Working a Third Shift: Postpartum Physical Activity & Maternal Responsibility

>>First off, we have Dr. Jaime DeLuca, and oh, here we go, I’m
an orthopedic surgeon and I just recently became a member of the Women’s Health Advisory Board of the American Academy
of Orthopedic Surgeons, which is a very interesting group, and they do amazing work
and I know our group would be very interested in this topic. Dr. DeLuca is faculty member at Towson, she’s the Department of Kinesiology, she’s an associate professor
of sports management, she’s got an interest in sport management, sport sociology, and teaching students, and she’s gonna talk
to us about this topic, which I thought was particularly
intriguing, the title, so I looking forward to hearing that. (audience applauds)>>Sorry, hi everybody. I’m glad you found my title intriguing. I asked my husband if he
wanted to help me rehearse last night and he told
me he didn’t even know what it meant,
(audience laughs) so hopefully by the end
of this, everybody will. So today, it’s an outline
of my presentation, I wanna talk with you a little bit about my own sociological research focus and what I believe is its relationship to the Exercise as Medicine Initiative, as well as how I try, in my work, to bridge the biological
body with the social body, and how important I think that is, in terms of us having
a fuller perspective, particularly about women’s health as I’m concerned with here,
but all health in general. So then I’ll move on to
talk a little bit about my postpartum bodies research study, which is grounded in the aim of bridging the gap between the
biological and the social, and I hope to speak to
some of the conclusions of this research and how I feel it has significant implications for women’s health in general. So, to give you a little bit of background about my work in sport
sociology and, in fact, how I think it’s related to
the realm of public health and the broader aims of
this conference, in general, my academic home is in a
department of kinesiology, and I am a sport management professor. I teach classes about sport marketing and sport and globalization, and really, about how sport is important
in our private lives and a crucial element of the
global economy in general. But, I’m actually a
trained sport sociologist, and that’s what my
research background is in. So, I would classify
myself as a sociologist of physical activity, within
that I study the forms and the practices and the experiences of being physically active,
and then how physical activity is provided for and
distributed amongst individuals throughout society, and I
use socio-cultural frameworks and theoretical lenses to theorize this and understand the human experience. So, essentially, what I do is
look at how physical activity is enabled and constrained for individuals based on societal structures,
so much of my previous work is actually focused on social class and the familial experience with sport and physical activity and people as a part of particular communities that are engaged in sports and physical fitness. So, in general terms I would say, my work attempts to understand
the cultural significance of physical activity, which is an area that I think is crucial to understanding how individuals negotiate their lives within the context of public health. So my focus today, that I can offer is some insights on the role of sociology in the physical activity
health promotion agenda, and specifically, its relationship to the Exercise as Medicine Initiative. As you can see here on this slide, our variety of critiques of the Exercise as Medicine Initiative. In general, I would like to think that most sociologists
understand and agree with the fact that increased levels of physical activity can
improve health outcomes and the incidence of disease,
but I kind of believe after this basic understanding, the realms of sociology
and medicine diverge down very different
paths, so as you can see from the slide here, if
you read these critiques, there are a variety of arguments that are pretty critical
of this initiative, and believe it or not, I do
have three or four more slides that are, with data that’s pretty critical from the sociological perspective. I don’t necessarily agree with all of it, but I do think it’s important to recognize some of this in order to
actually help individuals engage in exercise and physical activity and have that health promotion
agenda that involves this. So, the overarching
concept that structures a lot of these criticisms is, essentially, related to the cultural shift, the fact that we just heard a little bit about, that basically says that leisure time is now, theoretically,
monopolized by physical activity and there’s an over-medicalization
in society in general. In addition, I think the
field of sociology, overall, finds the concept of
individual responsibility and in fact, the moral judgment associated with individuals who
are deemed irresponsible to be very problematic, and so
a lot of the critiques listed actually relate to that as well, and, in fact, I’ll speak
to that a little bit with my own work too. In addition, I think
that issues of inequality and consumption are plaguing
and often structurally very impossible to overcome,
especially when it comes to a platform like this, and in fact, Jennifer Smith Maguire, who wrote the book Fit For Consumption argues that
the commercial fitness field largely functions in a
manner that reproduces the deeply entrenched class
based stratifications of health, and therefore, exercise can be medicine, but in fact, often, it’s only medicine for a distinct, more enfranchised
segment of the population. So, there’s also somewhat of a conflation, I think amongst laypersons,
of the terms fitness, exercise, physical activity and others, from also the previous presentation we see that those have distinct definitions associated with them that I’m not sure people take them up in
that particular way. So, often we can understand that fitness might be good for us, but this good isn’t necessarily directly
related to our health, and a fit body isn’t
necessarily biologically, physiologically or socially successful. So, I do, as I said,
believe that this platform is important, but I do
think that a recognition of the critiques is very
dependent on its success, because a variety of people
need to take up this platform and understand the importance of engaging physical activity in their lives, and so figuring out how
we can best structure particular messaging to individuals who could use to be more physically active is really important. So I believe it’s necessary
that we conceptualize the body, and indeed, physical activity and exercise as both biological and social. So to that end, my research is based on an understanding that
the body is both biological and social, and that
qualitative sociological methods of inquiry can unearth
particularities of the human body and lived experience, in
my case, postpartum women, that physiologically and
medically based methods cannot. But sociology as a
discipline is often relegated in favor of the hard
sciences with quantitative, data driven statistics, but it’s important to recognize that this field
has something to offer as well. So sociologists have pointed out that it’s true that
larger structural forces in society shape the everyday
lives of individuals, but it’s also true that
the everyday practices of individuals shape those
larger structural forces as well, and that the two are in
a dialectic relationship with each other, each informing, producing and helping to reproduce one another. So, effectively, they’re
mutually constitutive forces that don’t operate in isolation, and it’s important that we consider then, the body as both biological and social to have a more fuller,
complete, in depth understanding of how we can be physically active. So it’s through this particular lens that I’ve instructed the research project that I will now discuss a bit. So, (microphone pops) sorry. So it’s important to consider
both of these perspectives in order to bridge the
gap between the biological and social body, and this
is kinda the framework that I took in developing this project. So the empirical research
that I was working on before this project,
qualitatively investigated postpartum fitness
classes, maternal cultures, mommy and baby physical activity, and kind of exercises and classes and topics around those ideas, but I was continually faced,
when I would go to write up publications or look through the data with more questions than answers, many of which involved the
physiological processes related to postpartum recovery. So I found that it was obviously
a much more complicated and complex problem than
isolated understandings of body image or weight
loss or physical healing, so studying this process
through any one lens, to me, all of a sudden, was continuing to feel very incomplete,
but as a sociologist, I certainly lack the expertise needed to study this from more
than one perspective. So I sought out some of
the exercise physiologists in my home department
of kinesiology as well as a nurse who has an
interest in maternal health, and together we developed a collaborative, interdisciplinary, mixed
methods research study that focused on,
essentially, what it means to, quote, bounce back after childbirth and how and if, and in what ways this physical activity play a
role in that recovery process. So to that end, our research team uses a mixed methods approach,
which you might imagine, and these types of approaches
can be instrumental in bridging the gap between the biological and the social body. So to date, we’ve completed a pilot study and have also begun an intervention study which is a bit more comprehensive. The pilot study ended
approximately a year ago, it had 10 total participants
who were engaged in the study for about six months for approximately nine months postpartum. They participated in the
majority of the measures that you see on the
slide, aside from the ones with an asterisk, and the
data collected in this study prompted us to move forward
with a physical activity, an intervention study,
which is currently underway. So this stage of the research is following many more women, we’re
still actively recruiting, for a nine month period, for approximately the first year postpartum,
and they’re asked to complete all of the
assessments and measures that are listed on this
slide, and, in addition, the intervention group is
asked to hit the benchmark of 10,000 steps a day and 150 minutes of moderate to vigorous
physical activity per week. Adherence to the intervention
is monitored via Fitbits and Fitabase, and the
women who are in this group receive weekly text messages updating them on their progress and how they’re doing in relationship of the steps and the VPA. Anecdotally, without any
statistical calculation, it does appear that the intervention group currently is doing more activity than the control group, which is good, but what’s also obvious is
that nobody in this study is routinely, if ever, is able to hit these benchmarks weekly. So that’s certainly problematic and something we’ll
consider going forward. These charts show some preliminary, or some minimal, I should
say, demographic data about the women in this study. There’s more on race and other things that we’ve collected, but I think that this paints an interesting picture about the general level of privilege of most of the women
who are in this study. So, largely, they’re middle
to upper middle class, the majority of them
are working full time, and the majority of them also
have postgraduate degrees. So their level of privilege, to me, is something significant
and something I’ll revisit in a little while, talking about the data. So before I jump into that, though, I wanna offer some background on the sociological theorizing
regarding postpartum bodies. So Demi Moore’s Vanity Fair cover, which you see there on the end, in 1991, was actually a watershed
moment in the focus on the pregnant and postpartum
maternal body in society. So in our contemporary moment now, I think we’re used to
these types of images inundating magazine
racks at grocery stores and social media and things like that, but that hasn’t actually
been birthed for that long. So these types of images
also have a major influence in people’s lifestyles
and practices and habits and self image, but the
celebrated physiques that we see and the airbrushed pictures
and things like that can certainly have a damaging effect, particularly on a new mother, because it carries the
suggestion that quote, unquote, bouncing back or getting your body back is something that you absolutely must do. Weight and body image are key concerns for women in the postpartum period, and many do experience high
levels of dissatisfaction with their, quote unquote,
new maternal body. But to that end, we also
have the consumer market which is inundated with everything from stretch marks creams to exercise videos to support groups and fitness classes and even plastic surgery options for women who are trying to get back
their pre-pregnancy form. So, ultimately, all of these images promote the message that after a woman, after a baby is born, a woman needs to effectively erase all
physical evidence of motherhood and return to her pre-pregnancy self. So, drawing on an analysis
of Fit Pregnancy magazine, Dworkin and Wachs discovered
that the pregnant form is presented as substantially
maternally successful, but also aesthetically problematic. So if you read this a different way, we could understand that
it’s biologically successful, but sociologically quite problematic. So, ultimately, they discovered the idea that letting the body go constitutes failed womanhood and failed motherhood, and thus, conversely,
getting one’s body back would signify successful femininity and the aptitude and
ability to be a good mother. So that concept is very important to the narrative of bouncing back and kind of understanding that. This dichotomy led to the construction of the third shift of bodywork, which is a phrase grounded in sociologist Arlie Hochschild’s conceptualization of the second shift, and
to briefly summarize that, she argued that as
women gained more access to education and
professional opportunities, there was little change
in their role at home. So, consequently, many
American women have two shifts. One, in the paid labor
force, and then two, with their domestic and
household responsibilities that they maintained, so this
phrase of the third shift is kind of layered on this concept, and that now argues that in
addition to paid employment and domestic responsibilities,
women must also engage in bodywork in order to achieve a particular type of
physique and demonstrate their competence as mothers. So the third shift,
then, is kind of enmeshed in this body-society dialectic
that I was mentioning before, and it’s definitely
contextualized by a lot of the conflated ideas that operate around physical activity, health, wellness, exercise, fitness
and consumption, for sure. So all of these contribute
to the cultivation of a maternal body that has returned to its pre-pregnancy state. So, related to this literature, which I believe helps
contextualize my work, I’m gonna present some
of the data collected through over 60 qualitative interviews as part of this postpartum
bodies research, which speaks to this idea
of the motherhood triad, which I developed through our
qualitative coding process associated with these interviews. So within the interviews,
I found that the constructs of good body, good mother, and good health were often discussed in this
kind of dialectical fashion, and they were positioned
as mutually constitutive, and if not, at times, often
used as synonyms for each other. So, this triangular relationship to me, all of the sudden it became very important in terms of understanding what it meant for a woman to bounce back. So as you see on this slide, are quotes from participants, I
tried to choose a good, kind of mix of quotes from
different time periods, different interview time periods
and different participants. Some of ’em are quite interesting, some of the more interesting
parts are highlighted in blue. (coughs) Sorry, so the
good postpartum body we see discussed in various ways. You can kinda note
throughout some of the quotes the common themes of
health, physical activity, motivation and the desire to feel good, and in many cases, the women expressed that feeling good was
actually half the battle of them feeling like they looked good, and this was very important to them. The theme of being a good
mother was also very prevalent, and a priority that was
inextricably linked, devoting maternal
energies to childbearing. So being a good mother was
often discussed in terms of healthy familial lifestyles,
familial physical activity practices, and it didn’t
matter how many children most of the women had,
that they were focused on engaging in healthy
habits that would ultimately culminate in producing healthy children. So their good mothering practices were anchored in prioritizing health. Returning to pre-pregnancy weight was not necessarily the barometer
of bouncing back for them, many of them cared a great deal more whether or not they fit
into their clothes again and how they felt in general,
not only about their bodies but also in relation to how they looked in particular social contexts within which they interacted a lot, so
as a wife, as a mother, as a career woman, those
were very important to them. There was a clear emphasis on good health, as mentioned, good mothering
was linked to good health. The women felt strongly that
if they were not healthy they were not gonna be able
to be there for their children in a tangible way, or
actually, just of literally not, no longer be around. In many ways, health is
judged by the body, though, and its ability to bounce back rather than any kind
of medical assessments or medical information that they have about their actual health. Specifically, health was
often used as a euphemism for weight, so it was
almost, they would rather talk about the fact that
they weren’t healthy rather than the fact that
they were still overweight, which was a very kind of
interesting nuanced thing that I kept finding they were doing. So through the postpartum journeys described by the women in this study, it was clear that they wanted
their pre-pregnancy bodies back and the wrestled
with how to reconcile their new postpartum bodies,
their health practices and their maternal responsibilities. Various forms of postpartum bodywork, from diet, to nutrition, to
various consumptive behaviors to physical fitness were
discussed by the women as necessary means that
they were engaging in to recover their former selves. So some of the quotes from the women are very rich and layered, I think, particularly the ones on the slide to me are incredibly fascinating. I hope that these sentiments,
through these sentiments, that you’re reading,
hopefully you’re reading them, you can see this relationship
between these mutually constitutive constructs of good health, good body and good mother. There’s also, definitely,
evidence, I think of these competing tensions
between the presentation of the maternal body in society, versus this amazing biological thing that they just did in
terms of having a baby. So, preliminary conclusions from this, without having analyzed,
in fact, much of the data that we’ve collected, I could sum up, kind of in four different ways. So one, we found that
reshaping, recovering and cultivating the postpartum body which, in and of itself, obviously, has these important messages regarding maternal responsibility and moral capital is an important focus
for postpartum mothers. That the ability to bounce
back and the processes underlying it are only
possible due to particular forms and levels of
privilege which facilitate an opportunity for women to engage in this third shift of bodywork, be it through consumptive practices or actually physical activity, so the implications for women
who do not have this level of privilege are fairly significant. The women in this study
also often conflated the ideas of health,
mothering, and body image. And at best, this is inaccurate, and at worst, perhaps, dangerous and problematic in a variety of ways. The ideology underlying this mother triad could possibly obscure
real health concerns, mental or physical, perhaps. Thirdly, while not part of the data I presented on the slides so far, our interviews revealed that most women were not regularly physically active and they would talk about that frequently. The Fitbit monitoring
as well, as I mentioned, showed that women were
not regularly meeting the recommendation of 10,000 steps per day or 150 minutes of MVPA per week, and Likert scale findings from survey data that we collected found that on average, women selected that they, quote, often felt that they needed to exercise due to extreme worry
about their body shape. So, ultimately, while the data collected are full of references
and acknowledgements about physical activity,
our data indicates that mothers of young children do not have adequate physical activity. In addition, there are important tensions that exist between
prioritizing physical activity and what this implies about your ability to give your time to your child versus take away time from your child, and that’s particularly salient in my mind for the Exercise as Medicine Initiative. And lastly, postpartum women reported quite passionately in
our interviews, in fact, that they never received
any exercise prescription or any direction about how to
engage in physical activity. They were just told at
six weeks or eight weeks they were cleared to
resume normal activity, and even when prompting the doctor about, well, what does that mean, they said the doctor would
just say, “Take it slow.” Some of them were very upset about this, because they felt like
they didn’t have an outlet to really consult about how they could be more physically active or
productive in the things that they were doing, in terms of exercise and things like that. In addition, studies have shown that women who do not lose the weight by six months postpartum
are at a much greater risk for long term weight retention, and so exercise could
be an important factor in helping them lose the
baby weight, so to speak. So this, to me, brings about
another important tension between the biological and the social. So I don’t think we
necessarily want to insinuate that women need to erase
evidence of motherhood, but we need to find ways to speak to them about the importance of
being physically active for the variety of benefits
that it can provide. So the first citation on
this slide, obviously, is quite old, but interestingly, probably just as true
now as it was in 1996. So the years of
establishing a young family can constitute a fairly
big transition for women, and one which has very big implications on the ability to be physically active. So the considerations of
women’s varied perspectives on motherhood,
conceptualizations of health, wellness and fitness
and maternal body image are crucial to the
construction and delivery of successful public health messaging and Exercise as Medicine, and it relates to the importance,
availability of, and access to physical activity opportunity. Navigating the structural constraints and promoting the sociological benefits of physical activity is very important given widespread health
inequality across the US. Social class privilege
has a very powerful, but often unacknowledged
impact on one’s ability to engage in a healthy lifestyle, but as evidenced by the
highly privileged women that are a part of this
postpartum research, even those that have more agency, more control, many of them are
actually health professionals themselves, are not able to provision for adequate physical activity. So societally, it’s
important for us to recognize that we need to offer
at least this population more support, and to me,
this very much relates to the idea of exercise as medicine. So, in closing, I hope this presentation has made the case for the
sociology of physical activity being, both as tied to the
process of bouncing back as it is to understanding
exercise as medicine, particularly in the postpartum period. And I hope I have successfully articulated some of the tensions between
how we can conceptualize the body as both biological and social. Thank you.
(audience applauds) Anybody have a question?>>Man: It makes me think
about the role of social media Facebook and Instagram,
people tend to not, you could look through
that and you don’t see somebody posting “Look how
much weight I’ve gained since,” they don’t need people
trying to make you feel bad about, but you see all these
positive things on Facebook, I just wonder about that in this. I wonder about, particularly
with our children and with things they’re
saying on their Facebook and so forth, Instagram–>>Well, one of the things I talk about quite a bit with one of
my research colleagues is this idea of the fitspiration movement, that you’re posting all
these fitness related photos on social media and what
impact does that have, and in fact, this photo
here, is a Facebook photo that went viral, and she received a ton of negative blowback here because it says “What’s your excuse?” Right, ’cause she has three
kids three years and younger, and she looks like that. There is a lot of this
kind of material out there on social media, and a
lot of different opinions about it, and I think it
factors into this too, at a great degree.>>Man: You know, (microphone buzzes) talking about, at one point,
I was talking to a friend of mine about exercise and another friend, who was a marathon runner
and this friend was, “Oh, I can’t run marathons, I can’t,” and so trying to encourage,
well, walk around the block with that and maybe
intimidated by the fact that someone’s a marathon runner and think that’s exercise,
where you need to do more, do something.>>Right, yeah, yeah.>>Woman: So I just wanted to point out as someone who counsels
patients at all ages on how to incorporate exercise
into their daily life, I try to change it from
something on a to do list to be like, especially for women, who are trying to do it all, you know, that this is their 30
minutes out of the day that’s their time, and
when no one can tell them that they have to do their laundry or answer the phone for
awhile or return their email if they’re at work, but
it’s their 30 minutes when nobody can bother
them, it’s their peace, that they can fix their hair, where they can watch
Netflix or binge a TV show, but it’s like a protected time for them and when people have looked at that way, I think it’s a lot easier. You say, I haven’t looked at it that way, but I’ve thought of it as a negative. Kind of think of it as,
especially for a mom, trying to do all these different things and pulled in so many directions and not feeling like you’re
succeeding at anything,>>Right.
>>They’ve got 30 minutes where they can just leave it all.>>Well, and I think
that’s the exact tension, right, they feel like
they’re not succeeding at anything so why wouldn’t they try that? And a lot of my interviews, so
a lot of the women would say “Yes, this is the only
time I have to myself, “it’s my escape, that’s
why I would do it.” And a lot of them, then, use the, and I hesitate to call it an excuse, but say, “Well, I feel
like I’m taking time away “from my child and I
already take so much time “away from them doing
all these other things,” but yeah, I absolutely agree.>>Man: Maybe that’s where
we men need to step up, we have to take those 30, you
know, give ’em the 30 minutes. So thank you, ma’am, that
was an excellent talk. (audience applauds)

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