Pregnancy and postpartum are seasons of massive physical, emotional, and identity change — especially for people who love to move their bodies.
In this week’s Barbell Mamas podcast episode, I covered three big, very current topics that keep coming up in both the clinic and my inbox:
A new postpartum return-to-sport decision aid for soccer players
The evolving conversation around GLP-1 medications and pelvic floor health
Why so many postpartum people feel blindsided by normal pelvic and vaginal changes after birth
While these may seem like separate conversations, they’re deeply connected by one common thread:
we need better education, better expectations, and more individualized decision-making in the postpartum period.
Let’s walk through each one.
A new consensus statement published in the British Journal of Sports Medicine introduces a decision-making framework to guide postpartum athletes returning to soccer.
This work — led by Emma Brockwell, Sinead Dufour, Evie Casagrande, and my postdoctoral supervisor Margie Davenport — represents a meaningful shift away from rigid timelines and toward individualized, biopsychosocial care.
Instead of asking “How many weeks postpartum are you?”, the framework asks better questions:
Who are you?
What’s happening in your body and life right now?
What support do you have?
The framework begins by screening for true medical red flags, including:
Neurological symptoms or loss of consciousness
Signs of blood clot
Uncontrolled hypertension
Cardiomyopathy
Severe abdominal pain
Active eating disorders
Importantly, pelvic floor symptoms are not considered contraindications — they’re signals that may warrant screening or support, not a hard stop.
One of the most important additions to this guideline is the explicit inclusion of mental health and kinesiophobia (fear of movement).
Mental health screening uses items from the Edinburgh Postnatal Depression Scale, currently the only validated postpartum mental health tool we have — despite its limitations, particularly for anxiety.
Postpartum anxiety is common, under-recognized, and often dismissed as “just new-mom nerves.” Many people don’t realize they’re struggling until years later.
Fear of movement is also addressed through questions like:
“Physical activity might harm me”
“I should not do activity that could worsen symptoms”
“I cannot do physical activity”
These beliefs matter. They influence how safe someone feels in their body — and safety is foundational for return to sport.
The pelvic health section includes symptoms such as:
Urinary leakage or urgency
Vaginal heaviness or bulging
Fecal incontinence or loss of gas
Pelvic or abdominal pain
The presence of symptoms doesn’t automatically mean “don’t exercise.”
It means the plan may need to be personalized — potentially with pelvic health support.
That nuance is huge.
Rather than prescribing a linear checklist, the guideline introduces a seven-stage framework:
Building foundations
Building robustness
Reconditioning
Reintegration
Return to training
Return to play
Return to performance
Progression is collaborative, iterative, and contextual — acknowledging that postpartum bodies don’t exist in a vacuum.
This is what real-world rehab actually looks like.
GLP-1 receptor agonists are increasingly common — and understandably raise questions about pelvic floor health.
Here’s what the evidence currently suggests:
Higher BMI is a known risk factor for pelvic floor dysfunction, likely due to:
Increased downward load on pelvic tissues
Chronic low-grade inflammation associated with adipose tissue
From a mechanical and inflammatory standpoint, weight loss may plausibly reduce pelvic floor symptom burden.
However:
👉 We do not yet have direct data showing that GLP-1–related weight loss improves pelvic floor symptoms specifically.
That’s an important distinction.
As people lose fat tissue throughout the body, changes can occur everywhere — including the vulva and labia, which contain adipose tissue.
This isn’t unique to GLP-1s.
It’s likely a consequence of fat loss itself, not the medication.
We also know that:
Genital tissue changes with age
Pregnancy and childbirth permanently alter pelvic anatomy
Yet we rarely talk about this openly — which is why these changes can feel alarming when no one warned you.
One concern with GLP-1 use is loss of lean mass if nutrition and resistance training aren’t supported.
Strength training matters — not as an “instead of” GLP-1s, but alongside them.
This isn’t a GLP-1 versus lifestyle conversation.
It’s a both/and conversation.
Current recommendations suggest stopping GLP-1 medications at least three months before trying to conceive, largely based on animal data.
What we’re seeing clinically:
Higher gestational weight gain in those who discontinue GLP-1s before pregnancy
Likely rebound weight changes — which should be anticipated, not moralized
Postpartum use is more nuanced:
Postpartum weight retention carries its own health risks
Cardiometabolic risk matters
Blanket rules rarely serve complex bodies
These decisions deserve individualized, medically guided conversations — not internet hot takes.
This question came up repeatedly — and it gets to the heart of a much bigger issue.
Pregnancy and childbirth do change the pelvis.
Some expected changes include:
Increased vaginal opening size
Greater vaginal wall mobility
Lower resting position of the urethra
Temporary or persistent sensations of heaviness
Up to 40–50% of people have objective prolapse after first vaginal delivery — yet fewer than 10% have persistent symptoms.
Heaviness during return to exercise often reflects load tolerance, not pathology — similar to delayed onset muscle soreness.
Without education, these sensations feel scary.
With education, they become manageable.
Emerging research shows that sarcopenia in older adulthood is associated with increased pelvic floor symptom burden.
That tells us something important:
👉 Pelvic health is a lifespan issue
Strength training isn’t just about “bouncing back” postpartum.
It’s about supporting pelvic function decades later.
Many postpartum fears don’t come from symptoms themselves —
They come from not knowing what was normal.
If people learned earlier:
How the pelvis adapts to pregnancy
What changes are expected
What can improve over time
What support exists
We could reduce fear, catastrophizing, and unnecessary restriction.
Different does not mean broken.
Changed does not mean dysfunctional.
These conversations — return to sport, GLP-1s, pelvic floor expectations — all point to the same need:
Better education. Better context. More nuance.
Postpartum bodies deserve informed, individualized care — not timelines, fear-based messaging, or one-size-fits-all rules.
Christina Prevett is a pelvic floor physiotherapist who has a passion for helping women with different life transitions, including postpartum care and menopause.
