Pelvic Organ Prolapse Primer

Important note: DO NOT GOOGLE IMAGE SEARCH "PROLAPSE." You will only find worst-case scenarios and it will freak you the F out if you have recently been diagnosed with prolapse. Just trust me on this one.

Pelvic organ prolapse is a difficult subject to find information about. Moms commonly talk about their achy backs, pain in the early days of breastfeeding, or even joke about peeing while jumping (common but NOT normal!), but hardly anyone talks about prolapse. For many women, this is an embarrassing topic. And that's a shame, because prolapse is probably more common than you realize. We don't know what the true incidence of prolapse is, but chances are you know someone affected by it. You might even have a mild prolapse, but no symptoms.

If you're new here, you might not know that I have a mild prolapse and have gone through pelvic floor physical therapy, so this is a topic that's near and dear to my heart.

So let's start with the basics.

What is pelvic organ prolapse?

Pelvic Organ Prolapse occurs when one or more of your pelvic organs (uterus, bladder, rectum) is no longer fully supported by your pelvic floor muscles and the fascia (layers of connective tissue), and begins to descend. The vaginal wall starts to droop inward and, in severe cases, might protrude outside the opening of the vagina. 

Types of Prolapse

There are four basic categories of pelvic organ prolapse. I've adapted these definitions from Voices for PFD; see their page for more information. As you are reading these descriptions, it might be helpful to open a separate tab to the ACOG website, where you will find animations of the various types of prolapse (this is safe for work).

 Normal pelvis

Normal pelvis

Anterior Vaginal Wall Prolapse

 Cystocele (anterior vaginall wall prolapse)

Cystocele (anterior vaginall wall prolapse)

Anterior wall prolapses include Cystocele (bladder) and Urethrocele (urethra). Anterior means "front," so these prolapses affect the front vaginal wall (closer to your pubic bone than your tailbone). Cystocele and urethrocele can often occur together, and happen when the fascia (supportive tissue) of the bladder stretches or detaches from where it's connected to the pubic bone. The bladder falls down into the vagina, causing a bulge, loss of bladder control/stress urinary incontinence, feelings of heaviness, fullness, or achiness, or feeling like you're sitting on a ball.

Posterior Vaginal Wall Prolapse

 Rectocele (posterior vaginal wall prolapse)

Rectocele (posterior vaginal wall prolapse)

If anterior means "front," then posterior means, you guessed it, "back." Posterior vaginal wall prolapses include rectocele (rectum) and enterocele (intestines), and happen when the supportive tissue between the vagina and rectum stretch or detach. The rectum or intestines then bulge or descend into the vagina. Symptoms include a bulging sensation and straining during bowel movements or feeling like you're not able to completely empty the bowels.

Uterine Prolapse

Uterine prolapse. This is a grade 4 prolapse, which means the uterus is now outside of the vaginal opening.
Uterine prolapse. This is a grade 4 prolapse, which means the uterus is now outside of the vaginal opening.

A uterine prolapse is when the uterus moves down into the vagina. In severe cases, the cervix can protrude outside the vaginal opening. Feelings of pelvic pressure or bulging are very common if you have a uterine prolapse. If the uterus and cervix are low enough, the cervix might rub on your underwear, causing bleeding and irritation.

Rectal Prolapse

Unlike the other types of prolapse, a rectal prolapse does not affect the vaginal walls. This type of prolapse is less common and occurs when the rectum's supporting structures stretch or detach, causing the rectum to fall out through the anus. Symptoms include painful bowel movements, mucus or bloody discharge from the protruding tissue, and an inability to control your bowel movements. A rectal prolapse could also be mistaken for a very large hemorrhoid.

Prolapse Diagnosis and Severity

If you suspect you have a prolapse because you can either see or feel a bulge, or because you have any of the other symptoms mentioned above (especially heaviness or achiness in your pelvis; that's a big red flag), please go see a pelvic floor physical therapist! Many OB-GYNs are not well-versed in prolapse and may dismiss your symptoms as being totally normal after having a baby. THEY'RE NOT. Don't accept a shrug as an answer. Go see a pelvic floor physical therapist or a urogynecologist, as these are the two professionals who are the best suited to help with this particular condition.

To find a pelvic floor physical therapist near you, use this website or email me -- I'll help you find someone.

Prolapses are graded on a scale from 0-4. Your physical therapist or doctor will ask you to cough or gently bear down to see how far your prolapse moves, and then measure according to how close the prolapse is to your hymenal ring (just inside the vaginal opening; where your hymen is or used to be).

Grade 0: No prolapse is present.

Grade 1: Lowest part of the prolapse is more than 1cm above hymenal ring.

Grade 2: Lowest part of the prolapse is within 1cm of the hymenal ring.

Grade 3: Lowest part of the prolapse is below the hymenal ring, but the vagina has not completely prolapsed.

Grade 4: The vagina has completely prolapsed outwards.

Source: https://www.pelvicexercises.com.au

Prolapse Risk Factors

I like to talk about the risk factors for prolapse rather than saying "causes of prolapse," because you often can't say for sure what the cause was.

Ok, now you have a good understanding of the mechanics of pelvic organ prolapse: organs descend when their support weakens. But why does that happen? Why do some women get prolapse and others don't?

That's a tough question and one that can drive you insane after receiving a prolapse diagnosis. I can tell you from personal experience that after my diagnosis, I spent a long time mentally dissecting everything I did after my youngest daughter was born, trying to pinpoint what, EXACTLY, I did that caused my prolapse.

This way lies madness. Please, if you're reading this and you have a prolapse, be kind to yourself. It happened, for whatever reason, and it is entirely possible you didn't do anything to cause your prolapse. 

Risk factors include:

  • Vaginal birth (risk increases in cases of vacuum or forceps delivery)
  • Genetics: Some women are born with stronger bones, muscles, and connective tissues than others. Those with weaker connective tissues have a higher risk of POP.
  • Smoking
  • Pelvic floor injury
  • Hysterectomy
  • Surgery to treat pelvic organ prolapse (yeah, how's that for unfair)
  • Chronic constipation, straining, or coughing
  • Obesity
  • Menopause
  • Nerve and muscle diseases that contribute to the deterioration of pelvic floor strength
  • Heavy lifting and intense repetitive activity (running, CrossFit, etc)

Please note that you can have all of these things and not have POP. You can have NONE of these things and still have POP. 

Treatment

There's really only two options here: pelvic floor physical therapy or surgery. In cases of mild to moderate prolapse (read: the organ in question is not outside of your body), PT can be hugely successful in lessening or eliminating symptoms. This is the case for me. I still HAVE a prolapse, since once the structural support has been compromised it's highly unlikely that the grade will ever be reduced to zero. Most women who have had children are walking around with a grade 1 prolapse anyway with zero symptoms, so eliminating the bulge is not usually the goal of PT. You can have a grade 3 with no symptoms, or you can have a grade 1 with severe symptoms. There's not necessarily a correlation between the grade of your prolapse and your symptoms. For a wonderful post on this subject, check out Julie Wiebe's "What is the goal of prolapse rehab?"

Surgery is usually recommended in severe cases, and I would argue that PT should be included as part of this. A pelvic floor physical therapist can work with you following your surgery to help you develop better movement strategies, which increases the odds of your repair holding up. Prolapse surgery has about a 30% failure rate. Not a typo. Yeah, that's not exciting at all, which is why PT is usually the first line of defense.

In conclusion, for now

This is just an overview, and I hope it's been helpful for those of you who are searching for answers on the great, wide internet. In the next post I'm going to answer common questions about POP. Got a specific one you'd like me to answer? Email me!

POP Journal: Catching Up

Quick recap for those of you who are just tuning in: I was diagnosed with bladder prolapse when my little one was about 8 months old. I went to pelvic floor physical therapy and it changed my life. No joke, no exaggeration. That was a little over two years ago, and while it certainly hasn't been a direct route, I can now run, lift weights, and basically do all the things that websites about prolapse tell you not to do, with no symptoms. I've squatted 210 lbs, deadlifted 260, and my prolapse is no worse for the wear. 

(Your mileage may vary. This should in no way be considered medical advice and you should talk to a pelvic floor physical therapist before doing those things.)

What I haven't talked about is that I had to take a big step back in January of this year. Last summer and through the fall I felt amazing. No symptoms. Felt strong as hell. Give me all the things and I will pick them up and put them down. Got a phone book handy? I'll tear that mf-er in half. 

I was feeling so great that I decided to register for a powerlifting meet that would take place in January. Not to COMPETE, just to do it and hopefully set some personal bests. 

Have you seen anything about a powerlifting meet on this blog or on Facebook? No? No. Why? I didn't do it. 

About a month before the meet, I did something. I'm pretty sure it was holding the bottom position of a back squat that did it, and my pelvic floor was all NOPE. I called the workout for the day and left the gym almost in tears.

I was sure that I'd gone too far, pushed too hard, made everything worse and now I'd need surgery and how can I train women with POP when I can't even manage my own and what have I done oh god oh god OH GOD.

I went back to my pelvic floor physical therapist who checked me and said that she didn't think anything was different. I still had the one prolapse (I was convinced I'd also given myself a rectocele -- when the back wall of the vagina falls forward -- in addition to making my existing prolapse worse). She told me she didn't see any reason why I couldn't continue with my heavy lifting.

But I couldn't. Mentally, I just couldn't. I was terrified. 

If you have POP, you know what I'm talking about. You're afraid to move, afraid to pick anything up, unable to live your life for fear of making your prolapse worse. Because that's the worst case scenario and once those supportive ligaments have been pushed too far and they just give up, they don't go back. There is no cure. You either live with it or you get surgery, and the failure rate is about 30%.

How do you like them apples? Not well, actually, not well at all.

I talked about it with my trainer. He's a fantastic coach and defers to me when I say nope, my pelvic floor is not ok with that exercise right now. And yes, I do have those conversations in those exact words. You don't necessarily have to be that blunt, but your trainers, coaches, and instructors have to know what's going on. 

We dialed everything back effective right that second. Cut out all squats. Cut out everything heavy. Pivoted to low weight/high rep stuff while I monitored my strategy. Was I breathing? Was I thrusting my ribs? Was I clenching my pelvic floor because relaxing it felt scary? Actually, yeah. 

It's been almost five months since then and I've made enormous progress. We've added sprinting to my workouts, and that feels great. No heaviness or pressure and no pelvic floor problems during or after, always being careful of my strategy. I've recently started back squatting again, keeping the weight to less than half of what my max was before and deciding on a set-by-set basis how much to do that day. 

The hardest part of all of this is my pride. If I go to special events that my gym hosts and everyone else is testing their lifts, I'm not going to do that. Could I? Sure. Should I? Nope. The whole risk vs. reward question becomes a lot clearer when you're talking about irreparable damage and you're able to put your ego aside. 

I still feel strong. I still feel great about my workouts, and I'm not just lying on the floor doing clamshells and kegels for an hour. 

Every so often someone who knew I was registered for the meet asks me about it. I'm very open and tell them that my pelvic floor just wasn't ready, and I needed to take a step back. They always ask if I'll do one in the future, and the honest answer is that I don't know.

I might have maxed out on my big lifts and never PR again. I might never do a powerlifting meet. 

Can I live a happy and healthy life without any more PRs or powerlifting? Yes. Am I sad that that's a possibility? Yes. 

Most women, myself included, feel a very real grief after their POP diagnosis. It's not something that you "get over," though, because there's a constant recalibration of what works for you and what doesn't. That can and does change even from day to day. There's a lot of hope, especially for those who are diagnosed soon after having a baby. So much healing occurs during the first year, and even beyond, especially for breastfeeding moms, so I hope this doesn't come across as EVERYTHING IS AWFUL AND YOUR LIFE IS RUINED, because it's not. There have actually been a lot of positive changes in my life as a direct result of my prolapse, believe it or not, but that's a post for another time. 

Prolapse can feel so isolating, and it's invisible to well-meaning strangers, friends, and relatives. You wouldn't tell someone with a cast on their leg to go for a run; there's no such marker for prolapse. I will talk about my pelvic floor with literally anyone, but most women aren't quite so comfortable - and that's ok! So how do you explain to your friend that you can't go for a run with her when you look fine? What do you tell people at the gym when they want to know why you're not lifting heavy anymore, when it was going so well? 

Every time a conversation like that happens a fresh wave of grief, anger, and bitterness sweeps over me. Sometimes it's just a ripple that passes through my mind and then it's gone and I'm fine. Other times it crashes into me and drags me down to the depths where I just want to scream THIS IS NOT FUCKING FAIR.

Because that's the hardest part. You can do everything "right" and still get prolapse. You can do everything "wrong" and be totally fine. But at the end of the day, if you have POP, you have it. Trying to dissect the causes and pinpoint exactly what caused it is unproductive, yet we still do it. You can get to the point where you're totally or almost completely asymptomatic -- that's me, most days -- but your awareness of it is always there to some extent.

And that's what I grieve -- the ability to take my pelvic floor for granted. 

 

Happy Birthday, Fierce Mama Fitness!

One year ago today I was pacing the gym turf, checking my watch and re-reading the workout plan clutched in my sweaty hands.

A few people had RSVP'd for the first-ever Stroller Strong class, but would anyone show up? What if no one came? What if EVERYONE came? 

One by one, the moms rolled in with their strollers. FIVE PEOPLE! I was elated. And ohhhhh shit people are here that means I actually need to lead this workout.

I AM IN NO WAY QUALIFIED TO DO THIS WHAT WAS I THINKING

But we did it! I thought it went ok, and I loved the moms that showed up. I hoped with every fiber of my being to see them again, while a small, cynical voice in my head laughed and laughed because of course they would see what an imposter I was and why would anyone PAY me for this?

The next day I was scrolling through Facebook while brushing my teeth when I got a paypal notification in my inbox. Payment received for Stroller Strong.

I shoved my phone in my husband's face. WOOK WOOK WOOK! AH GOB A CWIENT!!

And then later that day, another. And another. And then one more. 

Four out of the five moms came back, and they're still training with me today.

Since that day so many new moms have joined us. Some have gone back to work. Some have had babies. Some are now pregnant! We've celebrated birthdays and powerlifting meets and worked out in ugly Christmas sweaters. We've made the dudes at the gym suffer through a Disney playlist. And an all-Britney playlist. And a 90s/early 2000s playlist with the very best music in the history of music by the Spice Girls, N*SYNC, and Backstreet Boys. 

We grew from two class times a week to NINE. We lifted millions of beans. We lifted ALL THE THINGS. We squatted. And we squatted. And we squatted some more. 

Kids that could barely crawl a year ago are now running and talking and attempting to deadlift more than their bodyweight. Babies that weren't even born now have full-fledged personalities and love being passed from person to person while their moms are lifting weights. 

Last night twelve of us went out for cheese and chocolate fondue. As I looked around the table at these amazing women with different backgrounds, professions, goals, and numbers of kids, all chatting and laughing and commiserating, I thought to myself....this. THIS. 

The dream that I've had for the last three years is not to be the most hardcore workout class. It's not to have the fanciest equipment or the trendiest programs or a big scoreboard tracking how many pounds we've collectively lost.

(Also, that last one? GTFO.)

I dreamt of this community. Of moms supporting moms, of having other people to lean on, people who have been there before or are right there in the trenches with you. THAT is what Fierce Mama Fitness is all about. And it's not because of me. It's because of these women, these resilient, courageous, STRONG women in every sense of the word. 

Thank you all for an amazing year. 

And the Oscar Goes to...

The girls melted into the couch. A late night at Grammy's house plus running themselves ragged at the splashpad sapped the very last of their energy reserves, leaving them with glazed eyes and limp limbs. 

Natalie poked at the bandaids on her knees. She'd fought a battle with the pavement and the pavement won handily. The scrapes hadn't bothered her at all while we were at the splashpad, but her beyond-tired state elevated her roadrash from minor annoyance to a full-blown medical emergency.

"Mama, I'm so soooooooooooore," she moaned pitifully. "I can't even waaaaaaaaalk."

I made some sympathetic noises and invited her to come to the table for dinner.

"But MAMA," she repeated, louder and more deliberately, "I can't waaaaaaaaalk. Carry meeeeeee."

She stretched out her noodle arms and waited.

Will and I exchanged a glance and stifled a laugh behind our hands. I lifted Natalie up and started to walk towards the table.

"OW OW OW OW OWWWWW!!! YOU'RE HURTING ME!!"

She thrashed wildly so I all but dropped her into the chair. For the five minutes she was at the table she picked at her food, glancing up at us to gauge our reaction after every dramatic sigh and heave of her shoulders.

"I'm too sore to eat, Mama. Carry me to the couch." And again with the noodle arms and huge, expectant eyes.

"You can walk, Natalie. Dad and I are finishing dinner right now." The couch is LITERALLY seven steps from the dinner table, COME ON, CHILD.

Her mouth parted in a little "O" of surprise and her face crumpled in on itself, tears spilling from  her eyes. She threw back her head and howled, "NOOOOOOOOOOOOOOOO!!"

A hysterical laugh-snort forced its way out before I could stop it. You have got to be kidding me.

Her tears continued as she slid off her chair and started hobbling towards the couch. 

"Natawee SAD," Olivia said solemnly, stuffing a handful of cheese into her mouth.

For the rest of the evening, through brushing teeth and putting on pjs and reading books, Natalie never broke character. She never straightened her legs, shuffling around like Dobby the house-elf and moaning about how sore she was. I was half-tempted to give her a sock and see if that would put her out of her misery. 

When we finally closed the door to her room and crept back downstairs, Will and I looked at each other and started giggling, the laughter finally bursting from us like an geyser of soda from a fiercely shaken can. 

No one tells you this about parenting, that one of your hardest jobs will be keeping a straight face. That your children will bounce wildly back and forth between incredibly sweet and so incredibly ridiculous and frustrating that you have to laugh to stop yourself from just getting in the car and driving away. 

As for last night's performance, there's no question: Natalie won the Oscar for Most Convincing Portrayal of Person Whose Legs Are About to Fall Off. I'm still hopeful I have a shot at Most Empathetic Mom Despite Child Clearly Faking It.

Or, barring that, Best Use of Props to Hide Face While Laughing Uncontrollably.

Educational Resources for Personal Trainers

Go ahead and do a search for "postpartum workout" on YouTube. I'll wait.

What do you find? Pages and pages of weight loss challenges, high intensity cardio, videos designed to help you "bounce back!"

There are some high-quality videos, of course, but finding them? Goddamn that's a challenge. And how do you KNOW what's good? How do you know who knows what they're talking about and who is just throwing together workouts based on what they think postpartum women want, rather than what they might need.

And if you are a trainer, or want to be one, who can you look to for evidence-based education that will help them and not hurt them?

ME!

Just kidding.

This is not the announcement of my 10-minutes a day exercise program that will blast belly fat and shred your abs and shampoo your area rugs while you sleep. I'm still learning right alongside all y'all (sorry, living in Tennessee for 2.5 years is starting to rub off).

A dawning awareness crept up on me that there was a huge hole in what I'd learned about working with moms that a brief webinar in my group fitness instructor training program didn't even begin to fill.

I googled endlessly and tentatively reached out to one of the bigger names I'd seen on Facebook: Jennifer Campbell of Mama Lion Strong and Healthy Habits Happy Moms. I honestly didn't really expect a reply, but she quickly and warmly responded with a few names that I should look into.

Now that I'm a little further down this road I understand her enthusiasm and willingness to share her knowledge. I have yet to meet a single trainer who works with moms who zealously guards her wisdom like they're patented trade secrets and doesn't want anyone else to know about it.

We're shouting this stuff from the freakin' rooftops. We want EVERYONE to know because it is LIFE-CHANGING. We dream of the day when every single trainer (and anyone who works with women in any health, fitness, and wellness capacity) has and uses this information. 

excuse-me-do-you-have-a-moment-to-talk-about-the-pelvic-floor.jpg

TL;DR: Here's a list of educational resources for personal trainers that I wish I'd known about when I was floundering in the flotsam and jetsam of crappy internet information. 

Some of these are affiliate links, but I bought all courses with my own money. I really, really love the work that all of these amazing people are doing and have learned SO MUCH from all of them.

The Foundation:

Julie Wiebe, PT

Start here. Do not pass go, do not collect $200. Start. Here. 

Her program for individuals is a great place to start if you want to dip your toe in before dropping several hundred dollars. It's $50 and you won't regret a penny of it. I also have a few of her pro courses and those are fantastic as well (specifically, The Female Athlete: Ready for Impact). If you've heard me talk about piston breathing, lifting beans, and basically anything related to the pelvic floor, this is where it all came from.

Next Steps

Where you go next depends on your budget, background, and current (or desired) clientele. You really can't go wrong with any of these, and none of them have the exact same information as any other course.

Don't ask me to pick a favorite or a "best" one. There is no BEST course. I'm happy to make recommendations if you want to email me, but I can't just say "this is the one course that everyone should take." I've taken (or am in the process of taking) most of these, and will update this page with more in-depth information after I finish them.

General Pre- and Postnatal Fitness:

Jessie Mundell and Girls Gone Strong

Disclaimer: Jessie's course is the only one on this list that I haven't enrolled in, but I know Jessie and she's an incredible resource of information about training perinatal women. I feel completely comfortable recommending this without having taken it myself. Jessie is also on the advisory board of Girls Gone Strong, and they have a whole page on their site that talks about the differences between the two programs. 

I've just started the Girls Gone Strong certification and what I've seen so far is incredible. I wouldn't be able to do this certification (or Jessie's course) justice by trying to adequately describe them here, so go take a look at both websites. I will say that they are both comprehensive, practical programs that look at pre- and postnatal fitness as far more than just exercise and also take nutrition, mental health, diet culture, body image and mindset into account. Which is awesome! We should all be doing that! Within our scope, of course. 

Diastasis Recti:

Diane Lee

If you're looking for some light bedtime reading to help you brush up on your DR knowledge...this ain't it. If you don't have a solid background in anatomy (read: if, like me, you're not a pelvic floor physical therapist), a lot of this will go right over your head. There's a lot of very technical information that is a bit beyond me, but what I can decipher is superb. If you're on a tight budget or if you haven't done any of the other courses on this list, I would skip this one for now. It won't make much sense or be very helpful without more background information. But combined with any of the other courses, you can consider this advanced training in DR. Fair warning, there's also a fair bit of manual therapy covered, which is obviously beyond my scope as a personal trainer. But physical therapists should absolutely get this book, as should trainers who understand their scope and have some experience with DR. I've heard her in-person workshops are fabulous as well, but I haven't ever been to one.

Bridging the Gap Between Rehab and Training:

Sarah Duvall

I'm eagerly waiting for this course to start in a few weeks. I've followed Sarah on Facebook for a long time, and her blog posts and YouTube videos are solid gold. If this course is anything like what she offers for free then I know it's going to be awesome. I'm quite confident in my theoretical knowledge about working with women who have pelvic floor issues, diastasis recti, etc (oh right and I AM ONE), but I'd love to have even more practical tools at my disposal. That's what I'm expecting and hoping to get out of Sarah's course. 

Crossfit Athletes: 

Brianna Battles and Antony Lo

I can't even tell you how much I love Brianna and Antony. They are the ones that eased my fears about lifting weights and helped me get my confidence back. Antony has a couple of shorter courses on his website, and while I give those two thumbs up, I highly highly HIGHLY recommend you see him in person if you can. His weekend workshop on the female athlete blew my mind and I'd attend AGAIN if given another chance. It's that good. 

Brianna is just as awesome and her course is fully online (it also includes Julie Wiebe's course; something to keep in mind when considering the price of all of these classes). You won't get exercise plans to share with your clients; her course is all about the WHY. If you don't have a personal training certification, I'd probably do that first, because the course assumes you have a working knowledge of anatomy and exercise technique. But once you have a handle on that, you'll learn how to apply the piston strategy to every level of exercise for every level of athlete, from the mom who just had a baby to someone who's training for the CrossFit Games.

What did I miss?

Any other courses on your radar that I missed? Is this helpful? Please let me know, I'd love to hear from you.

Pregnancy Exercise Regrets

When people ask what I do, I explain it in a nutshell like this: 

"I teach moms all the things I wish I had known about exercise and the pelvic floor before and after pregnancy."  

Did I do ANYTHING right when I was pregnant? It wasn't a nine-month facepalm, but there are definitely things I did that I now regret. If I had it to do over again, here's what I would change:

Being the valedictorian of pregnancy fitness.  I was in good shape going into the pregnancy and that competitive streak didn't shrink as my belly grew. I was soooo proud that even pregnant, I could out-plank, out-burpee, and outrun non-pregnant moms. I didn't think I needed to let pregnancy "slow me down," even though it quite literally DOES slow you down. "Light on her feet" is not a phrase usually applied to pregnant women, for good reason. I wish I could tell myself that there's no shame in slowing down and admitting that pregnancy changes things, because it DOES!

Core and pelvic floor what? I knew hardly anything about the core and pelvic floor. I hadn't experienced any leaking during or after my first pregnancy, so I assumed it would be the same the second time around. You can thus imagine my surprise when I peed myself while jumping rope around 16 weeks pregnant. I didn't investigate any further how I might prevent this other than "don't jump."  Brilliant solution, except when you discover your toddler hovering right at the top of the stairs and you have to leap to catch her. I only modified what I needed to in the moment, and didn't really consider the longer-term impact of all that, well, impact. 

Focusing on the short-term. Pregnancy is a very, very small window of time. *ducks as 38+ week moms toss their copy of "What to Expect When You're Expecting" at me*  But seriously! We're talking about 9 months out of how many years of the rest of your life? The choices we make during pregnancy DO impact our bodies, and sometimes the effects of those choices aren't fully known until later on. For instance: while I don't know if I could have avoided pelvic organ prolapse, I know that the things I was doing were NOT supporting my pelvic floor and certainly contributed to it. Was running and jumping rope worth having to think about this for literally the rest of my life? No, it wasn't. We need to be evaluating risk vs. reward during pregnancy and thinking about the long game.

pregnancy.jpg

 

But hey there's a silver lining! I did make some good choices! Here's what I'd do again:

Walking. I walked a ton, especially in my last trimester. We walked a loop or two of about 1 mile around the neighborhood with my parents several nights a week, and during the last few weeks, one loop was all I could handle. It was hilly, hot, and once was quite enough. Walking is so completely underrated as a form of exercise, especially for pregnant and postpartum women. I thought that I was pretty lame for not keeping up with running throughout my whole pregnancy, but now I'm very glad that I spent so much time walking. 

Relaxation. I took a nap almost every day of my third trimester when Natalie went down for her nap. If we ever have a third baby, there's no way I could get away with that luxury again, but I took advantage of it when I could! I'm a big fan of Hypnobirthing and I find their Rainbow Relaxation track to be incredibly, well, relaxing (duh), so I'd pop in my headphones, start listening to it, and be asleep within minutes. I always woke up just as it was ending about 20 minutes later, so I got a nice little power nap in. Oh napping, I miss you. I really, really needed that rest, though, and I'm so glad I didn't try to power through and be more "productive" during that time. Napping WAS productive for me.

napping.jpg

 

Weight training. While my exercise selection might not have been the best, I am grateful that I continued working out. It helped me feel more normal, more like myself, and when you haven't seen your feet in months and become winded just getting out of a chair, anything that helps you reclaim your sense of self is really important. Weight training and exercise during pregnancy is AWESOME - obviously I am pro-prenatal exercise and love having pregnant moms in my class. We just need to make adjustments as-needed (which is frequently! and that's ok!) and not keep doing what we've always done just because we can.   

TL;DR: 

What does it mean to be "pelvic floor-friendly"?

I may have mentioned the pelvic floor once or twice or a million times on this website and on my Facebook page. But how does that factor into our workouts?

What does it mean for a class to be "pelvic floor-friendly"?

It starts before you even walk in the door. I have all my moms fill out a detailed health questionnaire before coming to their first class so I have a lot of the information I need to make sure the workout is not only appropriately challenging, but also appropriate for whatever stage they may be in of pregnancy or the postpartum period.

These are questions you probably haven't been asked before by a personal trainer or group fitness instructor.

Do you have any bladder or bowel incontinence? Did you have a vaginal birth or a c-section? How old are your children? Are you currently breastfeeding?

There are all REALLY important questions and I write all my class workouts with these answers in mind.

A mom whose youngest child is five years old and who had a vaginal birth and no incontinence issues has different workout needs than a mom of a 5-month-old baby who experiences leaking every time she coughs or sneezes and is exclusively breastfeeding.

Are these personal questions? Yes. And I am so grateful for all the moms that trust me with this information. Because unless I know the honest answers, I'm not going to be able to help you work towards running without leaking, or whatever your goal may be.

What kinds of workouts can you do?

We mostly just sit around and take deep breaths while we stretch our hamstrings.

Kidding ;)

If you have any pelvic floor problems, whether it's leaking, pelvic organ prolapse, or anything else, you might think one of two things: 1) I can't do ANYTHING and the only kind of exercise I'll ever be able to do is walking, or 2) I already leak/have a prolapse, so it doesn't matter what I do. I'll just wear a pad or plan on surgery later.

There is a middle ground, I promise you.

It's really, really important that your first stop is not to my class, but to a pelvic floor physical therapist. I'm not a doctor or a physical therapist, I don't diagnose or treat anything, and obviously I'm not going to do an internal exam to figure out what, exactly, is going on with YOUR pelvic floor. That the job of your friendly neighborhood pelvic floor physical therapist.

But assuming that's all taken care of, I'm sure you're wondering what, exactly, a pelvic floor-friendly workout looks like.

stroller strong fitness for moms
stroller strong fitness for moms

And the answer is, it looks a lot like strength training. High impact exercise (running, jumping, etc.) is the primary culprit when it comes to bladder incontinence, but strength training takes those jarring movements out of the equation.

If you've never set foot in a weight room, I don't want you to freak out. No previous experience is required to join us at Stroller Strong. I will coach you through everything we do, and I'm not going to start you off with 200-pound deadlifts. Fear not -- this is a kind, supportive environment.

Moms doing bodyweight squats in a fitness class
Moms doing bodyweight squats in a fitness class

Strength training is SO GOOD for moms. You'll feel like a badass, and because we are also mindful of the pelvic floor while we lift weights, we're actually improving our pelvic floor function at the same time.

But what about cardio?

I can sense your panic. You love to sweat during a workout, and you don't feel like you've accomplished anything if your heart isn't racing when you're done. But if we're not running or jumping, how do we accomplish that in a pelvic floor-friendly framework?

Scroll back to the top of this post and check out that picture for just one answer. You see the sleds those mamas are pushing? If you think that won't get your heart-rate up, have I got a surprise for you!

Is anyone else concerned about the insufficient lighting in this facility? That just seems like an accident waiting to happen. I'm also sad to say that there will not be a fog machine at Stroller Strong.
Is anyone else concerned about the insufficient lighting in this facility? That just seems like an accident waiting to happen. I'm also sad to say that there will not be a fog machine at Stroller Strong.

We can also use battle ropes! There are few things as satisfying as the THWACK of the ropes on the floor, and trust me, you're gonna FEEL it. We can use one arm at a time, both arms, sitting on a box, standing, hang it from a squat rack and use it to pull ourselves up to standing -- for a single piece of equipment, we can do a lot of conditioning exercises with it.

Or if those aren't your cup of tea, how about medicine balls? Try to smash the ceiling (you won't, they're super high for a reason!) or knock your partner over as you use all the power in your body to fling that ball.

There's also an exercise bike. Full disclosure, I personally hate the bike. But if YOU like it that's cool and it's totally fine to use that to do some intervals!

My point is, WE HAVE OPTIONS. Sweating and improving our cardiovascular system is not the sole provenance of running.

Does that mean we're never going to run sprints or anything like that in class? No, it means that I take your personal needs into account, and if you are experiencing leaking when you run, I'm definitely not going to have you do sprints until that improves. Pushing through an exercise even when you're leaking is not going to help and your pelvic floor is not going to magically improve on its own.

Essentially I treat running and plyometric exercises (any kind of jumping movement, even something as basic as a jumping jack) as exercises that need to be earned. Remember how I said I wasn't going to start you off with a 200-lb deadlift?

Running sprints is essentially the same thing as a 200-lb deadlift for your pelvic floor. Just as we strengthen all the muscles that allow us to deadlift and gradually pick up more and more weight, we also gradually add in higher-impact exercises to be sure the pelvic floor can handle it.

Final answer: it depends

What it really comes down to is this: a pelvic floor-friendly workout is a little different for a mom with prolapse, vs. one with no prolapse or leaking but significant diastasis recti, vs. no pelvic floor issues at all. The beauty of strength training and finding alternatives to cardio other than running is that we can tweak a lot of different variables to make it work for YOU.

Links:More information about Stroller Strong Ready to give it a go? Schedule your free FITSTART session here!

One Year

Today my baby, Olivia Joy, turns one year old. It's been quite a year. Being a mom of two has been at turns surprising, exhausting, exhilarating, and hilarious.

I've learned a lot about my kids, but I've learned even more about myself.

I'm not nearly as patient as I want to be.

I'm stronger than I ever thought I could be.

I can survive for FAR longer than I ever thought I could on a fractured sleep schedule.

Before Olivia was born, I was determined that I'd do things differently in the postpartum period. I had a lot of regrets about my distinct lack of movement and exercise during my pregnancy with Natalie and after she was born, so I swung waaaay in the other direction.

I wouldn't be lazy. I'd get right back into working out. I'd "bounce back."

*cringe*

Well, I did work hard, and I did jump RIGHT back into working out, and, well, we know how that turned out. (Hellooooo prolapse!)

But at the same time as my prolapse diagnosis (and what actually drove me to pelvic floor physical therapy), I was learning an amazing amount about the pregnant and postpartum body and what happens when we push too hard, do too much, try to pretend like we DIDN'T just have a baby.

To say it's been an eye-opening year is an understatement. I wouldn't exactly say that I'm grateful for the prolapse, but I am grateful for the crash-course in pelvic floor dysfunctions that it's given me.

I know it seems a bit odd to focus on me me me when it's my daughter's birthday, but the conclusion I've come to, now that this is my second time through a baby's first year, is that the first birthday really isn't about the baby it all.

It's a celebration of surviving that first year, because goddamn is it hard.

Is it amazing and rewarding? Does it make your heart swell up so big you think it's going to explode out of your chest?

OF COURSE.

But it is tough. 

So today, on Olivia's birthday, I'm being extra kind to myself. For her, it's just another day. But for me it's a hard-won victory. One more trip around the sun and we're all doing ok.

That's definitely something to celebrate.

Now here's a slideshow.

Mason Jar Salads: Lifesavers for Busy Moms

Have you ever found what seems like the world's greatest tip on Pinterest, only to try it and have it be a massive fail? (You're not alone; there's a whole blog for that. It's hilarious.)

I'm pleased to announce that I HAVE FOUND IT: a Pinterest trick that actually works.

Mason jar salads are lifesavers for busy moms! More info at fiercemamafitness.com
Mason jar salads are lifesavers for busy moms! More info at fiercemamafitness.com

I have three words for you: Mason. Jar. Salads.

Why I love mason jar salads

I know, I know. That bandwagon left the station about four years ago. But I'm dead serious, you guys, mason jar salads are a GAME CHANGER. If you follow the Fierce Mama Fitness page on Facebook, you know how much I've been raving about these things.

I make five at a time. And then I eat the same salad for five days in a row. If you're not into repeating meals, this might not be as big of a game changer for you. But if you're looking for a way to get more veggies into your day, or if every day at lunch you find yourself eating the crusts off your kid's sandwich and inhaling another cup of coffee...give these a whirl.

So, if I've piqued your interest, read on!

What do I need?

  • Mason jars
  • Stuff to put in the mason jars

All flippancy aside, yes, you obviously need mason jars. Tupperware containers won't work as well, according to the research I did (what, you don't research your salads?). I use quart-sized jars and they make MASSIVE salads. If you want to make side salads, or you don't want a salad that could also be served in a bucket, you might want to try pint or pint-and-a-half size jars (affiliate links).

PRO TIP: Make sure you get WIDE-MOUTH jars, no matter what size you're using. Otherwise you'll have a heck of a time getting your salad in and out of the jar.

Choosing a mason jar salad recipe (or just wing it)

The first step is to decide what kind of salad you want. When I was reading all about mason jar salads, I went on a pinning frenzy and pinned all the best giant salad recipes that I could find. Some of them are mason jar salad recipes; some of them are regular salads that could easily be assembled in a mason jar.

Check out my pinboard here to get some ideas of your own.

I have two main criteria for my mason jar salads:

  1. Plenty of protein and healthy fats. I don't want to be hungry again an hour after I eat it, so it needs to be a complete meal.
  2. Interesting! Lettuce, carrots, chicken, and some dressing is just not something I can face for five days in a row. Give me flavor! Give me crunch! Awww yeah.

I've tried three recipes so far for my mason jar salads and they are all, in my humble opinion, DA BOMB.

Chicken, Apple, and Pecan Salad

BBQ Chicken Ranch Salad

Thai Chicken Salad (note: I made the dressing as per the recipe in that link, then decided I really wanted a thicker dressing that was more like a peanut sauce. So I just dumped in about half a cup of peanut butter. #problemsolved)

Ok, I've got my recipe. Let's do this!

You'll definitely want to block off at least an hour to prepare your salads, maybe two depending on the complexity of the recipe. The chicken, pecan and apple salad, and the Thai chicken salad both took closer to two hours to prepare because there was sooooo much chopping and prep work involved. I know this sounds like a huge amount of time, but when you consider that all you have to do for lunch for the ENTIRE WORKWEEK is literally dump your salad onto a plate...two hours really isn't bad at all. Not for five meals.

If you want to save time, you can get pre-chopped or pre-shredded everything. Lettuce, cabbage, carrots, chicken, etc. It's pricier to do it that way, but you'll save a lot of time, so it's really your call. I'm working on keeping our grocery budget down, so I went the slower, cheaper route for most things.

Ingredients that you'll need for mason jar salads.
Ingredients that you'll need for mason jar salads.

Step 1: Cook your protein.

I've only done chicken so far, but you could totally do a taco salad with ground beef or something like that. If you are cooking chicken, here's my best tip: boil it.

HERE ME OUT.

I know, boiled chicken sounds absolutely unappetizing, right? But trust me. If you drop a chicken breast into a pot of boiling water, it'll be cooked through in roughly 15 minutes, depending on how big it is. And since you'll be shredding it anyway to put in your salad (at least, that's how I prefer it), the texture isn't really an issue. So you can drop it in the pot and get a really good start on chopping your veggies and not have to worry about monitoring the chicken.

Yes, your kitchen will smell like boiled chicken for a little bit. FYI.

Step 2: Chop all your veggies and other fixings.

Keep your leafy greens separate from the rest of the veggies! This is super important. Don't toss them all in one big bowl as you go along, or else your lettuce will end up kind of slimy by the end of the week.

Step 3: Layer those bad boys!

This is where the magic happens. How you layer your salads is critical to keeping everything fresh and delicious for five days.

Laying guidelines:

  • Dressing goes in first! In the picture below, I don't have any dressing but I do have chicken salad, so that went in the bottom of the jars. You want your jars to be layered with the driest ingredients on the top and the wettest on the bottom.
  • Hardy veggies like cucumbers and tomatoes go in next. Really anything that can sit in dressing and not get soggy and gross. For my chicken, apple, and pecan salad, that meant putting my chopped apples and whole grapes on top of the chicken salad.
  • Misc. toppings after that. Nuts, cheese, corn, black beans, anything like that.
  • Leafy greens on top. Lettuce, spinach, cabbage, etc. You can fit a surprising amount of greens in the jars, so don't be afraid to really pack them in there. I used fresh herbs (cilantro and basil) in the Thai chicken salad, and I put those at the very top of the jar.
Chicken, pecan, and apple mason jar salads
Chicken, pecan, and apple mason jar salads

Step 4: Seal 'em up!

Make sure your lids are on tight. Keeping any extra air out is super important.

Step 5: Admire and 'gram it.

Question: if you make a mason jar salad and don't Instagram it, did it actually happen? No, of course not. Seriously, how pretty are these things?

Thai chicken salad with peanut sauce dressing mason jar salads
Thai chicken salad with peanut sauce dressing mason jar salads

Step 6: Enjoy!

As fun as it is admiring your salad collection in the fridge, it's even more fun to have a delicious, filling, restaurant-quality salad on your plate and ready to go in your belly in literally one minute.

Chicken, pecan, and apple mason jar salad.
Chicken, pecan, and apple mason jar salad.

Step 7: Show me your salads!

You've seen my salad Pinboard, now show me yours! Tag me on Instagram (@alexishelmrath) so I can see your lovely, nutritious creations!

Mama in the Making

You’re pregnant? CONGRATULATIONS!! Have I got some advice for you, mama. Eat vegetables. Lots of vegetables! But plenty of protein, too (but no deli meat WHAT WERE YOU THINKING??). Are you eating enough? Are you sure? You’re carrying really small. Have you gained enough weight? It’s not healthy for the baby if you’re that skinny, you know.

Wait, no, I didn’t mean for you to eat half that cake by yourself. Don’t you know eating for two doesn’t REALLY mean eating for two? You still have how many weeks to go? Yikes, think you’ll make it? You’re REALLY big. Are you sure it’s not twins? It’s not healthy for the baby if you to gain that much weight, you know.

Are you exercising? It’s important to stay fit. You definitely want to stay in shape. Why aren’t you working out more? You’ll have more energy if you do. It’s not healthy for the baby if you’re sedentary, you know.

Wait, no, I didn’t mean for you to lift THAT much weight. Are you sure it’s safe for you to be doing that? Here, let me carry that. You’re still going to the gym? Did your doctor say it’s ok? I mean, I guess if your doctor said it’s cool, but...if it were me, I just wouldn’t want to risk it, you know?  It’s not healthy for the baby if you overexert yourself, you know.

How’s your stress level? Are you sleeping enough? I hope you’re calm and well-rested. Sleep while you still can, ha ha! *wipes tear from eye after laughing at own joke* But seriously. You need to be chill and get enough sleep. It’s not healthy for the baby if you’re really stressed out, you know.

Wait, no, what are you doing? No coffee for you. You can’t function without it? Well, maybe you should have thought of that before you got pregnant. You’re having half a glass of wine to relax before bed? Seriously? If you can't go nine months without one sip of wine, I really don't think you're ready to be a mom. It’s not healthy for the baby for you to have any alcohol or caffeine. Ever. In any amount. Ever.

Are you trying for a natural birth? Well, don’t try to be a hero. It’s not like you get a medal for having a drug-free birth, amiright? You’re having your baby in a birth center? Yeesh, I’d want to be in a hospital in case something went wrong. Things could go south just like THAT. *snaps fingers* It’s not healthy for the baby if something goes wrong.

Wait, so you decided to have a hospital birth? Have you ever seen The Business of Being Born? You need to do your research, is all I’m saying. Doctors just want to give you a c-section, so I hope you at least have a doula and a solid birth plan. Birth is NATURAL! Why would you go to a hospital! Here, let me email you some information about the effects of epidurals on breastfeeding rates. It’s not healthy for the baby if you have any drugs during labor.

YOU HAD YOUR BABY!! CONGRATULATIONS!! Do you think you’ll miss being pregnant? It’s such a magical time. *sighs wistfully*

Lessons from a Toddler: Intuitive Eating

My oldest daughter, Natalie, is 2.5 years old. She has some strange eating habits that I wouldn't mind saying goodbye to. When she eats a sandwich she scoops out the middle with a spoon, leaving a PB&J carcass splayed on her plate.

She finds a raisin in the couch cushions from snack time three days ago and pops it in her mouth. "Mmm, Mama, it's yummy!" 

Lately she's gone out of her way to point out each food item on her plate, identify it, and tell me she doesn't like it. Then goes ahead and eats the whole thing.

ARGH TODDLERS.

But she does have one habit that I hope she holds onto forever, a habit that I'm working so hard to reinforce, and one that I'm working on adopting for myself.

If she's hungry, she eats.

If she's not hungry, she stops eating.

Not exactly rocket science, right? Simple, but not easy.

I've been watching her lately and it's truly amazing. She can be in the middle of a single animal cracker, decide she's all done, and put it down and walk away. She is the definition of intuitive eating.

HOWWWWW CHILD HOW ARE YOU DOING THIS? TEACH ME.

She has none of the emotional attachments to food that so many of us do. She doesn't stress eat. Granted, she also can't drive and has no debit card, so swinging through the Dunkin Donuts drive-thru for a caffeine boost and a couple donuts for herself isn't exactly something she has the option to do at the moment.

She doesn't tell herself she's "being bad" if she eats a cookie. She doesn't praise herself for "being good" if she eats broccoli.

And I don't want her to do that. Not now, not ever. I want her to eat cookies sometimes because she wants one, and broccoli sometimes because it's delicious, especially with sweet potato fries and a nice burger. IT'S JUST FOOD. IT HAS NO MORAL ATTRIBUTES.

I think that my husband, Will, and I have a pretty good relationship with food. This hasn't always been the case for me.

I've done Weight Watchers and carefully meted out points for bread. I did mental arithmetic all day that left me with nothing for dinner except a salad of carrots and lettuce and a spritz of 1-calorie salad dressing, because I'd already "used up" my points.

I know many people lose weight and have been successful with Weight Watchers. They've also made a lot of changes (mostly positive, from what I understand) since I did the program almost 10 years ago. But I really, really didn't like how OBSESSIVE it made me about my food. Weighing literally everything. Cutting a cookie into thirds and eating one piece because that's all I had the points for. Thinking about nothing but POINTS POINTS POINTS all day long. This approach works for some people, it made me totally crazy. I lost weight while doing Weight Watchers but I didn't feel healthy, either mentally or physically. This is just my own personal experience and I'm not saying NO ONE SHOULD DO WEIGHT WATCHERS EVER.

I've gone the other way and completed a Whole30. I felt much better than I did on Weight Watchers, but then as soon as the program was over, I couldn't maintain it. I fell face-first into a pile of chocolate and went on a crazy sugar binge that left me nauseated and with a massive headache. I know it's a Whole30...as in, 30 days. Not meant to be continued indefinitely. But even eating that way, even, say, 80% of the time, left me feeling cranky and deprived.

Whole30 devotees, I know you are probably reading this and thinking but but but you didn't slay the sugar dragon! You need to do another one! It's amazing and life-changing and you'll feel so much better if you just do it!

I know you mean well. I really do. I used to be a Whole30 evangelist, too. But here's the thing: I don't have Celiac disease. I have no food allergies. Did I feel good when I wasn't eating bread and dessert every day? Yes. But was it sustainable for me? No.

For me, personally (and that's the key word, right there), bread is ok. I don't want to cut a huge swath of foods out of my life. I like dessert. I like toast with my scrambled eggs in the morning. And I'm going to eat the damn toast, because as I said earlier, IT'S JUST FOOD. IT HAS NO MORAL ATTRIBUTES.

I don't want my daughters to be afraid of food. I don't want them to see food as the enemy, as something to be controlled and mastered, something that you achieve victory over by eating certain things or not eating others.

How do we teach that? My relationship with food has gotten to a point over the years that I'm comfortable with, but it's not perfect. I have days where I eat a lot of Oreos and then I feel not-so-great about it. But for the most part, I move on. I ate the Oreos. It's over. I don't punish myself by eating less the next day or exercising more and trying to "work it off."

Can you imagine telling your kids that? That because they ate cookies today, they need to go for a run tomorrow? Insanity. So why do we treat ourselves like that?

I'm not a nutrition expert. I'm not a doctor. I'm not a psychologist. I'm not anything except a mom trying to do right by her kids.

So when Natalie offers me an animal cracker, I accept it with a big smile and a thank you! and I eat it. I love animal crackers. She loves animal crackers.

And when she offers me a couch-cushion raisin, I politely decline while snagging it out of her hand and throwing it in the trash. I don't love couch-cushion raisins. That's one food group I'm totally ok with cutting out of all of our diets.

My Story, Part 3: A Radical Change of Heart

If you're just joining us, this post will make much more sense if you read Part 1 and Part 2 first.

THIS IS SO EASY! I'd proclaim on social media. I FEEL GREAT! WE'RE SLEEPING SO MUCH! I LOVE BEING A MOM OF TWO KIDS!

I crumbled every once in a while. Sobbing in the shower for no particular reason. Staring at Olivia and wondering why I wasn't content with just Natalie. Wishing we had waited until Natalie was older and more self-sufficient before adding to our family.

(Yes, I did seek treatment from a therapist for postpartum depression. If this is something that you, too, are experiencing, please pick up the phone and make an appointment. The website Postpartum Progress is a wonderful resource. Know that you're not a bad mom and you're not alone.)

Mostly I missed my old self. I wanted to lace up my running shoes and knock out a three mile run, easy breezy. Planking? Sure, I can plank for days! You want to see some push-ups? Bam, let's do a bunch! I missed doing those things and was desperate to feel like more than a milk factory.

At the time, I was working with an amazing online coach (Jessie Mundell at JMG Fitness Consulting -- definitely check her out if you're looking for an online program!). She gently suggested that I go see a pelvic health physiotherapist, just to make sure everything was healing a-ok and that I was doing the right things to strengthen my pelvic floor. I'm embarrassed to say I brushed her off. I didn't think that advice applied to ME. After all, I'm fit! I wasn't like these other women who "let themselves go" during pregnancy.

PLEASE note that I was a complete and total idiot for believing things like that, and I'm ashamed to have had those thoughts. I'm sharing it with you now because I want to be 100% open with you about how I got to where I am now. Basically I was a judgemental asshole. I'm sorry.

So I skipped visiting a pelvic health PT and jumped straight into the Couch to 5k running program and into an intense strength training program.

I was 6 or 7 weeks postpartum and INSANELY proud of "getting back on the horse." I was being congratulated right and left in person and online. Superwoman, beast, amazing, so inspiring! I really did feel like a rockstar. I am the valedictorian of postpartum fitness! In just a few short weeks I moved from bodyweight exercises, to lifting weights with just the barbell, to adding a significant amount of weight (for me). I was back squatting 70 pounds and deadlifting 100 pounds. I was also running 2-3 times per week.

A photo posted by Alexis Helmrath (@alexishelmrath) on Sep 24, 2015 at 7:39am PDT

 

If you look up "pride goeth before a fall," this is the picture you'll see.

When Olivia was a little over three months old, our household got hit with the plague. It was a miserable two weeks as we all traded some nasty virus back and forth. I could barely get out of bed, let alone work out. I never did make it back to the original, aggressive schedule I'd set for myself, but I did work out here and there.

While all of this was going on, I'd started finding more and more inspirational women in fitness to follow on social media. I was discouraged with the training I'd received, particularly since the guidelines I'd learned for working with pregnant and postnatal women (my ultimate goal!) just...didn't seem right. I reached out to one amazingly awesome trainer, Jen of Mama Lion Strong, for advice on reputable, ACCURATE continuing education. She pointed me towards some fabulous resources, and that truly changed everything.

I dove into learning about the ins and outs of the pelvic floor. What it does, why it matters, and why basically EVERYTHING I'd been doing was such a bad, bad, bad idea. I inhaled all of this radical (to me) information and finally, finally, finally understood everything that Jessie had been trying to tell me months earlier.

When I came up for air two things were abundantly clear to me:

1. I needed to go see a pelvic health PT. 2. The fitness industry, particularly the pieces of it that serve perinatal women, is broken.

The constant push of harder, faster, stronger, of "get your pre-baby body back!," of "lose the baby weight fast!!!," of hating our postpartum bodies and beating them into submission, of "what's YOUR excuse?"...these ideas are not serving anyone.

I thought I was respecting my body -- I never pushed through pain or discomfort. I thought I was challenging myself and being strong. I thought I was doing the right things.

But I wasn't.

My visit to the physical therapist revealed that I have a grade 2 bladder prolapse. She's confident that because I only have a few symptoms and because the overall tone of my pelvic floor is in pretty good shape, I can make a lot of improvements in a 4-6 week span if I'm diligent about doing my homework.

She can't say for sure what caused it, but she agreed that everything I was doing certainly didn't help. This is something that I'll have to keep an eye on (figuratively speaking, of course!) pretty much forever, because prolapses don't ever completely go away. In the grand scheme of things, though, it's extremely managable.

There's a lot of things I wish I could change about how I treated my body during pregnancy and after Olivia was born, but I can't. I honestly didn't know better at the time.

But now I do. I know better, and I will do better -- for myself and for the women I'll be working with.

This message of respecting your body, of honoring the work it did during pregnancy and birth, of loving your postpartum body for the AMAZING things it's done, this is the message I want to spread far and wide.

Does that mean we'll never run or lift weights again? Of course not!

But the thing I've come to realize is that the time we spend being pregnant and recovering after having a baby is actually very, very short. I have exactly one pelvic floor and I've already done a number to it, and for what? Some likes on Instagram?

Let's take the long view, mamas.

It's not easy. I know this. I'm living proof of this. But if we can accept and believe --TRULY believe -- that our self-worth is not measured by how quickly we get back to running 5ks or by how many weeks it takes us to fit in our pre-pregnancy jeans?

That would be a beautiful thing.

My Story, Part 2: Jump Around! ...or not

If you're just joining us, this post will make a lot more sense if you read Part 1 first.

Our instructor offered more low-impact options for those of us who were pregnant or just beginning their fitness journeys, but I never took them. I took an enormous amount of pride in still doing jump squats, burpees, and suicides, even at 20+ weeks pregnant.

(Are you wincing? I hope you're wincing.)

At the time I was studying to become a group fitness instructor myself, because we were planning a move to Knoxville, TN, and my biggest dream was to start a mom-and-baby fitness class of my own. The guidelines for working with pregnant and postnatal women was (and is), well, let's just say it: woefully inadequate. A very slim chapter of my textbook was devoted to "special populations," and of that only a few pages was spent on the specific needs of the perinatal woman.

Most of the current fitness advice for pregnant women boils down to "you can continue what you were doing before you got pregnant; just listen to your body." And this is good advice to a point. Listening to your body is always a good thing.

But sometimes your body is SHOUTING at you and you don't realize it, because everything else you've been told about working out while pregnant or after having a baby is misguided or flat-out wrong.

One day in class while I was about 16 weeks pregnant we were doing a circuit of exercises. I was at the jumprope station and I was killing it. Valedictorian of fit pregnant ladies, remember?

And then I peed myself.

I don't think anyone knew what happened, but still, to say I was mortified is a bit of an understatement. I rushed to the bathroom, cleaned myself up, and then finished the rest of class while I attempted to hold a kegel pretty much continuously.

Juumping rope was clearly off the table for me. Sneezing became problematic. But peeing yourself while you're pregnant is just what happens, right? A sad and unfortunate but completely unpreventable part of having children, right?

So I started wearing a thin pad to every class. It never happened to me quite like that again, but I'm certain I was leaking at least a little. I continued running and doing burpees, but eased off the jump squats and jumping jacks. Unless I was feeling particularly great that day, in which case I still did them. Because I am strong! I am fit! No need to let pregnancy slow me down! I will be an excellent example for all pregnant ladies everywhere. Look at me and be motivated! ...but let me change my pad first.

We moved to Knoxville in April 2015. Without my workout group I felt lost, but I continued studying and passed my group fitness instructor certification test later that month. I ran a few times (with a pad, of course), but by then I was in my third trimester and running had become really uncomfortable, so I quit and focused mainly on my strength training. My dad had a weight bench and a barbell, so I spent my time doing back squats, presses, pushups, and planks.

I finally stopped planking when my belly touched the floor.

The weather grew hotter and my bump grew bigger and my motivation waned. I stopped lifting weights and just did simple bodyweight workouts a few times a week, then maybe once a week, then didn't do much at all except walk in the final few weeks of my pregnancy. My main focus was on practicing my Hypnobirthing excercises and on dropping into a set of squats whenever I felt the tightening of a contraction.

My daughter, Olivia, was born four days before her due date in a very, very quick labor. I was up and walking around within a couple hours of her being placed on my chest, and while I followed the guidelines my midwife had given me about rolling to the side before I sat up, swinging both legs off the bed together at the same time, etc., I was still VERY mobile in the early weeks after Olivia's birth.

8 a.m. vs 11 a.m.

A photo posted by Alexis Helmrath (@alexishelmrath) on Jul 7, 2015 at 1:50pm PDT

I didn't feel like I had a choice. My husband had a limited amount of paternity leave (read: none, except for the handful of vacation days he'd accrued since starting his new job), and I had a two year old at home. She still needed her diaper changed and she still napped in a crib, and I wasn't about to teach her how to climb in and out by herself. I avoided lifting her for as long as I could, as per the midwife's advice. That turned out to be about a week, and then I was on my own for most of the time with a newborn and a toddler.

It's ok, I told myself. I'm strong and I'm fit and I'm careful about how I lift her. It will be ok.

I was so proud of how capable I was, of how much more I was able to do this time around compared to after Natalie's birth. Physically I felt much better the second time around. Less achy, especially in my back, less pain from the delivery, and very little of the excruciating breastfeeding pain I experienced with Natalie as she and I attempted to learn together how to do it.

I really saw this as my chance at redemption. After Natalie was born and my husband, Will, went back to work, I felt so helpless. I didn't know what to do with this tiny creature who felt like she was destroying my chest every time she needed to eat, which felt like every hour around the clock. I cried a lot. I hurt a lot.

I didn't want to feel like that again. This newborn thing was now old hat, and I was determined to show myself and everyone else how awesome a mom I had become, to prove how much I'd grown in between my first baby and my second.

Continue reading the final installment in Part 3.

My Story, Part 1: From Bookworm to Bootcamp Badass

I was never athletic as a kid. As my sister will tell you, I much preferred reading a book to running around outside. Gym class in elementary school was fun -- Parachutes! Capture the flag! Red rover! -- but in high school? I prayed every day for some kind of natural disaster that would simultaneously strike all the athletic fields and the gym, leaving no other option but to sit quietly and contemplate all the ways our lives are enriched by not playing team sports. But then after college I discovered that fitness could actually be fun, and it didn't have to involve standing awkwardly in the farthest corner of a field, wishing fervently for the ball to never, ever come my way.

It turns out that bootcamp-style fitness was my thing. Pushups and sprinting drills and burpees, oh my! I LOVED it. And I was good at it. Not at first, of course, but as I went to more classes I got stronger, faster, and tougher. I got really good at pushing through that mental wall where your brain is saying pleeeeaaaaaase let's just lie down on this nice soft grass and take a nap.

That led to a brief flirtation with CrossFit, which I quit after two months because I got pregnant with my oldest daughter, Natalie (now 2.5 years old). I probably could've continued, and I know many women do, but it was just too much for me. I was tired and nauseous and skipping classes left and right, so I dropped my membership and did literally nothing the rest of my pregnancy. My commute involved a fair amount of walking back and forth from the T (we lived in Boston at the time), so I did get in a lot of daily activity that way, but I didn't do any formal exercise or classes. Mostly just sitting on my butt and eating a lot of mac and cheese.

Ah, the luxuries of a first pregnancy.

Natalie was born at the end of July in 2013, and by early September I was itching to start running again and start to get back in shape. My midwife had cleared me for exercise, so I very slowly started the Couch to 5k program. It took me at least 12 weeks to finish the 6-week program, and by that time the cold and early evening darkness had started to descend on New England, so I shelved my running shoes and really didn't do much for a few months. I'm a fair weather runner, fo' sho.

Natalie-alexis
Natalie-alexis

In February 2014 I was invited by a friend to try out a mom-and-baby stroller-based fitness class. That's the one I credit on my about page with changing my life, because it did, 100%. I started by going to class once a week, and then after two months I jumped in with both feet and did my best to get there three times a week. That was really the tipping point for me in terms of seeing results, and soon enough I was in even better shape than I was before I got pregnant with Natalie.

That summer I felt amazing. I was attending classes regularly and training for my first post-baby half marathon, which I completed in October 2014 with my second-fastest time ever.

That baby stole my medal!
That baby stole my medal!

I wish I could say that I was solely motivated by the desire to outperform myself, but I'm going to be completely honest with you -- I'm way too competitive for that. Every time I could run faster than someone who used to be faster than me, or do more pushups or hold a plank for longer than anyone else, it thrilled me. This is...not the best personality trait. A little fun, healthy competition - sure. But I took it to a new level in my own head. EYES ON YOUR OWN PAPER, HELMRATH.

(I'm working on it.)

I got pregnant with our second daughter, Olivia, in late October 2014. And I was ecstatic. This was it -- my chance to be the valedictorian of all fit pregnant ladies. I would not let myself go like I did the first time around. I was going to keep running, keep planking, and keep burpee-ing.

...continue reading Part 2.