Meghan

I agree with you entirely that that, you know, we have, I think over emphasize that you must be safe to, you know, engage in physical activity during pregnancy, probably to the point that it's not really, it's been more harmful than helpful. And certainly if you look over time at physical activity guidelines, they have changed wildly ACOG American College of Obstetricians, gynecologists didn't have their first statement on pregnancy physical activity until the mid 80s.

Tanya Tringali

Are you pregnant? Or a new parent looking to ensure a better postpartum experience? Or are you a birth worker looking to improve your postpartum care skills? Check out thriving after birth and online self paced course by me, midwife and educator Tanya Tringali. It's 10 and a half hours of video content featuring experts in lactation mental health, pelvic floor health, pediatric sleep issues, you also get worksheets and a workbook as well as options to have a one on one session with me, sign up and Motherwitmaternity.com/thriving. And let's improve postpartum care together.

Tanya Tringali

Hey, everyone, I'm your midwife, Tanya Tringali. Welcome to the mother whip podcast, a show about the issues we healthcare consumers and providers face every day as we interact with the medical system. We'll talk about its blind spots, shortcomings, and share strategies we can use to feel seen and heard no matter which side of the table we sit on. Megan, thank you so much for joining us today.

Meghan

It's wonderful to be here. Thank you so much for inviting me onto your podcast. Oh, my goodness,

Tanya Tringali

I'm so excited to have this particular conversation. I think it's going to be different than any conversation I've had on this show before. In that it's kind of got an academic bend to it. I mean, this is your this is your baby. This is your work. This is your dissertation, right?

Meghan

That's right. That's right. It took me seven years to give birth to this baby.

Tanya Tringali

that is crazy. So I have so many questions for you. And I want to hear a little bit about the process. And I know that we have listeners who are considering doing something like this themselves, but have some fears. And so as much as I want to talk about your work, I also want to talk about just your feelings around doing it and advice for people who might take this path. But before we do all of that, tell us a little bit about yourself.

Meghan

Okay, well, let's see. I've been a midwife since 2002. What inspired me to become a midwife was actually my undergraduate degree was an anthropology and so I did some examinations of birth practices cross culturally, I guess, I've always been fascinated by birth by pregnancy and birth, I always just thought it was really interesting and cool. And I learned that Western medicine is not the end all be all of birth practices, shocked my little 19 year old brain. But it was it was an eye opener that you know, that Western medicine had gone into different cultures and really kind of muck things up, you know, not taken, what they could learn just really sort of imposed what, what they thought was right, you're making air quotes here. And, and that, and I wanted to learn more. So I started looking a little bit into the history of midwifery in the United States. And this was actually from, you know, having a college, you know, job working in an organic restaurant that had, you know, a magazine section and I was at work one day on my lunch break, looking for something to read and picked up a copy of midwifery today. And my first thought was, Wow, I thought they burned all the midwives as witches. So I opened midwifery today and started reading and was like, This is so interesting. Why is it that midwifery doesn't seem to be more widely practiced the United States, it wasn't visible to me, in my community. And so I started digging into literature because I'm a little nerdy science girl and discovered that there were, there was good evidence for midwifery care. It just wasn't mainstreamed into American medicine. And I really came away from that experience, thinking, Boy, every woman deserves a midwife. And that I could be that person to provide that type of care. And so that's really kind of how I got started. So I went from being an anthropology major finished my Anthro degree, enrolled in nursing prereqs went to nursing school, and after a couple of years of practicing as an RN, I applied to midwifery school.

Tanya Tringali

But you became a nurse always knowing you were going to be a midwife.

Meghan

Yes, yeah. Yeah, I made a conscious decision. about you know, do I want to be a nurse midwife do I want to be a direct entry midwife, I went through that whole process and you know, evaluated what I thought was going to work best for me in my life and decided that I would pursue the nurse midwifery route. But I've certainly enjoyed working with my direct entry colleagues over the years as well. So there's more than one way to be a midwife.

Tanya Tringali

Yeah, totally. Well, this is this conversation is already really fun for me, because like, I know you, but I don't know you that well. But now I know we have some other things in common. I too, thought all midwives had been burned at the stake. That was exactly my, you know, thought when I found a midwife to take care of me when I was very young and pregnant. And something I've never forgotten. And I too, explored all the various paths to becoming a midwife and ultimately became a nurse. Even though I, my goal was to be a midwife, because I didn't have a bachelor's degree at the time, and it didn't make sense to, you know, finish my degree in theater and dance, and then start over again, you know what I mean? So yeah, I love I love hearing people's journeys into midwifery. So Okay. From there, I think there's probably another piece of history for you that might be relevant. Because obviously, we're going to interface with this conversation around physical activity and exercise. So I'm assuming that you have an athletic background as well. Is that true?

Unknown Speaker

Oh, I did some sporting activities growing up. I played volleyball, very poorly, but very passionately in high school.

Tanya Tringali

I love it.

Meghan

I grew up in Michigan, downhill skiing on you know, basically frozen sand dunes. And, you know, enjoy that. So, but I never really considered myself an athlete. You know, but I, I enjoyed being outdoors, I enjoyed being physically active. So, you know, I was more of like a recreational hey, let's get outside and do something kind of person.

Tanya Tringali

So how do the two worlds collide?

Meghan

Oh, gosh, I think probably the, the sort of like little kernel that you know, first sort of, like, has grown into this giant plant was when I was pregnant myself, and I kept my gym membership. And the looks that I got from people were just stunning. And you know, and it hadn't really occurred to me that I hadn't really seen pregnant women in the gym. Um, but yeah, if people really looked askance once it was once I was visibly, you know, showing my pregnancy, that, and that, and it just sort of like was like all those little things that sort of tucked into the back of my mind, why aren't there more pregnant people in the gym?

Tanya Tringali

Are you able to think back to when fitness was just something that was interesting to you in the context of pregnancy? And how you have changed, kind of clinically speaking, in terms of how you talk to people about this topic, once upon a time and not just talk to them, but how you incorporated it and incorporated it into your care then versus now?

Meghan

Yeah, yeah, that's a great question. So I guess that in my clinical practice, I've, I always recommended being physically active, but didn't really sit down and talk to people about what that meant, what that meant to them. Those kinds of things. It's like I had my schpeel you know, that was like, being physically active during pregnancy is very important to you and your baby's health, you know, you can kind of hear it in your in your brain, you know. And it really wasn't until I was asked to write a textbook chapter, this was, gosh, many years ago now about lifestyles while pregnant. And it was sort of this grab bag textbook chapter that covered working covered, sexuality covered like lots of sort of topics, aspects of people's lives during their pregnancies. And one of the included topics was physical activity. And that was the first time I really sort of jumped into the literature. What specifically about physical activity is good for people. And one of the things that came through loud and clear was that there was fabulous evidence for for the benefit of physical activity mean basically, name a concern of pregnancy, being physically active is going to make it better. There are really very few things that physical activity don't improve during pregnancy. But very, very few people were able to be physically active during pregnancy and no one knew why people were trying interventions. Researchers were out there doing different things with you know, you know, from You know, providing, you know, home exercise thinking wealthy, but people can do it at home, they'll do it or no, they need to be in a structured environment with, you know, with a specialist. And this is what's going to get people to be physically active and none of it worked. And so that was really, you know, just like when I read that, the literature about the evidence of midwifery and decided that, you know, I was going to be that midwife, I read this literature about that we didn't have an understanding of why people weren't able to either engage or maintain physical activity during pregnancy and said, Well, I guess I'll have to be the one that's going to develop that evidence. And that was kind of what got me started on the track to doing a dissertation and starting to develop my own body of research.

Tanya Tringali

So cool. I mean, I know our audience can't see us. But I'm kind of grinning from ear to ear, my cheeks kind of hurt, because you're talking about, like, my two favorite things that I love so much. And it's so nice to hear that the kind of totality of your experience and how, you know, I love that analogy of how you found midwifery and how you, you know, ended up becoming so passionate about physical activity, those two things really, really resonated with me. Oh, that's so cool. Okay, this actually segues nicely into how we actually met. And so Megan and I met because we were co authors on a chapter in a textbook that will be coming out this year, in a textbook called prenatal and postnatal care, a person centered approach, that's the name of the book, it will be the third edition of this book. And just like you pointed out in your first chapter writing experience, in this in the first and second edition, the chapter that we worked on was a little bit of a catch all maybe an improvement from where yours was back way back, when. But the catch all was sexuality, environmental exposures, and exercise. And they were all thrown in together. And that always bothered me about this book. It's a book that's very near and dear to me. And it bothered me that exercise didn't have a standalone chapter. And it was something I was like making a strong case for. And so Megan, and I came together. And, Megan, as you are starting to gather, has this really wonderful focus on physical activity, I have this kind of like technical experience around exercise. And with a little bit more of an emphasis or a lot more of an emphasis on, you know, athleticism, I'll say, and honestly, Megan really opened my eyes to a whole part of the equation that I don't think about enough. Like I have a little bit of tunnel vision, on the part of exercise that I love the most, and the population that I like to work with the most, it's very technical skill. But Megan brings this midwifery prospective, for lack of a better word, to what most people engage in, day to day. And so this might sound stupid of me to say, but I had not even fully accepted that physical activity and exercise. Were not synonyms. Until I started working on this chapter with Megan. And that's why Megan's on the show with me, because I think that what Megan does is so much more accessible than what I do. And so, with that said, I definitely want to give Megan lots of time to tell us about her work. And her research. And I've read some amount of the paper that I understand will soon be published is that...

Meghan

hopefully this year, this year, I will get my dissertation research published, it will happen.

Tanya Tringali

Well, I've gotten I've had the pleasure of reading that and I definitely have lots of questions. And I just I think that this is a topic that's really interesting to people who listen to this show. We know that people who listen to the show are healthcare consumers in many different ways who are interested in the perinatal period, but we've also got healthcare providers of all kinds of stripes, obviously, plenty of midwives. But I talked enough about physical activity that we've got pelvic floor physical therapists who listen and I just think there's there's a reason why anyone listening to the show would find your, your, your work, so interesting. So tell us a little bit about this study.

Meghan

Okay, well, first of all, let me let me say a little bit more about the distinction between physical activity and exercise. Because I do think that this is something that they are words that are used sort of interchangeably and certainly before I really started on this, this my journey, I kind of use those terms interchangeably, too, but they're really very they're they are considered to In things, so, exercise is sort of planned recreation. That's the way that I sort of conceptualize this, that these are, these are choices that you make to engage in behavior that is specifically intended to increase your respiratory rate, increase your heart rate, burn calories, whatever, whatever your goal is for that. And physical activity is really everything that you do during the day. So when, you know, I pour out dog food into my dog's dish, you know, out of the heavy bag, you know, that is physical activity, I am burning calories I am exerting myself, you know, it's it's a combination of, of strengths to hold the bag and cardio to drag the bag over to the top dish to pour it out. So it's where it falls into different domains. So it can be physical exertion at work, it can be physical exertion, in transportation activity. So if you walk to the bus stop, that is physical activity. It's not planned recreational activity, but it still burns calories, it's still you know, is increasing your heart rate, respiratory rate. So, and to my mind, that's more accessible for people to think about, because one of one of the concerns or barriers that people often expresses, they don't have time, that is a big barrier to being physically active. But it may be that people are thinking about it only in terms of I don't have time to take out of my busy day to do this planned recreation. Whereas if you can get them to think a little differently about everything that they're already doing, you know, if you are walking up and down stairs at work, that is physical activity, or in your home, you know,

Tanya Tringali

you're chasing your toddler, if you are vacuuming your home,

Meghan

absolutely, it all counts, it all counts. And if you if you can say okay, well, I'm already going to do these things. But maybe I'm going to do them with a little bit more vigor, to increase my intensity, then you're actually getting more physical activity. And so that is potentially a way that people can increase their total activity without taking any extra time.

Tanya Tringali

So it's interesting lately, and probably because I met you, a thought that has been occurring to me is that people can engage in exercise planned recreation for their hour a day, let's say, but otherwise be sedentary. And so I have thought a lot about that. Because I feel like what you're doing is actually combating the 23 hours of the day, that is not what I'm working on. That's been one of my repeating thoughts since I met you.

Meghan

And and there's a whole separate set of literature on the effects of sedentary behavior. And, and I think it's starting to sort of get out into public consciousness now that sedentary behavior will undo your physical activity, that if you that if you engage in too much sedentary behavior, it doesn't matter if you're getting that hour a day of extra of planned recreation. And that was something boy, we better believe that was on my mind while I was chained in my computer writing my dissertation. Sure, I'm not sure how, how sedentary my behavior had become. And, you know, and, and so yeah, the lifestyle physical activity is a way that you know, if if people can make a conscious decision, okay, I have a 30 minute lunch break, I'm going to take 10 of those minutes, and I'm going to walk Yep, you know, they're still not taking any additional time. But now not only are they increasing their, their, their energy expenditure, they're also breaking that sedentary pattern, you know, if you just, you know, I'm certainly guilty of this eating lunch at my desk, you know, or just moving to a different room to sit and eat. You know, I should try to be more intentional about saying, Okay, well, maybe I'll run down to the laundry room. You know, I live in an apartment building in Chicago. So I've got to go down a couple flights of stairs, I will go throw in a load of laundry over my lunch break and just to get on the stairs and you know, sort of killing two birds with one stone. So laundry is not going to do itself.

Tanya Tringali

So on that note, I'm so glad you stopped me from launching right into your research because that was so important. But it also reminds me of one more thing I think we should actually mention before you launch in and that is can you talk a little bit about the guidelines around physical activity for the general population, but also just for people who are pregnant. And I don't know if you have any point To make specific to how the physical activity that you're focused on, relates to how we talk about it when we're talking about, quote, unquote, moderate activity, you know, moderate or moderate levels of exercise.

Meghan

So the recommendations for pregnancy physical activity are no different than they are for the general adult population. So that recommendation is 150 minutes weekly of moderate to vigorous intensity, physical activity. So and during pregnancy, we really focus more on the moderate end of the physical activity spectrum. There's certainly not anything wrong with engaging in vigorous activity. But you know, there are anatomical and physiological changes that happened during pregnancy that may make that less accessible. And we certainly don't want to introduce any new barriers. One thing that we don't know is what is the minimum threshold of physical activity that's efficacious? We just don't know that. We're very focused on the sort of standard guideline in fact that the ACOG guidelines specifically talk about planned recreation, they don't even talk about lifestyle, physical activity. And I don't think that this is an intentional thing. I think this is just the way that it got written. So because you know, a, you know, American College of obstetrician gynecologist isn't are not exercise physiologist, they're not steeped in the door. So, but that's, that's how the guidelines are written. So and we also don't really know the effects of sedentary behavior specifically on pregnancy, that pregnant people are just hard to study, just, you know, I don't think anybody would disagree with that for for lots of reasons, and possibly some some reasons that we've done to ourselves over the years. So those guidelines are helpful, in that it sort of can give you for someone who's very motivated a goal. You know, if that's, if that's something that's helpful to an individual, but it can also be a barrier. And it can be that you can give the impression that if you're not achieving this 150 weeks of moderate intensity, physical activity that we know is associated with improved health outcomes, that anything less than that is not worth anything. And that's not true, either.

Tanya Tringali

Yeah, we don't want to throw the baby out with the bathwater. But it's unfortunate that we're not at a point where we can make a statement like I'm making this up, this is not real 300 minutes of low intensity movement equals that of 150 minutes of moderate, like, it's a shame that we're not at a place where we can make a bold statement of that nature, or do you think it's like a moot point? Hey, everyone, it's me, Tanya, your host here at the mothership podcast. You know, I sometimes I invite my clients on the show to talk about their birth stories and postpartum experiences. But I want to tell you a little bit more about what those clients and I actually do together, I started mother wit to help people in the perinatal period achieve their health and wellness goals. That means whether you're hoping to conceive and struggling with high blood pressure, or high blood sugar, or you're having trouble managing anxiety, or depression in the postpartum period, or maybe you just need support and advocacy between prenatal or postpartum visits, I can help get a discount on your first consultation with me at Mother weight maternity.com using the code first console 10% off, that's one 0% symbol, all one word, I'm looking forward to working with you, and maybe having you on the show too.

Meghan

So it's interesting, I do think that there's that there, there is pretty wide recognition now that that pregnant people, if they're physically active, tend to engage in lower amounts, lower intensities of physical activity. And so we may not even be recognizing the activity level that people are actually engaging in with this fixation on moderate intensity activity. And even in my own research on my, in my dissertation study, I did focus on moderate intensity activity, but part of that it's like almost a catch 22 Because you want your study to be able to be compared to other studies. And so if everybody is looking at moderate intensity physical activity, then you're sort of have to look at moderate intensity physical activity to otherwise you can't really compare, you know, at least in a small dissertation study like what what I've done, but certainly looking forward I am interested in measuring you know, lower levels of activity having measures in this as you're seeing starting to see this more often just sort of broadly in the in the physical activity literature, measuring sedentary behavior separately from physical activity. So yep, so it loves are changing, things are changing, but it's you know, everything takes Time.

Tanya Tringali

Totally. Okay, you've hinted at a few things already. So now I think it's time to tell us a little bit about your study.

Meghan

Okay. So the one, the one aspect of, of my study that we haven't really talked about yet is that I focused exclusively on black pregnant people. And I was very intentional. And in doing that, first of all, black pregnant people have been virtually ignored in this literature. Most of the studies that have been done on pregnant people have been overwhelmingly done in white, well educated middle class populations. And in those studies that did include, you know, a sufficient, like sample of people of other races and ethnicities, there was no subgroup analysis, or just sort of lumped in, there was one study that I looked at, that was actually done on a national sample. So it had a huge number of participants, and they looked at white people, and then everybody else, so they lumped every other race and ethnicity into this sort of other category, which just, you know, is really dead. It's feels gross. That's just right. It's, it's, it's it, it seems, it's white norming, you know, and we see this throughout the medical literature, you know, that that white is reference, and then and then everything else is somehow different. Or that whatever we know about white people can automatically be applied to people of other races and ethnicities. And this has sort of been the dominant paradigm for a long time. And it's, it needs to change. So the other reason that I was very interested in looking at a sample of all black pregnant people, is because this is the population, the United States that is experiencing the greatest amount of maternal mortality and morbidity, and I'm sure that the population for your podcast knows that very well. So I won't belabor that point. But a couple of the more common complications of pregnancy, specifically gestational diabetes, and pregnancy, hypertension, both of which physical activity actually improves, it can prevent it, and it can treat it. But and you would think, well, gosh, this should be, you know, super accessible to everyone. But as we've said before, apparently not. And we don't know why. So I wanted to know, for my dissertation research, what factors influence black, people's pregnant, like pregnant people's physical activity behavior. And so I was looking at characteristics that, you know, are sort of reside within the individual, like, how confident are they to be physically active relationships that might affect a person's feelings about being physically active, so social support from their family, and social support from their friends to be physically active. And then I was looking at factors that sort of broadly exist, you know, outside the individual, they all affect the individual, but they may not be things that the individual can affect as much as their confidence or their social support. So their neighborhood characteristics, experiences of discrimination, and also various demographic characteristics, you know, so age, education, income, sort of those those sorts of factors. And then I measured people's physical activity by having them wear a physical activity monitor. So this was a research grade monitor, called an accelerometer. And then they also answered survey questions about what their physical activity was, like during their pregnancy using an instrument that was intended for use in pregnant people. And then I looked to see what are what are the relationships? What are the associations between these these different factors to see if there was anything that seemed like it could potentially be either a factor that needed to be accounted for when you're looking at well, how can we potentially develop an intervention that might help improve somebody's pregnancy physical activity? You know, for example, sometimes people cite lack of childcare as a resource. And if it looked like people who had already had children had more barriers to being physically active, that could be something that potentially needed to be accounted for in an intervention. Or you know it did it seem more like internal factors, you know, that it was really their confidence to be physically active, whether they were receiving social support if those things seem to be affecting their behavior and There are some things that were known from those prior studies that had been done on on white well educated middle income women that had been identified as potential barriers or potential facilitators that could be, you know, targeted in a, in an intervention. And what I found in my study was that none of the things that had been identified in white pregnant people seem to be influenced the behavior of my sample of black pregnant people. Now, of course, this is just one little snapshot of folks residing in the Midwest, all my data was collected during the pandemic, you know, there were definitely factors that could have could have influenced things. And it could have just be just the sample of people. But it does point to, to an idea that you can't say what, you know, has been done in other countries with other populations. And say that, okay, these factors are somehow universal and apply to every pregnant person's experience. So really, what this dissertation taught me was that I have a ton more to learn.

Tanya Tringali

I guess that's the way it is with every study, right? I mean, most studies are going to raise more questions than they will answer. And that's what then propels the future. Have more and hopefully better research, right? Yes. So in your case, I think you're hitting on some really beautiful ideas that people need to hear. Like, don't group everybody is other. Maybe let's be intentional about our, our study populations, and our who's who's included in our sample. That was such a great point. You know, one thing that I was thinking about when I realized that oh, my gosh, you did this all during COVID. was, I think everyone can relate to how important your social network is your social supports, I should say, in being able to engage in activity of any kind. And that had to be really hard for people during COVID. I would imagine that that was one of the biggest changes that happened for people. I don't know, you know, how you went about talking to people about that? Or talking about it, per se?

Meghan

Yeah, yeah, I had one question and one survey that had to do with people's confidence to be physically active. They asked how, how difficult it was, and sort of ask them to rate on a on a zero to 100%? How confident are you that you could overcome this barrier? And one of the questions was, how confident are you that you could find a place that you would feel safe from COVID? And honestly, I did not do an analysis? Just have that one question. But you know, there, we definitely had to account for it. I mean, it, it, it affected things like, you know, where I could meet people to give them the, the accelerometer device that they wore during their pregnancy, you know, to gather their physical activity information, you know, trying to stand six feet away from people with my mask on and yeah,

Tanya Tringali

Wow. So I'm curious if you came into this with your own ideas or hypotheses about what you would find? And if you, or if you were able to refrain from having ideas like that, and then how it all turned out?

Unknown Speaker

Yeah, no, I definitely had hypotheses. And my hypotheses were based on another paper that I'd written this was actually a systematic review of of studies, non intervention studies that had looked to examine what factors influence pregnancy physical activity. And that's where a lot of my ideas about what types of what types of variables I would include, came from acknowledging the fact that a lot of these studies were a cross sectional, so they were just looking at a snapshot in time that the populations were mostly white, you know, then in my study was going to be different I study was a sample of all black pregnant people. And I did a longitudinal study. So I did all of these things twice, about 10 weeks apart during their pregnancy during the second and third trimester. But I had to start from somewhere I had to, you know, say, Okay, well, these are the variables I'm going to examine. And for my systematic review, it really very clearly demonstrated in that review, that it was things that could potentially be modified, like self efficacy, that seemed to really influence people's behavior. If people were confident that they could be physically active, they were much more likely to be physically active. If they had a habit of being physically active prior to pregnancy, they were more likely to be physically active during pregnancy, you know, so there were there, there were these factors that seem to reside within the individual that could that seemed to have a much greater impact than whether you were you know, had a college education or you know what your income was, or Um, you know, things that I tend to think of as being more difficult to manipulate within an intervention and maybe manipulates not exactly the right words, I don't want to sound like a little, you know, Machiavellian, you know, scheming person that I'm going to, like, get people to do what I want. That's not what I'm trying to say. But it's a lot easier to try to build up somebody's confidence than it is to, you know, change their neighborhood, for example. Yeah.

Tanya Tringali

Sure, that's a great point. Are you able to say from your research, what activities were the most commonly engaged in and what what types of things maybe you were surprised by because they were the least commonly engaged in.

Meghan

So one of the this is very consistent across the literature is that the the activity that my sample most commonly engaged in was walking, walking during pregnancy seems to be an activity that lots of different folks are are comfortable doing, that they're comfortable, they're confident they can do it. And I don't think that COVID really changed that a whole lot. Because this was an outdoor activity, you know, and that was basically about the only place that we could move around freely was if we were just outdoors. So that didn't surprise me, one of the activities that came up as not only being an activity that a lot of the folks in my sample engaged in prior to pregnancy, but they also continued throughout their entire pregnancy was dance. There was lots of folks that were dancing. And I thought and that is not something that I've seen mentioned. So basically, the the top two were walking was number one dancing was number two.

Tanya Tringali

And when you say dancing, I don't know if you can answer this, but like, do you just mean like somebody's putting on music in their home and dancing around their house or, like, semi more structured than that?

Unknown Speaker

It was undefined. However, however, the person filling out the survey, define dance. That's thats

Tanya Tringali

love that. That's really, really cute.

Unknown Speaker

But I thought, you know, that, that that once again, that's something that can be sort of infinitely modified, you know, as pregnancy progresses, you know, that it may have been, you know, being very social being out in a public place, and, you know, dancing with your friends prior to pregnancy. And then maybe by the time you got to your third trimester of pregnancy, it was something that you were doing more, you know, slower music, maybe in your own home, you know, I don't know, because I didn't ask those kinds of questions. But that would be a wonderful thing to explore, is to find out more about, you know, what is it what type of dance and where, where are people engaging in dancing? And you know, how did they feel about sustaining that behavior over the course of their pregnancy.

Tanya Tringali

So fun fact about me, I dance, Argentine Tango, I have her a gazillion years, and I danced it through my pregnancy, which was really interesting to maintain my center of balance, while very pregnant, in high heels. Nonetheless, I don't think I could do that now. But that's why I was so interested in the dance as a as an option, because I was definitely the only pregnant belly that was showing up. Argentine Tango...

Unknown Speaker

That is a very vigorous form of dance. That is not that is not for the faint of heart.

Tanya Tringali

It's also 1920 years old. So just a little context, right. Like I was a dancer, and that was something I did for fun.

Unknown Speaker

We had we had last night on the Super Bowl. We had Rihanna.

Tanya Tringali

I know! That was crazy. I just saw that too! So, interesting.

Meghan

Yes, yes. And, you know, I am not a not a football fan. And I don't know what made me turn on the Super Bowl last night, but I watched it and I was so glad to. I kept looking at her belly. I'm like, I know she had a baby recently. Is this postpartum belly? Or is she having a baby?

Tanya Tringali

So I had a similar thing. So my husband was watching it. And I said, Call me over when the halftime show comes on. I don't normally care. But I had seen a post on Instagram of Rihanna with a very big pregnant belly. And there were like words over top. That was a quote from her about how important it was for her kid to see her do this. And I remember being not sure whether she would be pregnant or not like that post wasn't it wasn't clear to me. Anyway, we're watching it. And I think she looks a little pregnant. But her belly looks so much smaller than the picture I saw. So then I was confused. And Pablo, my husband says, I think she had a baby recently. And I thought, well, so maybe that's a postpartum belly. I don't know. And then I ended and sure enough, I immediately saw the headline.

Meghan

Yeah, yes. Yeah. She was. I mean, that was some vigorous dancing. She was doing No kidding. Yeah, yeah. I don't think I don't think I could get my hips to move like that.

Tanya Tringali

Well, not to mention, she was very brave going up on those floats that went very high up in the air. Yeah. Oh, okay.

Lo

Are you Are you pregnant? And thinking about what making milk for your baby will be like? Do you wonder why feeding human babies human milk has become so challenging. I'm Lo Nigrosh, a lactation consultant and host of the milk making minutes, a podcast that explores baby feeding through the lens of systemic and cultural barriers. Come listen to others share their insight about their own milk making experiences, and empower yourself to feed your own babies in the way that feels best for you.

Tanya Tringali

So what was there anything just to finish that thought? Was there anything that you expected to see people do that they weren't doing at all, in terms of just regular physical activity?

Meghan

You know, I think that the thing that and this isn't a type of activity, this gets back to my you know, actually, that device that people were wearing that was measuring their physical activity was just how little activity people were getting. And I was looking at moderate intensity activity. And you know, I said earlier that, you know, this is something that is probably not exactly what we should be doing when we're examining pregnancy physical activity. But, you know, the, the 150 minutes a week of moderate intensity, physical activity, that we're supposed to be encouraging everybody to get the sample of people that I had, in my study, we're getting 20 minutes a week of moderate intensity activity. So way, way, way below.

Tanya Tringali

So it's funny at one point, I had a question for you that now I can tell is moot. But I think it's an interesting thing to bring up. I initially wondered, if putting a monitor on somebody would make them change their behavior from what it typically is that their baseline and I was thinking, right, where I was getting that from, I know you're following me already, is when you ask someone to do a food diary, they often change their their dietary intake, because they're already feeling watched, even without, you know, giving them advice or anything, they will often be like, Oh, maybe I won't eat that cupcake. Because my midwife is going to look at this. Like there's that way that people can change their behavior. And I wondered if that would happen. But I'm guessing with these low numbers, that doesn't appear to be the case?

Meghan

Yeah, I don't think that I don't think that that that that happened during the study. I very intentionally when I was talking to people about the study said, I don't want you to change your reticular activity. This is really, you know, I'm wanting to know what you're just doing in your day to day life. Yeah, so but you're absolutely right, that, you know, it's that. So that's that quantum physics thing that you know, the moment that you observe something you have changed. That's nature, you know, and that's absolutely true when you're studying human behavior as well.

Tanya Tringali

So the other thing, though, that I think comes up in this, and I don't know if, you know, there was a way to make sense out of this, even though I know that, in theory, you'll agree with me. You know, when we see these low levels of physical activity in pregnancy, how much of that this is like the big question, how much of that can we attribute to fear of physical activity causing harm? Because that's one of the reasons I'm so engaged in the work that I do, because I think that we, as healthcare providers inadvertently instill fear in people. And I think we have it's a vicious cycle. And I'm wondering if you have any sense of if that's why we see it so low? Or if that's just not something we could capture in the study that you did.

Meghan

So not not, I didn't look at that specifically, in my study, what I looked at was whether pregnancy worries as a general statement seemed to influence behavior. And I didn't find an association between that. So yeah, I used a survey questionnaire called the pregnancy distress questionnaire that asked specifically about in a number of different domains, things that might concern somebody during their pregnancy from concerns about their health concerns about their baby's health concerns about economic changes, or changes in their relationship. So not specifically about concerns regarding physical activity, but in the qualitative literature, that's something that has come up. Yeah, that people that that it's, it can be, it's really sort of interesting, it's kind of there. It's a double edged sword in that it's sort of if you aren't convinced that being physically active is is something that is important and that you value that during pregnancy. People tend to sort of like really stick to that belief, whereas people who really value being physically active and think it's really important to their house sometimes will go the opposite way where they will, you know, being be very you know, adamant that I'm going to continue to do my very intense physical activity during my pregnancy. So it can sort of cut both cuts both ways. So I agree with you entirely that that, you know, we have, I think over emphasize that you must be safe to, you know, engage in physical activity during pregnancy, probably to the point that it's not really, it's been more harmful than helpful. And certainly if you look over time that physical activity guidelines, they have changed wildly. That's a really fun dive if you ever want to get in just, you know, look at the the literature out there about guidelines for physical activity during pregnancy, me ACOG American College of Obstetricians, gynecologists didn't have their first statement on pregnancy physical activity until the mid 80s. So

Tanya Tringali

Thank you, Jane Fonda. I actually don't know if Jane Fonda had ended.

Meghan

But I mean, really, you can save that this was this was a cog responding to the culture, I think for sure, you know? Yeah. So I think you probably probably can, at least in part, thank Jane Fonda for that. But if you just look back more at like, just sort of general guidelines for being, you know, healthy during your pregnancy in the in the, you know, early 1900s, the advice was to pregnant people was to not ride your horse, which, you know, makes sense, but that they should walk three miles a day. Can you imagine, if we sat down with with a person in the OB clinic and said, you know, you really got to start walking three miles a day?

Tanya Tringali

Well, first of all, we would not say it like that now. But how many steps that is that they have to take?

Meghan

And that would be what 30,000 steps? I think.

Tanya Tringali

I actually don't know. I feel like I should know. But I'm kind of numerically inept when it comes to like, just remembering numbers,

Unknown Speaker

way more than 10,000. I can tell you that.

Tanya Tringali

I can't remember. Like, when I walk 10,000 steps, how many miles does that always turn out to be? I can't even remember.

Unknown Speaker

Anyway. And that's a whole nother conversation, that 10,000 Steps thing is not like, based on like...

Tanya Tringali

that arbitrary number everybody's striving for now. And yet, when somebody says it with enthusiasm, I really have a hard time, I just go, I'm not even going there, like this person's act enthusiastic about it. So I'm not gonna take that away.

Meghan

That's right. And that's really I mean, that. And that's where we should be focusing our conversations with folks about being physically active during pregnancy, instead of trying to, quote educate them that it's safe. Being, you know, excited, like I was saying earlier, you know, that people sort of they come with it with a set of beliefs. And, you know, it's I say, often, you know, if all it took was education, nobody would smoke cigarettes. I don't know, anybody who doesn't know that smoking is bad for them. But I know lots of people that smoke. So education is not the key. So it's not to convince people that being physically active during pregnancy is safe. It's saying, Okay, well, what were, you know, do you value this? You know, what are what are your interests in your pregnancy? You know, what is it that it's important to you from this experience? And then you know, what types of activities or what kind of behaviors only want to say, activities, what type of behaviors would help that person to achieve their stated goals for their pregnancy? And just let them work it through? You know, if if there was somebody that, you know, had was not physically active prior to pregnancy, you know, is there a time in the past when they ever were active? And what benefits that they perceive from that? And how do they feel that those that they might realize some of those benefits now, you know, when in the beginning of the conversation are saying that there's really not a whole lot that pregnancy physical activity doesn't improve? That is Drew, you know, if you're having a rough time sleeping, during pregnancy, which a lot of people say that that's a concern, being physically active can be something it'd be helpful for that, you know, I mean, there's so it's aligning people's needs and people's values, with their behavior.

Tanya Tringali

Well, and to go out on a tangent or something unrelated to this, but you know, to make that point even stronger, I see this idea in action, most commonly for me, when somebody's postpartum, and they start to say things like, I recognize that I'm going to need to be able to keep up with this baby who's becoming a toddler and, or they'll say, I want to be healthier so that I can enjoy my kid and my family for longer. There's these various wake up calls that happen for people. Yeah, I call them a lot postpartum.

Unknown Speaker

That's change talk. That's people thinking about how can I make a change that's going to improve? Meet my goals? You know, if my if my goal is to be able to keep up with my toddler, you know what changes and that's listening for those cues and picking up on them as a clinician is so important and just saying, Wow, yeah, I hear what you're saying that, you know, yes, toddlers can be a handful to keep up with, what are you thinking about doing? And just, you know, starting the conversation from there. So the whole thing about guidelines on what, you know what, whatever Professional Organization recommends, blah, blah, blah, somebody values that if they explicitly state, I would really like to know what ACOG says about pregnancy, physical activity, share it, you know, if they're talking about how, you know, their major goal is to, you know, not hurt have a preterm birth. You know, that's, that's 150 minutes of physical activity, even though we know that it's associated with lower rates of preterm birth, that number means nothing. But you know, what behaviors does a person think that they can achieve, that's going to help to meet their goal of half of having their baby at full term? You know, and if, if Harry sharing information about how being physically active can improve that is helpful to them? Great, share it, you know, it might help move the needle a little bit. But I really think you know, right now, that's really where we need to be focusing the conversation is, you know, to what is important to that individual?

Tanya Tringali

Well, I love hearing glimmers of how it is that you now talk to your clients about this topic, it's really beautiful. And on that note, I want to talk more. And please stop me if there's something else about your research that we haven't gotten to that as that you want to get out there. But I also want to talk to the people that are considering doing a doctoral program than the midwives that are going to do a Doctor of Nursing Practice or a doctor or midwifery or get a PhD, and, you know, all the various other health professionals or birth workers that are considering taking on this huge task, it is something I have thought about over and over and over again. And over and over and over again, I come back to nope, my reason for nope, is deeply rooted in how much student loan debt I still have. And that's the end of the conversation in my mind. But that aside, I think there are people that are ready, they're at a stage of their career and a stage of their life where they're considering this. And I think people have a lot of different feelings about it. Can you talk to us a little bit about your journey to making this decision? And what that was like for you what the experience itself was like?

Unknown Speaker

Sure, sure. So in a certain respect, the decision was made for me about whether I was going to pursue a doctoral degree or not. And that was because I had taken a faculty position at Frontier nursing University. And this was the time period before the program that people were enrolling in was a doctoral program, it was still a master's program, and then we had a post Master's DNP. But when the program changed, so that people were basically enrolling in a DNP program, people like myself, who had a master's degree really sort of needed to go ahead and move towards that doctoral degree. So in a way the decision was made for me. Because I wanted to keep my job. That's fine. The decision was, you know, do I want to get a DNP a doctorate in nursing practice? Or do I want to get a PhD, and a PhD is a research doctoral degree. So and I really saw that from where I was in my career that I really didn't picture ever being, you know, a full time clinician, again, that really academia was going to be where I was going to stay for the rest of my career. So to me a DNP didn't make as much sense because it's a clinically focused degree. So I decided to pursue the PhD. And...

Tanya Tringali

that's a helpful answer. Yeah. Yeah. I mean, it's so simply stated, but I think a lot of people need to hear that baseline answer before going on from there. That's so important just to make that decision and how do you make that decision?

Lo

Yeah, yes. You know, if you are, you know, if you are a clinician and that's really where your heart is and where you want to stay. Getting a DMP is definitely the way to go. And there are there are distinct advantages to having a DMP, meaning that the masters prepared midwife or nurse practitioner has got a really solid foundation for engaging with patients one on one and operating within a group practice. What the DMP does is it really sort of moves that skill set to the higher level of working with than a healthcare system, and being able to affect change on a higher level than just the one on one interactions that we've been talking about so far in this conversation. So, I mean, they're there, it's a worthwhile, in my humble opinion, the degree to get just just for that reason, it's a lot. It's not that you can't gain those skills without the doctorate. But, you know, it's it, I think it's always easier to go to a, an organized program, where they're going to teach you the set of skills than trying to seek out the opportunities on your own and identify all the knowledge that you need to gather. So then the research doctorate is really, you know, if you are wanting to be operating on a different level, where you are really trying to generate the evidence, that's then going to inform clinical practice down the road. So you know, sort of some of the things that I talked about today, in my own research, you know, the idea is that eventually, it's going to get to the point where there's, there's an intervention that can be tested to see whether it improves physical activity for black pregnant people, I actually don't think that that intervention is going to reside within the healthcare setting at all, I really think that this is something that needs to reside within the community. For a lot of reasons, health care providers, I mean, gosh, all the laundry list of things that need to be taken care of, in a, quote, 15 minute prenatal appointment, only Molly, you're lucky if you've got all 15 minutes, you know. So I think that it's tough to really, because it's such an individual decision, and, you know, requires really is sort of like intense time to to you know, really flesh out what it is that a person can do to be more physically active that probably in a in a non healthcare setting is probably a better place for that to reside. And that's just that's where I am right now, in my thinking, I might try out a community based intervention and think nope, nope, I really got to do is get the health care providers on board. It may change.

Tanya Tringali

So what have you found most rewarding about this so far?

Unknown Speaker

Oh, gosh. I getting this dissertation has been immune, it took me seven years. And a lot of and it's not because it's a seven year degree. It's a four year degree. But it took me seven because of some, you know, changes that happen in my life. You know, we all had a global pandemic. And then I had some personal challenges as well. That definitely lengthened out my program. But even if I would have finished it in four years, it would have been the hardest thing I've ever done. This the the I thought I was a good writer until I started this program, I thought that I was a pretty good like critical thinker until I started this program. You know, there was it was a very humbling experience. But coming out of it, I feel like I have really, really, really like developed a very deep well of knowledge about this thing that I was very interested in pregnancy physical activity that I can draw now. I have met some amazing people, I have seen what other disciplines are doing in this area. It's not just you know, midwives and obstetricians that are, you know, doing this work. There's exercise physiologist are super interested in pregnant. Yeah, pregnant people, you know, in a way that I didn't appreciate until I started this degree. So...

Tanya Tringali

that's why I like the Canadian guidelines more than what I like the Canadian guidelines have around exercise in the perinatal period more than the ACOG ones to begin with for other reasons. But they did that statement jointly with exercise physiologists and I was like, right on good for you for working together. That's what it should be.

Meghan

Yeah, we all need to get out of our silos. Right. Yeah, totally start talking to people. Yeah.

Tanya Tringali

So I was going to ask you what your biggest challenges were too. And I think you may have just spoken to that. That really was interesting to hear you say that you thought you were good at these things. And so I'm going to guess that you were already good at them. But that you that change and learning can be so hard that now you're just like catapulted to another level. But do you feel in retrospect, like you were not truly were not good? And now you are or what? Like what's that? Like?

Meghan

Um, writing scientific writing is really different. You know, writing a research paper is just a really different it's kind of like I took one semester of German realism and learning how to write for media. And it's just a really different way of doing things. And so that's, that's, I think, really what I mean, it's not the, you know, my head poor grammar or something like that, you know, before I started this program or you know, wrote with incomplete sentences, it's just I didn't have the technical skills. And really like, for about the first two years of the degree, I would listen to my professors talk and it was almost like, I was listening to somebody speak a language that was sort of like English, but not exactly English, you know, this, and their minds just worked so differently, like, they can see things that I was just like, wow, they're, they're operating on a whole different level than me. And that's really, you know, that that's, that that was a very humbling experience, you know, because, you know, I thought of myself, as you know, I'm a faculty member at a university, you're a faculty member at a university, we have so much in common. And I think that that's, it gets to be that, you know, I teach midwifery students, and I see that same sort of role transition from Rn to CNM, you know, where they're like, I'm a labor and delivery provider, I'm a labor and delivery nurse, you know, you're a labor and delivery provider, you're a CNM, we have so much in common. And yes, that you do have a lot in common with that person. But, you know, with each other, but, you know, once we start talking about clinical management, and start talking about, like all of the pieces that need to go into making clinical decisions. The RN sort of says, wow, there's a bigger role transition here than I thought, and I was going through that same process. Yeah. Yeah. lovin, clinically focused midwife to being an academically focused nurse researcher.

Tanya Tringali

So I think that speaks to one of the most common things we all go through with growing pains, but possibly also. I don't know. I'm, I want to say women dominated professions probably have this more. And that is imposter syndrome. Like, would you say that you experienced outright impostor syndrome or not quite at that level?

Meghan

Um, I don't think I'm really, really don't think that, that I dealt a whole lot with imposter syndrome. And I'm, I'm a little bit older and 53. And I think that there's some of that's just a function of age, you know, I've been around the block, you know, and, you know, I can, I definitely can see the value in my previous life experiences and how they apply to what I'm doing now. And, you know, I think that that's really helpful. Does that mean that I was never intimidated or felt like I was, like, you know, like, maybe maybe in the, in the deep end of the pool a little sooner than I wanted to be? Absolutely. I definitely had uncomfortable moments, you know, where I was like, oof, yeah. The first I presented, not my dissertation research. But another secondary analysis that I had done at a research conference at Rush University, where I got my doctoral degree, shortly after the pandemic, when we could all be in public together again, but everybody was masked. And it was in one of those like traditional medical theaters, you know, where like, the seating goes straight up. And these were, you know, people from the College of Nursing people from the College of Medicine, you know, very esteemed, you know, faculty and researchers and administrators. And I just remember standing down in the well, and looking up and just thinking, holy moly, how did I get here? Yeah, yeah.

Tanya Tringali

So on a final note, do you have a piece of advice that you would give to somebody embarking on a similar journey?

Meghan

So I got a really good piece of advice from one of my co faculty when I started my PhD. And I think that this applies to whether it's a DMP, or a PhD. It's a marathon. You know, it's about endurance, if you just keep moving forward, you will finish you know, basically, and I think that that's true. And I would honestly, I would say the same thing for somebody who's considering moving from a BSN to MSN. And that you know, you are if you have been accepted into the program, you have everything that it takes to finish the program, you would not have been accepted into it if you did not have the chops to finish it. The tough point is just continuing to move forward. And you know, in the face of those obstacles are saying, You know what, I may not be able to focus 100% on school right now, but I'm not going to let school go because this is still very important to me. You know, and if you if you can do that, we'll finish We'll be successful.

Tanya Tringali

Awesome. Anything else you want to add? Before we part ways?

Meghan

Tanya, I really enjoyed writing that book chapter with you. I thought that our skills complemented each other or different domains of of our interests and in pregnancy physical activity, I thought complemented each other so well and made it an incredibly strong book chapter. And I'm really looking forward to seeing it in print.

Tanya Tringali

Me too. Oh, me, too. Thank you so much for talking to me, and for letting me experiment with taking on an academic on this show, because it's definitely a first and we're gonna follow this episode with one more, another colleague of mine from Georgetown who's going to talk about her work next next episode. So I feel like I broke the ice on doing something a little bit harder on the podcast. Thank you so much for joining me today.

Meghan

It was absolutely my pleasure, Tanya.

Tanya Tringali

Thank you for listening to the mother whip podcast. If any of the issues we discussed today resonate with you or your experience, I'd love to hear from you. Leave me a voicemail at 917-310-0573. Or better yet, email me a voice memo at Tanya at Motherwitmaternity.com. I really want to hear what worked for you what didn't work, what support you'd wished you had, how you got through the tough times how you advocated for yourself, or especially any tips you want to share with our listeners. I want to hear all of it. And if you'd really like to work together, you can get a discount on your first consultation with me at Motherwitmaternity.com using the code first consult10%off. That's one 0% symbol, all one word. Okay, that's all that's wonderful being in community with you all. Thanks again for listening and see you next time.

Unknown Speaker

And remember, listeners, nothing we discussed on this show should ever be considered medical advice. Please speak to your local provider about anything that comes up in this show that resonates with you and your needs and your health care.

Transcribed by https://otter.ai