This episode, the CHASIcast examines the post-partum complications they don’t talk about. Join host Dr. Martha Dow, along with Dr. Iris Lesser, associate professor at UFV’s School of Kinesiology (and CHASI faculty associate), as they examine how pregnancy and physical activity interact, in a world that’s all about body image.
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You can learn more about Dr. Lesser’s current project from the poster below.
Transcript
CHASIcast voice-over
Coming up, on the CHASIcast …
Dr. Iris Lesser
There does tend to be this … assumption that your body is for everyone to look at and to comment on.
CHASIcast voice-over
Dr. Iris Lesser, CHASI faculty associate and assistant professor at UFV’s School of Kinesiology, on how pregnancy and physical activity interact, in a world that’s all about body image.
Dr. Iris Lesser
There’s also this societal expectation that you figure it out, and you turn back into who you were.
CHASIcast voice-over
The postpartum complications they _don’t_ talk about, in this episode of the CHASIcast.
CHASIcast voice-over
From UFV’s Community Health and Social Innovation Hub, this is the CHASIcast: a program dedicated to bringing experts and insights to the issues that shape our lives, because Words Have To Matter. Now, here’s your host, Dr. Martha Dow.
Dr. Martha Dow
It’s my pleasure to welcome Dr. Iris Lesser to our podcast today. So welcome, and thanks for taking the time.
Dr. Iris Lesser
Thanks so much, Martha. This is fun.
Dr. Martha Dow
Yeah, I know, it’s a bright spot in my day, too! What would be great, I think, is just – if you could talk a little bit about sort of your journey, you know, to UFV through UFV, in the – in the work that you do. And, uh, it’s so interesting to me, so I’m excited to hear you talk about it.
Dr. Iris Lesser
Sure. Well, I mean, my work, my teaching, my research – all of it has definitely just followed my own passions, and just kind of how things change over the lifespan, and the things that become important and relevant to you. So I started out at UFV as a sessional, when I was doing my PhD, and then moved on to a limited term appointment as I finished my PhD. And … as I kind of moved into this faculty role as an assistant professor, I had, uh – one kid already goin’, and another kid that was in the oven, and it really just kind of became this goal to focus on postpartum wellbeing from a physical activity lens.
Dr. Iris Lesser
I’m quite open about how I struggled when my first child was born, from both an anxiety and a depression lens, and how, for me, you know, having that tool of physical activity really got me through it, and seeing how other women, other mothers don’t necessarily have those tools in the toolbox. And we really don’t do a great job of caring for our new moms – we’re a little bit more concerned about the babies. So I’ve since then really just tried to focus on that field and improving sort of that maternal physical activity care.
Dr. Martha Dow
Can you talk – I find it interesting, because I – I mean, I’ve felt so privileged that sort of my political and my personal and my professional lives have always been so, you know, connected. Can you talk a little bit about how you sort of – y’know, navigated that? Because I think as women, we still – people look to, you know, keeping those lives kind of separate, and we’re almost criticised. Can you talk a bit about that?
Dr. Iris Lesser
That’s an interesting point. I mean, maybe it’s 2024, maybe it’s UFV, but I think times are changing. If anything, I’ve somewhat felt the opposite. I’ve felt like having those experiences, and being, you know, really … to the point about those experiences, gave me more credibility. And I think my students really respect that ability to … be doing it in the face of those challenges. So you’re not speaking to someone else’s challenges, you’re living it.
Dr. Iris Lesser
And those lived experiences really help to frame what it is that you’re trying to achieve. And I’ve really found that to be positive. Whereas, you know, I’ve done some work in, you know, cancer survivorship and physical activity – and I’m very clear about the fact that I haven’t stepped in their shoes, I don’t have that lived experience, and while you can obviously learn from others, it’s also nice to be able to “get it.”
Dr. Martha Dow
So when you – and you mentioned students, so in terms of “getting it,” you must have – I mean, we all do – mature students in our classrooms that have children, but lots of students, you know, that don’t – that are kind of transitioned right out of high school. So obviously, you’re teaching kin, so can you talk a little bit about the interests that are a little heavier on the mother kind of content of that and parenting, to the strict sort of exercise aspect of your work?
Dr. Iris Lesser
Yeah, it’s a good question. I mean, when we think about the field of exercise, physiology and exercise prescription, we often think about fitness and performance. And there’s so many other layers to it – I mean, physical activity is so beneficial for mental well-being, for social connectedness, for so many other components of overall well-being, that we often don’t think about. We’re still really rigid about thinking about exercise as aesthetics, and looking a certain way, and achieving a certain outcome.
Dr. Iris Lesser
And so, that’s really where I challenge my students to do – what I call “burst the kinesiology bubble,” to recognise that they’re in a kinesiology bubble, that they’re in the lab, that they’re getting fitness-based measures that are not normal, that are the extreme, that are the outliers, and that they’re going to have to learn how to work in the real world to work with real people. That challenges are different across the lifespan, and most of them are young, and so they haven’t experienced that yet.
Dr. Iris Lesser
And we set up our clinical exercise therapy course to have them working with an individual with a clinical condition out in the real world, and they have to learn how to engage with someone and be an empath. And that’s something that is really important to me, it’s that people come out with a Kinesiology degree, and are real people that really get it so that we don’t continue to see people beating each other up for not being good enough.
Dr. Martha Dow
Is that, uh, you know – I don’t teach in kin, obviously, I’m in the social science side of the house. Um … is that a path that’s pretty well worn for kin – that’s been going on long time? Is – are their struggles and, you know, challenges with respect to that … sort of nuanced goal that you have for your students?
Dr. Iris Lesser
I think it’s pretty novel. I think … a lot of the kinesiology field is still more focused on, kind of, the strict performance based science. And, you know, while we’re starting to see more focus on physical activity and health, it’s often more through health sciences than kinesiology. And so I do feel like it’s relatively novel. And as one of my colleagues, you know, has said – “you know, you’re the first exercise physiologist I’ve ever met who’s interested in behavioural medicine.” And it’s like, “but why wouldn’t you be?” You can’t engage somebody in exercise if you don’t understand how to work around human behaviour. And instead, we think we can kind of just treat humans like, you know, mice, and we’re not mice! It’s very hard to change human behaviour.
Dr. Martha Dow
So – and then you add that it’s in an area where we kind of see as – I think we still have these ideas about pregnancy and “motherhood is so natural,” etc. So then you add that into this mix … can you talk about, you know, some of the challenges there, and – it was great to hear, by the way that you don’t find … haven’t found sort of that tension with the personal and your professional, so that’s exciting to hear. How does that play out in your work?
Dr. Iris Lesser
Yeah, I mean, there’s a lot of social complexity there, for sure. And when we think about working with new mothers, I mean, one of the things that we often see within our research is this sort of “bounce back” narrative culture. So it’s something used in the postpartum literature to describe that, in the face of all of the other components of becoming a mother, and childrearing, and sleep deprivation, and physical change, that there’s also this expectation that you get your pre-baby body back, which in reality, there isn’t a pre-baby body, you are always a post-baby body. But this, you know, continues to challenge the many identities that a mother faces.
Dr. Iris Lesser
And so not only are you trying to figure out how to raise a child and recover from birth, but there’s also this societal expectation that you figure it out, and you turn back into who you were. And that’s something that I think has really made postpartum movement – physical activity – a challenge to navigate, is the assumption that you’re doing exercise in order to push your body back into something, rather than to support yourself through that transition.
Dr. Martha Dow
Do you think – what does the literature say? What does your experience say, in terms of sort of that – your professional work? Are we getting better? Is there hope? You know, there’s so much conversation about, you know, body positivity … is that helping? Is it a long road to go? Or is there something different going on around pregnancy?
Dr. Iris Lesser
I do think there’s something different in the pregnancy/postpartum literature. There are a few researchers in that area specifically that study sort of that body image, body identity piece, and they discuss a lot of how it’s much harder to be body positive in that avenue – that there does tend to be, you know, during pregnancy, this assumption that your body is for everyone to look at and to comment on, and that in postpartum, that it should just have gone back to where it was. And we don’t really know how to navigate any of that.
Dr. Iris Lesser
And then the conversations are often either uncomfortable or avoiding. And so, yeah, broadly, we see more body positivity or body neutrality, but I don’t think we’ve seen that extend a lot into that postpartum field, particularly if we interrelate it with physical activity, because as soon as you say “physical activity,” there’s the assumption you’re trying to change the body.
Dr. Martha Dow
Mm-hmm. So when – you know, I’ve been really fortunate to hear about some of your projects. I wonder if you could talk a bit about, you know, either, you know, what’s foremost for you right now? Because I think some of the things we’ve talked about – sort of remind of the challenges of getting just women to think about, one, that they need to take the time, that they can take the time, that – what it means for change in terms of their body. Can you talk a little bit about what you’re doing right now in terms of research, and how that’s going?
Dr. Iris Lesser
Yeah … we just finished up a randomised controlled trial, which had some really interesting outcomes. I mean, you go into a research study with a hypothesis. And we based our assumptions on the literature and what we see in other non-postpartum populations, that if we were to provide a movement programme, such as yoga, so sort of a mind-body physical activity programme, that we would see improvements in things like self-compassion, and heart rate variability, which is a metric of how the nervous system is handling stress. And so based on what we saw in the literature, it was, you know, “okay, let’s try out this yoga based programme, we’ll give the option, or randomise into a group that comes to a class twice a week for 12 weeks, or it gets access to the same online programme, twice a week for 12 weeks, and then our standard education control group.” And the outcomes of that study are very much not what we expected! We actually managed to negatively impact self-compassion, _and_ negatively impact heart rate variability by providing this programme for new mothers.
Dr. Iris Lesser
Now, the big question would be why, right? And if you just did quantitative data analysis, you wouldn’t know. Luckily, we also did qualitative based interviews and acceptability and feasibility metrics. And what some of these women said, particularly those in the online group, who weren’t able to do social comparison, and see the struggles of other mothers, had some really thought-provoking comments about how much the expectation of trying to fit in this form of physical activity made them feel like a failure. How much, in their own heads, they felt like … they must be incapable compared to everyone else, because they couldn’t see everyone else. And even comments about how the fitness instructor in this online group who, you know – classic fitness instructor, very lean – how it just made them feel like … they were never going to be good enough, they were doing a comparison and an emulation that just said, “they’re making me feel like crap.” And that really came out in their outcomes.
Dr. Iris Lesser
And so this next study that we are recruiting for now with a student based project, is trying to use individualised metrics. So again, heart rate variability, which is a way of sort of figuring out – how have you slept, how stressed are you, how resilient is your body. And after we get sort of a baseline metric of that heart rate variability, guiding them through personalised exercise based on how they are doing. So if their HRV is really low compared to normal that morning, then we’re gonna tell them to go engage in light stretching, in really basic movement, and maybe just focus on household and not really try to fit in any type of additional movement. If they’re kind of normal to where they typically are, there will be a time to engage in physical activity or movement if they desire, going out walking and engaging in something that makes them feel good. And if they’re doing a little bit better than normal, if they actually slept a little bit last night, that might be a time to actually challenge and try to get, you know, an engagement in a physical activity that might be a little bit more challenging, and could lead to longer term change.
Dr. Iris Lesser
And the hope is that, if you’re doing it according to how they’re doing, instead of trying to compare to others and feel like they’re failing, they instead feel supported, and self-compassionate, about actually realising – sometimes you have to take a step back, because you are caring for another human being, you are not sleeping properly, you’re probably not eating or drinking the way you need to … and this is a marathon, not a sprint. So there isn’t that ability to just say, “I’m just gonna suffer through for a week and it’ll all be fine,” ’cause … seven and a half years, and then it’s still a marathon.
Dr. Martha Dow
And I – it doesn’t change.
Dr. Iris Lesser
[chuckles]
Dr. Martha Dow
I don’t know if that’s helpful!
Dr. Martha Dow
I – I find it – a bunch of things about what you just said really, really interesting … one, it makes so much sense. Intuitively, it makes so much sense. So I think it’ll be really interesting to see what your research finds. That idea about comparison and social comparison is – you know, as a sociologist, I find really interesting. I wondered as well about this – you know, one of the things out of COVID is we’re keeping some aspects of Zoom and online world. And you mentioned a bit about that sense of community, or even the assumption that happens when you can’t be in the room. Can you talk a little bit about that from an exercise point of view?
Dr. Iris Lesser
Sure, yeah, it’s a tricky one, too, because at the same time of having people say that, they were feeling worse about themselves and that online environment, they also talked about how great it was to have the flexibility of being able to do it whenever they wanted, and when their baby was napping, and so – you kind of get this, like, wanting both sides of it – like “I want the flexibility, I don’t want to have to drive and show up in person,” but then “I want to be with others.” And I think we’ve really seen, sort of, through moving on from COVID, that a lot of us are feeling that way – that we both miss being around people, but we’re, like, discouraged from the effort of going to be around people. And so I don’t know if this is something that is a bit of where we are in the moment in the context of human behaviour, or if it’s something that we would see in this population regardless. But there’s definitely a desire to be around other moms, to be able to laugh it off, ’cause the women who were in the programme together, and I attended quite a bit – we were jokin’ around, we were laughing when we fell out of poses, those there were babies crying, there were people nursing. And so you don’t get that view online.
Dr. Iris Lesser
But then they had to get out of their comfort zone to get there. They have to sometimes wake a baby up from a nap. And, you know, all of these things that make motherhood harder. And so, where do you find that balance, and how do you make it happen? Like, do we need to do what we’ve done in some of our, you know, cancer studies, where it’s a synchronous online platform, and you can see each other? Does that create social connection? I’m not sure – I think you kind of need to be in person to create those dynamics. So it’s a real challenge – I don’t know if we’ve done any good by kind of making people think, “well, I never have to step out of my house, I can just do it here,” or if that kind of took away some of the fun that came with physical activity.
Dr. Martha Dow
Yeah, I think it’s … I think that’s – we’re going to be trying to sort some of those questions out for a long, long time … in all sorts of sectors. I wondered … you talk about, sort of, how – how long do you see … the kind of work that you’re doing with moms [as] important, relevant for them? So in other words, how long after they’ve given birth? Like, where does – how does that all – what’s the science on all of that?
Dr. Iris Lesser
Yeah, that’s such a good question. It comes up in almost every one of our reviews of a paper – “what is postpartum?” What are we calling that? And so – the first study we did, where we had a questionnaire, and we had about 650 mothers complete a questionnaire about their activity level and other dynamics of well being. And we didn’t actually say, “what is postpartum?” We said “if you are postpartum.” And so that kind of was interesting, because then most people were under 12 months, which is often the Canadian context, because most people take a 12 month mat leave. And then there were a few people who were like 18 months, and there there was a couple of people that were, like, two years, and it makes you sort of question well, “what is postpartum?” And we’ve looked into other literature sites, and we’ve – I’ve even asked this question at conferences to people who … do work in women’s health, and you get all kinds of responses.
Dr. Iris Lesser
There’s the clinical view – and clinically, postpartum, it’s technically only six weeks, it’s when your body has kind of gone back to that – post-labour, your uterus has shrunk, your hormones are somewhat levelling out. Other people talk about “the fourth trimester,” which is that three months after you have a baby, when you have a newborn and don’t really have any routine. We often go with 12 months as, sort of, the timeline that you’re often, at least in Canada, home and engaging full time with infant care. I would argue that postpartum is however long you are continuing to struggle with the demands of motherhood – and as one naturopath put it, to me, it’s from the moment you give birth for the rest of your life.
Dr. Martha Dow
Mm-hmm. Yeah, I think so. And it doesn’t – you know, I think that’s the other thing, you know, as a mom … that we don’t talk about, because we wanna – we’re always, you know, encouraged to say – it almost is “oh, man, it’s a bad day,” or they’re the best things ever. And we don’t have anything in between where we can just like, you know, the mundane, the daily, as – as we look at it in sociology. So I think that’s really interesting as well. I also am struck by the language of struggle. Because I think again, we get judged for, like, what does struggle get to be – how … how bad does your day have to feel, or do you have to feel for that to warrant? Or is it just being a mom, and then that gets me marginalised. I wonder if – and it seems just to fit with so much of what your participants have said – can you talk a bit about that?
Dr. Iris Lesser
Yeah, from a participant standpoint, they talk about the struggle a lot from a domestic responsibility challenge. Because even in 2024, particularly when you’re on parental leave, the domestic responsibilities fall to the person who is at home. And so, if you are taking a 12 month maternity leave, and you are home with an infant, and often home quite a bit, because of naps and other demands, you’re also responsible for all meal prep, for all cleaning – all of those additional domestic responsibilities that really never go away. And so, when you’ve perhaps returned to work, and you are still dealing with, of course, having children – because just because you’re back to work doesn’t mean you don’t have children – but you also have those … additional domestic responsibilities. They experience that as the struggle of motherhood. And so, you know, sometimes it’s just the taking care of children. But I would say – many mothers will say that if you took away all of those extra obligations, they quite enjoy being with their children! It’s that you’re always multitasking.
Dr. Martha Dow
And I just find that … so connected to “the naturalness of motherhood,” so why _can’t_ you do all those things? Because it’s natural to be a mom, like, that’s your – you love being home with … I do for a reason, right? Like, those kinds of dynamics, very interesting.
Dr. Iris Lesser
It is very interesting. And it – it also really plays into this – what’s called “the supermom” – this idea that you’re seen as being exceptional if you’re doing it all, rather than recognising that doing it all is not healthy. And so where does, you know, movement, physical activity play into that? Are you adding something in, that’s becoming just an additional obligation, that’s causing further stress? Or have you found a way to engage in physical activity, what we call “within motherhood,” which means that you’re building in something for you without, kind of, adding in another layer that just makes it all seem like too much.
Dr. Martha Dow
Mm-hmm … I wanted to ask about a couple other things, one of which is using both quantitative and qualitative – I wanted to hear a little bit more about what brought you to that, because there’s lots, you know, as we know, we have lots of colleagues that kind of find themselves in one camp or the other. Can you talk a bit about that, and the value of that?
Dr. Iris Lesser
Yeah, I mean, I’ve definitely changed my ways since coming to UFV. And, you know, I went from sort of biomedical physiology and, you know, very expensive medical scans to finding other ways to gather data. And there’s actually one additional methodology that we’ve moved towards, and published a couple papers on, called “autophotography.” And this is where we’ve asked new mothers to take photos or imagery, either of themselves, or objects, or something that describes their experience in physical activity, and then they describe what that photo or image means to them. And you get a really participant-centric view of what the experience is. So a combination of that sort of personal reflection, being able to ask in semi-structured interviews about their experiences that go far beyond what we can learn from questionnaires … it’s kind of resulted in us being able to answer questions we otherwise would just go, “I don’t know, I don’t know what happened.”
Dr. Martha Dow
Mm-hmm. Really interesting. Before I let you go, I want to ask about systems and structures, right? So we’ve talked – really appreciate it – about, you know, women’s experiences … what are both the challenges and opportunities you see in working with physicians around some of the work that you’re doing? Working with, you know, city rec, or municipal rec sorts of departments, or … or even small businesses … around some of this work?
Dr. Iris Lesser
Yeah, that’s also, you know, a really great question. We’re finishing up a commentary right now about how to support postpartum women and physical activity from a social equity lens. And I think every time we look at sort of this additional piece of physical activity, we have to be aware of accessibility and equity. Because not only is there very little available right now that’s specific to that population, but it’s quite unaffordable. We’re often talking about privatised … you know, postpartum yoga classes in a studio, or we’re talking about accessing pelvic physiotherapy, which is extremely important and often not covered, or you need extended health for. Or if we’re talking about – just broadly recreation providers, is there childcare opportunity, or is there opportunity to have your infant with you? Because I know a lot of recreation centres say “nope, no strollers, not safe,” and so that creates another disadvantage. Health care providers, I think, are ones that we can definitely tackle. And you know, everybody I’ve spoken to in the community that works in maternal health is really keen, and they really do want to know more and to help their patients. But the challenge with health care providers is always having adequate time.
Dr. Martha Dow
Mm-hmm, yeah, absolutely. It’s interesting – I had a friend … her baby’s, I think, about 18 months, and … so I was saying “you should come out skating!” She said, “I tried once, but it was an adult skate, and I had the stroller and I don’t -” and was told no. I mean, she ended up going on anyway – but, right? And I just though, “oh my goodness, like, baby could not have been happier,” right? So – it’s just this strange sort of resistance that seemed odd.
Dr. Iris Lesser
Yeah – rules can be a problem.
Dr. Martha Dow
Yes, exactly. Well, you and I know both – both know that. If you thought about sort of the thing that you’re most excited about right now, given all the work that you do – sort of, you know, the thing that you see the most possibility of making some change around, or the … what would – what would that be just as we close out?
Dr. Iris Lesser
I think I’m pretty excited about the imagery piece, being able to represent both postpartum bodies, and what movement or physical activity means, in a more collaborative way. Just those comments from women, from studies, really feeling like … that’s not who they are. Like that – they can’t recognise that person, it’s making them feel worse about themselves. I mean, to me, that’s a real stab in the gut. And I think if we’re gonna talk about, you know, body positivity, and physical activity, and health, and mental wellbeing, then let’s take away that one additional constraint of not feeling like the imagery matches who you are.
Dr. Martha Dow
Yeah. Wonderful – it sounds so exciting. Well, thank you so much for taking the time – we’re gonna have to do it again, because I have so many of the things I’d love to talk about, but – thank you very much, and … thanks for the good work that you’re doing.
Dr. Iris Lesser
Well, thank you, and thank you for supporting it.
Dr. Martha Dow
Our Knowledge Mobilization Team includes Jeff Mijo-Burch, Kristen Bencze, Andrea Moorhouse, Frankie Fowle, Mara Penner, Sharon Strauss, and Emma Hones. Our theme music is by Chris Majka. I’m Dr. Martha Dow. Thank you for listening, and we’ll see you next time here on the CHASIcast.
CHASIcast voice-over
The CHASIcast is a production of the Community Health and Social Innovation Hub at the University of the Fraser Valley in Abbotsford, British Columbia.