Supporting the Woman, Not Just the Baby: Rethinking Pregnancy Pilates & Postnatal Recovery with Peta Titter

Season 3 Episode 18· August 2026 · 75 min

Listen to the full Spotify episode here

Did you know that most pregnancy exercise guidelines were written to keep the baby safe — and barely consider what happens to the woman's body at all? In this eye-opening conversation, women's health expert Peta Titter reveals why 44% of pregnant women in Australia experience pelvic pain that's largely preventable, why the "six-week check" has nothing to do with clearing you for exercise, and why the advice to avoid lying flat after 12 weeks has more to do with protecting women's wellbeing than anyone realised. It's a reframe that every Pilates instructor — and every expecting or postnatal mother — needs to hear. In this episode, I sit down with Peta Titter to talk about evidence-based exercise in pregnancy, pelvic health, and what real postnatal recovery looks like.

ABOUT Peta Titter

Peta Titter is the founder and CEO of the Women's Health Education Network (WHEN), a clinician, researcher, and educator, and one of Australia's leading voices in women's health, with more than 35 years of experience spanning intensive care, continence nursing, pelvic health, pregnancy, postnatal care, and menopause. Based in Australia, she is the lead author of the WHEN Exercise and Pregnancy Guidelines and brings more than 10,000 hours of experience as a principal Pilates practitioner specialising in pregnancy and postnatal movement, alongside her current PhD research at the University of Tasmania on antenatal education. Learn more at WHEN Australia.

WHAT YOU'LL LEARN IN THIS EPISODE

• Most pregnancy exercise guidelines are built around fetal safety, not maternal safety — as an instructor, you can help clients make truly informed decisions by being upfront about what we do and don't know.
• The "no lying flat after 12 weeks" rule exists to protect women from fainting and feeling unwell, not primarily for the baby — a slight incline is enough; there's no research-backed exact angle.
• 44% of pregnant women in Australia experience pelvic pain — you don't need to wait for a client to be in pain before modifying her program; simple swaps like double-leg instead of single-leg work can help prevent it.
• A diastasis recti is a normal, functional adaptation to pregnancy (98–100% of women get one) — abdominal work should support it, not "fix" it, and no single exercise or program has been proven to resolve it.
• Avoid cueing pelvic floor "lift and hold" in group classes — with a tight, normal, or loose pelvic floor all potentially in the room, a one-size-fits-all cue can reinforce dysfunction in some clients.
• Strapping a baby to your body for exercise (especially walking) in the early postnatal weeks is linked to prolapse risk — babywearing research focuses on infant benefit, not maternal safety during movement.
• The "six-week check" clears a woman medically (checking for retained products, healing, etc.) — it is not a fitness clearance, and gentle, appropriate movement can begin much earlier.
• Rib and lateral breathing techniques (e.g. using a TheraBand around the ribcage) can relieve pregnancy rib pain within a few breaths and are useful cues for postnatal breath and core reconnection too.

FROM THE EPISODE

"Just because you can do something doesn't mean you should do something."

"She's not actually broken, she's just delivered a baby, she's grown a human. That's, you know, something has gotta change in her body... it's not a broken thing and we don't need to fix it."

FREQUENTLY ASKED QUESTIONS

Is it safe to lie on your back during pregnancy? Medical guidelines generally recommend avoiding lying flat on the back after the first trimester (around 12 weeks), because the growing uterus can press on the vena cava. The bigger, less-discussed risk isn't to the baby — research shows fetal impact is rare — but that some women can feel faint or actually faint when they stand up. A slight incline is enough to relieve the pressure; there's no research specifying an exact angle.

Can you do abdominal exercises while pregnant? Yes — in fact, you should. Traditional sit-ups aren't recommended because they load the rectus abdominis, which is already stretched to support the growing uterus. Instead, focus on the obliques and transverse abdominis through exercises like sideline work, single- and double-leg lifts, and quadruped work, which support the body without adding unnecessary pressure.

Do sit-ups fix or worsen diastasis recti in pregnancy? Despite recent claims online, no research shows sit-ups are "safe" or beneficial for diastasis recti in pregnancy — the studies behind that claim only measured the size of the gap, not abdominal wall function or pelvic floor impact. Most women's diastasis will improve on its own in the postnatal period, and no single exercise or program has been proven to fix it.

How much pelvic pain is normal during pregnancy? Pelvic pain is extremely common — around 44% of pregnant women in Australia experience it — but "common" doesn't mean it should be ignored or accepted as inevitable. Simple preventative modifications, like avoiding loaded single-leg work and building pelvic and glute strength, can reduce the risk before pain starts, rather than waiting for it to appear.

When can you return to exercise after giving birth? There's no universal rule, and the standard "six-week wait" is somewhat arbitrary — the six-week check confirms medical healing (no retained products, etc.), not fitness readiness. Gentle movement, including pelvic floor connection work and breathing exercises, can begin within days, while higher-impact or loaded training should be built up gradually based on the individual woman.

Should every pregnant woman do pelvic floor (Kegel) exercises? It's more nuanced than simply "doing your Kegels." Because pelvic floors can be tight, weak, or somewhere in between, blanket "lift and hold" cues can help some women and harm others. Instructors are encouraged to educate clients generally about pelvic floor health and refer them to a pelvic floor physiotherapist or their midwife/obstetrician for individual guidance, rather than giving one-size-fits-all cues in class.

Is it safe to wear your baby while exercising postnatally? It's best avoided, especially in the first six weeks. Baby-wearing research focuses on benefits to the baby, not the mother's body, and there are documented cases of women developing prolapse after adding a baby's weight back onto their body for walks shortly after birth. If you want to move, put the baby down, hand them to a partner, or use a pram instead.

What should exercise professionals watch for as red flags during pregnancy? Warning signs include a swollen calf, unusual shortness of breath, and seeing spots in front of the eyes (a sign of pre-eclampsia) — a full list is available through RANZCOG (the Royal Australian and New Zealand College of Obstetricians and Gynaecologists). Pilates instructors aren't qualified to diagnose, but if something doesn't seem right, the appropriate step is referring the client to her pregnancy care provider.

FULL EPISODE TRANSCRIPT

Lightly edited for readability

Louise: Welcome to the Art of Pilates podcast. I am so delighted to be joined by Peta Titter, founder and CEO of the Women's Health Education Network, WHEN — check it out. She's a clinician, a researcher, an educator, and one of Australia's leading voices in women's health, with more than 35 years of experience spanning intensive care, continence nursing, pelvic health, pregnancy, postnatal care, and menopause. Peta has dedicated her career to translating the latest research into practical, evidence-based education for women and health professionals. She's currently completing a PhD at the University of Tasmania, investigating whether antenatal education adequately prepares women for the physical changes that occur after birth. She's also the lead author of the WHEN Exercise and Pregnancy Guidelines, and has more than 10,000 hours of experience as a principal practitioner in Pilates specialising in pregnancy and postnatal movement. Today we'll be discussing evidence-based exercise during pregnancy, pelvic health, postnatal recovery, and what every Pilates instructor should know when working with pregnant and postnatal clients. Peta, welcome to the Art of Pilates. It's wonderful to have you with us.

Peta: Thank you so much for taking the time to chat with me about these sorts of things. I'm so excited — I'm bursting at the seams with thousands of questions, so let's hope I can answer them.

Louise: You've worked in intensive care, pelvic health, continence nursing, and now research and education. What inspired you to dedicate your career specifically to women's health?

Peta: It happened when I got burnt out through nursing. I was a flight nurse in Europe for a long time and did intensive care retrievals — got really burnt out. I married a Dutchman, so we were living in Holland, and my Dutch wasn't good enough to work in intensive care, so I needed a change. I just wanted to get away from illness — I'd had enough of it. So I decided to train as a Pilates instructor. I did part of my training in Holland, and then we moved back to Australia and I retrained when we got back here. We were newlyweds — well, we got married a bit older, but we were still newlyweds and struggling financially, so I still had to do some nursing. I'd work at the Royal Children's Hospital and then run into the Pilates studio, still in my scrubs, to get changed. Lots of women knew I was a nurse, and they'd tell me things they weren't telling the other instructors — about continence, initially about leaking urine. I hadn't had babies at that point, and I'd worked in intensive care where we put tubes in absolutely everything, so I had no idea about continence from that perspective. They'd say things like, "It's expected — I've had a baby, I'm getting older, this is just something that's going to happen." I was taken aback. I thought, no, this is not expected — I'm pretty sure this is not expected. So as much as I wanted to leave nursing, it pushed me to retrain as a continence nurse. And I found out it is not normal. It can happen, but there are things we can do to improve women's lives — not always fix it, but improve it.

Then I had my babies late in life, at 38 and 40. During my pregnancy at 38, I had a pelvic floor injury — I had the catheter removed, stood up, and my bladder emptied on the floor. A covering obstetrician came in and said, "Well, at least you know where to get cheap pads." He thought that was adequate information to give a new mum who'd had an injury. I was furious, and I knew my rights, so I kicked him out of my room and asked for a new obstetrician. But I thought — there are so many women who don't know they can do that.

We wanted to have our babies quickly, so I wanted to get pregnant again before 40 — there's under 20 months between the girls. I had my Pilates studio at the time and followed the exercise guidelines to the letter for pregnancy, and I still leaked urine quickly, got pelvic pain, and my diastasis opened up. I thought, why is this happening if I'm following the guidelines? So after my daughter Emma was born, I went back to university almost straight away and did my advanced diploma, and researched what the exercise guidelines actually were and what diastasis was. What I found was that the exercise guidelines were written almost entirely to keep the baby safe — not the woman. I thought we'd moved on from that, but we hadn't. That's what really pushed me into studying women's health properly. My husband got sick of me yelling at the computer saying, "why are you doing that, you shouldn't be doing that" — so he started a not-for-profit and gave it to me and said, do something with this.

Louise: Wow, that is so romantic — in a very practical way.

Peta: She's very Dutch — very practical. Stop talking about it and do it.

Louise: So you founded the Women's Health Education Network, WHEN. What gap did you see in women's healthcare that made you feel this organisation was needed?

Peta: I saw such a gap across so many parts of women's health, because I'd worked across so many different nursing fields — it was overwhelming. Initially we wanted to start in pregnancy and postnatal, but interestingly we started with older women, because when we ran focus groups — we always listen to women first — they were saying things like, "I feel invisible. I go to the doctor with knee pain and they say, what do you expect, you're getting old." They were also very accepting of continence issues, so we started there. Now we've moved into so much more — pregnancy, birth trauma, miscarriage, and postnatal care. It's so needed.

Louise: There are still so many conflicting messages about exercise during pregnancy. From an evidence-based perspective, what do we actually know today that's changed over the last decade?

Peta: Honestly, we don't know much. A lot of what we're working from is expert opinion, not actual evidence. That's one of the biggest issues in women's health — we're not transparent about what we know and don't know. As health and fitness professionals, we don't want to be seen not knowing the answer. But with most of this, we don't know the answer, and we may never know it, because it's genuinely hard to get ethics approval to research pregnant women. So a lot of what we look at is based on fetal safety, not women's safety — it's not based on pure evidence.

Louise: So many women are worried they'll do the wrong thing. What are the biggest myths you hear about exercise during pregnancy?

Peta: There are so many. One of the biggest is: "if you were doing it before pregnancy, you can do it now." What WHEN stands for, essentially, is that just because you can do something doesn't mean you should. We don't know the long-term impact on a woman's body — it could be nothing, but it could be something. Take running: everyone says it's safe now, and it is safe for the fetus — but there's no research on what it does to the woman's body. Think about the hormones — relaxin and progesterone softening the joints — plus more load, plus running. We don't know the long-term impact.

Because WHEN is one of the only non-profits looking at women from their teens right through to over 65, we can see the whole picture instead of siloing it. I think new research will come in the next decade, because more women are choosing not to have babies, so we'll be able to compare bodies that have and haven't been through pregnancy.

On the flat-lying myth — this really bothers me. Medical guidelines say don't lie flat after the first trimester (12 weeks), because the growing uterus can compress the vena cava, the venous return to the heart. Historically the concern was blood flow to the uterus, but we now know that's rarely an issue — there have only been a couple of documented cases of fetal heart rate deceleration from this. So the fitness industry has relaxed the rule to anywhere from 16 to 28 weeks. But what's being missed is the impact on the woman — some women feel faint and can actually faint when they stand up, and we don't know in advance who that will happen to. So why aren't we thinking about the woman's mental health and safety, not just the baby's? I remember — and I don't even vacuum — but I fell over a vacuum cleaner while pregnant, and I felt guilty for the rest of the pregnancy even though I know the baby is very well protected in the uterus. We're putting women at risk and telling them it's fine because the baby's fine, without valuing the woman's own body and mental health. That's the real reason we recommend the 12-week cut-off — it would be foolish to go against medical advice, but ours is about protecting the mother; we already know the baby is quite safe.

Louise: Is there an actual incline angle you should use?

Peta: There's no defined number — no research on the exact angle. As long as she's not completely flat, a slight incline takes the pressure off the vena cava.

A lot of the pregnancy exercise research is also done on elite athletes, and most pregnant women aren't elite athletes, and aren't necessarily willing to accept the trade-offs an elite athlete might. But it's absolutely fine for a woman to do whatever she wants with her own body — as long as she's making an informed decision, which right now she often isn't. We need to say clearly: we don't know if this will be damaging to your body, it probably won't be, but we can't promise you the answer. If she chooses to run, support her — recommend a softer surface, not concrete — but she's a consenting adult with every right to decide.

Louise: I had a friend who ran before six weeks postpartum, and her belly — really her uterus, which hadn't shrunk yet — was visibly bouncing. She wanted to shed the baby weight quickly, which is troubling, because if she was breastfeeding she actually needed that extra energy reserve.

Peta: The pressure from society and the fitness industry to get women's bodies "back" is misguided — they're never going back to exactly what they were, and that's not a bad thing. They've grown a human. If you de-identified everything that happens to a woman's body in pregnancy and labour and presented it to a doctor without the words "pregnancy" or "labour," they'd say this person needs years of rehab. Instead we say, six weeks, back to exercise, get your flat stomach back. But a woman's anatomy was never built for a flat stomach in the same way — we have a uterus and ovaries that men don't. Society, and our industry, have a lot to answer for.

Louise: Do the pelvic bones actually shift permanently?

Peta: Yes — the pelvis is wider at six weeks postnatal than it is at three months pregnant. This is one of the biggest things missed in postnatal rehab — we talk about pelvic floor and diastasis, but not actual pelvic bone and ligament changes. Interestingly, in perimenopausal and postmenopausal women, when you put them into single-leg work, their pelvises can look like a postnatal pelvis again, because oestrogen drops and things become unstable again. Whether it's a caesarean or vaginal birth, the pelvis has to expand — the body doesn't "know" in advance which kind of birth it will be. Once ligaments and tendons are stretched, they stay stretched, because they don't have great blood supply — unlike muscles, which we can strengthen. This is one of the areas we neglect most, and Pilates — with pelvic curls, elephant, and similar exercises — is one of the best tools we have to strengthen the pelvis itself, not just the pelvic floor.

Louise: What does the research tell us about the benefits of staying active throughout pregnancy, for both mother and baby?

Peta: Our exercise needs don't really change just because we're pregnant — we should stay active throughout our whole lives. I think people tend to go to one extreme or the other with pregnant clients: mollycoddling them, or pushing too hard. There's a middle ground — you can work a pregnant woman hard, you just need modifications, and modification is one of Pilates' great strengths.

One of my pet peeves is pelvic pain. Looking at the statistics, 44% of pregnant women in Australia get pelvic pain — that's massive. For some women it's mild, but for others it's debilitating enough that they choose not to have another baby, have to give up work, or can't look after their other children. Any other statistic that high causing pain or disability, we'd be doing preventative health work around it — but we don't act on pelvic pain until it's already present. Simple things like using double-leg instead of single-leg work can reduce that risk without sacrificing intensity. Squats, for example, are a pregnant woman's worst nightmare but best friend — on a TRX or otherwise, along with heel raises, tucks, and tilts, they strengthen the pelvis while still working hard. We're effectively taking agency away from women by waiting for pain before we intervene.

Louise: Are there exercises that should generally be avoided completely during pregnancy?

Peta: It really comes down to the woman's own decision, and the level of risk you're comfortable taking as an instructor. A pregnant woman's body is hardy and capable of most things — the question is whether it's wise long-term. We recommend not standing on reformers or unstable equipment, for two reasons: if she falls, she'll instinctively try to protect her belly and risk injuring herself, and as the instructor, your instinct will be to try to catch her, which is also risky for your own body. We recommend minimising loaded single-leg work — unloaded single-leg work, like clams lying on the side, is fine; it's loaded single-leg work that puts excess shear through the pelvis that's the concern. We also recommend not lying flat on the back after 12 weeks. Beyond that, it's really her choice. If she's new to lifting, we'd suggest capping added weight around 15 kilos; if she's an experienced lifter, that's her decision — we don't know the long-term impact on joints and pelvic floor either way.

Louise: I've seen guidelines suggesting the fire hydrant exercise can cause sacroiliac joint pain.

Peta: It can — if it's loaded. Unloaded, lying on her side doing a fire hydrant, or well-balanced on all fours, should be fine. But loaded single-leg work on the reformer with heavy springs can affect the sacroiliac joint. One exercise I'd still use is having her lie on her side on the reformer with her leg under the foot bar in a clam position, pushing upward and opening the knee — it works the glutes hard, but it's safe because it's closed-chain and unloaded.

Louise: What about planks or "hovers"?

Peta: I personally wouldn't have a pregnant woman hold a plank. Most women are already hypermobile through the elbows, and a plank adds extra load through already loose joints. It's also hard to maintain core engagement in that position when there's likely already some diastasis present, and it places a lot of pressure on the pelvic floor — plus there's a fall risk.

Louise: And balance changes — is that from around 20 weeks?

Peta: It varies by woman — some show and feel the shift in their centre of gravity before 20 weeks, some later. A first pregnancy might not show until 32 weeks, while a third pregnancy might be obvious by eight weeks. It really depends on the individual, and that's true of pregnancy generally — every woman is different, and we need to treat them as individuals.

Louise: Let's talk abdominal exercise during pregnancy. How should we approach strengthening the abdominal wall while respecting what's changing?

Peta: For a while, our industry avoided abdominal work altogether, and that's wrong — we should be doing it. Think about the anatomy: a non-pregnant uterus is about the size of a walnut, and it grows enormous to house a baby. That pressure has to go somewhere — either into the diaphragm (not an option, that's life-threatening), downward into the pelvic floor (already hard to rehab), or out through the stomach muscles, the rectus abdominis. That's the best option. Around 98–100% of women get a diastasis — some separate, some stretch — and the Pilates industry tends to see this as a bad thing, but it's actually a functional adaptation that allows room for the baby. We just need to support it, not eliminate it.

Because the rectus is stretched to its functional maximum, sit-ups themselves are a poor choice — they use a muscle that's not really functioning normally at that point. But the obliques and transverse abdominis are doing a huge amount of work supporting the pregnancy, especially since babies rarely sit perfectly centred — they tend to sit to one side, which is part of why pelvic and rib pain can worsen. So there are plenty of good abdominal options beyond sit-ups: sideline work, single- and double-leg lifts, quadruped work — all good for the obliques and transverse abdominis.

There's a lot of misinformation right now claiming sit-ups are "safe" in pregnancy, based on two recent articles. We've critiqued both on our website and published a position statement. Neither article actually states sit-ups are safe — they only measured the size of the diastasis gap, using inconsistent methods (calipers, fingers, ultrasound) and inconsistent definitions (some say 2.2cm, some 2.8cm; measured at different points). Neither measured abdominal wall function, and pelvic floor impact was only self-reported — and self-reported pelvic floor data is notoriously unreliable, because women are embarrassed to report leaking. So people online saying "we now have permission to do sit-ups in pregnancy" are misinterpreting the research. You can do sit-ups if you want to, but frankly, most pregnant women would find them deeply uncomfortable. The real question isn't just "is this technically safe," but "is this right for this particular woman, and what does she want?"

Louise: Even the classic cue "pull your tummy in" seems risky with all that intra-abdominal pressure.

Peta: It's going to be uncomfortable regardless. We also tend to only think about women from the pelvis up — what about varicose veins, which are common in pregnancy? What is that squashing pressure doing to them? We need to stop siloing body parts and look at the whole woman.

Louise: You were lead author of the WHEN Exercise and Pregnancy Guidelines. What are some key recommendations every exercise professional should know?

Peta: The guidelines were developed by 30 professionals, then reviewed by a 14-person clinical governance committee to validate the evidence — it wasn't one person's opinion. What makes them different is that they put the woman on equal footing with the baby, which is unusual and has drawn pushback — but historically the baby has always come first, and I think society will eventually catch up. That underpins our recommendations: avoiding flat-lying after 12 weeks, double-leg over loaded single-leg work, and so on. With weightlifting, there's no clear evidence either way about harm — we know long-term weightlifters leak more during lifting but not more overall, and we don't know if the lifting itself is the cause. It's the same with running — we just don't know. Transparency is key: if a woman needs to run for her mental health, support that, but be honest that we don't have all the answers.

Louise: Your honours research examined the exercise guidelines and diastasis recti. What have we learned about preventing or managing it?

Peta: You can't prevent it — trying to would cause other problems, like pain. In terms of managing it, support is key during and after pregnancy. Lying on her side, a soft ball or support under the bump can stop it hanging down and pulling the separation further. In bed — usually lying on the left side, as recommended — support under the stomach helps for the same reason. Most research shows that in the postnatal period, diastasis doesn't disappear entirely without intervention, but it does improve. No single exercise has been proven to "fix" it. Programs claiming to fix diastasis are overstating the evidence — it isn't there. There's also no proven link in the research between diastasis and pelvic floor or back pain issues, though logically you might expect one; a lot of that data is self-reported, which is unreliable. It's not that she's "broken" — she's grown a human, and something in her body was always going to change. That said, if a diastasis is affecting her mental health, that's a completely valid reason to want to work on it — just as valid as back or pelvic pain.

Louise: What about abdominal binding?

Peta: It's controversial — bind too tight and you create downward pressure; too loose and it doesn't do much. It's also uncomfortable, especially when you're already sleep-deprived. Expensive specialty binders aren't necessary — a simple compression garment (a "chewy grip," from the chemist) works just as well and is far more affordable. If she feels like "everything's hanging out" and wants support, that's a reasonable option — but binding for too long can prevent the body's own muscles from doing the work, becoming a bit of a crutch.

Louise: Pelvic floor dysfunction affects so many women, yet it's still not openly discussed. What are some of the biggest misconceptions?

Peta: There's a growing social media push telling everyone to "stop pelvic floor work" in favour of purely functional work — that's terrible advice. Even with a tight pelvic floor, you still need pelvic floor work, just done differently. I actually tell Pilates instructors: don't cue pelvic floor generically in class, because you don't know what's happening in each woman's body. If you cue "lift, hold, hold, hold" for a room with a mix of tight, functioning, and loose pelvic floors, you could be reinforcing a harmful pattern in some clients. Instructors are well placed to be health promoters — talk about what's happening to the pelvic floor in pregnancy, that it will be altered (not necessarily damaged), and where to get help. The problem is that help is often expensive — pelvic floor physios are excellent, but can cost around $240, which isn't accessible for everyone. Continence Health Australia (formerly the Continence Foundation) offers a free, anonymous helpline, and their Pelvic Floor First website — currently being updated — has a good section on pregnancy and postnatal health.

We haven't advanced much in prolapse care since ancient Greece, frankly — a modern pessary is materially similar to devices used millennia ago, just made of silicone now instead of what women historically used.

Louise: What about biofeedback devices — the little machines people sit on that monitor pelvic floor lifting?

Peta: If it helps a woman psychologically — feeling like she's lifting more — that's a benefit, but there's no strong evidence they outperform simply doing pelvic floor work without the device. Sometimes just placing a hand there is enough to feel the lift. One of the biggest myths is that women should just innately "know" how to use their pelvic floor. No one automatically knows — especially after birth, when everything has shifted. We teach kids about every other muscle at school, but never the pelvic floor. It's worth noting the different way we've historically framed this by gender too — men are often told pelvic floor work improves their sex life, while women are only told about incontinence and prolapse. I now tell all women: pelvic floor work can improve your sex life too, because that matters just as much for women.

Louise: Should every pregnant woman be doing pelvic floor exercises, or is it more nuanced than "just do your Kegels"?

Peta: I actually dislike the term "Kegels" — two women were teaching pelvic floor work a decade before Dr Kegel, one a physiotherapist and one a nurse, and he got the credit. Let's just call it pelvic floor work. It is nuanced — women should talk to their midwife or obstetrician. One key point: the pelvic floor also needs to learn to relax, because the baby's head needs to pass through it. Even as a continence nurse myself, in labour, my obstetrician had to remind me to relax my pelvic floor — I was holding on through pain and discomfort, and knowing the theory didn't make it automatic. Learning to relax the pelvic floor is just as important as learning to contract it, in pregnancy and throughout life — it needs to work like any other muscle: contract, relax, contract, relax.

Louise: What role can Pilates play in supporting pelvic floor health during pregnancy and after delivery?

Peta: Broadly, any good exercise supports pelvic floor health, and pelvic work specifically is important. My own theory — unproven — is that many women's glutes "panic" when they become pregnant and try to do all the stabilising work themselves, becoming tight, which then pulls on the pelvis and contributes to pelvic pain. There's a difference between a tight muscle and a strong one — you want strong and stretched glutes, so controlled stretching in pregnancy (not going to full range) is valuable, because it takes some of that pulling load off the pelvis.

On leaking urine specifically — it's important women get it checked rather than accepting it as "normal," because untreated, it tends to progress rather than resolve on its own. It's also worth understanding that breastfeeding suppresses oestrogen, and oestrogen affects the whole body — muscles, tendons, ligaments, even the brain (which is relevant to postnatal depression too). Women often say, "once I stopped breastfeeding, everything tightened up" — it's not that tissue tightened, it's that muscles could fire more effectively again as oestrogen returned. That's not a reason to avoid breastfeeding, just something to be aware of.

Louise: Your PhD is exploring whether antenatal education prepares women for what happens after birth. What are you discovering?

Peta: My PhD isn't finished, but so far my view hasn't changed. Speaking with midwives and universities about what's taught in antenatal education, it's overwhelmingly focused on baby care — breastfeeding, and so on — not on the changes to the woman's own body. Midwives are honest that they simply don't have time to cover more, and they're already overworked. I compare it to weddings versus marriage — the labour is like the wedding, heavily focused on, while the postnatal period is like the actual marriage, which gets far less attention. We're told labour is a "natural process," which is true — but so is a heart attack, and we still support people through heart attacks. We tend to withhold information about possible complications because we don't want to scare women, but that undermines informed consent. If you had knee surgery, you'd be told everything that could go wrong; the equivalent doesn't happen with birth. Women are among the strongest people on the planet — think about the fact that most of us manage pain every month through periods — yet we're often treated as though we can't handle honest information.

Louise: What should every woman know before giving birth about her postnatal recovery?

Peta: That she should cut herself some slack. She's done something extraordinary — created and grown a life — and her body will be different afterward. That's not a bad thing. We put a real stigma on bodies changing, but growing a human takes enormous energy, and being different doesn't mean being less amazing.

Louise: When is it generally appropriate to return to exercise after having a baby, and what factors should influence that?

Peta: It depends what you count as "exercise" — I think we should talk about movement more broadly, since movement matters just as much. From the start, women can be doing small things: pelvic floor connection work within 24 hours of a vaginal birth (even if she can't feel much yet), or once it's not pulling on the scar after a caesarean. Breathing work is valuable too — ribs genuinely expand in pregnancy, and for women with rib pain, wrapping a TheraBand around the ribcage and cueing deep lateral breathing (holding each side) often relieves the pain within three or four breaths.

Postnatally, I'd start with rib and lateral breathing — hands on the ribcage, breathing in and out to encourage the ribcage to soften. The old "funnel your ribcage" cue is one I'd avoid entirely — ultrasound shows it actually depresses the bladder and pushes the pelvic floor down. A better cue is to find your bra line and draw your spine gently back into the bed or chair, engaging from the back rather than funnelling from the front. Simple, old Pilates regressions — pool-noodle or towel-roll breathing behind the bra line, knee openings — can be done at home from very early on.

Realistically, if you calculated the "load" a new mother carries every day — lifting a five-kilo baby that gets heavier by the day, for hours at a time — that's a workout in itself. The "wait six weeks" rule is fairly arbitrary; movement at home that feels good to her body can begin much sooner, while a return to high-impact training should be built up gradually once strength allows. The six-week medical check confirms healing (no retained products, etc.) — it isn't a "cleared for exercise" checkpoint. On a reformer, gentle leg and footwork isn't meaningfully different in load to walking around, though it's actually lower load on the pelvic floor.

It also helps to remember pregnancy itself takes closer to 10 months (40 weeks), yet birth — the single biggest physical change a woman's body goes through — typically happens over just 24 to 48 hours. Everything is stretched and shifted almost overnight, so we need to be patient and kind with postnatal bodies, not rush back into intense work.

One thing I do actively discourage: strapping a baby to your body while exercising, especially in the first six weeks (and really, at any point). Babies are no longer contained and stabilised inside the uterus — they move, and that added, shifting weight, especially during longer walks, has been linked in the women we see to prolapse (bladder, vaginal, or bowel). Baby-wearing is genuinely great for the baby, but the safety research is about the baby, not about what it's doing to the mother's body during movement. Wear your baby while sitting down if you like, but leave the baby with a partner, or use a pram, if you want to go for a walk or exercise.

Louise: That's wild — you get through labour fine, and then randomly develop a prolapse afterward.

Peta: It's not really random — it usually traces back to something that added strain, often unknowingly, and it's absolutely not the woman's fault; we're just not teaching women how to protect themselves. A simple example: constipation is extremely common in pregnancy, but we rarely teach women to lean forward, bring their knees up (using a stool or rolled towels), to reduce strain on the bowel and pelvic floor — straining increases the risk of haemorrhoids and further pelvic floor changes, and the same principles apply postnatally, particularly after a vaginal birth when the first bowel movement can be genuinely painful.

Louise: What about perineal massage?

Peta: There's good research supporting it, but every woman is different, and plenty of women aren't comfortable touching that area — some have experienced trauma there. It should be an individual decision, made with medical guidance on whether it's right for her.

Louise: With over 10,000 hours of Pilates teaching experience, what do great pregnancy Pilates instructors do differently?

Peta: They look at the woman in front of them rather than sticking rigidly to a set program. That means treating her the way you would any client — not necessarily the same exercises, but giving her agency: asking how she's feeling today and what she wants from the session. Most pregnant clients are already somewhat uncomfortable — the more you can ease that, the more likely she is to keep coming back.

Louise: If instructors could change three things about how they teach pregnant clients tomorrow, what would you recommend?

Peta: First — stop assuming "she did it before pregnancy, so she can do it now." Her body has genuinely changed: oxygen-carrying capacity shifts, plasma volume increases by around 50% even in the first trimester, and she's often carrying extra physiological load before she's even aware of it. Women in their first trimester often say "I don't know how I got so unfit" — she isn't unfit, her body is doing enormous invisible work. Second — stop assuming how a woman "should" feel at a given stage; one woman might be comfortable at 32 weeks while another struggles at 14 — ask her, don't decide for her. And third — remember that just because a woman can do something doesn't mean she should.

Louise: What are the red flags exercise professionals should watch for and refer on?

Peta: There are quite a few — RANZCOG (the Royal Australian and New Zealand College of Obstetricians and Gynaecologists) publishes a solid list of red flags, including things like a swollen calf or unusual shortness of breath. Seeing spots in front of the eyes can be a sign of pre-eclampsia. As instructors, we're not qualified to diagnose — but if something about a client doesn't seem right, the appropriate response is simply encouraging her to check in with her pregnancy care provider.

Louise: What are you most excited about in the future of pregnancy and postnatal care?

Peta: That government attention is finally turning toward birth trauma — New South Wales recently held a birth trauma inquiry, and we've just had Birth Trauma Week. It sounds like a heavy topic, but it's a genuinely positive shift — for a long time women have been told their experiences are "just normal," when explaining what's actually happening to their bodies in advance could reduce how traumatic those experiences feel. I'm excited that we're starting to look at the whole woman, not just as a vessel for the baby.

Louise: Peta, you're amazing — such an advocate for women. Before we wrap up, I have a quick rapid-fire round. One pregnancy myth you'd love to retire forever?

Peta: Just because you can do it doesn't mean you should.

Louise: One piece of advice every expecting mum should hear?

Peta: It's your body, and don't let anyone touch it unless you want them to.

Louise: One habit with the biggest impact on women's health?

Peta: I can't pick just one — but one of the biggest recent improvements is period underwear. It sounds like an odd answer, but this generation has so much more freedom and confidence because of it.

Louise: One research paper everyone working with pregnant women should read?

Peta: I don't think there's a single one — that's actually the problem with the question. As fitness professionals, we tend to read one article and build our whole understanding around it, which is biased. You need to read widely, or find an organisation doing that wide reading for you — which is exactly what our position statements aim to do.

Louise: What's next for you and the Women's Health Education Network?

Peta: We're moving into research on miscarriage, and currently working on vaginal changes in perimenopause and how they affect exercise — which is relevant to postnatal women too, since it comes back to low oestrogen. We also have ethics approval for a project looking at how social media apps (tracking sleep, feeding, milestones) affect the mental load of mothers with children under two. We're also developing position statements on pelvic floor health, working with Continence Health Australia on Pelvic Floor First. If instructors are seeing something in their studio they don't understand, we welcome emails — if there's a clear need, we look at building it into future research.

Louise: Where do you think Pilates instructors unintentionally become overprotective with pregnant clients?

Peta: We tend to treat them as fragile, keep programming too conservative and repetitive, and then they get bored and stop coming back — which comes from a caring place, but isn't always helpful.

Louise: And conversely, where do you see instructors pushing clients beyond what current evidence supports?

Peta: Largely from applying elite athlete research to the general pregnant population. Elite athletes have very different expectations of, and relationships with, their bodies, and are often willing to accept trade-offs the average woman wouldn't choose.

Louise: How can instructors confidently progress strength training during pregnancy?

Peta: Increasing load is one of the best tools for building strength — for example, progressively increasing springs on reformer leg and footwork, adding a small pelvic tilt once she's at the top of the spring range, and continuing to build arm work as tolerated. Increasing load safely increases both strength and bone density.

Louise: Peta, this has been such an exceptional interview. How can people find you?

Peta: Our website is www.when.org.au. We're a not-for-profit, and everyone involved — all the health professionals — volunteers their time, so we'd love more support from the Pilates industry; one studio already runs charity classes with proceeds going to WHEN. We also have an online pregnancy and exercise course, built directly from a survey of what instructors wanted to know, with a Pilates instructor asking me the questions and full demonstrations through every stage of pregnancy. You can also follow us on social media — our handle is WHEN Australia.

Louise: Thank you so much — I've really enjoyed this conversation, and I'm looking forward to speaking with you again soon.

Peta: Thanks so much for having me. It's really great that we can get this information out to people.

Links & Resources

Women's Health Education Network (WHEN)