Jen:
Welcome to the Mum Safe Movement Podcast. I'm your host, Jen Dugard, and in today's solo episode, I wanted to share some of the things that piss me off a little bit. Now, I've been working in the fitness industry for 17 years and I feel like I'm feeling at the moment Like maybe my voice is not loud enough, or maybe my voice is not heard enough. So lately I've been thinking about myself as a little bit gray. I've always had this personal policy that we must raise our industry to a higher level rather than shaming or calling anybody out. And whilst I'd never shame an individual, I am wondering if my message about working with mums more safely and effectively and raising the standard of maternal health and fitness sometimes fades into the background because until now I have shared my opinion in a very neutral kind of way. If you were ever to catch me on a stage and you asked me a question, I might be a lot more vocal, possibly because of the confines of four walls. but on social media I've been careful. But after 17 years in the fitness industry and 15 of them dedicated to raising the standard of the way we work with mums, I have to admit that I'm really fucking frustrated. I'm frustrated by the way things move too slow, really slow, and I'm frustrated that the places or those people in places of power, who may from time to time have given me airtime, they've listened to what I have to say, simply do just that. They listen, they nod, and then they go back to business. I was talking with a friend this morning about how it feels to have an opinion and how it feels for people to push back on that opinion. I posted a post on Instagram, not last week, the week before. and the statement was how lunges, no, how Pilates and yoga are damaging your pelvic floor. Now it was a very blanket statement, I get that, and I also know how I could have made it more palatable and not upset those members of the yoga and the Pilates industry that pushed back on that post and all credit to them. But if you flipped through the post further, it did go on to explain that no exercise is a bad exercise, it's simply how it's being done. And that post came from a pissed off place where those of us, and I love yoga and I love Pilates by the way, those of us that steer more towards strength training get a bad rap. So there's this misconception amongst the industry, not really amongst the industry, amongst mothers. that doing yoga and pilates in pregnancy and postpartum is safe. Now maybe it is and maybe it's not and maybe removing her from a strength training environment and pushing her into a yoga or pilates environment in pregnancy is not all that effective. But really none of those things matter and it was me just standing up and saying I'm just frustrated with the preconception or the fact that strength training gets a bad name in favor of this blanket misconception that one type of exercise is better than another type of exercise when it comes to working with pregnant and postpartum women and This kind of formed the basis of what mom safe stands for Mom safe is not a one-size-fits-all Community we have yoga people we have Pilates people we have CrossFit people we have strength training people, when I say people, I mean, mumsafe trainers and instructors, because my mission was never to create a one way is the right way environment. It was to say, hey, here's a set of guiding principles, which you'll find inside of safe return to exercise. And then as you become a mumsafe trainer or instructor, these are the benchmarks that I know make sure holding whatever discipline that you do to a high standard. And part of that is partnering with a pelvic health physio and being registered with one of our fitness bodies. Obviously I have a favor of Ozactive, but get yourself registered. So let's move away from that conversation, the yoga and Pilates, and please know, I was never targeting, but then hey, here I am saying maybe I should be a little bit less gray, and then I put up a post and then I... my instinct is to kind of neutralize the conversation by explaining myself away. And it's interesting because there are a couple of comments on there that I didn't reply to. And I chose not to reply to them because it was taking up headspace. And for me, it was I wasn't insulting anybody, although I know it was a blanket statement. And you can interpret that however you like. But if one person then goes away, if one mother questions... any discipline of exercise that she's doing, whether it's yoga, Pilates, gym, CrossFit, ballet, I don't care what she's doing, but questions the ability and the education of the person that is guiding her, or if one instructor in any scope of our industry decides to kind of go back and go, oh, I'm not qualified in this area, then the poster's done a good thing. And hey, we started a conversation. Let's recap some of the statistics, which are part of the reason why I get so pissed off in this space. So in 2022, it was reported that 4.4 million women used our gyms and fitness facilities. That was in comparison to 3.5 million men. Okay, so we've got less men using our gyms and fitness facilities than we do women. Now there was a statistic from the ABS in 2016, and I quote this a lot, which reported that 77% of women over the age of 15 in Australia would become mothers. Now, I asked my 15-year-old son to help me with the maths on that, and it turns out that 42.7% of the population that walk into our general fitness facilities are mothers, not... just women, and I shouldn't use the word just, but not only women. So we've actually got more mothers using our gyms and fitness facilities than any other demographic. In 2021, 315,705 babies were born to 311,360 mothers in Australia. That's a lot of babies. and a lot of births. More statistics for you that women make up 80% of those who report living with incontinence. Half of all women who've had a baby will experience prolapse. And in 2013, it was estimated that the annual cost of incontinence in Australia is $6.7 billion. Now I could go into more and more statistics around birth trauma, but I wanted to keep the statistics here kind of surface level because this pissed off conversation needs to be pitched at the people that don't think that they're a player in this game, where those people that are running our big botched facilities and are general fitness environment that are not necessarily running specialized exercise sessions for mums, understand the statistics in the way it relates to them. Because I know that when I'm talking to the trainers that show up to do safe return to exercise, or they've done another awesome pre and postnatal course, and there's lots of them out there, that I'm kind of preaching to the converted. but what those statistics do for those people. And if you've not heard them before and you are nodding along as you go, then this gives you more ammunition to say, hey, we need to do better. I did a survey in 2016. We surveyed 756 mums. We need to do it again, but we did it back then. 50%, sorry, 59% of the women surveyed said that their pelvic floor was not checked at their six week checkup. 82% were not referred to anyone postnatally for a pelvic floor screening. And 50% of those who said they were living with pelvic floor weakness had never sought any help. And 60% of those people, those women, mothers, were given no return to exercise guidance at all. We really must do better. That was 2016. I'm frustrated that although we have a rising tide of independent exercise professionals who have sought out more knowledge and know that they need to know more, there are those huge companies, businesses and brands and even the government that choose to ignore, to remain ignorant, to properly serve the 42.7% of their clientele that they feel like they don't have to fix the way that they serve them. because it's not broken. But the reality is that they are broken. These women, and I really don't like to use the word broken, especially when it relates to women, but I'm going to use it in this sense because many women do feel this way. They shouldn't because they're absolutely not broken. They're simply not being looked after well enough, but how can they be expected to feel any other way when they have no explanation for what they're going to? So these women may be paying you, and I'll say you in a general term, big box gyms, fitness facilities, anyone else that is working with general population. They may be paying you money to come into your exercise facility, and they may be keeping coming in droves, often because of the absolutely fucked up message that women are given about their body and the way they've been told that it should look. And many of these women are on a quest to get their body back. We're not gonna have that conversation today. I don't think that the people running these facilities actually understands the toll it takes on a woman's emotional and mental being when her body doesn't work in the way that it used to. And that the exercises given to you by your uneducated exercise professional, although uneducated through no fault of their own, because we don't know what we don't know, and that is part of the problem, make you feel worse. I don't think that these people understand what it feels like to leak when you jump. and to make sure that you only buy clothing to wear for the gym that hides what's going on. I don't think that they know what it's like to spend the rest of their day with an aching in your pelvis, knowing that something doesn't feel right, but have been offered no questions, no guidance or safe space to make sense of it. I'm frustrated because to me, the problems we have are so incredible. simple to fix if somebody decided it was worthwhile to execute. If someone decided that mothers were worthwhile. It sounds a little bit different when you put it like that doesn't it? We all have a mother or someone that acts as a mother figure towards us. We know how the majority of mothers are incredibly selfless in making sure that everybody around them is looked after, often leaving themselves to the bottom of the list. And if you're listening to this and you are in a position of power, maybe acknowledging your own mother, or your potential, your partner's potential suffering because of pregnancy and childbirth would make a huge difference to your motivation to create change. I highly recommend that you go speak to some mothers because there are so many women suffering in silence from things that were to do with their pregnancy, birth and postpartum experience that- could have been addressed many, many years before now. We need to understand that postpartum is forever. We need to understand that there are grandmothers living with pelvic floor weakness, whatever it may be, because nobody has spoken to them about what happened to them through their childbirth and beyond. And they've kind of slipped through the cracks now. So let's go into a few specific problems, shall we? And some solutions to go with them. Mothers are given absolutely no standard return to exercise guidance when they leave the hospital. And their six week checkup is the end of their medical care, not clearance to return to whatever exercise they were doing beforehand. Trainers don't know this. In the fitness industry, for whatever reason, we've taken six week checkup as meaning she's ready to return to exercise. That is exactly what it means in a way, but what it really means is it's the end of her postpartum medical care. And then from an exercise perspective, it means that she is ready to embark on her postpartum exercise journey, which... needs to begin with a rebuild from the inside out or a I don't want to use the word rehabilitation, but maybe that is the right word. I'm not sure why I'm stuck on that word right now. A rehabilitation process to move her forward into what her exercise journey looks like now. We're not even trying to get her back to anything. Although what I would say is if she is uneducated, she will see her six week checkup as a tick of approval to get back to the exercise she was doing beforehand. and she may do it in a very, let's say, enthusiastic way, which may not be the best approach for longevity of her exercise journey. We wanna make sure that she eases into the exercise or movement of her choice safely and effectively. So not only does mum not know this, but trainers don't know this. And as an industry, we must make this general knowledge in our certificate three and four education. I actually don't believe that full pre and postnatal training belong in this stage of learning for a new exercise professional. But I do believe that we must move them, we must move our graduate professionals from unconscious incompetence to conscious incompetence. meaning that they now know what they don't know. They then know, they would then know where their scope of practice ends and they would know that in order to work with this special yet mass population, they would benefit from doing some continued education in the space of pre and postnatal exercise. It's really not that fucking hard. If every single RTO gave me 15 minutes, I could get this done. 30 minutes or an hour would be better of course, but 15 minutes inside of our education so that we understand as new graduate trainers where we're at in terms of our level of education. Let's talk about if we did take it a little bit deeper. Many certificate three and four qualifications have specific modules on training older adults and also younger children. I did a little bit more digging on the Statista website. I kind of like that website. And the number of people participating in fitness and gym activities in Australia in 2021 by age, there were 2.2 million older adults, so 55 plus. let's remember some of those are mums, and 283.2 15 to 17 year olds. there were 3.34 million mothers. Yet when we think about populations that we wanna educate our graduate trainers in, we're gonna work with them around younger adults and we're gonna work with them around older adults, but we're not gonna work with them around mothers. Let's just let that sit for a little while. We also need to bust the myth, and I talked about it before, that it's still believed by many that postpartum has a timeframe. I took this quote from OzActive, and we've recently updated the OzActive pre and postnatal exercise guidelines, which I'm very proud to have been part of. The postpartum period is defined as the time immediately following birth and is often without a definitive end point. I love this quote, although I would say, I would take out often, I would take out and is without a definitive end point. So to fix, let's call it problem number one, where mothers are given no standard exercise, return to exercise guidance at all, and trainers are given no education around what they're educated in and what they're not educated in, or at least working with moms, we could simply fix that with a 15 minute presentation. in all of our certificate three and four courses or any other course that is leading you or towards being an exercise professional. Let's look at another issue that pisses me off. Specific pre and post, specific pre-exercise screenings are not provided. And when I'm talking about specific, I'm talking about a mum walks into the gym and... she's offered a generic pre-exercise screening. And it's often not done by the person that's going to train her. And I understand the implications of all of this, but we do need to make sure that we are given specific pre-exercise screenings. And I say that, but I also know that in some gyms, there is absolutely no pre-screening exercise process, pre-exercise screening process happening at all. which absolutely blows my mind, especially from an insurance perspective. How can you possibly train someone if you have no idea of their history and make sure that you're fully informed? But that's probably a conversation for another time. And let's hope that most gyms are doing the right thing. But when it comes to mums, there are three generic questions on most pre-exercise questionnaires. Question number one. is have you had a baby in the last 12 months? Well, the fact that we've just talked about postnatal being forever, you can see the floor in that question from the get go. So she may very well say yes to that question and move on to the next one, or she may very well say no to that question, have an 18 month old, a two year old or a six year old, and she's still suffering or experiencing. things that are happening to her body that are a consequence of pregnancy, birth, and postpartum. And we're now deciding that because she's over 12 months postpartum, that we don't need to ask her any more questions. That blows my mind. Question number two, they're asked if, if and only if they've had a baby in the last 12 months, if they had their six week checkup, because of course that is a tick of approval. We've already talked through the fact that a six-week checkup is not a tick of approval. So there's the flaw in question number two. And question number three is generally, do you feel okay? I can tell you there are a lot of mums that feel okay, but then down the track, they're not okay. Because although yes, sometimes a pelvic floor can be uncomfortable or painful, in many cases, it's not. In many cases when she has a weaker or lower tone pelvic floor that is further put under load due to the incorrect exercise or no I'm gonna say incorrect exercise because I'm getting bold right I'm gonna say the less optimal um the less optimal incorrect exercise choice for her right now she is potentially lining herself up or under the guidance of somebody that's lining her up for pelvic floor dysfunction or pelvic floor weakness or worse things that are happening down the track. Now I'm always very hesitant as well to talk about the consequences of these things because they don't always happen to everybody and we need to be very aware not to scare people with that. But as an industry we do need to have an awareness of what these consequences are. And I believe we need to move forward from a place of do no harm. So when we move slower into exercise again, and we go through the right procedures of making sure she can activate a pelvic floor, of teaching her about her transverse abdominis, and all the other step-by-step processes, it's not about moving her too slow, it's about moving her through each step so we know where she's at and that we do no harm. Problem number three, women are not automatically referred to a pelvic health physiotherapist postpartum. And many of our exercise professionals that are working with moms don't, well one, don't know they exist. And if they do, don't properly understand the value of working with a pelvic health physiotherapist or your mom, client seeing a pelvic health physiotherapist. As exercise professionals, we can't, cannot see or feel her pelvic floor. And no matter how good we are at our, excuse me, no matter how good we are at our job, we can't give her proper feedback or know what exercise intensity is right for her right now. Research suggests that 60% of women, instead of drawing their pelvic floor up when they're cued, they actually push it out. So I'm sure that you can imagine, If we as exercise professionals with no guidance, but we've heard about pelvic floor exercises, say, do pelvic floor exercises, or have you been doing your pelvic floor exercises and your mom client says, yes, we don't know that she's been doing them well, but we will take her on face value and go, okay, you've been doing your pelvic floor exercises. I think you understand your pelvic floor. I'm gonna take it that you do. And then I'm gonna cue pelvic floor brace. some kind of activation at the hardest point of the exercise because as trainers I know that you know that. We need to either breathe out or create tension or stability or whatever word you wanna use. Bracing, I hate it, but use the bracing word. When the exercise is at its hardest point. So let's say you've got a mom that has said to you, yes, I know how to do my pelvic floor exercises but she's never seen anyone. And she looks pretty strong on the outside. So you put her under a barbell Let's say you go 40 50 60 kilos, whatever it may be Whatever it may be and at the bottom of that deadlift or the back squat whatever it is you're doing you give her that q2 brace or tense or switch on or whatever it is and She thinks that she is drawing her pelvic floor up, but actually she's pushing out and she is now bearing down or pushing out under load. We as exercise professionals need to make sure that never happens to our clients. We need to make sure that postpartum, and in pregnancy, but let's roll with postpartum right now, our clients see a pelvic health physiotherapist postpartum to make sure she knows how to properly contract and release her pelvic floor. so that when you cue or when she is doing her pelvic floor exercises, she draws up instead of pushing out. It blows my mind that this is not a thing that we're more aware of. So 60% of those 42.7% of women, mothers walking into your gym, are potentially pushing out through their pelvic floor when they think that they're drawing up. Further to this, generic pelvic floor retraining is incredibly flawed. One, because we know they could be pushing out, but also if she has a hypertonic pelvic floor, this could show up as leaking. So what is our assumption? A woman that is leaking needs to do more pelvic floor exercises. Well, a hypertonic pelvic floor is one that is too tight. That means that she cannot release, or her pelvic floor does not release. to fully contract. Now, if I've got a muscle that is tight, I need to learn to relax that muscle in order to be able to take it through its full range of motion and it to be able to contract optimally. Now, if I'm uneducated as an exercise professional and my client, my mom client hasn't been to see a pelvic health physio, I might assume, like I said at the beginning, that her pelvic floor is weak and we need to do more strengthening exercises. I know that you can see the floor in that. A pelvic floor that is too tight that is given more pelvic floor exercises without being, without even the release bit, the relaxing phase being cued could have the potential to create even more problems down the track. Now I've just talked about all the problems, but the opportunity here is huge. Huge, not huge, huge. We have an awesome opportunity that is definitely a byproduct of the solution is that if every single gym environment recommended that every woman that had ever had a baby went to see a pelvic health physiotherapist, then as an industry, we would be a huge advocate for change. We would be picking up a huge number of the population of women, of mothers, who've left the hospital with absolutely no guidance, found their way into a gym that would never have been likely to, unless they stumbled upon a trainer that knows more. to have been given this information. Imagine if every single one of those 42.7% of women got referred to a pelvic health physiotherapist in their initial screening appointment. Now I understand in a big box gym or a generalized training environment, it's hard to enforce that they go, but we have to know that we would be a huge part of creating the change that we need if the policy was that every mother that walked into a gym got referred to a pelvic health physiotherapist. We'd be picking up so many women, many who had babies years ago, and bridging the gap, and literally changing their experience of being a woman. Problem number four, when our moms do get into the gym and pass that initial screening, many are offered personal training sessions upfront, or if they're not offered PT sessions upfront, they're in the gym and they're being, they're sought out by trainers that are looking to connect with new clients. Yep. What I know is that very, very few big box or commercial gyms or general training environments ensure that the trainers that these mums are connected with are actually vetted to see that they're appropriately certified in looking after her. The answer to this feels like a super big no-brainer to me because if she's not having a good exercise experience, she's leaking or whatever else it may be. Her body doesn't feel right and over time, the logical step is that at best, she's gonna stop training with that specific trainer and at worst, she's gonna stop coming to the gym altogether. Not that properly looking after moms should be a retention strategy, but if that's one of the ways that we get this over the line in those generic training environments, then let it be. But we need to make sure that every single trainer that is given a lead that is a mum is properly certified in pre and postnatal exercise to enable or to be able to look after that woman properly. Now there's a whole lot of other grey around this in my opinion when it comes to insurance. Like we all tick boxes on our insurance to say that we are qualified in the exercise that we are delivering to the person that we are delivering it to. I'm just gonna ask a question, whose responsibility would it be if a woman walked into a gym, the gym gave the lead to a trainer that was not qualified in working with a mom, the mom experiences an exercise induced prolapse, whose problem was that? Whose responsibility is that? Was it the gym? Was it the trainer? Was it the mom for not asking for the... trainer with the right qualifications. Let's just let that land. Problem number five, we have right now a huge lack of communication between industries, the medical industry, the allied health industry, and the fitness industry. But the reality is that we're all in this together and we must strengthen our relationships and ensure continuity of care for every single mother. We've started to do this inside of MomSafe. with our allied health. When I say started we've been doing this from the get-go. From the whole 15 years that I've been working with mums, I have partnered with a women's or pelvic health physiotherapist and one of the criteria of our MumSafe trainers is that they must be partnered with and create a two-way relationship. with the physiotherapists, the pelvic health physiotherapists that they're referring their clients to. It's not good enough to just send your clients there and hope that everything is okay. It's a good start. And if Big Box Gyms could do that, awesome. We've reached a new level of standards within our general industry. But if you are a trainer that is specializing in working with moms, you must create a two-way relationship with that physiotherapist so that... you understand what is going on with your client's body so that the information is relayed back to you and you can create the best possible exercise routine for her based on that information. So we've got many, many pelvic health or women's health physiotherapists on the MUMsafe website. And I'll create this as a call out. We are in the process of launching our pelvic health physiotherapist, official MUMsafe pelvic health physiotherapist partners. We're gonna be taking on 20 to begin with, to get this right. And if that is you, if you're a pelvic health physiotherapist, or if you're someone who knows a pelvic health physiotherapist, please get in contact because strengthening the ties or the connections between our industry and or industries is so incredibly important in creating lasting change. So to start to wrap things up a little bit, oh my goodness, I could go on for such a long time and I'm sure that this will not be the first, the last episode around the frustrations that I see in the industry and do as I get braver. Maybe I'll start to piss more people off, but it's all for a good cause. When we look after the health of mothers, there is a ripple effect. Her relationship with herself is better. There's less depression. Her relationship with her partner is likely to be better because who wants to have a close relationship with somebody when your body feels broken? Her relationship with her children will be better and her relationship with herself will be better. Mums are role models. They're the center of our family and they contribute a huge amount to society. So we need to look after them. But this shouldn't be the only reason we choose to look after mums. to be in service of others. Yes, it will make a huge difference in the long run, but the simple fact is that she deserves to be looked after. And as a collective, we can do better. So this episode, it's a way for me to start to get some of this shit off my chest. It's also a call out to every single person, industry, brand, and business that serves mums. Yes, in a specialized way, but really everywhere and anywhere that mums go to be looked after. where we can now clearly see and say that generic just isn't good enough. Like I said, it is an attempt on my part to get some of the frustration off my chest from having done this for the last 15 years and to truly feel like we're not moving fast enough into creating change. And to articulate some of the things that we need to do. to do better that again are moving way too slow. It's a call out to you if you're in a position of power that you can create change, to either take what you've heard and run with it or reach out to me and let me help you. I've been sitting in this stuff for 15 years and I have insight and experience that only comes with longevity in this space. And then it's a call out to you, the exercise professional who's nodded and agreed with everything that I've said. And I know there's more to say. To keep on fighting and to keep on raising standards at a grassroots level. In your community, one mother at a time because your voice is so needed. Keep sharing what you do. join our Mum Safe mission, or at least share this episode with a mum, with another trainer, with somebody in one of those positions of power, so that together we can reach more mums and ensure all women are looked after safely and effectively at every stage of motherhood. And to wrap up, I'd just like to acknowledge and offer a huge thank you to every single exercise professional who has completed safe return to exercise and especially to those who have joined the Mumsafe team. You've joined a movement, you are building an army, you are creating the change that we need to see in the world for mums and to every single physiotherapist who supports our Mumsafe trainers in the quest that they have to ensure all of their clients are looked after safely and effectively. So that's it for today. I hope that you've taken away something of value, something that gets you fired up, something that makes you go out there and have a conversation, whether you agree with me on these things or not. Have a conversation about the misconception in the industry around pre and postnatal exercise or what it means to be a mother or what it means to look after a mother. something that makes you go and reflect on the way that you operate in the industry. Whatever it is, I would absolutely love to hear from you. And I know that when we join together and we collaborate, that's the word isn't it, collaborate, we get to make lasting change. And hopefully, just hopefully at a really fucking faster rate, than we have done so far. I'd love to connect with you.
