Kim (00:02.614)
Okay, I just asked you, is it Zeno? Did I say okay? I was like, did I brain fart right when I did? Okay. Hi, Dr. Zeno, welcome. Thank you so much for joining me today. Nice to see you again.
Dr. Aldene Zeno (00:05.18)
Yes. Yes, uh-huh.
Dr. Aldene Zeno (00:15.388)
Yes, thanks for having me. Good to see you.
Kim (00:17.514)
Yeah, it's been...when did we talk? It was a few months ago...
Dr. Aldene Zeno (00:21.524)
Was that the fall? Well, we talked a few months ago, but we did that event maybe five, six months ago. Yeah.
Kim (00:26.27)
Yeah, that's when, yeah, yeah. Anyway, but you've been a little bit busy lately. You have recently launched a book. So I wanna get into pelvic health stuff, but I wanna start with your book because I know that's a huge accomplishment. So tell us a little bit about your book.
Dr. Aldene Zeno (00:32.54)
Yes.
Dr. Aldene Zeno (00:38.484)
Absolutely. Sure.
Dr. Aldene Zeno (00:43.012)
Yeah, and I mean the book is very pelvic health focused. So it's called Thriving Through Pregnancy with Fitness and Black Momma Magic, or I lovingly call it Black Momma Magic. And it's a book about fitness and pregnancy. My inspiration to write it came from just going through my own journey as an OB-GYN, going through pregnancy and also being an athlete and a certified CrossFit trainer. I was just surprised by the lack of evidence-based information out there.
for women and especially that I would find relatable as a woman of color. And so I thought there was definitely a need to be met there. And it does focus on, you know, the latest guidance about exercise and pregnancy. But as a subspecialist, as a urogynecologist, my focus really is on pelvic health. So I do spend, I think, a couple chapters toward the end of the book talking about postpartum recovery and, you know, some of the common questions I get, like,
How can I squat without peeing on myself? Or how can I jump without peeing on myself? How do I get back to running? When can I start doing ab exercises? So I include those types of questions. There's specific workouts and recipes for pregnancy and postpartum in there. And I'm just so excited that I was able to get it out there in the world. And hopefully other athletes, and especially women of color and black women can relate.
Kim (01:46.082)
Mm-hmm.
Dr. Aldene Zeno (02:12.906)
to that experience and feel confident getting after it in their own pregnancies and post-partum journeys.
Kim (02:18.858)
Yeah, yeah, so you're covering two really underserved populations, which is the athlete in and of itself and then women of color as well. So I'm super excited to get my hands on it and read it. But what brought you here? So what brought you to the world of your subspecialty of urogynecology and focusing on pelvic health? How did you get here?
Dr. Aldene Zeno (02:27.124)
Absolutely.
Dr. Aldene Zeno (02:41.724)
Yeah, so like I said, my background is in OB-GYN, so obstetrics, the delivered baby's part, and gynecology, all the other women's health stuff that we're expected to do, but there's several subspecialties within that, including urogynecology. During my training, my exposure to it mostly was through my program, which was located in a more affluent area in Northern California. And so my frame of reference for people dealing
and other pelvic floor disorders was that it was more of like an affluent person issue or it was more of like a cosmetic issue. What finally clicked for me is when I did an international surgical service rotation, I worked with a urogynecologist in Guatemala and just seeing how universal these issues are, how burdensome they are for quality of life, I was just really struck by it.
the surgeries and the procedures we can do that are relatively simple and a lot of vaginal surgeries so you know low relatively low risk compared to other surgeries with good outcomes and good recoveries and yet helping these patients feel validated and feel that they can return to their normal lives with less embarrassment and less pain or less better bladder control that kind of thing. That's where it all really clicked for me as far as how
prevalent these conditions are and how I could really make a difference in this space. So coming back and then going through subspecialty training, I was exposed to more of the ways that we work with other providers like pelvic floor PT or physical therapy and others to help kind of optimize these outcomes through non-surgical means and as well as other things that I can do in clinic and you know with different medications and things to help
these women. So it's really been a journey. And now I would say that the most the latest iteration that for me has been tying in the relationship between aging and perimenopause and menopause and how that all affects the public floor as well. So these are really all things that I would say typical OBGYN residents are not necessarily taught in their training. And yet, obviously, it affects 100% of 50% of the population.
Dr. Aldene Zeno (05:13.039)
when you're talking about menopause and things. And all pelvic floor disorders affect somewhere between one and two or two and three women. So these are very common issues. We know that they're medical conditions. They're not necessarily cosmetic. And so a lot of people can access them through coverage with their insurance and things like that if they have insurance. So I really just enjoy the way that I can help women feel better about themselves.
with what I do every day.
Kim (05:43.242)
Yeah, yeah, thank you. I am so grateful for people like you. And I'm also, I'm appreciative of the lens that you bring with fitness and also the collaboration with pelvic floor PT or physical therapy as well. I think that is, I see it happening, I see it happening more than it has been. So that's, that's.
I feel hopeful about that. I hope that it's just the norm going forward. But yeah.
Dr. Aldene Zeno (06:12.144)
Yeah, I think it's kind of a twofold thing. I think on one hand, I think other providers and other patients themselves are a little more aware of it. And it seems like there's more discourse around this stuff, whether it's through social media, or I'll even be watching certain shows like And Just Like That, or a lot of other shows where they highlight kind of midlife and things. And it'll be just part of the conversation for the characters on the show. So I think people are becoming more
Kim (06:24.343)
Yep.
Dr. Aldene Zeno (06:42.038)
aware of it, it's becoming a little more acceptable in conversation. And then even in the cross-fit world, there have been some studies specifically looking at incontinence and other pelvic floor disorders and high-impact exercise and symptoms that can be brought out through doing high-impact exercise. So again, I think people are having the conversations, which is really important.
Kim (07:09.398)
Yep, yep, yeah. So in your book, it really was looking mainly, starting at pregnancy, so looking at pregnancy, but you've also, as you were talking about, you've included the postpartum piece in there. So what's the current standard recommendations from an exercise perspective as it pertains to pregnancy? And then I wanna get a little bit more granular and talk about your recommendations from a pelvic health perspective.
Dr. Aldene Zeno (07:37.425)
So.
Probably within the last five years, the American College of OB-GYNs revised their recommendations for exercise and pregnancy, and they've made it very clear that we want women to be active during the vast majority of normal, healthy pregnancies. So there are certainly exceptions for people that have certain risk factors that might compromise the pregnancy or the fetus health, but for the vast majority of women,
Dr. Aldene Zeno (08:08.794)
the exercise recommendations are essentially the same for when you're not pregnant. So the recommendation is for five days a week of moderate intensity exercise or about 150 minutes a week and then or three days a week of vigorous exercise and to also include one to two days of strength training and that. So that's relatively new from the from more of like the national
and exercise recommendations. But the thing that they also emphasize is that all of this is relative. So when we talk about moderate intensity or vigorous intensity exercise, that's going to look different when you're pregnant because your body's changing compared to when you're not pregnant. I think that what a lot of trainers and even physicians kind of lack or are kind of missing the boat when it comes to their guidance.
is that a lot of people tend to make these sweeping statements about what people can do in pregnancy when so much changes in nine months with your body and with the pregnancy itself too. So a lot of these recommendations really need to be tailored to maybe portions of the pregnancy. For example, you know, doing push-ups on the ground is pretty much the same when you're in your first trimester.
compared to like third trimester, it's just not physically feasible. So there's a lot of things like that I think as for fitness trainers and for physicians they tend to kind of miss the boat. On the other hand, I think that people are becoming more aware of and we're also seeing more visibility from athletes doing things like Serena Williams and playing in the Australian Open when she was in her first trimester.
Kim (09:42.594)
Hehehe
Dr. Aldene Zeno (10:08.454)
Swoops who was in the WNBA one of the first athletes postpartum to return to professional training like I think within the first two months or something postpartum and they her team went on to win the national title that year so we're getting more visibility of women who are in their pregnancies or postpart early postpartum and going back to their professional activity but for
They're not gonna, you know, first of all, our livelihoods probably don't depend on physical activity to the extent that it does right for a professional athlete. But a lot of us don't also have the same support systems to help us with the nutrition and the childcare and sleep and rest and recovery, all that stuff during pregnancy and post-partum to be that active.
Dr. Aldene Zeno (11:08.294)
from at least from what I heard when I was pregnant are saying like, oh, if you were doing it before you were pregnant, that's probably okay to keep doing it. And it's cool, like I love seeing those commercials of like pregnant women surfing or pregnant women running the marathon, like that's awesome. But that doesn't, there's a lot of nuance to that, especially when you're talking about pelvic health. And especially when we're talking about preventing issues like incontinence and prolapse. So my goal with the book was to try to get into those nuances.
and to try and help the readers maybe toe the line between, you know, just because I was doing it before, should I keep doing it? But I think from my experience when I was delivering babies and when I hear from my colleagues, it tends to be the opposite. A lot of women in our culture at least still get the messaging that they need to, you know, rest and put their feet up more, which isn't also the case for most people. So, yeah.
Kim (12:03.358)
Right, right. Yeah, so what are, say, a couple of things that you would recommend from, like, thinking, we can't 100%
guarantee that we are going to prevent prolapse or we're going to prevent incontinence but we can step in with a few things to help mitigate that risk. So when we think of pregnancy what are some of the things that you counsel your patients on as it pertains to fitness and their activity level. So if you let's say you had a CrossFit athlete who is now pregnant what would you what recommendations would you be making thinking about the pelvic health?
Dr. Aldene Zeno (12:39.32)
So one thing that...
I try to impress on people is the idea of what's normal and what's not normal. And I think for a lot of women, they've been told, oh, it's normal to leak a little if you jump or cough or sneeze or that kind of thing, or it's normal to leak a little if you're doing a squat or deadlift. And especially if someone is developing that before pregnancy or during pregnancy, I try
Dr. Aldene Zeno (13:13.11)
injury anywhere else. So it, you know, I recently, for example, torn my Achilles tendon. That was not my call to keep doing what I was doing, right? That was a wake up call to do something different. And it's just like that for people that are dealing with any pelvic floor disorder, especially prolapse and incontinence. When I, when a lot of patients get to the point of seeing someone like me, if I take them to surgery, sometimes I can physically see
support structures in the pelvis. And so especially in cases where people are like, well, is it normal that I'm already leaking a little bit and that kind of thing, isn't it okay to just keep doing deadlift and like pee a little? And unfortunately there's tons of videos of that online. Um, but no, that I try to impress on people to think about it just like any other muscle injury and to recognize you shouldn't keep doing what you're doing most likely.
Kim (13:59.554)
Yeah.
Dr. Aldene Zeno (14:13.33)
ways potentially with working with a professional who's experienced in this area to potentially offload the pelvic floor during your squats or to change your breathing patterns so that you're not putting so much pressure in that area. Like if you lift in, you're kind of bearing down. So that's one thing for sure. If you're questioning if it's normal or not and it doesn't feel normal to you, it probably isn't normal. Just ask an expert.
Kim (14:30.167)
Yep, yep.
Dr. Aldene Zeno (14:42.71)
The other thing as far as exercise in pregnancy and especially with pelvic health is for a lot of my patients, again, not just with prolapsing continence but to also consider the issue of pain. For a lot of women, and again, it's kind of just like the issue with prolapse or loss of support.
Dr. Aldene Zeno (15:13.05)
And for a lot of women, if they're pregnant and they have pelvic pain, they automatically worry about their pregnancy and about the developing baby. But it can come from something as benign as round ligament pain, which we often see, especially later in the second trimester, or pubic symphysis pain, where you kind of have that midline pain down in the pelvis, and other types of shooting pains. So similar to these other pelvic floor disorders.
these are technically benign conditions, meaning that they're not going to harm the pregnancy, but obviously they're painful and there are people that are qualified to help kind of mitigate those issues so that you don't necessarily have to put your feet up and rest the rest of the pregnancy, you know, especially if everything else is okay. But at the same time, it doesn't do you any benefit to keep doing what you're doing if it's causing you pain every time.
Kim (16:01.255)
Yeah.
Dr. Aldene Zeno (16:12.51)
time. Yeah, so paying attention to those signals I think is super important.
Kim (16:17.726)
Yeah, yeah, and yeah, I wholeheartedly agree. And I think, as you say, we're starting to notice trends of people, there is more awareness, there are more people talking about it. And at least if the seed is planted, and making people a little bit curious, and maybe asking their care provider.
or seeking out people who have the expertise from a fitness perspective, and also seeing more and more fitness people at least getting on the bandwagon and wanting to learn what the pelvic floor is. So that's all helpful. But...
When you, like you talked earlier in part of your book, the, you say black mama magic, there are different considerations sometimes for the black women and women of color. So what are those differences? What do we need to highlight? Or what would women of color need to maybe pay more attention to?
Dr. Aldene Zeno (17:11.344)
So.
On one hand, I do think that there's been this increased awareness around Black maternal health disparities, and particularly when it comes to morbidity and unfortunately mortality. So the statistic that is often closed that Black women are three times more likely to die in childbirth compared to white women in the United States. That unfortunately is true. However, the story or the conversation about Black maternal health, in my opinion, can't
just end there. And there's a great documentary called Birthing Justice and it kind of dives into a lot of these structural racism issues that contribute to this problem. But it actually ends very hopeful and it ends very joyful and when I was watching that I was like we need more of these kinds of stories about black women having joyful birth experiences. And I was so fortunate to
Dr. Aldene Zeno (18:12.53)
a fitness trainer, Siobhan Robinson, who she had to have a labor induction, but she also was active throughout her whole pregnancy and had a safe normal delivery. So I think that getting these stories out there and having it out there as something aspirational and as our truth is just as important to continue that conversation about black material health.
for that is also that we know that there are certain things in our culture that make it, that present as barriers for a lot of black women and create, you know, kind of divisions or, you know, challenges when it comes to trusting their healthcare providers. And so I talk a lot in the book about my experience, you know, delivering in a hospital, where I felt comfortable delivering with my colleagues essentially. But I also talk about doulas
and offer resources at the end of the book talking about other birth worker resources. And I think that's also important because even for me having worked in a hospital where we had doulas on the labor and delivery floor, my experience with that had been that it was a mostly affluent person's right to be able to even access that. And I think that's important for people to know
workers can be involved, you know, for an entire pregnancy in postpartum. They can just be involved for parts of the pregnancy or parts of the postpartum. There are programs especially for black women and in Los Angeles too to support women with other birth workers like doulas and midwives and things. So I think, you know, one of my goals with this book was to help people feel empowered to advocate for themselves and to be aware of
different options when it comes to their birth journeys.
Kim (20:15.818)
Yeah, yeah, a big like, you know, a lot of people, a lot of cultures will say birth takes a village and I've certainly I think I think health care in general takes a village and I love that you are providing those options for people so at least that they know that they're there because sometimes it's just there's a lack of awareness. I didn't even know about pelvic floor PT. I didn't even know about doulas or whatever. So I absolutely love that.
I want to shift, we've talked about the pregnancy, the next phase or next chapter is the postpartum. And I remember when I was first doing this work and getting into pelvic health, I was very focused on getting the information to women ahead of time with the eye of prevention and mitigating some of the risks that are increased from a pelvic health perspective with pregnancies. But then the more I was working with people and learning about pelvic floor and pelvic
and diastasis recti and all this. I then started to shift to postpartum recovery because women were coming to me years after they'd given birth and wishing that they'd known and what can I do now? And then looking at how...
recovery or the postpartum healing is revered in other cultures. And yet in North America, it's a sprint back to the gym and we have to get our selfie and not look pregnant as fast as possible. And so kind of, you know, and then ended up creating another company focused on optimizing recovery and taking some of those traditional practices. And it was around the same time that CrossFit was starting to make a huge
name for itself and there were so many people pursuing.
Kim (22:01.742)
CrossFit type activities or more intense activity as their way to feel strong again. So they feel after they've performed one of the most amazing feats of strength, they often will feel at their weakest and they're looking for something more intense because that's what they think they need to get stronger. And so there was this real battle really about the information that we were trying to say is, allow yourself to heal and do the recovery and do the retraining so that you can go back to CrossFit. So what are your recommendations
part of recovery perspective in general and then getting again more granular thinking about the pelvic floor.
Dr. Aldene Zeno (22:37.668)
Yeah, yeah, that was such a
surprising part of the journey for me because again, having been trained as an OB-GYN, I've taken care of pregnant women. I've seen women the first day postpartum and then we often don't see them until like six weeks in the U.S. and then from there could be like six months, two years later. So there's obviously a lot that happens in that time, right? And so navigating breastfeeding and for people that are chestfeeding or choose to do that, navigating
Kim (23:02.427)
Hehehe
Dr. Aldene Zeno (23:11.394)
nutrition and then also having a newborn and just all everything that comes with that. I think I was surprised at how much time I needed to recover. I was also surprised that when I delivered the baby probably the first week or two, I probably felt weaker during that time than I did in the last few weeks of my pregnancy. Like I remember, you know, when you're
Dr. Aldene Zeno (23:41.174)
you have to do like all these like acrobat maneuvers. And I was just surprised that I still didn't have the core strength to just like do a regular sit-up to get out of bed immediately postpartum. I think I was also surprised that when I did go back to CrossFit and I probably started exercising again, more around like five months. And again, this is during the pandemic and I'm kind of doing my own reading around this.
Kim (23:41.279)
Yeah.
Dr. Aldene Zeno (24:11.094)
months, I had started to do some exercise on my own and then the CrossFit Open was coming up which is like kind of this national thing where a lot of gyms will participate in these exercises and you kind of can compare where you stand in your gym and they even have this app where you can see where you stand regionally and nationally. And so one of my goals was to be able to do all the workouts at five months postpartum.
Dr. Aldene Zeno (24:41.054)
feel very good afterwards. And so it was finally around like six months postpartum, I met a coach who she had a young child and she was like, Oh yeah, it took me more like two years to really feel back to myself. And I was really surprised. Like I, in my mind, I was like, I worked out my entire pregnancy, I came in pretty healthy, I had an uncomplicated delivery. And so again, I think that's a big part of the book is to just share that part of my story and how common that is.
is and how we don't have a ton of great evidence behind it, especially in like medical literature. I think people in physical therapy are probably more aware, but there hasn't been a lot of research done on that because, you know, it's a very vulnerable time in somebody's life, so it's probably hard to actually measure a lot of the stuff that we're looking for, like, you know, simple things like when can I start doing SIPS and stuff.
include a great graphic that was published in the British Medical Journal by a physiotherapist and I apologize, they gave me permission to use their research but I forget their name. But it's a very specific guidelines for kind of based by weeks of how to return to running. But the more I research, maybe I think that sounds right. Yeah.
Kim (25:52.11)
I'm gonna go.
Kim (26:03.586)
Was it Grania Donnelly?
She's from Ireland.
Dr. Aldene Zeno (26:10.814)
UK. Yeah. But the way that they lay it out is more like get to this level and then go to the next level and get to this level and then go to the next. As opposed to thinking about, you know, I'm six weeks postpartum, aren't I supposed to be doing XYZ? Everybody's body is just so different. Everybody's birth experience is different. The way that we carry the pregnancies are so different. It changes every pregnancy as your body changes. So be
Kim (26:11.542)
Yeah, yeah.
Kim (26:20.011)
Yes.
Dr. Aldene Zeno (26:40.754)
my body and learning kind of where I was. And I did end up eventually working, you know, with a personal trainer who's a PT also, but, so that gave me more insight into, again, just focusing on where I'm at, what I was appropriate for my body at that time, and just not paying as much attention to what metrics that I randomly had in mind based on like, yeah, exactly. The, yeah, exactly.
Kim (27:05.8)
Instagram tells you.
Dr. Aldene Zeno (27:10.874)
Just being more present. I think took a lot of that pressure off from feeling like I was behind or something another thing that I love right now speaking of like social media, but is I do think like in our generation. There's more of this. There's been this like soft girl season movement where People are just like you said paying more attention to the importance of just being present and allowing time and we
We know a little about with like tissue remodeling that things are changing, you know, that scars heal after like six months to a year. And that's probably true of the, even the slight, you know, small injuries that we have in our public floors from birth trauma. But just the gift of having the gift of time and being present, you know, as a new parent, I think is very important as well. Yeah.
Kim (28:04.835)
Yeah, yeah, wholeheartedly agree. And I remember.
you know, exactly like you, I thought, well, I've been fit. I'm going to be fine. And I had uncomplicated pregnancies and births, and I used the epino, which is, you know, that's ultimately what got me into this world of pelvic health. And I didn't have any external tearing. And I was like, okay, I'm done. That was all I need to do. And then I really wanted to get back to running. I just miss running so much. And I remember running at two weeks postpartum, which I wouldn't recommend anybody do, and I felt like.
Dr. Aldene Zeno (28:15.225)
Right.
Dr. Aldene Zeno (28:18.876)
Yeah.
Dr. Aldene Zeno (28:28.828)
Yeah, great.
Kim (28:39.748)
like it just didn't feel right. And so I stopped, which is good, but it was that wake up going, well, like, and when I look back at it now with everything I know, I find it shocking that more of us don't go, I don't think that's a good idea. Like we just, we have this, you just had a baby, you're fine. And you're gonna be fine at six weeks and everybody gets this green light. And then, and that's what we have this like, oh, well then everything is gonna be fine. And it's, as you say, so different.
Dr. Aldene Zeno (28:41.472)
Yeah.
Dr. Aldene Zeno (28:56.252)
Right.
Dr. Aldene Zeno (29:06.34)
Yeah. Well, and I do think...
I do think the medical industry unfortunately plays into that, right? Like I said, a lot of people just have their delivery, they come back at six weeks. What we're looking for at six weeks is basically to see that the stitches have healed or that the tissue edges have come together basically. But that doesn't tell you anything about function. I'm like very open in the book and I'll be open
Dr. Aldene Zeno (29:38.934)
weeks and I was like, okay, this is, I'm not ready. Like the thing for me was like, I was dealing with postpartum atrophy, which again, I've seen people and talked to them about that, but different story when you're dealing with yourself, right? And it really felt like sandpaper. I thought I had cut myself again and I actually made another appointment to see my doctor and they were like, okay, there's nothing wrong. It's just, I think it's just a little atrophy. I was like, okay, I knew that. I mean, I honestly just really had no-
Kim (29:42.047)
Yeah, yep.
Kim (29:51.349)
Yes.
Kim (30:06.453)
Yeah, yeah.
Dr. Aldene Zeno (30:09.274)
idea and it's hard to have that insight when you're in like newborn zombie land but yeah.
Kim (30:13.93)
Yeah, yeah. And it's actually interesting. I was a few doctors that I follow, and you may have seen this as well too, at the recent Ishwish conference. They're suggesting, and I don't think that it has been, you know, 100% decided, but I think there were people saying, we need a new term, which is genitourinary syndrome of lactation. So the whole menopause movement is bringing a lot of awareness to GSM, genitourinary syndrome of menopause, which is the atrophy, dryness, and urinary symptoms,
Dr. Aldene Zeno (30:38.748)
Yeah.
Kim (30:43.964)
of other signs and symptoms that people may feel specific to the pelvis. But it mirrors the postpartum period really. And yeah, and I remember having, you know, been years later.
Dr. Aldene Zeno (30:54.64)
Yeah, 100%. Yeah.
Kim (31:00.946)
even post-operative, not so much the GSM per se, but there's a lot of things that I promote from a post-op perspective that mimic what I recommend from a postpartum perspective. And now being in the, working with a lot of people in the menopause phase, a lot of them have daughters who are now in that prenatal postpartum and just bringing light to the things like the atrophy and the dryness and the vaginal symptoms
mimic, so share this with your daughter, share this with the younger population. But as you say, there's also, we can be told, but until we actually experience it ourselves or go through it, it sometimes doesn't hit. Oh!
Dr. Aldene Zeno (31:45.596)
Sorry, I can't hear for some reason. Let me see the audio.
Kim (31:51.334)
Oh, I can hear you. You there? Okay. Okay, sorry. I'll go back to like a lot of the women that I now work with are in that menopause, perimenopause, postmenopause phase, many of which have daughters who are now having their own babies and...
Dr. Aldene Zeno (31:53.144)
Oh there. Okay good. Now, now I can hear you. That was weird. Sorry, I cut out like mid-sentence. We were talking a little about...
Kim (32:16.19)
them, I encourage them to share, first of all just share in general about public health, but share the GSM symptoms because it's going to be very relevant to the postpartum phase. But then the last thing I was saying is that until we go through it ourselves, sometimes it takes that personal experience.
Dr. Aldene Zeno (32:29.46)
Absolutely.
Kim (32:38.882)
people can tell us all we want and until we actually experience it ourselves, it doesn't hit home or we don't take it as seriously.
Dr. Aldene Zeno (32:42.694)
Yeah.
Dr. Aldene Zeno (32:46.448)
Yeah, I mean, it definitely sheds a different light on it. And I do think that...
probably for me going through that experience helped me be open to seeking different sources that maybe in medicine are not as traditional but there's just this is obviously something that women have been doing since then like since the back in the day since forever, so there's a lot of lived wisdom in pregnancy and in postpartum and in mothering and in you know breastfeeding and so
Kim (33:03.787)
Uh huh.
Kim (33:11.842)
Yep.
Dr. Aldene Zeno (33:25.158)
I think again one of my goals with the book was to just hopefully encourage people to have those conversations Again with you know experts, but also with each other and just sharing my story I feel like is one way that I'm able to do that
Kim (33:39.318)
Yeah. So CrossFit wise again, with yourself, you went back, your goal was to have, to be able to do all of the exercises at five months, didn't feel so great doing it. Speaking to somebody else, they were more like two years. So what was it, when did you feel like, okay, I'm back, I can do all the things, I feel great, I feel powerful? Maybe sometimes we don't feel the same and we never will in certain exercises. I don't know, was that your experience?
Dr. Aldene Zeno (34:04.415)
Yeah, absolutely.
And that's why I talk in the book about bouncing forward, which I think is, I didn't make that up. That's obviously something that people I think are thinking about now that, you know, traditionally we think of the postpartum phase being just the first year postpartum. And we, people talk about the fourth trimester being like that first, you know, one to three months postpartum. But there's, I think this idea now being forever postpartum and that your bodies are completely changed in some ways
it's not necessarily good or bad, it's just it is what it is. And so for me, and for a lot of reasons, my priorities have changed obviously now being a mother and now being a business owner and you know so many other things. Yes, absolutely I still want to be healthy and I still want to promote healthy lifestyles, but I'm not necessarily trying to like track my PRs or my you know my
Dr. Aldene Zeno (35:08.058)
For me, it's less about quantity and it's more about quality. And I'm very much more intentional now, having gone through pregnancy and also having an injury like an Achilles tendon rupture, to really focus on the quality of my movement and longevity. So for me, it probably took around 18 months or so postpartum. Somewhere around like one year to a year and a half is when I started working more with a personal trainer.
Kim (35:16.887)
Mm-hmm.
Dr. Aldene Zeno (35:37.058)
with some, I call it lightning crotch and a lot of other people do too, but it was still some of that pubic symphositis pain that for some reason I didn't really have during my pregnancy, but postpartum, and we know that that's a lot of it is hormonally influenced and things like that. We just have to give time for that to kind of come back together and heal. There's a lot of ligaments in the pelvis that just need time to kind of get strong again. But I also paid more attention.
working with the trainer on like my posterior chain muscles especially like in pregnancy or you know you got all this weight in front so people tend to become more quad dominant or using you know a lot of those muscles in your front leg compartments and so kind of regaining some of that strength in my glutes and then also in my calves which especially haven't gone through an
Kim (36:33.55)
Mm-hmm.
Dr. Aldene Zeno (36:37.278)
And then somewhere around like 18 months I started to feel more like okay I can run without pain. I'm feeling stronger which is why I decided that I thought at that time about doing a triathlon and so I that's how I kind of end the book because it was for me not necessarily, it kind of mirrors my journey and my approach to fitness in general now. It was more about setting a goal and
feeling some sort of small win for claiming my time to do the training, especially as a mom and to carve out, you know, one an hour, hour and a half in the mornings to do that type of thing, completely by myself and like untethered by people wanting something from me. And so being able to do that just really gave me this appreciation for approaching fitness in a way that's more about
Kim (37:24.054)
Hehehe
Dr. Aldene Zeno (37:36.658)
and promoting a healthy lifestyle for my family as opposed to hitting certain numbers, yeah.
Kim (37:44.846)
A few questions before we wrap up about specific to CrossFit because that's an area of focus for you. We do have evidence about high intensity activity and pelvic floor and more prevalence with things like incontinence. Not so much with prolapse actually, like it's not what we think it is. I think there's a lot of fear around specifically prolapse and heavy lifting. So
Are you, like, do you modify any movements in CrossFit? Do you recommend any modifications? Do you recommend specific breathing patterns that would offer more protection, quote unquote, or more awareness to the pelvic floor for yourself or for your clients who are doing CrossFit?
Dr. Aldene Zeno (38:32.572)
Yeah, there's definitely some good research out there about some of the common culprits when it comes to things that provoke incontinence. And probably the reason that incontinence is more prevalent among CrossFit athletes compared to prolapse is that's exactly what we see in the general population too, right? Like incontinence is like one in two women over the course of their lifetime. Whereas prolapse, the numbers vary, but there's one study that looked at, you know,
that actually have symptoms and that was closer to like 15 to 20 percent of women over the course of their lifetime. So the common culprits when it comes to CrossFit movements are squats, box jumps, and then deadlifts. So the thought behind things like, and jump roping too actually, double unders especially. So double
Kim (39:26.826)
Yeah, double unders, yeah.
Dr. Aldene Zeno (39:32.406)
cool thing to check off on your list across the things. But obviously with double unders and box jumps, you're dealing with a high impact activity. And the thought is potentially athletes may not be able to activate those pelvic floor muscles in an efficient or effective way when they're doing those types of movements. Because we know that with incontinence, it's not just being able to squeeze really hard, which I think the common belief is that
to have to have like really strong kegels or something. It's about being able to relax those muscles in the appropriate time and contract them when you need to. So when it comes to people who already are dealing with incontinence, I'll kind of focus in on those movements and try to modify them. In general, I'm looking at either offloading weight or
Dr. Aldene Zeno (40:32.406)
and box jumps, potentially step ups as opposed to box jumps. Or definitely not like rebounding where people like jump up and jump down like over and over again. Maybe see how you're doing with just jumping up into like the correct position, knees bent to absorb the impact, stand up and then kind of step down. With double unders, if people are not able to do that
Kim (40:45.635)
Mm-hmm.
Dr. Aldene Zeno (41:02.166)
leaking even a single unders, potentially even considering a different type of cardio until that person has done some more focused physical therapy for that area and then potentially be able to build up to that. With any lifts, but especially squats and deadlifts where you're potentially dealing with a lot of heavy weight, again, you can modify the weight itself, but one thing I'm looking for is to make sure people aren't bearing down a lot.
Kim (41:07.371)
Mm-hmm.
Kim (41:15.255)
Yep.
Dr. Aldene Zeno (41:32.226)
with some coaches I've worked with in the past, they would say things like hold in your power while you're doing the lifts and things. In medicine we call that Valsalva, which is where you know you take a deep breath and then you go to do the lift and on your way up you're like really straining right? You're holding in your power. And interestingly enough that's a lot of times what we're telling people to do in delivery right? Is sometimes they're told to not make sound when they push or something like that to get them to try and
what we call closed glottis push. But when it comes to lifting, again, if you're trying to go for quality over quantity and preventing injuries to your pelvic floor, I'll encourage people to do open glottis lifting so they're kind of breathing throughout the lift and never at any point holding their breath. Other ways to offload, instead of just taking weight off of the barbell, for some people, it may mean just focusing
on air squats or just no weight, even doing something assisted like holding onto a pole or holding onto the side of a wall. Again, so you're taking some of the weight off of there. And then with squats, I could talk all day about proper technique, but technique really does matter, especially I feel like with squats, same with deadlifts and any lift, but there's a lot of factors that play into that, not just strength but mobility too.
Kim (42:55.342)
Mm-hmm.
Dr. Aldene Zeno (43:02.846)
And then potentially considering modifying the depth of the squat. So doing a squat to a box or a bench and then focusing on that movement until you can kind of progressively do that with good mobility and good form without, you know, prolapse or incontinence symptoms. So I think hopefully, you know, coaches, if they're listening to this, or, you know, a good coach or a good trainer will be able to kind of...
Kim (43:20.151)
Yeah.
Right.
Dr. Aldene Zeno (43:31.806)
and do those types of modifications instead of just saying, oh, don't do that. Like my first doctor told me when I was pregnant, they just said, oh, I don't think you should keep doing CrossFit, you know, I don't think that's the answer either. I think that with the proper coach that you can coach people through proper technique as well.
Kim (43:37.067)
Right.
Kim (43:54.571)
Yeah. We're not gonna get into this, but a part of your practice is performing surgery. So potentially incontinence surgeries, prolapse repairs, what have you. Do you have any sort of max amount of weight that a person could lift? So many people go through a pelvic surgery and are told they can't lift anything over X pounds.
And I find that, coming back to it's not personalized. It's what 25 pounds to one person is incredibly heavy. 25 pounds to a very trained person is nothing. And so I don't think we ever will have a not over this weight, but just lifting practices in general. Do you think that there should be limitations on people who have had a pelvic surgery as it pertains to lifting and higher intensity activity?
Dr. Aldene Zeno (44:50.16)
So the common thing people say is to avoid lifting over somewhere between 10 and 20 pounds. And they'll often say that for the first six weeks after surgery. I've worked with mentors who said to just stop heavy lifting period after prolapse surgery. There is zero evidence for that. And there's very few things in medicine where we make these types of strong statements with zero evidence,
across the board when it comes to women dealing with prolapse. For some reason, physicians feel comfortable saying that and there's zero evidence for that. So again, that's where I encourage people to work with a skilled trainer or physical therapist or chiropractor to help them go through, you know, whatever movements they are within their goals, whether it's lifting or just squatting or whatever.
good form and then progressively add resistance or weight or whatever. We also get that in our pregnant and postpartum patients and one of the things that I appreciate about the new exercise guidelines from the American College of OBGYNs is that they really emphasize relative perceived exertion or RPE, which is something that I think a lot of fitness
with. But it's exactly as you said, if you were lifting, you know, dead lifting over 300 pounds before you were pregnant, if you're told to just lift 20 pounds for the whole pregnancy or postpartum, you know, you're gonna miss out on a lot of gains as we would say. Like you're gonna miss out on a lot of potential benefits of lifting heavier and honestly that probably wouldn't get a lot of those people to that moderate intensity or definitely not vigorous intensity
So just being aware of what your limitations are, I think, and then being able to modify that again with guidance throughout pregnancy, postpartum, also super important. Yep. Yeah.
Kim (47:03.126)
Yeah, yeah, speaking my language. Love it. So where can people find your book and where can people find you so they can follow along and potentially even work with you or and find out more about your practice?
Dr. Aldene Zeno (47:18.936)
Sure. So my book, Black Bomb of Magic, is out right now on Amazon. So you can look it up on Amazon and order directly there. My goal is to have it in brick and mortars and you know, bookstores and things by summer or so. But for now it's on Amazon. They're delivering all over. As far as where I'm physically located, I'm in the LA Metro area in Glendale. You can find me on Instagram at Dr. Aldine. So that's D-O-C-T-O-R.
and my website at www.draldene.com. So www.draldene.com.
Kim (47:59.662)
Awesome, and we'll share those links down below as well. Thank you so much for your time. Huge congratulations to you on your book. I know how much work that takes, especially when you, as you say, you've got your own children and family and practice and everything. So thank you so much for your work, for all that you do to help women, and for sharing your knowledge with us today.
Dr. Aldene Zeno (48:06.548)
Thank you.
Dr. Aldene Zeno (48:11.893)
Yeah.
Dr. Aldene Zeno (48:19.528)
appreciate that. Thanks for having me. This was awesome.
