Postpartum Exercise10 min readReading Time: 7 minutes
Getting back to exercise after pregnancy and delivery
What does the research say about postpartum exercise and what common postpartum complications we need to look out for?
The postpartum period can be divided into three phases. The first phase starts and ends at the hospital. It’s restricted to the time you spend at the hospital right after giving birth. The second phase lasts during the vaginal postpartum bleeding (lochia) which normally lasts for 4-6 weeks. The third and last phase lasts up to one year after pregnancy or until the woman has stopped breastfeeding. This phase is also the period of time when it’s okay to introduce exercise again.
Lack of research
There’s a lack of research on pelvic floor regenerative and recuperative capacity after a vaginal delivery. The recovery process applies not only to muscles, but also to the pelvic floor’s nerves. It appears that the nerve supply to the pelvic floor is at least reduced up to 6 weeks postpartum after a vaginal delivery. There are no guidelines regarding return to high-intensity exercise in early postpartum and how this would affect the pelvic floor. However, we know (though from fairly small studies) that early return to heavy physical work increases the risk of urinary incontinence and appearance. The theory is that the pelvic floor muscles can be overloaded if they are not properly healed before the individual returns to high load or high intensity exercise. Athletes who have been at risk of pelvic floor injury like sphincter injuries, birth with vacuum extraction, prolonged second stage of labour or a large baby, may need to skip activities that contribute to a large abdominal pressure for a longer period of time. However, there is no strong evidence for this position.
Complicated delivery and C-Section
Women who have been delivered by means of a suction bell, tong or by caesarean section have different recovery times than those who have an uncomplicated vaginal delivery. The risk of injury is greater in cases of vaginal delivery with a suction bell or a tong, both in terms of sphincter damage and levator avulsions. Caesarean section does not damage the abdominal muscles but still involves a 12-15 cm long scar on several different levels in the abdomen. Restrictions following a caesarean section extend to about 6 weeks afterwards, but far from all have recovered enough physically to return to exercise at that point. The return to exercise should be dependent on blood pressure, possible anemia, fatigue, pain levels and wound healing. After a caesarean section, the supporting tissue and membranes of the abdomen need to heal. After the first 6 weeks, the supporting tissue and membranes of the abdomen have 51-59% of their original strength and after 6-7 months they have still only achieved 73-93% of their strength.
How to make a gentle return to exercise after pregnancy
When you feel that you have recovered enough to start exercising (and have received an approval from your midwife or Doctor) you can gradually resume both cardio and strength exercise. The increase of volume and intensity should be gradual. Something as minor as a break from exercise for 15-30 days results in a decrease in your muscle mass, meaning you’ll have to set your goals at a realistic level and not aim to continue where you left off before pregnancy. After a bunch of months, more for some and less for some, the question regarding exercise usually comes up. How do I get started? How do I exercise safely? Is it dangerous to start exercising too early?
Your postpartum exercise routine should focus on back and inner abdominals
Many mums feel exhausted in their backs due to static and non-ergonomic feeding positions. On top of that, everyday life suddenly contains a lot of lifting and carrying. However, if you focus your postpartum exercise routine around back and inner abdominal exercises it will help you gain the strength needed for your busy mumlife!
No matter what type of training you like to do or what you’re training for, a strong core will always benefit you. It’s common though to forget about the inner abdominals when composing an ab workout routine and solely focus on the six pack. Even though the six pack looks cool it doesn’t do much for the valuable core stability.
Why core stability is important
Our core protects our spine and is in majority responsible for our posture. A weak core may lead to tons of different discomforts down the line, especially after pregnancy when the weak core is accompanied with a lot of carrying and static feeding positions.
To gain a good core stability it’s not only the inner abdominals we need to exercise but also our pelvic floor muscles and deep lower back muscles.
Increase the exercise intensity and load gradually
It’s important that the inner abdominals and pelvic floor muscles get enough time to recover and regain strength before the exercise intensity and load are drastically increased. How much time YOU’ll need will depend on many things like exercise experience, if you stayed active during the pregnancy, if you had an uncomplicated birth or not and your individual ability to recover.
The safe way to return to exercise after pregnancy is to:
- Start with breathing exercises for your inner abdominals och pelvic floor muscles (this you can do right away after birth or c-section if your Doctor doesn’t tell you otherwise).
- Increase the load and intensity in your workouts very slowly after getting an “all clear” to exercise from your Doctor or midwife. Most women are allowed to start exercising after their first post birth visit at their maternity clinic.
- Let your postpartum exercise routine mainly consist of exercises for the inner abdominals, pelvic floor muscles and deep back muscles.
Easy to follow bullets for safe postpartum exercise
- The inner abdominals and pelvic floor muscles should be prioritized.
- If you experience a pressure or pain in the pelvic region or rectum or urine leakage while exercising, it’s a sign of not yet properly functioning pelvic floor muscles. Continue doing pelvic floor muscles exercises.
- Avoid holding your breath while lifting weights. Holding your breath will increase the abdominal pressure with in turn increase the load on your pelvic floor muscles.
- If you want to lift weights, sit down. It will decrease the load on your weakened core.
- If you want to do cardio training, start with low impact alternatives like bicycling before you start with high impact activities like jogging or aerobics.
Down below follows postpartum exercise guidelines for each time frame
- 0-3 weeks postpartum
As soon as you can walk without pain or leakage, taking walks is a great physical activity for the time directly after delivery. Start with a short distance and a slow pace and as you feel more comfortable, slowly increase the distance and speed. Practice activating your pelvic floor muscles as you walk. You do this by replicating the muscle activation you do when stopping to urinate.
You can also start with exercises for the inner abdominals and pelvic floor muscles. We have written an article about a pregnancy ab workout routine for the inner abdominals and pelvic floor muscles. Click the link to read the article and feel free to do all those exercises except for the “Side Plank” and “Abdominal Twist”.
- 3-8 weeks postpartum
During this timeframe you will have a 6-week check up at your maternity clinic. Make sure to advise your Doctor or midwife regarding “an all” clear to start exercising.
Except from doing what’s recommended for the previous time frame, all types of low impact exercise is fine after you have gotten an “all clear”. The definition of “low impact” is no jumping. Examples of low impact activities are walks, cardio on a cross trainer, bicycling and swimming and weight lifting.
Make sure to increase the load and intensity level very slowly and always be mindful of your posture. You might still experience pelvic girdle pain so don’t do anything that hurts.
Make sure to go through the list above “Easy to follow bullets for safe postpartum exercise” once again before you start exercising.
Introducing a pelvic floor muscle exercise – focus on maximum strength
Lie down on your back, knees bent and feet on the floor. Activate your pelvic floor muscles by tightening the two rings of muscles around your front and back passages, pulling the pelvic floor muscles up inside. Tighten as hard as you can for 5 seconds and relax for as long as needed. Repeat 2-3 times. Over a couple of days or a week, increase the sets until you do 10 maximum strength activations per exercise session.
8-12 weeks postpartum
For this time frame the same guidelines are current. Instead increase the intensity and load if you feel it’s safe for you.
When can you start jogging?
If your pelvic floor muscles are strong, meaning you don’t have any problems with urinary leakage or feel a pressure or pain in the pelvic region or rectum, you can start jogging. A good way to introduce jogging is to do intervals with jogging and walking. Make sure to keep a light activation of your pelvic floor when you jog.
Pelvic floor endurance
Your pelvic floor counters the downward abdominal pressure all day long, hence endurance is important.
Lie on your back with knees bent and feet on the floor. Activate the pelvic floor muscles with 50% of your maximum strength, hold for 20 seconds. The challenging part is to keep the tension while being able to breathe. Start with 2 * 20 seconds but aim to endure for 1-2 minutes!
12-16 weeks postpartum
If you have any remaining pains in the body or pelvic floor, you should consult a physiotherapist to get an individualized postpartum exercise plan. You might have to avoid something and focus extra on something else.
Returning to a sport or competition-based exercise plan should also follow a step-by-step increase.
Make sure to treat yourself with love and compassion, giving yourself time to heal
Most people are not back at the same level of fitness, as they were before pregnancy, until at least half a year after delivery/caesarean section.
There is some research about women in the military and their postpartum rehabilitation. On average, it takes 11 months for female soldiers to return to their original strength and condition after pregnancy and childbirth. It’s outcome was negatively affected by various complications – thyroid problems, high blood pressure, hemorrhoids, breast inflammation and surgical procedures. A small amount of 17% of the military women said that 6 months was enough to get back to the same physical fitness as before.
Sleep deprivation and general fatigue can make the body more sensitive than usual. The risk of injury will therefore be slightly greater than normal. Listen to the body and let the recovery take the times it needs.
If you don’t feel like exercising at all, it’s usually not a disaster. Your overall health does not depend on how quickly you get started after giving birth. What you can do for preparatory purposes before returning to exercise is to focus on the pelvic floor muscles and your posture. Then you will have a good foundation to stand on when you get the energy and motivation to start!
It’s beneficial to wear the right clothes when exercising, especially if you are breastfeeding and need to be available for your baby. We recommend these postpartum activewear (click the link).