The Mama Making Podcast

Mel Cosio, PT | A Practical Guide to Pregnancy, Postpartum, and Fitness

• Jessica Lamb, Mel Cosio • Season 3 • Episode 91

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On this week’s episode of The Mama Making Podcast…

Mel Cosio, a physical therapist specializing in CrossFit and pregnant/postpartum athletes, shares her expertise on staying active during pregnancy and postpartum. 

Mel discusses the importance of listening to your body, making exercise modifications, and celebrating small wins. She also highlights the benefits of working with a pelvic floor physical therapist and when to seek support. Mel shares her personal journey, including preparing for an unmedicated birth, the mental fortitude required, and practical advice for returning to exercise after birth. 

This episode is full of insight and encouragement for moms who want to stay active while navigating the changes of pregnancy and postpartum.

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Jessica | The Mama Making Podcast (00:01)
Hello everyone and welcome to the Mama Making Podcast. If you're new here, I'm your host Jessica. If you're not new, then welcome back. Today I'm very excited to have Mel Cosio here with us. Mel is a physical therapist with MoveWell out of Birmingham and she specializes in CrossFit and pregnant and postpartum athletes. So glad to have you here. Thanks Mel for joining us.

Mel Cosio (00:11)
.

Thank you. Yeah, thank you, Jessica.

Jessica | The Mama Making Podcast (00:26)
So tell us a little bit more about you, your family, where you're from, whatever you're comfortable sharing.

Mel Cosio (00:31)
Yeah, for sure. So as she mentioned, I am in Birmingham, Alabama now with my husband and our one -year -old son. My husband and I moved here about eight years ago from California. Didn't have plans to stay in Birmingham, but we just met a great group of friends and got connected and got rooted here and welcomed our son last May and

Now we keep busy between me working as a PT, chasing him around, and we have a couple coffee shops in the area as well. Cala coffee.

Jessica | The Mama Making Podcast (01:08)
cool, what coffee shops? Okay, I can't remember if we, which, where in Birmingham?

Mel Cosio (01:15)
We've got one in Cahaba Heights, like just past the summit, and then one in downtown Birmingham, right across the street from the Alabama Theater.

Jessica | The Mama Making Podcast (01:19)
Okay.

okay. yeah, I, when we visited Alabama or Birmingham in, what was it early June, maybe, we had like a laundry list of breweries and coffee shops. So I, I'll have to look back to see if, it's on our list of once we, we checked out, but, yeah. So tell me, well, with that said, I attended a postpartum workshop at Nexus CrossFit.

Mel Cosio (01:33)
Yeah.

Nice.

Yeah, cool.

Jessica | The Mama Making Podcast (01:52)
in Birmingham, that you led and it was so awesome. And I just wanted to have you on to learn more and talk more about, I mean, you can only fit so much in your presentation. So I would love to talk more about you, your background, how you got into PT, how you got specifically working with moms. Where did it all start?

Mel Cosio (02:03)
haha

Yeah. Yeah, for sure. So as far as getting started in PT, I went into undergrad knowing like I wanted to do either do like something in medicine or something more like engineering route and just felt more called to do like something in medicine. And I also played D1 softball and in my freshman season, I got injured and ended up needing surgery. And so that was still kind of like when I was deciding like which

route in medicine do I want to go? So I met my PA before surgery and I was like, like maybe I'll go that route. And then after surgery, I required PT for like three or four months. And pretty much like the first session with my PT, I was like, this is it. This is like exactly what I'm looking for. So from that point on in my freshman year, I decided to pursue PT. I just really liked how it was a blend between like

medicine but then also like the therapy aspect of it is very true because you really get to know your patients which isn't true of all healthcare professions and that was something that like really called me to PT is like I wanted to spend time with my patients I wanted to like really make a personal impact and be someone that not just got them through the injury but potentially sees them through like different phases of life and that kind of took me to

staying in like sports just because I really enjoy being involved in sports, whether at first it was like more like I played softball. So I really liked overhead sports, whether it was like softball, volleyball, baseball, those kinds of things is what I really like to focus on early on in my career. And then as my husband and I started talking about having a family and we had family and friends having babies all around us and talking to like my sister and other close friends, I just realized that there was like this huge gap

in healthcare for women who were going through pregnancy and then postpartum and especially the women that like to work out in those parts of their lives. So a couple of years ago I started to get more interested in working with women during pregnancy and postpartum and part of it was like kind of selfish because I was like well I'm probably going to be going through this pretty soon so like I want to know what the research says and like

start to develop like some clinical preferences too. So I started learning more about it taking like continuing education courses on training pregnant and postpartum athletes. My preferred form of exercise is CrossFit and so I like really specifically started training in how to keep pregnant women and postpartum women in the CrossFit gym. But as I believe you know like CrossFit involves

tons of different types of exercise, whether it's like cardio and you're running, biking, rowing, swimming, weightlifting. It really covers like all bases. So basically like if you can get someone in a CrossFit gym, you can probably keep them moving anywhere else they want to be moving.

Jessica | The Mama Making Podcast (05:21)
Yeah, totally. I, I, so I'm sure I've mentioned it a ton on the podcast, but my husband owns a CrossFit gym. And so when I was pregnant with my son, I was like, my God, I'm going to be the mom. That's like nine months pregnant. I'm like doing overhead squats on my like birthday. But it wound up being a very different journey for me. I got a pubic synthesis dysfunction at like maybe eight or 10 weeks. I started feeling it.

Mel Cosio (05:37)
Yeah.

Jessica | The Mama Making Podcast (05:51)
And so CrossFit was like, I could barely walk. So CrossFit was like just not an option for me. so I wound up having to go a very different route as well and would definitely have loved having someone who was familiar with, CrossFit specifically. Cause I feel like, it's just like no man's land with doctors who are like, yeah, don't work out for the first.

Mel Cosio (05:54)
out.

Jessica | The Mama Making Podcast (06:19)
two months, but then go back to your regular stuff. And then you're like, okay, well, how do I make an accommodation for X, Y, Z? So I think, and I had a really great chiropractor that did like personal training and things like that, but, and focused on, like perinatal women, but it would have been nice to have someone who understood like both sides. and I feel like my journey would have been a little bit more, informed, I'll say.

Mel Cosio (06:21)
Totally.

Yeah, for sure. And that's something that I'm really passionate about is like.

OB -GYNs and midwives and everyone have definitely like have their place. But unfortunately, a lot of those healthcare providers just don't know how to work with someone who wants to be more physically active. Because for so long, the recommendation is like just walk and do yoga, which for a large part of the population like that is enough because that might be more than what they're doing right now. But then for the percentage of people that like do work out more intensely,

they're just giving that same recommendation and it's like, well, I'm not going to do that. Like I definitely like to move. I want to stay moving. and like in your case, there's some things that are like out of your control. There's so many changes that your body's going through when you're pregnant that like you want it to work out, but like physically it just wasn't going to happen. but there's ways to like tailor it, to fit like what you're able to accomplish. And I think that's something too, that

you, I'm sure like told the healthcare provider like, yeah, I'm having this like pain and they were probably like, that's just kind of part of it. When in reality, like there could have been something that, could be done just because like, that's a big part of it too is like, I'm not just, helping people figure out like what to do in the gyms. I'm also helping people realize like, okay, if you're having pubic synthesis pain, or if you're having SI joint pain, here's some positions or movements that like might be more tolerable and like,

Jessica | The Mama Making Podcast (07:58)
Yeah.

Mel Cosio (08:18)
for you being used to CrossFit, they might look very different than CrossFit movements, but like, we're gonna still stress those muscles just in a different way.

Jessica | The Mama Making Podcast (08:22)
Mm -hmm.

Yeah. Yeah. So knowing what you knew prior to having your son, what did you do differently for your pregnancy and postpartum? having seen kind of the, the, I don't want to say treatment, but the way other people experienced their journeys ahead of you.

Mel Cosio (08:46)
Yeah, great question. So I was committed, I thankfully had a pretty straightforward pregnancy in terms of like, I had morning sickness, but not to the point where I was throwing up. I was just pretty nauseous the entire day. And some days were better than others. And I realized pretty early on in those weeks six through 12 that like,

If I pushed myself too hard in the gym, I was going to pay for it later. but then there was also days that like, I would take it really easy and I would still pay for it later. So I just found like a pretty good mix between, I think that that time I was getting myself in the gym like two or three times per week and just like backing off intensity big time and then walking like three to four days a week as my exercise. And so.

my goal early on was just to like stay moving because I was like if I can just stay moving during my first trimester like everyone says this is like the worst part. And I'm grateful that I was able to tolerate exercise because I know several women that just it's not in the cards for them and that's okay too because when you're dealing with like the nausea especially if you are getting sick like your body just needs a chance to recover. And then heading into the second trimester I'd learn like

Jessica | The Mama Making Podcast (09:46)
Yeah.

Mm -hmm.

Mel Cosio (10:08)
That's when some changes start to happen. You might have to modify some movements, but it's been really cool to see CrossFit change recently with like some of the top athletes becoming pregnant and having babies and returning to CrossFit. And so you've seen some women like push the envelope a little bit in their return. And then you've also seen other women like make modifications at different times. And so going through training, there's just like blanket recommendations like you might conserve.

changing from a barbell to dumbbells with snatches around this time. And so I kept those timelines in the back of my head and was just following my intuition. That was something that was really important to me was just realizing that pregnancy for me, I didn't feel like was a time that I needed to really push myself. I was just happy to be in the gym and doing movements that felt good and familiar. And...

when the day came that I didn't feel like it was appropriate for me to do burpees or to do barbell snatches or to do barbell cleans, I just was like, okay, I'm gonna switch the movement to this. And I was able to move past it. So that was a big mindset shift was just like realizing like there's no pressure to do what I'm supposed to do or like what's written on the board for the workout. And then I just kept a like close watch on my intensity.

There was sometimes in the second trimester that I felt like I want to get after it today. and I was able to, because I was like in my second trimester, Alabama, it gets really hot. my second trimester was primarily like at the start of the year. So it was a lot cooler here, towards the end of the second trimester and my third trimester, it started to heat up quite a bit. And so I had to be a lot more careful about like, okay, it's 85 degrees and super humid, like

Today's not a day that I need to really exert myself a ton. And just heart rate's not super, especially on my Apple watch, I don't think it's the most accurate. But I would keep an eye on it and just see what level of intensity does it feel like I'm giving, what does my heart rate say, how am I feeling. So I was just checking in with my body more and giving myself the chance to take more breaks during workouts.

Jessica | The Mama Making Podcast (12:22)
Yeah, I think people who work out have like a very unique sense of themselves in terms of like, okay, like I know myself, if it's hot, I am not doing a high intensity workout, or like, I could do like a heavy lift, but I am not doing like a running workout or like very high intensity, because my body doesn't respond well to heat, and like humidity and being like over exerted. So I think, for example, but I think

Mel Cosio (12:28)
Totally.

Yeah.

You

Jessica | The Mama Making Podcast (12:50)
I think then in pregnancy, it's like, okay, no, my body, but then like you get pregnant and you're like, what is happening? And every, every day feels different. So I could see that being a little discouraging, but then I think kind of, like you said, changing your mindset to being like, okay, we just have to see what today brings is, is really helpful. when I was pregnant, I, I previously did yoga alongside of CrossFit. And so I was like, okay, I just need to, like you said, I just need to keep my body.

Mel Cosio (12:56)
Yeah.

Yeah.

Jessica | The Mama Making Podcast (13:20)
moving and like if I've moved and have like felt in touch with my body that day, like that's more than I could ask for. So I felt like even in, in when I was doing yoga, I was like, my God, today, my balance is totally off or like, I have to adjust my body this way. And I am sure it's exactly the same in CrossFit or any other like high intensity workout where you're like, okay, this is a little different. I'm not sure why, but my body is, changing for sure.

Mel Cosio (13:27)
Yeah, totally.

Yeah, for sure.

Jessica | The Mama Making Podcast (13:51)
So did you prepare for birth any differently than the average given your background?

Mel Cosio (14:00)
I would say probably yes, most people would agree with that. My plan going into birth was I wanted to go unmedicated and we had a doula, we delivered in a hospital and so my goals were to go unmedicated, vaginal birth. Our son in the weeks, like very close prior to having him was doing all sorts of moves and was breeched for a little bit and then wasn't breeched and then was breeched again.

And it was like week 39, he was, I think it was week 38. He was breeched. And so my doctor was like, all right, we've got to have the conversation about a C -section. And I was like, this dude has been like flipping around. Like he still is moving in there. And I was like, I'm going to get him to turn. And she was like, you can consider this procedure and like, we can try to like manually turn him. But like read this article and like the pros and cons of this procedure.

And so I think it was like right around 39 weeks. We were like supposed to go in on a Friday. And so like that Thursday, I was like, I had talked to a girlfriend that went through a very similar thing and she was like, everything I recommended or everything that I read recommended doing like inversions. And I was like, I feel like I just want to do a handstand. And she was like, I mean, you do CrossFit, you probably could just do a handstand. Like they typically recommend just like.

getting in a pike position or like on your knees on a couch. And I was like, I feel like they just want you to create as much space and like, I have no problem getting on my hands. And so sure enough, I like kicked up on my hands and did like three 30 second handstands and then went through, there's this, it's called like the miles method. Yeah, yeah. So I did that. And as I was like going home,

Jessica | The Mama Making Podcast (15:47)
The Myers, Myers circuit. Yeah.

Mel Cosio (15:55)
I felt like a really big shift and I was like, my gosh, I think he moved back. And so sure enough, the next day when my doctor was like planning on talking C -section, everything, she was like, well, against all odds he flipped back and is in a good position now. So that I think was one way that like my delivery prep was a little bit different. Yes.

Jessica | The Mama Making Podcast (16:14)
It's so awesome that it actually like worked because I did the my I did the mile circuit. I have like a crazy birth story, but for like a week I did it like every few hours just to get him in position. So and I could feel like slight movements, but to feel like that huge turn was probably really cool.

Mel Cosio (16:25)
Yes.

It was a crazy, and like one time I looked down at my stomach and I could like see him doing it. And that was the time that he went and breached. And I told my doctor, I was like, he made like a really big movement. I saw like my entire abdomen moving. I feel like he flipped. And this is at like 37 weeks. And she was like, that's highly unlikely. Like babies don't really move a whole lot after 36 weeks, because there's just not space. And I was like, well, I'm telling you like my belly looks different now than it has in the past six weeks.

Jessica | The Mama Making Podcast (16:39)
That's so crazy.

Yeah.

Yup.

Mel Cosio (17:04)
And sure enough, I like lay down on the table and she was like, so yeah, that looks like a butt and that looks like a head. And she checked on the ultrasound and was like, yeah, you're right. He's breach. and so that's when we started developing the game plan. but yeah, also from like a prep standpoint, I read and did like some, hypnobirthing stuff. So like I found a hypnobirthing, podcast that I was

really adamant about doing every single day. I don't do the job of like sitting still and like a big part of this like Hypno birthing podcast was like sitting still and just like really connecting with your body. And so I like emphasize that and then also read all sorts of books on like unmedicated childbirth and just started to develop like some mental fortitude and like that's something that I tell friends. Like I really think that CrossFit helped me in that because

Going through, it's only an hour long workout, but like you've been there. And then I remember you're like in despair and you're so hot and you're like, why do I do this for fun? But you push through it. And so like, I talked to a girlfriend who has had three kids right before I gave birth. And she was like, just think of it like a workout that like, you can always, you can do anything for one more minute. You can do, even though it might be more than one minute, like you can do anything for a minute. So just like keep resetting that clock.

And so like during my long labor, I thought about that a lot. And then another girlfriend that I had had deliver unmedicated three months before me, read the same book that I like really helped like prepare my mentality. Animes guide to gentle, maybe not gentle childbirth. I think it's just animes guide to childbirth. She was like, yeah, one line that stood out to me was the only way out is through. And so like,

Jessica | The Mama Making Podcast (18:52)
I think you're right on that.

Mel Cosio (18:57)
I just kept thinking that the only way to get through this, like the only way out is through. The only way that I'm gonna get past this pain is this baby coming out of me. So I just gotta keep on. And so doing all that mental prep really helped me. And then just, I stayed active up until the day that I went into labor, I did a workout that morning. And that was something that was important to me. And the last few weeks of pregnancy, I had shifted to a lot more of pelvic, or,

pelvis opening exercises, so like squats and lunges and things that require like different types of internal and external rotation of my hips. There are some exercises that like were recommended to me in one of my continuing education courses just to help get those hips opened up so that the baby can hopefully like start to drop lower and lower. So my last couple weeks of training, I was doing like all sorts of those kinds of movements, not really what was written up on the board at our gym.

Jessica | The Mama Making Podcast (19:59)
Yeah. And I think just like getting into the space that you're usually in, like helps you feel normal as well. So you're not doing the same stuff. And probably by your last day, it's like, you're not doing any heavy lifting or anything, but I think there's like a sense of normalcy to, to going back to your same like space or gym every, every how, however often you're going.

Mel Cosio (20:07)
Yeah.

No.

Totally. That's something I tell my patients all the time is like, it's tough, especially if you're an athlete who typically like RXs workouts. It's hard to kind of like check your ego and realize like at some point things will probably look very different. And I have patients all the time who are like, well, I just don't want to be a burden to the coach. And it's like, you are not a burden to the coach. Like if you are in the right gym, those coaches are more than happy to help out a pregnant person.

Jessica | The Mama Making Podcast (20:36)
Mm -hmm.

Mm -hmm.

Mel Cosio (20:51)
And so like, don't consider yourself a burden because coaches don't feel that way. I also coach CrossFit. And so like, I know from experience that if someone asks me for help because they're going through an injury or they're going through pregnancy, like I'm more than happy to help that athlete. and then the social aspect of it, like that's the beautiful thing about not just CrossFit, like any sort of like running group or any sort of group workout setting is totally about community. And so like,

Jessica | The Mama Making Podcast (21:02)
Mm -hmm.

Yeah.

Yeah.

Mel Cosio (21:20)
I tell especially like first time moms, like you find a big part of your identity through working out. And so, and you're getting ready to go through like one of the biggest shifts in your life. And so like there is gonna be a window after you give birth that like you probably won't be around these people because you'll be tending to a baby. And there's no telling like when you will feel ready to go back into the gym. And so stay in the gym, like maintain those social connections because

you're going to go through a period shortly that things will look very different.

Jessica | The Mama Making Podcast (21:55)
Yeah, I agree. I think what you said earlier about, just going back to that mental shift, obviously preparing your body physically is, is the best thing you could do. But I think, prepping that mental space in like practicing moving from like one head space to another is, incredibly helpful. Cause like through the birth process, like the second you realize like, okay, this is happening through the time, like your baby's there.

Mel Cosio (22:11)
Mm -hmm.

Jessica | The Mama Making Podcast (22:24)
your mind is just like all over the place. So I think being able to like practice it ahead of time, I also did an app, I think it was the gentle birth app, where you just like sit and practice it. I mean, I also did yoga too. And sometimes I would go multiple times a day just to like, like I would go to an actual class and then like a meditation class just because I was like, I got to figure out how to get like my mind right. But yeah, I think even after like even after birth, knowing like, in comparison to fitness, like

Mel Cosio (22:28)
Totally.

Yeah.

You

Jessica | The Mama Making Podcast (22:54)
It's not going to look the same. It's not going to, even in those last few days, like it's going to be an adjustment for me. So being able to be like, it's just temporary or like you said, the only way out is through like going through this process and knowing that at some point you'll be back to where you were, I think is incredibly helpful. And then on the community aspect, I feel like

Like we had, we were so lucky when we had our son that, someone did a meal train for us and we like didn't make a meal for like two months just because everyone from our gym was like so excited to drop things. Like everybody wants to do something. So like, Hey, make me a freezer meal or like send a door dash gift card. And that is like so appreciated from like first time parents, especially I feel like, but then like, as you have more kids or people are doing like.

Mel Cosio (23:32)
Yes.

Jessica | The Mama Making Podcast (23:48)
their last baby, like being able to like help people and still keep that community going, I think is incredible as well.

Mel Cosio (23:56)
Yeah, totally. Meal trains are the best.

Jessica | The Mama Making Podcast (23:58)
So yeah, they're amazing. So pivoting a little more to the actual workout part of things, what are some things that you think women should know about in pregnancy, in postpartum, as it relates to working out of any kind of chosen activity?

Mel Cosio (24:08)
Mm -hmm.

Yeah, so my biggest recommendation for pregnant and postpartum people is if it feels right for you, it probably is okay. And so that's like especially important. I have a lot of women like early on in pregnancy ask like, is it okay for me to keep doing CrossFit? Is it safe for me and the baby? And the answer is typically yes. If you have concerns and like definitely see your doctor or get in with like a pelvic floor PT.

That way you can be assessed by a medical professional to see like, yes, you are truly safe. But typically, especially moms are so intuitive. If you know that something feels okay, or if you know that something feels wrong, you're probably right. And so trusting your gut and going with it is one of my biggest forms of advice. And then I already talked about shifting the mindset a little bit. So realizing that like,

you should be satisfied with smaller wins. And so like you might be in a CrossFit class and you might like normally an hour long class might be no big deal for you, but now you're pregnant and you're growing a human or maybe multiple humans. And so realizing like, if you only get 30 to 45 minutes out of that workout, that should still be a success. You shouldn't be thinking like, I didn't finish this. Change the expectation a little bit and realize like I got myself to go to class. I did move and I feel better because of that.

Jessica | The Mama Making Podcast (25:33)
Hmm.

Yeah.

Mm -hmm.

Yeah, absolutely.

Mel Cosio (25:50)
and leave it there and in helping people.

Jessica | The Mama Making Podcast (25:53)
Yeah, if the warmup feels hard, then maybe now your workouts can get cut short.

Mel Cosio (25:58)
Yes, yeah, exactly. And like one of the things that I recommend, either for my patients or if I'm like coaching a class, for pregnant people is like, I change whatever the workout is, I'll change it to like an AMRAP. That way they can move for 12 minutes or whatever it is versus feeling like they have to complete a certain amount of work to be accomplished instead. It's like, okay, you're going to move your body for 12 minutes. And if you take 30 second breaks, like no one's going to know because

Jessica | The Mama Making Podcast (26:18)
Hmm.

Mel Cosio (26:26)
you're going to be done after 12 minutes and you don't have to share how many rounds and reps you got. And that's something that I think really helps pregnant people and postpartum people change their mentality because they still feel like they accomplished what was written for them, which is an important thing for people who, like especially crossfitters who like to accomplish things. So that's some advice I typically give. And then I'll...

typically go over some recommendations of like when movements should change in the CrossFit gym. But they're just like super loose recommendations. And we can go over those timelines if you would like. But it's just when most women feel like it's appropriate to start modifying movements. But I tell people like, if you wanted to do barbell cleans until you're 40 weeks pregnant, like that's your own discretion. Like you're not, it's not not safe as long as you're not bumping.

your belly with the bar, it's probably fine. It's just like, pros and cons that worth continuing that movement versus like messing up your bar path and making the return to that movement a little bit trickier.

Jessica | The Mama Making Podcast (27:32)
Mm -hmm.

Yeah. Yeah. Those are all great. I love the idea of changing it from like a standard workout to an AMRAP as many rounds as possible for those non -crossfitters. But, yeah, cause then you are completing that workout as prescribed versus like, I only did three out of the eight rounds or whatever it is. You're still feeling that like accomplishment. I mean, in mental health, they talk about, like mastery.

Mel Cosio (27:56)
right.

Jessica | The Mama Making Podcast (28:03)
all the time. So I feel like Crossfitters very much fall into that of like, I am mastering this workout. And I think in pregnancy, like so much is changing. And it would be nice once in a while to figure a way to like, complete a workout without feeling like, I didn't do it how it was written for me. So I love that suggestion. So what would you

Mel Cosio (28:24)
Right.

Jessica | The Mama Making Podcast (28:32)
How would you do post? Well, do you want to talk a little bit? Just do very brief about the different like stages or like week cycles.

Mel Cosio (28:41)
You're saying like with movements? Yeah, so usually in the first trimester, like no changes really need to be made. My recommendation is like, that's more dependent upon how you're feeling because people go through like completely different first trimesters. And so as we kind of touched on already, like if you're someone who is sick, like just getting through the day, like especially if you're working or if you're chasing around another toddler, like you're just trying to survive.

Jessica | The Mama Making Podcast (28:43)
Yeah.

Mel Cosio (29:10)
So like that is an accomplishment in and of itself. If you're someone who wants to work out, then like that's great. No changes really need to be made. Like you can keep running, you can keep lifting. You can continue doing burpees. Typically some, typically people will give up burpees sometime between like 12 and 20 weeks. Some people continue doing burpees. Like I think for those who follow CrossFit, Tia Claire Toomey did like an open workout at like 36 weeks pregnant and did burpees and like.

Her baby was safe. She was very safe about it.

Jessica | The Mama Making Podcast (29:41)
Yeah, when you have abs like that, it really protects your baby.

Mel Cosio (29:44)
Yeah, exactly. Yeah. So that's just like, these are super loose general recommendations. And so first trimester really like no changes need to be made. It's just you listening to your body. Second trimester, some changes start to be made just because you've got a belly growing now. And so typically around 16 to 20 weeks, people will notice like a big change in their bar path with a snatch.

So they might consider modifying the snatch, like rather than coming from the ground, they might do a hang snatch or a muscle snatch or just give up the barbell snatch altogether if they feel like their bar path is so influenced by their belly. And that's just something like some people don't want to do that because it's not efficient or they don't want to mess up the coordination of the skill. And then others might find that like as that bar strays further away from your body, you are putting stress more on your shoulders and your back. And so it might not just be worth it because you don't want to

injure yourself, which is a legitimate concern. Cleans are typically a little bit later. Cleans are typically somewhere between like 22 to 26 weeks. People will start to really notice a big change in their bar path. And so they might find that that's an appropriate time to switch over to dumbbell cleans or deadlifts that they're more worried about getting that like hip hinge movement around like

24, 30 weeks, some people might feel like they can no longer get on the rig. For some women it happens way before that because it's harder to manage your intra -abdominal pressure whenever you're hanging and when some people do that they start to notice that they have like incontinence issues or they feel more pressure in their abs that they're not used to and that's uncomfortable. So some people might find like really early on they have to give up pull -ups and that was my experience. Like I gave up

pull -ups and other rig movements way before I thought I would. And it was just because I was having a really tough time managing my intra -abdominal pressure and it was just like, it doesn't feel right to me anymore. So even though I'd love to keep doing this movement and I'm capable of it, it's not right for me anymore. Those are the big ones. Running, there's different recommendations. People who run a lot, I'm sure we all know of a friend that's run into the day that she gave birth.

Jessica | The Mama Making Podcast (31:47)
the arm.

Mm -hmm.

Mel Cosio (32:07)
some others might find again, like in the first trimester, they might give it up, whether it's because they like can't tolerate it from like a nausea or fatigue standpoint, or for some they start to notice that like, I have incontinence whenever I'm running and I don't want to like create that habit. but for most people it's just, like the second trimester towards, the end of that second trimester, especially once you start to get more and more weight on that pelvic floor.

Jessica | The Mama Making Podcast (32:23)
Mm -hmm.

Mel Cosio (32:34)
Women will typically stop running and the good thing is is there's the bike and there's the rower. Some changes have to happen on the rower. Yeah, exactly. I think that covers like the main questions people usually ask when it comes to movements in the gym.

Jessica | The Mama Making Podcast (32:41)
Yeah, a lot of different options.

Okay. do you want to talk specifically about postpartum and like, I mean, I feel like it could be a whole, whole other podcast, but, do you want to talk a little bit more about kind of the same miles to like week milestones and like what to look out for?

Mel Cosio (32:55)
Yeah.

Yeah.

Yeah, so postpartum, I would say is like, has to be even more unique than pregnancy. Cause pregnancy, even though everyone's pregnancy is a little bit different, that baby's pretty darn safe. Now there are circumstances that like, you might have a placenta issue or you might have issues with your blood pressure, blood sugar. There's different things that can go on, but those are typically like so closely monitored that like, if you have questions, you're probably seeing your doctor next week.

Jessica | The Mama Making Podcast (33:12)
Mm -hmm.

Mm -hmm.

Mel Cosio (33:36)
Postpartum, it's like the wild, wild west. You give birth to that baby, you have an appointment with your doctor six weeks later -ish, and then they're like, all right, you're on your own. When in reality, like your body just went through the biggest change that it could possibly go through. And most women aren't given a ton of advice. So my first bit of advice to anyone who is postpartum is to get in with a pelvic floor PT. It doesn't matter if you had an uncomplicated delivery.

vaginally or if you had a c -section or if you had like a Traumatic birth whatever it is. You are appropriate to go to a pelvic floor PT And the beautiful thing about that is like if you are feeling great Then it's just one more health care provider to give you like you are good to start moving again And if you're not doing great or if you just have like a million questions That's what that person is there for and they'll help determine a game plan for like

This is how often I want to see you. This is how long you can expect to be seen. And the nice thing about that is just you have someone advocating for you and keeping touch with you in those weeks where things are like so confusing, especially again, for first time moms. So that is my number one recommendation. People typically ask like, when should I go and see a pelvic floor PT?

I recommend for someone who gave like an uncomplicated vaginal delivery, you can see a pelvic floor PT as early as two weeks. A lot of people, myself included, was asked like, they won't do internal, right? Like it does not feel like it's an appropriate time to do that. And one of my closest friends, the pelvic floor PT, and she was like, they should not do internal. Like they might like kind of look down there just to assess things, but she will most likely not get her hands on you.

So you don't have to worry about that. It'll be a lot of other stuff going on and just getting like a good baseline for where you're at. Other people who might've had like a more complicated delivery or maybe don't have like the family help that like someone can sit in and watch the baby or whatever the reason is. As long as you're getting it in somewhere between like four to eight weeks, this is especially true if like you're doing something that wants to get back to exercise.

I always recommend getting in with a pelvic for PT before you resume exercise. and so again, as I touched on, like most OBs will see their patients again around the six week mark and most women are then told like, you're good to get back into it. But like, that's kind of a crazy recommendation. Cause like prior to that point, most women are told like, don't do anything except for light duty, like lifting your child and going for walks. recommendations are even different for women that go through C -sections.

Jessica | The Mama Making Podcast (36:10)
Mm -hmm.

Mel Cosio (36:22)
And so I think you're probably picking up what I'm putting down and that like everything is so different. It's hard to give like a blanket statement, which is why I say like every every woman just needs to go to a pelvic floor PT because that's gonna be the health care professional to be like, hey you at two and a half weeks postpartum you can begin these kinds of exercises whenever you feel ready for it and like maybe you feel physically ready for it, but maybe you're not ready mentally and that's okay. And so

Jessica | The Mama Making Podcast (36:48)
Yeah.

Mel Cosio (36:52)
I can talk like a little bit more specifically, like my own personal experience. I had like a uncomplicated delivery, like no tearing, none of that. And in my first week postpartum, I was tired as to be expected, but I felt like ready to walk. And so my husband and I started going on short walks together. Always recommend walking with a partner just because like lightheadedness will hit you, especially while you're continuing to bleed after delivery.

Jessica | The Mama Making Podcast (37:21)
Hmm.

Mel Cosio (37:21)
it'll like sneak up on you and you need to have another person there with you in case like you do need to sit down or you do need more attention than just like sitting down. and then from there I got my, public floor PTE valid two weeks postpartum. she gave me the green light. She was like, you know what you're doing when it comes to exercise, I'll give you some recommendations, but like, you can probably help, guide yourself. and so at that point I started doing some like,

Jessica | The Mama Making Podcast (37:30)
Mm -hmm.

Mel Cosio (37:52)
breathing work, really focusing on reconnecting my pelvic floor, my core and my breath. And then I started working on mobility. You don't really realize like how stiff you become towards the end of pregnancy because you were like so full of baby. But it was made aware to me that like my thoracic spine, my middle of my back was just like so stiff. So that was something that my PT was like, you should do some open books and start moving your spine more. And I was like, wow, yeah.

and then people also just get like their glutes get really weak and something like a bridge is a very simple movement that is, appropriate for a lot of people early on in postpartum and it just feels good to like use your muscles in that way. so yeah, I started like some gentle, pelvic floor connection, breath work and some like hip strengthening stuff around the two week Mark, started to progress into that was all done on my back.

And then around week three, I progressed into hands and knees. And then from there, I started doing stuff in like half kneeling. And that's like a pretty normal progression. If anyone's been through PT for whatever the reason, not necessarily like childbirth, a lot of times like exercises will start on your back and then you'll go to your hands and knees and then you'll go to like kneeling and then standing finally. And I started

upper body movements, I think around the end of week three, and I was just doing like seated overhead presses, keeping a close eye on bleeding just because it is normal that when you exert yourself more, you bleed more. And so that is a recommendation, like, is to always monitor your bleeding because there is too much that could happen if you are jumping back into workouts too soon. And so it is important, especially like the first couple workouts to really monitor that.

Jessica | The Mama Making Podcast (39:31)
Mm -hmm.

Mel Cosio (39:48)
And then once I started to feel like I was able to manage my intra -abdominal pressure better, then I started to get more confident doing more familiar movements like squats to a box or certain types of hip hinges. And that kind of stuff started coming back closer to four weeks. And then leading up to week 12, I was just really focusing in on core -specific movements that I would never do normally, but it was really important to me to like...

address like everyone goes through the separation of their abs during pregnancy. And so it was important for me to really work on strengthening my core canister before I started loading it, whether it was like with a front squat or pull up, whatever it is. So that was my return to exercise in a nutshell, but like all of those recommendations are very different for some of that goes through a C -section. And that's just because like C -section, it

Jessica | The Mama Making Podcast (40:42)
Mm -hmm.

Mel Cosio (40:47)
is the most common orthopedic surgery, but like they aren't treated like orthopedic patients. Like, and what I mean by that and like more simple terms is if someone has a knee replacement, they're like automatically given a referral to PTF twice a week for the next like two to three months at least. Whereas a woman goes through a C -section and she's told, I'll see you in six weeks. And like, this is what you can expect. Don't lift your car seat. Don't lift anything more than

Jessica | The Mama Making Podcast (40:51)
Mm -hmm.

Mel Cosio (41:14)
I've heard it anywhere from 10 to 25 pounds. People get different recommendations. And some of those recommendations are just unrealistic, especially for a new mom, but then especially with a mom that has a toddler around. You can't just tell someone you can't pick up your kid. That's not realistic. Instead, they should be given the tools, this is how to do it more safely, and teach them proper body mechanics. So.

Jessica | The Mama Making Podcast (41:28)
Yeah.

Right, yeah.

Mm -hmm.

Mel Cosio (41:42)
When someone goes through a C -section, that doesn't necessarily mean that like they just can't do anything. They definitely have to be more careful. But if someone after a C -section is feeling like they want to move, again, walking is probably appropriate. Some exercise is appropriate. They just have to be a lot more careful of core movements just because we don't want to be tugging on that incision and those layers that were impacted by the C -section. There's definitely more of a healing period needed after that.

Jessica | The Mama Making Podcast (42:12)
Yeah. And I think, I think people don't, automatically think, I had a C -section. I should go to a pelvic floor therapist because nothing happened. But you're also like carrying a baby on your pelvis for nine months. And like, that's creating some change down there as well. So I think, and also there's an educational piece to it as well. Nobody's telling you anything from the time you deliver till your six week appointment. So having that.

Mel Cosio (42:19)
Yeah.

Totally.

Jessica | The Mama Making Podcast (42:40)
pelvic floor therapist in your back pocket who can educate you on like, here are the changes that are happening. Here's what's normal. Here's what's not. and then also like desensitizing your C -section scar, like no one's telling you to do that. And then you have scar pain when your kid's like five. So I think you could utilize that person as an educational resource as well. and I will mention, cause I know if it was me, I'm like, okay, insurance going to cover this. I would.

Mel Cosio (42:54)
Right.

Jessica | The Mama Making Podcast (43:08)
before I'm very big on like getting all your resources together before baby comes. Cause the last thing you want to do when you're like sleep deprived in going through it is researching who you can see, who's your insurance, when you can get in. So I would suggest asking your provider, whoever your provider is for the recommendation for pelvic floor after, I mean, you could go while you're pregnant, but asking your provider.

Mel Cosio (43:11)
Yes.

Jessica | The Mama Making Podcast (43:34)
prior to delivery for that recommendation so that it's in your file and then you can know already who you're able to go to so that when you need it, you can just like have it like that and don't have to do all the back end research on it.

Mel Cosio (43:48)
Yeah.

Yeah, I agree with that. And I even go so far as like recommending there's, thankfully there's more and more pelvic floor PTs, popping up and like, there's some really good ones in Birmingham. and a lot of the really good ones are booked out for like eight weeks. And so if you're waiting until after you have that baby, and once you have the energy and the time to like make an appointment, you're going to be like, I have to wait eight weeks now. And so I typically recommend to my friends, I'm like,

Jessica | The Mama Making Podcast (44:17)
Mm -hmm.

Mel Cosio (44:20)
get the appointment booked before you have the baby. And I'll typically say like book it for like four weeks out. That way you're on the schedule. You know that like around four weeks you're going to have that appointment. And like if you decide to change it, then you can change it. If you want to see if you can move it forward, you can always call and ask if you can get it moved forward. But at least that way you're communicating with someone relatively newly postpartum around the time that you might feel like you're starting to get eager to move a little bit more.

Jessica | The Mama Making Podcast (44:28)
Mm -hmm.

Mm -hmm.

Mel Cosio (44:50)
And then I also think it's worth noting that in most states, depending on like where you're listening from, you can go and see a PT without a doctor's referral. Alabama just passed this direct access law last month and while it's not like totally unrestricted, now women can go to a PT first without having to have a doctor's referral. So I always tell people like, just get into the PT and like,

the PT will help you get the referral that you need. And the other thing is like, if you have the appointment set or like if you don't have the appointment set, always ask your doctor like at the time, like when they come and check on you after delivery, just ask them for a doctor's referral. Cause at some point most states do require that doctor's referral and it's just easy to not have to track your doctor down weeks later to get that referral.

Jessica | The Mama Making Podcast (45:21)
Yes. Yeah.

Yeah. Yeah, absolutely. Anything you can do ahead of time is I highly suggest.

Mel Cosio (45:47)
Yes, yeah, make it easier on yourself.

Jessica | The Mama Making Podcast (45:50)
Yeah. So with all of this said, what would you like to see go differently for women in pregnancy and postpartum as it comes to movement or just opportunity to be more well?

Mel Cosio (46:08)
Yeah, I would love to see women not have to work so hard to get what they want. And like going with that, what we just talked about where like women are the ones that are having to set up these appointments and like potentially like do it all themselves without like really easily being handed like, this is who I want you to go see, go see them at this time. Women have to use their own discretion and also just like be the one to like get it going. I just wish that more healthcare providers.

So sorry about the dogs. Not have to work so hard and have more healthcare providers be the ones to suggest these things. And just back them up because it can be scary. Like most people have no idea what pelvic floor PTs do. And so they'd be like, are they going to be like in my business? And it's like, maybe, but like, if that's not your speed, like there's so much more that a PT who is specialized in this area can do for you.

Jessica | The Mama Making Podcast (46:39)
It's okay.

Mm -hmm.

Yeah.

Mm -hmm.

Mel Cosio (47:08)
If that's not your cup of tea. That's what I do is like all external stuff and like all about helping people reframe their mindset and then also like learn how to manage their intra abdominal pressure and like do movements differently. But people pregnant women just don't know what's out there unless they listen to like podcasts like this or they read books and they they know how to ask the right questions. So I just wish that

Jessica | The Mama Making Podcast (47:10)
Yeah.

Mm -hmm.

Mm -hmm.

Right.

Mel Cosio (47:36)
there was like resources that were more readily available for women. And then it was easier to get help postpartum.

Jessica | The Mama Making Podcast (47:42)
Yeah. Yeah. Yes, I agree. Yeah. I don't know where to start with that, but hopefully having more people like know what their options are, I think is, is start one. I remember when I went to that my pelvic floor therapist, I went, I think about it. I don't know when I started going, maybe I was like two or three months postpartum and,

Mel Cosio (47:56)
Yes.

Jessica | The Mama Making Podcast (48:09)
I, she did some internal work cause I did have a small prolapse. so she did some internal work, but like everyone was shocked to know that she mostly did like copying on my lower back and like that helped. And like, you don't even think that. So I think there's a huge education piece as well as to like what they can actually do for you. Yeah. so what do you have coming up? Anything exciting, any workshops?

Mel Cosio (48:19)
Yeah.

Yeah, totally.

No workshops at the moment. I'll probably continue to give the one that you attended at Nexus, as well as some more pregnancy, training during pregnancy workshops, but none are on the books right now. Yeah, right now we're just surviving summer.

Jessica | The Mama Making Podcast (48:52)
Okay. Yeah. Yeah. Yeah. yeah. I know. yeah, I think the one that you did at Nexus would be great for like a short virtual one, or even if you just sent it out to, or the option to do it with other gyms. I mean, everyone has pregnant people. So yeah. So, yeah. So, where can people find you? Social media, email.

Mel Cosio (49:02)
Yeah.

Yeah, it's a good idea, a webinar.

yeah, Instagram, I'm at Melcocio .pt. Mel is -E -L -C -O -S -I -O .pt. I work for MoveWell, so you'll see me on their Instagram a little bit. That's at MoveWellMobile. And then if people have questions, they can either shoot me a DM to my PT account or...

MelanieCosio .dpt at gmail .com is my email address.

Jessica | The Mama Making Podcast (49:47)
Awesome. Well, thank you so much for being on. This is amazing. Of course. All right. We'll talk to you soon.

Mel Cosio (49:50)
Yeah, thanks for having me.

Okay, bye.