will include you getting a workout in because once you pick them up and go home, that’s it.
And so again, some of that is privilege and resources and that kind of stuff as well. But like training moms to put themselves first. And that’s kind of that first taste of self-care is like, we just think, oh, work and home. And I very much remember as soon as I was done with work with my first, I would go right home and be home 30 minutes later and let the nanny go. And finally I realized I was like, Oh, actually, if I can add an extra hour in there, I can either go run errands or I can go for a walk or I can do something where I’ve got a little bit of buffer and trust me when you know, your kids are older, you need that time to switch hats, because you don’t know if you’re picking up a grenade that’s live or dead, or you really don’t know what you’re going to pick up. You have to be mentally and physically prepared for that.
So I kind of go through that whole continuum to understand that this isn’t just like a pregnancy thing, or just like an immediate postpartum thing of like: hey, we’ve got to get this figured out long game to get you bridged to ultimately what does that look like in a year out? What do you want to be doing? And is that feasible? Like I’ve got moms around here that want to run the Marine Corps marathon under a year and some are prepared to and some that’s not a great idea. And so again, can we set those expectations early and get a better sense of reality and figure out where we can push it, where we really need to, to find more resources.
22:58 Dr. Ginger Garner: Yeah. Yeah, I remember, and I’ll share this little short story because, you know, for some moms like myself. At that time, when my kids were younger, I didn’t have any family around. So there, and as a physical therapist, as an athletic trainer, and as a former personal trainer, like way 30 years ago, I hate gyms. I just hate gyms.
23:22 Dr. Carrie Pagliano: Oh, I did too. I’ve gotten over it.
23:25 Dr. Ginger Garner: I totally hate gyms. And even I worked in one, you know, that was my first clinic was working in one, So there were multiple things converging. Like if I had that moment to go to the gym, I wouldn’t because to me it was like Glennon Doyle described it as, and it was like nail on the head. She’s so good with her words. She said, going to the gym is like being chased by a tiger. Like, why do I want more people yelling at me? I have enough people yelling at me at home.
23:54 Dr. Carrie Pagliano: Yeah.
23:55 Dr. Ginger Garner: And I said, oh my gosh, that sounds, that just, that hits it. So I would have to take little snatches of time here and there, which is when I really learned about the benefits of cross-training, that I didn’t have to do it all at one time, right? Imagine that.
24:15 Dr. Carrie Pagliano: I want to pause on that one for a second. You and I are both like, wow, imagine that. This is our day job. Don’t feel bad if this is something new to you because this is our job and it’s still novel to us.
24:29 Dr. Ginger Garner: Right. As a new mom, you know, I had before kids, I had the luxury of going for a half an hour run, or I’m going to go get my mileage in, or I’m going to go do the things that I want to do. I just did it. And afterwards, I even right, even with it being the day job, I thought, but I still want to do it the way I used to do it. Oh, yeah, that’s the only way I’ll be as fit. And actually, it ended up being better with cross training. Yes, I was getting less injuries, I felt more balanced, I wasn’t as exhausted, you know, etc, etc. The list goes on. So yes, having to recalibrate our mindset, and hold space for that while also kind of rejecting the social norms that would burn us out, like the hustle culture and the leaning in and all that crap. holding space for our own wellbeing, but then pushing that other stuff back is hard because you just wrote something the other day, you put up a meme that said, oh, oh, it’s talking about double standards. It said
25:30 Dr. Carrie Pagliano: Oh yeah, the Ali Wong.
25:32 Dr. Ginger Garner: Basically, yes, asking women, you know, all the damn time, how do you balance family and work? Men don’t get asked that. Why? Because they don’t. They don’t, right.
25:40 Dr. Carrie Pagliano: Her delivery was spot on if you ever get to see the video. It’s Ali Wong and she’s just the bomb anyway. And it’s like that little bit of, they don’t, like everybody’s like, yeah, not wrong. And this comes from a loving place with a very supportive spouse and all that kind of stuff too, but ain’t the same damn thing.
26:03 Dr. Ginger Garner: It’s just not, I’m sorry. It is absolutely not. And I was reading a blog the other day. I believe it was, her first name is Zawn [Zawn Villaines] and she mentioned, she writes about motherhood all the time and double standards and and she was talking about the same thing and the pressure that this essentially what we were talking about this earlier is the pressure that gets put on moms that we just completely take on like oh we’re supposed to be able to do all that but at the same time, the standards are not, you know, held to men in the same way, meaning she wrote this. This is from her. She wrote, meaning if, if dad show up and take their kids to target for 20 minutes and don’t accidentally kill them, then there’s massive rounds of applause. Right. But we could have been the primary caregiver for the first 10 years, getting it all right. And there’s, there’s silence. It’s like, oh, you’re supposed to be able to do that. Right. Yeah. Moment.
27:06 Dr. Carrie Pagliano: I’m just thinking about this morning, all the things that I did for my kids between 8:30 and 9:30 this morning, because it’s all just like secretarial crap and making sure things are done and people have appointments. And now it’s, making sure they have resources and being there as a teacher and being there, you know.
27:28 Dr. Ginger Garner: Yeah, absolutely. You know, I started to block it in time. And maybe this will help y’all listening. I don’t know. If it doesn’t discard it and ignore it. But I started to block the time because if you look at the stats on how much more a mom spends with time with house giving and child rearing, it is substantially more than partners would. So I didn’t block it to document it and go point and go, look, look at how much time I’m spending. However, it helped me realize that I needed to have that time.
So instead of rushing off to the clinic at 8 a.m. and then with my hair on fire, forgetting my lunch, sometimes even I forgot like my laptop cord and stuff. Hell to the no, I can’t do this anymore. So I just blocked 6 a.m. to 9 a.m. And instead of succumbing to the pressure that would say, oh, just get up at 5 a.m., be the member of the 5 a.m. club, I’m like, damn it, I need eight hours of sleep, you know? I’m not subscribing to your 5 a.m. club. You can, you just got to go to bed at 8. I mean, the kids they’re at eight 30, you know, I’m, I’m rounding. It’s like herding cats, you know, getting all of them into bed. Um, and then getting the laundry and the book bags and all that stuff done. So just blocking that time out, just, it seems so simple, but that’s the expectation now, you know, can you take a call? No, I can’t. It’s 8:30. That’s kid time that I cannot get any of them out the door before nine o’clock.
28:58 Dr. Carrie Pagliano: I do the same thing. Mine’s a little bit different now that my kids are older. And I think that’s the other thing too. You know, you, you mentioned like, Hey, it can’t be like, if you used to be a morning workout person, like I used to run in the morning and when your kids are little and can’t be, um, left alone, you can’t do that.
29:16 Dr. Ginger Garner: And it’s so hard to recalibrate.
29:19 Dr. Carrie Pagliano: But guess what? There’s some point that they will, I can’t promise you when, um, but like I go to the gym at for a 5.30 class, two days a week. And I’m back by the time I need to get thing one up and get him ready and do carpool. And then come back and I get her up and I get her ready and I get her out the door. And that’s blocked time, like don’t talk [to me].
And because it’s before 8.30, it’s usually not a problem work-wise. But then after school, like I don’t take work calls, even if it’s from doctors after a certain time. But I also try not to bring my notes home. And once my work is done, I try and make sure that it’s done so that if one kid’s got practice, the other one can come with me and we can walk the dog and study civics or something like that. I can be a parent to them. on that block of time too. But it makes it tight because the school day is really freaking short. I know those of you that your kids are in child care are like, I can’t wait to not write that check again. Trust me, I understand. But they have so many days off.
30:29 Dr. Ginger Garner: They do. And when they get out at three o’clock in the afternoon, I have- [Oh, it’s such a short day.] It is. It is. If I don’t have, I have to lean on other people. It’s a village, a family member to go and pick them up because I wouldn’t get anything done if I don’t get to the office to see patients until nine, but then their pickup, I have to be there at 2.50, basically I’m getting absolutely nothing done. So someone has to take over in the afternoon to be able to do that. It does come down to, I don’t want moms to think, oh, I just need to manage my time better.
Some of it is just an impossibility. Like I was that morning workout person. And it was just awful to think that I couldn’t start my day because exercise is probably one of the most powerful pieces of medicine, types of medicine that we have in terms of our mental health. It’s an anti-inflammatory. You know, activity, not to mention that it just keeps us fit in general, but sleeping better, etc. Being able to manage things, cognitive power. I mean, it’s just, it’s amazing to be able to do that. I don’t want moms to think that it all comes down to the heavinesses on them. Just shift your mindset, manage your time better. It’s definitely more than that because I don’t want moms to think that the burden all falls on them because I thought that too. If I was just stronger, if I was just more energetic, if I was just independently wealthy.
32:03 Dr. Carrie Pagliano: I will say I have gotten better at how I use what time I have. I will say after my second, I don’t think I went back to workouts as quickly, because again, you got more stuff going on and whatever. Now, again, like, because you have so many things that you have to take them to, It’s like, do you want to sit on the bleachers for an hour? No, no. My back does not want that. My butt does not want that.
So that’s where I get, maybe I’ll take the dog out for a walk or I’ll be with my son or we’ll go do something else like it. And again, it’s kind of like having an infant because the more you get used to, Oh, this is what they’re doing now. Something will change again. They’ll have a growth spurt or, you know, they’ll have a wonder week or something like that. That’s going to be the rhythm going forward. It’s recognizing when the change, if you can see the change coming to prepare for it, or if all of a sudden you’re in that and it switches to, you’ve got to switch strategies. And you might not be able to do that 5.30 AM class or something like that. Like you might have to shift it. And then there’s always that rando thing thrown in with your husband that has to go out of town.
And even though, and my husband does a great job, he takes the kids two mornings a week while I’m at clinic. And if he is not here, I still can’t leave them alone to go to school by themselves. They’ve got carpool. They’re fine. But so I’ve got to change my entire work schedule to do that. So there’s those things that get plopped in that are like rando grenades that you think you get it all figured out.
33:36 Dr. Ginger Garner: Mm-hmm. That’s right. Yeah.
33:38 Dr. Carrie Pagliano: The sooner you kind of get used to that being the rhythm, then it’s not so like, “oh my God.” This is not something that’s happening like, like you kind of can step back from it and move it around for what it needs to be and then go back in again, I guess it’s not going to change that much.
33:58 Dr. Ginger Garner: Right. Because there’s so many flooding emotions, feelings, and logistics in being a mom and wanting to be active that I often have to say, okay, I’m borrowing from the mental health field, which we have to do a lot in physical therapy of the dialectical behavior approach to say two things can be true at one time. Yes. Really miss that morning workout. but I’m also going to walk the dog in the evening or push the stroller in the evening or whatever it is. And I can be mad about it, but I can also at least get it in at some point during the day, which is good.
And I had to fight with that for a while, not too long because you know, my first was, as all firsts are, just everything is new every day. And now my first turns 18 in December and everything is still new every day. So that same lesson that I learned about not getting a morning workout in or whatever, which seems very trivial, but it’s not.
It’s like every single day there’s some emergency happening. As parents, as moms, we have to step back and go, “Okay, if I miss a whole week of working out or whatever it may be, Olympic athletes don’t work out 365 days a year. They’re not on their game all the time.” They have off season, they have cross training, they have all kinds of things. So I encourage moms to maybe think about it that way. You can’t be on, on peak all the time.
35:34 Dr. Carrie Pagliano: No. And also, too, like not respond to everything like it’s a poor alarm fire. Because that’s not sustainable.
35:45 Dr. Ginger Garner: Yeah. Yeah. So that brings us to a really good question. You know, and we’ve talked about time management, we’ve talked about not putting all the burden on yourself for time management, not putting all the burden on yourself because there are social policies that need to change in order to better support moms. And in the United States particularly, every country has its problems, but we don’t have the policy in place that allows us to thrive as moms, not in healthcare and not in the cultural sphere, not yet anyway.
But I will put in the show notes the bill that Academy of Pelvic Health that, you know, the task force that I was just, it was an honor to sit on to help co-write that bill. I’ll put that in there because if you want to be active and take two minutes of your time, you can go and just click on the link, send your Congress member an email and say, hey, support this postpartum bill that will improve our access to care and the affordability of care, which means you don’t have to be gaslit anymore and just, you know, get patted on the shoulder and say, off you go back to running back to the thing that you want to do. Someone can be there to support you, you know, chiefly pelvic rehab in some way. So we’ll put that in the show notes, because that’s pretty important.
But the other thing that I wanted to ask was a really practical question about, you know, moms are ready to go out and do that first thing. Push that stroller. They want to unload that stroller. I remember someone’s always sweating, crying, like fingers, blood blisters on your fingers, trying to lift the stuff in and out. It’s so freaking heavy. So, you know, what do moms do first? I know you’ve talked about low reaction vertical force and testing out a couple of those things. Walk us through that.
37:35 Dr. Carrie Pagliano: Yeah. I would say in those first, I would say four to six weeks, the expectations are really basic, like I said, basic coordination stuff, finding breath, so on, but then also getting out, going for walks, a lot of the preparation for running an impact. Ideally, we want moms walking 30 to 40 minutes, either solo, which sometimes doesn’t happen, pushing a stroller. And then a different variable is if you’re carrying a baby in a carrier, obviously because there’s more weight there.
If you have symptoms, pelvic floor heaviness or leakage, sometimes that can be more prominent or noticeable with a carrier. And again, too, like it’s also resource dependent. Some moms may not have a safe place that they can walk. So it’s, you know, do you have a vehicle that could get you to a mall or something that you could walk around? Are there still malls? Like, you know, just things like that.
So there’s a lot, even in that first little bit of getting out the door and kind of doing that in addition to, hey, I’m trying to find a sleep schedule and, you know, figure out how to put my baby in a carrier and do I go to the grocery store? Is my baby going to cry? Yes, your baby’s going to cry. That’s kind of like the first focus is to get some of that basic stuff in.
And then, um, at that six week mark, like I said, we’re going a little deeper and looking more specific. Are there any deficits? Did you have anything kind of coming into the pregnancy that needs to be addressed? And this is where I think there’s a lot of attention paid to pelvic floor because of the delivery mode. You can have pelvic floor issues regardless of cesarean or vaginal delivery, because you carried a baby for that long. I went through prolapse issues, leakage, abdominal separation, pelvic girdle pain, all the things. And I think that brings up another note too, that people are like, oh, well, I want to prevent.
And prevention is tricky because some of it is based on genetics and how you use things and past injuries and so on. Don’t you think that, you know, knowing my job, I would have prevented everything I possibly could have? And so I look back in the rear view now, and were there some things that I probably should have prepared differently for that we know much more about now? Yeah, 100%. And a lot of things that I went through probably were, again, with the knowledge I have now, years later, predictable. But there’s so many things that we can do when they pop up early. And I think that’s what drives me nuts a little bit is when physicians are like, “Oh, that’s just pregnancy or that’s just your weight gain.”
No! Okay? So I think earlier conversations about doing the things to make being more active, comfortable in pregnancy. Not just assuming that, um, you should do everything gentle. But again, the research that we have is it’s tiny lightweights and body weights. And we have research now from Christina Prevett saying, no, we have women readily and actively lifting 200 pounds, which is light for them, in a gym, and they’re doing fine on the other side.
So again, we’ve got some disparities in the literature and some things that need to get caught up. But the next part really is, I think, what’s feasible, logistically, and where are the deficits that you have? And what are we trying to work back towards? And so that’s where I do a lot of habit stacking stuff. Because even if you find a place to put the gym, And you have maybe like two or three extra things.
Like for example, one of the things that comes up a lot is people don’t realize how they lose their single leg balance. I think there’s some stuff that goes on hormonally with the vestibular system. Dizzy mommy syndrome comes up. Like you can’t go on the swings or in merry grounds like a freaking nightmare. Our foot size changes, those sorts of things that moms don’t realize. And maybe they also had chronic ankle issues as a soccer player. Those things come back up. And so when you have ankle issues and you’re trying to run your foot hits the ground, it’s not mitigating that impact well. It’s going to kick it up the chain and guess who’s to blame? Pelvic floor.
And the pelvic floor is kind of like the mom where it’s like, all right, if you don’t do it, I’ll take care of it. Right. And so that’s where I think we get into this idea that all postpartum rehab is, is a bunch of pelvic floor exercises. Then some people get freaked out about abdominal separation. It happens, but you know, I think we’re doing better with that piece of it, but it very much is whole body rehab. And, you know, depending on what you want to get back to, there’s going to be some additional things that you may need to focus on. It may be ankle strength. It may be balance. It may be hip exercises. It may be core. You may not do a darn kegel while you’re there, and that might be the right thing to do. And so I think adjusting our expectations as to what postpartum rehab is to prepare for your sport.
So for example, for running, we might work on a couple of those things to kind of fill those gaps between week six and eight, and then maybe start a walk run program, which is not a couch to 5k, by the way, because the couch to 5k, isn’t like a return after injury, it’s a return from you haven’t done anything. And those are two different things and doesn’t take into account hormones and pelvic floor and all that stuff. But that’s what a lot of people turn to. And they turn to something that’s not appropriate for that scenario. And then they end up with shin splints or they over run and end up with hip flexor tendonitis or, um, all of a sudden they’ve got leakage, like, and then it just blows up.
And so I think the other thing is return to postpartum requires repetition for a couple of different reasons. One is so you don’t throw yourself off the cliff with the lemmings. Like I. when I do a run-walk program, we may do the same run-walk ratio two to three different times. And the reason why is one, we’re building time under that task. You’re building up endurance, you’re getting used to that, but you’re also building confidence that if it went well once, it went well three times, and you can do that pace or that ratio or whatever it is, and you’ve got that before you move on.
If you switch variables every single time, and something bad happens, you’re going to freak out and you’re not going to know what to do. And now we have to walk back from that because that’s traumatic. And it just adds a whole nother layer that we didn’t need to. So that’s where I do think people miss the boat a little bit on postpartum rehab is it has to be very intentional. Almost like a return after injury and very kind of repetitive. And it’s slow up front.
I have a friend Lisa Marie Ryan, she’s a postpartum coach. And she said slow is fast. And I was like, yeah, that’s it. Like slow up front, we’re playing the long game here. If we go the slower we go, the more consistent we go, the more intentional we go up front. That means we don’t have to deal with that crap later on. And the sooner we can kind of get that in our heads, the better. But it’s so hard because we want to get back and be that mom that does the things and her pictures and have people see us and be an example for our baby that totally isn’t understanding any of that right now.
45:33 Dr. Ginger Garner: Yeah. Yeah. I will describe, um, two prongs of that when I’m working with new moms and pregnant moms who are about to cross that threshold is we have, a short game and a long game. Oh, yeah, we have a short game and a long game. And the short game is oftentimes like, we want to set them up for success in that first 30 days of the things that are going to help with pain management, they’re going to help with the obvious things that are we’re not talking about what your abs are going to look like, you know, in six weeks. We’re talking about, you know, managing your pain and your stress, and some of the things you mentioned earlier about if you need a lactation consultant and that kind of thing.
And then the long game, which is some of the things that, you know, we’ve been hinting to the whole time that creates a need for there to be pelvic PTs, pelvic OTs and pelvic practitioners. That it does have to be a graded return. And, Carrie, you have some great things on your Instagram account about the low reaction, vertical forces and just testing little tiny movements out. And really it does come down to that.
Gosh, I remember trying to lift something in and out of the car. This is like my, my two oldest are 16 and 18 now. So I’m really reaching back there of. leaving the grocery store and even doing this, right? We do this for a living. It doesn’t mean that we can prevent incontinence, you know? Like, it doesn’t. Those things are going to happen sometimes with 100% incidence, just like, you know, DRA or abdominal splitting, that’s pretty much 100% incidence. Like, we’re not going to prevent that. It’s just going to happen.
And then not beating yourself up about it as, you know, I’m thinking back to that leaving the grocery store and going, oh, Well, I wasn’t planning for that accident to happen. Good thing I’m only two miles from the house, right? But then giving yourself grace to know, “Oh, well, that’s part of it. And even if I was a pelvic PT or OT sitting in the grocery store parking lot, I’d probably still leak a little bit because we can’t prevent everything.” Yeah. Yeah.
All right. Do you have questions, curiosities, whatever it might be? Carrie, would you share how we can get in touch with you? Website, Instagram handle, all that fun stuff?
Dr. Carrie Pagliano: Yeah, it’s super easy. It’s just my website is carriepagliano.com and Instagram, you just find me @carriepagliano. So we try and be super easy and straightforward to find me there. Yeah, I tend to hang out on Instagram. Twitter is still, or whatever we’re calling it this week, is still a little vile. I like different pictures.
48:26 Dr. Ginger Garner: It is. I’ve stopped. I quit way back when, probably almost a year ago, I stopped being on whatever that is, the formerly named Twitter. But yes, Instagram. We’re hanging out with you on Instagram. Please check her out, check out her work and what she does. She’s based in the DC area and doing some fantastic things. Plus just a really awesome down to earth, open role model for all of us as moms.
49:00 Dr. Carrie Pagliano: Thank you. That’s so sweet.
49:03 Dr. Ginger Garner: Yeah. I love all your myth busting. So you guys got to check it out. Cause there’s lots of myths to bust and lots of encouraging facts and little tips and tricks too. Because we just want you to know you’re not alone out there. No, and you can get back to what you want to do. All right. Thank you so much, Carrie, for being here.
49:32 Dr. Carrie Pagliano: Thanks for having me.
https://youtu.be/u8QFPB7MqAk Follow us for Free: About the Episode: What if your pain isn’t “normal” — it’s been misunderstood? In this episode, Dr. Ginger sits down with Dr. Madhu Bagaria, a...
https://youtu.be/04zjmpV1td4 Follow us for Free: About the Episode: Men’s sexual health is often misunderstood and reduced to quick fixes. In this episode of The Vocal Pelvic Floor, Dr. Ginger...
https://youtu.be/p3A1foLw6wI Follow us for Free: About the Episode: What if your desire isn’t broken — it’s just been misunderstood? In this episode, Dr. Ginger Garner sits down with Dr....