Active Mom Podcast: Pregnancy, Postpartum, Perimenopause, Menopause & Beyond

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Brand new PT. Skilled nursing. Asking her patients what kind of exercise they enjoy. Women there for heart disease, osteoporosis, a broken hip.

And over and over, the same answer. They hadn't exercised since they had a baby.

That's where Dr. Lisa VanWiel's research started. She's a pelvic health PT and researcher at the University of Wisconsin La Crosse, and her work links leaking to a lot more than your bladder. Mental health. How women see themselves. Even heart health.

Not to scare you. Because if leaking is a signal, it's also a chance to get in early.

What we get into:
 🔹 Why Lisa sees leaking as a signal about the whole body, not just the pelvic floor
 🔹 What her research found about leaking, postpartum mental health, and how women see themselves
 🔹 Whether every mom actually needs pelvic floor PT (my answer might surprise you)
 🔹 Why nobody needs permission to move their own body
 🔹 20,000 medical records and a surprising link between leaking and heart health
 🔹 Association vs causation, in plain English

If you've ever wondered whether leaking means you should stop moving, press play. Then tell me: did anyone talk to you about your pelvic floor before you had your baby?

Find Lisa on Instagram at @empower_lab.

This episode is education, not individualized medical advice. Talk with your own provider or pelvic floor PT about your situation.

Chapters:
00:00 Welcome
00:36 Meet Lisa
02:19 Taking PT boards eight months pregnant
03:20 From pediatrics to pelvic health
05:50 Why prevention became the mission
10:04 Reproductive transitions and lifespan health
12:21 Leaking as an alarm signal, not the ending
14:21 Leaking and postpartum mental health
17:32 Leaking and identity
20:57 Active moms, and a system not built for them
22:28 Awareness vs actually getting care
27:01 Does every mom need pelvic floor PT?
28:53 Why gatekeeping activity is paternalistic
33:55 Pelvic floor PT is strength training
36:05 20,000 charts: leaking and heart health
39:12 Association vs causation, explained
41:25 The two competing theories
42:45 What’s next: female athletes and return to exercise
44:39 Teaching our daughters about their bodies
47:53 What it means to be an active mom
49:24 Where to find Lisa

The Active Mom Podcast — a real mom's guide to pregnancy, postpartum, perimenopause & beyond, for active moms and the professionals who help them get there.

Quick-hit conversations with moms, providers, and researchers... because you don't have a lot of free time (you're probably listening at 1.5x right now).

Follow so you don't miss an episode. Rate & review ⭐⭐⭐⭐⭐ — it's how the next mom searching for these answers actually finds them. Share it with the friend who needs it.

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She booked the appointment. She showed up. She wants something to change. And she still hasn't done her exercises.

Sónia Coelho Cristóvão, physiotherapist and PhD researcher at the University of Gothenburg, kept seeing that in her clinic. So when she started building a digital pelvic floor program for Sweden's public healthcare system, she went to the research first. Her new review pulled together 18 studies to ask two questions: do digital pelvic floor programs actually work in pregnancy and postpartum, and what do women say helps or gets in the way?

🔹 Why pregnancy and postpartum told two different stories in the research
 🔹 The surprise: women using digital programs stuck with their training more, and got stronger
 🔹 The 5 things women say make or break their pelvic floor training (spoiler: they WANT to do it)
 🔹 Why tracking features can turn into one more burden
 🔹 Why women still want a real person in their care, not just an app
 🔹 Where AI could help programs adapt to YOU, and why she's a little more cautious lately
 🔹 Kegels vs no Kegels, and why that's the wrong fight
 🔹 What's next: exercise dosing and C-section recovery

If your home exercise program lives in a drawer somewhere, press play. And clinicians… when a patient tells you she didn't do her exercises, what do you say next?

This episode is education, not medical advice. Talk with your own maternity care team or pelvic floor PT about your situation.

The Active Mom Podcast — a real mom's guide to pregnancy, postpartum, perimenopause & beyond, for active moms and the professionals who help them get there.

Quick-hit conversations with moms, providers, and researchers... because you don't have a lot of free time (you're probably listening at 1.5x right now).

Follow so you don't miss an episode. Rate & review ⭐⭐⭐⭐⭐ — it's how the next mom searching for these answers actually finds them. Share it with the friend who needs it.

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Don't jump. Don't lift heavy. Exhale on the way up. Protect your pelvic floor from all that pressure.

Funny thing, though. Nobody ever tells you not to cough.

So where did the "too much pressure" advice actually come from? Dr. Sabine Vesting, a physio in Gothenburg, Sweden, and researcher with the MFM lab at the University of Ottawa, went back through studies dating to 1978 to find out. More than 4,000 papers screened. 52 that measured it. And not one measured it directly inside the abdomen.

She's back on the show (Ep 184 was her first visit), and we get into:

🔹 What a sensor in the vagina, rectum, stomach or bladder is really picking up when you move
 🔹 Why the scary jumping numbers don't mean what you've been told
 🔹 Coughing vs running, and why how LONG matters as much as how high
 🔹 What the pressure data can and can't tell us about leaking on the run
 🔹 How urethral support changes after a run, in runners who leak AND runners who don't
 🔹 Why passive support may matter more than strength for some runners who leak
 🔹 Pessaries for active women, and why "isn't that for old women?" needs to retire
 🔹 Over-the-counter devices, sizing kits, and why bigger isn't better

If you've ever been told to skip something "because of the pressure," press play before you take that advice.

What's one thing you've been told to avoid because of pressure?

Find Sabine on Instagram: @BineVesting

Research mentioned:
-Vesting S, Rodrigues MP, McLean L. Measurement and interpretation of intra-abdominal pressure during physical activity: a scoping review. Int Urogynecol J. 2026. doi:10.1007/s00192-026-06635-2

 -Rodrigues MP, Vesting S, Bérubé MÈ, Collins G, McLean L. The posterior urethrovesical angle in continent and incontinent women before and after a treadmill run. Int Urogynecol J. 2025. doi:10.1007/s00192-025-06460-z

This episode is education, not medical advice. Talk with your own care team or pelvic floor PT about what's right for you.

The Active Mom Podcast — a real mom's guide to pregnancy, postpartum, perimenopause & beyond, for active moms and the professionals who help them get there.

Quick-hit conversations with moms, providers, and researchers... because you don't have a lot of free time (you're probably listening at 1.5x right now).

Follow so you don't miss an episode. Rate & review ⭐⭐⭐⭐⭐ — it's how the next mom searching for these answers actually finds them. Share it with the friend who needs it.

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In June, my very first mom friend texted me about a relay for her 50th. I said yes. THEN I asked what I'd signed up for.

3 running legs in less than 24 hours including night running. And I'm a morning runner, because over the years, evenings are exactly when leakage sneaks in for me, even on a walk.

So I did what I'd do with any patient. I fit myself for a pessary. It took 4 devices, a lot of frustration, self-talk, and a brain trust of PT friends talking me off the ledge. 

This is a solo, fully TMI episode (you've been warned) about the whole process, start to finish line.

What we get into:
 🔹 Why I stopped blaming "endurance" for leakage that shows up later in the day
 🔹 Support pessaries vs space-occupying pessaries, and why that difference ended up mattering for me
 🔹 The dish, the ring, the Soma and the cube: what each one did (and didn't do) for MY anatomy
 🔹 Why "that didn't work for me" says nothing about what will work for you
 🔹 What it was actually like wearing a cube through a relay, including the one gravel stretch where I wondered if I was about to lose it (literally)
 🔹 The running research out of Linda McLean's lab in Ottawa that changed how I looked at my own problem

If you've ever been offered a pessary and thought "not for me," or tried one, hated it and quit... listen to this one. And clinicians, this one's for you too.

Oh, and our team of masters women came in second. We also brought the music. Leave it to the moms to make it fun.

Have you ever been offered a pessary? Tell me how that conversation went.

Questions about my pessary journey, or trying to find someone near you who fits them? Email me at [email protected] or DM me on Instagram @carriepagliano. I'm happy to help.

This episode is education, not individualized medical advice. My anatomy, my solution. Yours may be completely different.

 Chapters (approximate)
00:00 Why a solo pessary episode
02:21 How I learned to fit pessaries
05:30 My history: 2 C-sections, perimenopause, evening leakage
07:40 Is later-day leakage really just endurance?
09:40 Support vs space-occupying pessaries
12:00 Trial 1: the dish
13:00 Trial 2: the ring
18:00 Trial 3: the Soma, and why "it didn't work for me" isn't a verdict
20:30 Trial 4: the cube
24:00 Race logistics: when to put it in and take it out
27:25 Night leg: 5 miles downhill in the dark
30:30 A 5:30 a.m. porta potty and posterior wall support
34:36 Final leg: 7 miles uphill
37:00 Awareness vs discomfort
38:30 The research that changed how I saw my own problem
41:54 Your story isn't my story, and where to get help
44:16 Next up: the DC half 

The Active Mom Podcast — a real mom's guide to pregnancy, postpartum, perimenopause & beyond, for active moms and the professionals who help them get there.

Quick-hit conversations with moms, providers, and researchers... because you don't have a lot of free time (you're probably listening at 1.5x right now).

Follow so you don't miss an episode. Rate & review ⭐⭐⭐⭐⭐ — it's how the next mom searching for these answers actually finds them. Share it with the friend who needs it.

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Carrie was taught to go gentle. Brianna was taught to go harder. Neither one worked.

Bri Battles reached out and said let's chat about history. I said okay. So here we are, two podcasts running as one episode, looking back at the last 10, 15, 20 years of how pregnant and postpartum athletes have been advised. And I promise you, we barely scratch the surface.

Bri came up through the barbell side. I came up through the clinic side. Same women, opposite ends of the field, and for most of those years the two sides were not talking to each other at all.

So we get into where we've come from and what's ahead. Which is funny timing, because I'm already in peri and Bri is over there hoping we get it figured out by the time she gets here.

🔷 The Theraband-around-the-belly era of diastasis "rehab," and the logic that made grown clinicians think it would work
 🔷 Where the six week rule got its power (hint: it was a paperwork problem before it was a healing timeline)
 🔷 Kegels, SI belts, and what pelvic health looked like when it was its own silo
 🔷 The CrossFit video that pulled pelvic PTs into the conversation, and why "that's bad" was all we had
 🔷 Performative pregnancy, performative postpartum, and what I'm calling performative perimenopause
 🔷 Why some women need a kick in the ass to do MORE, while athletes need permission to adapt, and why those are two completely different conversations
 🔷 The trouble with "listen to your body" when you've trained yourself to override it
 🔷 What I'm screening for now that I wasn't asking about a year and a half ago
 🔷 The weighted vest conversation I had with my neighbor, and what it says about all of this

History matters here because it repeats. If you want to know whether the rule you were handed is current or just old, you have to know where it came from.

Bri is at @briannabattles and @pregnant.postpartum.athlete. Her show is Practice Brave.

So what decade is YOUR advice from? Come tell us.

The Active Mom Podcast — a real mom's guide to pregnancy, postpartum, perimenopause & beyond, for active moms and the professionals who help them get there.

Quick-hit conversations with moms, providers, and researchers... because you don't have a lot of free time (you're probably listening at 1.5x right now).

Follow so you don't miss an episode. Rate & review ⭐⭐⭐⭐⭐ — it's how the next mom searching for these answers actually finds them. Share it with the friend who needs it.

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Three years ago Joy Black came on this show to talk about climbing in pregnancy and postpartum, and quite honestly, we had almost no research to point at. She came back this time as a published researcher. Two papers, both in Sports Medicine, both with Dr. Margie Davenport's lab at University of Alberta.

So we sat down and broke them open.

The first is qualitative: 11 elite climbers, Olympic and World Cup level, on how they actually made decisions while pregnant. Not "is climbing risky, yes or no." Something much more interesting. They're assessing risk continuously, move to move, inside a single climb.

The second one is big. 692 climbers. Roughly 64,000 hours of climbing during pregnancy. And it gives us numbers we have never had before.

More than half of those climbers were never given a single recommendation about climbing during pregnancy by a practitioner. Not "here's how to modify." Not "here's what to watch." Nothing. And fewer than 40% were offered any rehab at all postpartum.

We did not tell them no. We said nothing. Which they heard, correctly, as we have no idea what you do.

🔹 Why a fall in climbing is not what you think it is, and why that distinction changes everything
 🔹 What the fall rate and adverse event rate actually were across 64,000 hours
 🔹 The modifications climbers make on their own, top roping, vertical over steep, lower grades, not topping out
 🔹 Controlled impact versus chaotic impact, and why a six week okay is not clearance for either
 🔹 What to ask a climber in your clinic when you have never climbed in your life
 🔹 The prolapse story that made me want to stand up and cheer, and maybe throw something

I promise you, you do not have to be a climber to help a climber. Joy says it better than I do, and she says it about halfway in.

Guest: Joy Black, climbing coach for pregnant and postpartum climbers, @climbingwithjoy, trainedbyjoy.com. 

Her first time on the show was Season 2, Episode 12.
Research collaborator: Dr. Margie Davenport, @drmargiedavenport

Studies discussed:
 🔹Davenport MH, Ray L, Black J, McHugh TL. "An Informed Risk Assessment": A Qualitative Exploration of Elite Climbers' Experiences During Pregnancy and the Postpartum Period. Sports Medicine. 2025.
🔹Davenport MH, Osachoff L, Ray L, Black J, Cheung NKY, McHugh TL. To Climb or Not to Climb: A Cross-Sectional Investigation of Risks and Benefits During Pregnancy and Postpartum. Sports Medicine. 2026.

The Active Mom Podcast — a real mom's guide to pregnancy, postpartum, perimenopause & beyond, for active moms and the professionals who help them get there.

Quick-hit conversations with moms, providers, and researchers... because you don't have a lot of free time (you're probably listening at 1.5x right now).

Follow so you don't miss an episode. Rate & review ⭐⭐⭐⭐⭐ — it's how the next mom searching for these answers actually finds them. Share it with the friend who needs it.

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Labor Day is in the rearview, the temps are finally doing what they're supposed to do, and this is the last rewind of the summer. Quite honestly, this is the one I wanted to close out on.

When Margie came on for this one, she spent a good chunk of the hour telling me she couldn't tell me things. I'd ask, she'd dodge. I'd ask sideways, she'd dodge nicer. At one point I told her she was like a mystery novel and I just wanted to know what happened on the next page. She said she'd love to tell me, but she can't.

She wasn't being precious about it. The Canadian postpartum guidelines were still in peer review, and she walked me through exactly why researchers go quiet. Until a paper has been through that process, she is not going to stand up and tell you something is safe. She also told me the first draft went out to postpartum women for feedback and came back with a note that it was going to cause a lot of mom guilt. So they went back and reworked the messaging. As a mom herself, that was not a message she was willing to send.

Listening back now, with the guideline published and Margie already back on the show this past summer to walk us through it, this one plays completely differently. This is the hour right before.

🔹 Why the assumption that elite athletes have the best of everything is mostly wrong, and what happens to the ones who get told they're done at the first trimester
 🔹 The athletes nobody has studied: the ones who wanted to come back and couldn't. Margie's team put out the invitation and got almost nothing back.
 🔹 The one thing Margie says she'd go back and do more of, in pregnancy, in postpartum, and now heading into perimenopause
 🔹 Postpartum and perimenopause showing up in the same body at the same time, and how little we currently have to offer either one
 🔹 In Canada, 7% of all grant funding goes to women's health. The postpartum guideline got none of it. It got built by volunteers and undergrads.
 🔹 The PhD student she says to watch, and why sleep may turn out to matter as much as exercise in this window

Margie is one of my favorite people to just throw questions at, and this is her at her most honest about what we still don't know.

Margie first came on the show back in Ep 38 in 2022, and she was back this summer on Ep 252 to walk through the guideline once it published. If this one leaves you wanting the answers, that's the episode with them.

Find her on Instagram at @drmargiedavenport.

One thing this whole hour keeps circling: screening before somebody hands you a program. Nobody can tell you what your body is ready for without looking at it first. If you're in the Arlington area, come see me in the clinic. If you're anywhere else, telehealth and virtual consults are open. 

This is education, not individualized medical advice. If you're having symptoms, get eyes on it.

The Active Mom Podcast — a real mom's guide to pregnancy, postpartum, perimenopause & beyond, for active moms and the professionals who help them get there.

Quick-hit conversations with moms, providers, and researchers... because you don't have a lot of free time (you're probably listening at 1.5x right now).

Follow so you don't miss an episode. Rate & review ⭐⭐⭐⭐⭐ — it's how the next mom searching for these answers actually finds them. Share it with the friend who needs it.

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Somewhere between 2019 and now, "wait 12 weeks" turned into a rule. It is not a rule. It never was.

I have been in pelvic health for 26 plus years, and right now I am watching that number get handed around in Facebook groups, on social, and quite honestly by a lot of professionals who are leaning really hard on it. I don't know that the foundation exists to do that. So this is a solo episode where I walk you back through how we got here.

🔹 Why the six week visit was a medical checkpoint, not a green light to run
🔹 What the 2019 UK document really is, and what it isn't
🔹 The 2024 international Delphi: 95 professionals, 12 countries, seven professions, and what they actually agreed on
🔹 Why "returning before 12 weeks is possible" is the line that keeps getting missed
🔹 The one in a hundred outlier, and why I will not shut her down
🔹 Gatekeeping. My own profession has been doing it, and I was a product of it
🔹 The 2025 Canadian postpartum guidelines, including why sleep got named a movement behavior
🔹 The four variables nobody puts on a timeline: sleep, fueling, support, mental health
🔹 What you control and what you absolutely do not
🔹 The line a kindergarten teacher gave me that I now use with patients

If you are a mom trying to figure out when, this one gives you better questions than a date on the calendar. If you are a pro who has been leaning hard on 12 weeks, this one is an invitation to step back.

And if what you really want to know is where YOU are right now, that is what the free Return to Run Readiness Screen is for. Balance, strength, impact. https://course.carriepagliano.com/R2Rreadyscreen

IN THIS EPISODE
(00:00) Why we are talking about 12 weeks right now
(02:44) Where the six week mark came from
(03:55) The 2019 UK document that was never a guideline
(05:22) ACOG moved off six weeks in 2018
(08:50) The 2024 Delphi: what 95 professionals agreed on
(11:16) The one in a hundred outlier
(14:07) Gatekeeping movement in pregnancy and postpartum
(16:08) The 2025 Canadian postpartum guidelines
(18:06) Phase based instead of date based
(20:26) All roads end up in the same place
(22:03) Sleep
(22:50) Fueling and energy availability
(25:13) Support, childcare and logistics
(28:32) Mental health, and what is going on physically
(31:51) What you control and what you do not
(39:28) Episodes to listen to next

STUDIES MENTIONED
Christopher SM, et al. Br J Sports Med. 2024;58(6):299-312.
Deering RE, et al. Br J Sports Med. 2024;58(4):183-195.
Davenport MH, et al. Br J Sports Med. 2025;59:515-526.
Schulz JM, Thornton JS. Br J Sports Med. 2024;58:511-512.
Christopher SM, Cook CE, Snodgrass SJ. PLoS One. 2021;16(8):e0255383.
ACOG Committee Opinion No. 736. Obstet Gynecol. 2018;131(5):e140-e150.

The Active Mom Podcast — a real mom's guide to pregnancy, postpartum, perimenopause & beyond, for active moms and the professionals who help them get there.

Quick-hit conversations with moms, providers, and researchers... because you don't have a lot of free time (you're probably listening at 1.5x right now).

Follow so you don't miss an episode. Rate & review ⭐⭐⭐⭐⭐ — it's how the next mom searching for these answers actually finds them. Share it with the friend who needs it.

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Shefali got hate mail.

Not a snarky comment on a post. Emails. From other people who work with postpartum runners, coming at her over a single number in a consensus paper.

The number was three. As in, after a minimum three week period of rest and recovery, some people might be ready to start doing some things. Drills. Not a 5K. Not a race. Some things.

And she wasn't even giving her opinion. She surveyed clinicians and exercise professionals, coded what they said, and reported it back. That is the entire job of a Delphi.

I'm bringing this one back for the Summer Rewind because there are so many new moms getting back to running right now, and the six week clearance conversation has not moved an inch. It is still the default. It is still a date instead of a plan. And I promise you it is still costing women the strength they walked in with.

🔹 What a Delphi study actually is, and why it exists when the research is thin
🔹 Where the six week rule came from and what it never accounted for
🔹 The consensus on what "postpartum" means, and on who gets to call herself a runner (you'll like this one)
🔹 Why detraining is a real cost and not a theoretical one
🔹 The bias every one of us carries: the moms who were doing great were never in your caseload
🔹 Shefali on her own two pregnancies, and what changed between them

If you have ever been handed a date instead of a plan, press play. And if you're the one handing out the dates, I especially want you in this one.

Which date were you given, and did anybody explain it?

The Active Mom Podcast — a real mom's guide to pregnancy, postpartum, perimenopause & beyond, for active moms and the professionals who help them get there.

Quick-hit conversations with moms, providers, and researchers... because you don't have a lot of free time (you're probably listening at 1.5x right now).

Follow so you don't miss an episode. Rate & review ⭐⭐⭐⭐⭐ — it's how the next mom searching for these answers actually finds them. Share it with the friend who needs it.

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This one is going to ruffle some feathers.

Hypopressives. Low pressure fitness. Whatever your algorithm is calling them this week. The theory has been the same since 1984: you do the breath, you hold the posture, your intra-abdominal pressure drops, and your pelvic floor switches on because of that pressure drop.

Nobody had measured the pressure.

Silvia Saraiva did. She trained 36 women who had never done a hypopressive in their lives, gave them two weeks to practice, then brought them into the Motor Function Measurement lab at the University of Ottawa with an intra-abdominal pressure sensor, EMG inside and out, and ultrasound running. Supine and standing. With the hypopressive posture and without it.

The pressure didn't drop. 

The pelvic floor did turn on. Just not through the mechanism we have all been teaching.

Here's what makes this conversation worth your time: Silvia is hypopressives-trained. She still teaches them. She has patients who seek her out specifically to learn them. She is not here to tell you to stop. She is here to tell you the explanation doesn't hold up.

🔹 What a hypopressive actually is, broken all the way down
 🔹 The theory, and where it came from
 🔹 Why the measurement tools matter more than most of us want to admit
 🔹 What happened to intra-abdominal pressure lying down versus standing
 🔹 How hard the pelvic floor actually worked, compared to a max contraction
 🔹 Whether nailing the posture changed anything
 🔹 If the pressure didn't drop, what IS causing the contraction
 🔹 What Silvia tells the patients who ask her to teach them
 🔹 Where hypopressives fit if strength is the goal

Silvia Saraiva, BScPT, MScHK, is a pelvic health physiotherapist and researcher who completed her Master of Science in Human Kinetics at the University of Ottawa under Dr. Linda McLean. Her paper is out now in Physiotherapy, and there is a second one coming.

When you learned hypopressives, or taught them, was the pressure drop the whole point? I want to know what you were told and what you think after listening to the pod!

Saraiva S, McLean L. Intra-abdominal pressure and pelvic floor muscle activation observed during hypopressive exercises performed in supine and standing: An observational cohort study. Physiotherapy. 2026 Sep;132:102316.

Silvia on Instagram: @thepelvicgirl
The lab: @mfm_lab

 00:00 Intro
 01:00 Why we have never covered hypopressives
 01:45 Meet Silvia Saraiva
 02:25 Ottawa to northern Ontario
 05:45 How far the nearest pelvic floor physio really is
 06:55 Why hypopressives are big in Brazil, Spain and France
 07:35 What a hypopressive actually is, step by step
 09:00 The theory: pressure drops, pelvic floor turns on
 10:00 Why how you measure it matters
 10:50 The tools: pressure sensor, EMG, ultrasound, dynamometry
 14:40 Crosstalk, motion artifact, and the problem with earlier studies
 16:15 What clinicians miss when we skim to the conclusion
 18:45 Who was in the study
 21:05 Training beginners, and the expert who flew in
 23:45 Are hypopressives easy? No.
 28:15 The findings
 30:00 Did position or posture matter?
 31:30 If the pressure didn't drop, what is causing the contraction?
 32:40 "You're just not doing it right"
 33:30 What Silvia tells patients now
 35:35 What about a high tone pelvic floor?
 37:40 Prolapse and first line care
 38:20 What she would study next
 42:30 When the explanation is wrong but the results are real
 43:40 Where to find Silvia 

The Active Mom Podcast — a real mom's guide to pregnancy, postpartum, perimenopause & beyond, for active moms and the professionals who help them get there.

Quick-hit conversations with moms, providers, and researchers... because you don't have a lot of free time (you're probably listening at 1.5x right now).

Follow so you don't miss an episode. Rate & review ⭐⭐⭐⭐⭐ — it's how the next mom searching for these answers actually finds them. Share it with the friend who needs it.

Questions or topic requests? DM me 💌