Defining Moment Getting Back on Track (and Field) After Pregnancy Giving birth begat a new career. By Christine Iverson, PT, DPT, OCS | July 2016 Listen to 'Defining Moment' Motherhood is a pivotal event in a woman's life. Preceded by expectations, filled with surprises, and shaped by individual decisions and circumstances, it's a journey that's at once universal and unique. One thing that all new moms have in common is the overwhelming sense that everything has changed. When I became pregnant for the first time 4 years ago, I'd just completed 12 years in the military, having served as a physical therapist (PT) in the Army. I expected I would miss the deep sense of accomplishment and honor I'd felt helping Infantry and Special Forces soldiers to heal. And I did. I also expected, because I'm a workaholic, that I'd return to work as a PT 6 weeks after delivery. That didn't happen, however. I decided to take a little time just to be a mom. Little did I know that what I'd regarded as a brief hiatus would completely change the course of my career. My pregnancy, though technically high risk, was relatively normal. I started having contractions at 22 weeks but never was placed on bed rest. I delivered vaginally at 39 weeks. As I prepared to leave the hospital, my obstetrician gave me the standard advice to resume exercise gradually. That sounded easy enough. I was a lifelong athlete and former NCAA Division I runner. How difficult could resuming exercise be? As I began walking—make that waddling—around my neighborhood, pushing a stroller in front of me, I wondered where the rehab protocol was for this. I mostly was continent, so I didn't meet my OB's threshold for a referral to women's health physical therapy. I had no overt orthopedic injuries, but I felt far worse trying to exercise postpartum than I had after any of my running injuries over the years. For those past injuries I'd received hours and hours of physical therapy. In fact, as with so many PTs, I'd based my career choice largely on the expert care I'd received. I quickly found, however, that most of the readily available postpartum exercise books and Internet instructions were written by fitness instructors or personal trainers. They tended to be narrowly targeted at improving the appearance of my belly. None of them reached the threshold of what any athlete would consider a challenging workout progression. My OB's advice to gradually resume exercise was in line with the American Congress of Obstetricians and Gynecologists' guidelines for recovery after childbirth, but it lacked specifics and didn't spell out the kind of progression I was accustomed to providing to my orthopedic patients. While nothing about pregnancy and childbirth is injurious by definition, the whole-body changes a woman experiences during pregnancy are complex—as are the demands on her body in the postpartum period. Exercise after pregnancy is about far more than simple reconditioning. Optimal return to athleticism after childbirth requires rehabilitation of the affected muscles and joints, restoration of motor control, keeping an eye out for injury prevention, and understanding the intricacies of the postpartum condition. As I began to research the topic I discovered a wealth of research reports on the anatomic changes that occur during pregnancy, postpartum biomechanics, breastfeeding and exercise, the effect of a mother's exercise habits on the likelihood of her baby developing a lifelong love of movement, postpartum fatigue and depression, and injuries that are common among new moms. So much pertinent information was available! But it was buried away in research journals, beyond the easy reach of moms. That's when it hit me. The art, science, and soul of our profession is rooted in getting people moving. PTs heal, optimize performance, restore function, and prevent injury. Our expertise should be available to all new moms—not just those with severe pelvic floor issues and orthopedic injuries. Even women who have "uncomplicated" pregnancies and deliveries experience complicated changes to their bodies. Many new moms find exercise and athleticism so daunting in the early months and years of motherhood that their temporary break from fitness maintenance may become permanent. But exercise is so important to their long-term health—and that of the women and men their babies will become. "It's time to help." Those words echoed in my mind. I felt compelled to share what I had learned. So, gathering together the available evidence, I wrote a book for new moms. It features a rundown of the latest research on postpartum exercise and offers a challenging exercise progression that melds orthopedic sequencing, pelvic floor basics, functional fitness approaches, and injury prevention. But there's so much more work to do to reach all the moms who need help. For so many, exercise isn't simply about being able to fit into our pre-pregnancy jeans. It's about the fact that we love to move and are dedicated to fitness. Exercising is how we cope positively with change and face each day with renewed vigor. It's time that we as a medical community catch up with the needs of the postpartum athlete. Nearly half of all American girls now participate in high school sports. The same proportion of women, statistics show, are getting at least 2.5 hours of moderate-intensity cardiovascular exercise a week. Some 20% do strength training twice a week. CrossFit gyms are booming, as are women-only and women-centric athletic competitions. Many women who participate in these activities and events are mothers. For them, like me, general advisories to "gradually" return to exercise aren't enough. What are the keys to challenging ourselves in the ways that we always have, but doing so safely? During this pivotal time in my life and career, I've concluded that PTs must lead in this area. What is required, as I see it, is a fundamental change in the way the profession of physical therapy addresses this need. I'd like to see PTs offer postpartum exercise classes in community settings ranging from new-parent support groups at hospitals and Ys to workout spaces in gyms and even at running stores. I envision PTs like me—ourselves new moms—in the forefront of such efforts. Who, after all, is better suited? It strikes me as a perfect fit in another way, as well. In this manner, new-mom PTs who want a break from the demands of the clinic nevertheless can continue to make a difference—and meet their state's "active practice" licensure requirement (where applicable) at the same time. I'm exploring these teaching avenues myself. The moms in our communities need our help. We are ideally trained and skilled to be the experts in helping them safely return to exercise after pregnancy. What I have learned about postpartum exercise has been invaluable to me as a mom, woman, and athlete. It has lit the way to this exciting chapter in my career. It's my hope that my PT colleagues will join me in lighting the way for other postpartum athletes. I want all new moms to know, and have the opportunity to experience, what I've learned and experienced in recent years: that motherhood can be a baby bump along the road to future finish lines and personal bests. Christine Iverson, PT, DPT, OCS, lives in Alexandria, Virginia, and has a website at http://postpartumathlete.com.