Returning to exercise after giving birth

Pregnancy and childbirth lead to changes in your core muscle function. Your core is a group of muscles including your pelvic floor, your abdominal wall, and your diaphragm which is  located under your lungs and helps you breathe. These muscles work together to help support your skeleton and organs. The coordination of these muscles is affected by pregnancy and childbirth. Your whole body, including your pelvic floor, should slowly recover and eventually return to your pre-pregnancy fitness levels. We recommend you see a Pelvic Health Physiotherapist after you give birth so you can safely return to good physical shape.

If you have experienced one or more of the following, your pelvic floor will need special care to recover:

• Needing forceps or vacuum or both to help your baby out

• Pushing for more than 2 hours

• Experiencing a severe perineal tear

• Needing an episiotomy

• Having a baby over 8.5 lbs at birth or with a head circumference over 35.5 cm

• Delivering after several prior vaginal births

When returning to pre-pregnancy level of physical function and exercise it is important to be aware of common pelvic floor and core issues including:

• Leaking urine when you cough, sneeze, or laugh during your daily activities, or during exercise

• Pain in your vagina and/or vulva with sitting or during activity

• Vaginal or perineal heaviness, bulging

• Difficulties emptying your bladder or bowel

• Pain at the scar site (vaginal or abdominal) with activity

• The presence of a separation of the abdominal muscles (the six-pack muscles) to accommodate a growing womb. This can persist after you give birth and even when your uterus is back to its pre-pregnancy size

If these issues do not resolve in the first few weeks postpartum, it is important to see a Pelvic Health Practitioner (pelvic health physiotherapist, gynecologist or urogynecologist) who can assist you in resolving them.

There are many physical and emotional changes that take place with pregnancy, childbirth, and becoming a new parent. It is important to consider all the other factors that play into your body’s ability to recover from childbirth and the expectations on your body after giving birth such as:

• Your level of fitness pre-pregnancy and during pregnancy

  • Consider where you left off and how long it has been since you were doing that activity. A slow and steady return to movement allows for your body to gradually adjust to all the changes that it has gone through and get stronger with your day-to-day activities. Consider seeing a qualified pelvic healthcare provider to get your pelvic floor and abdominal muscles checked before resuming any high impact activities.

• Increased fatigue and low energy reserves

  • Often, new parents must contend with sleep deprivation as well as compromised nutrition and hydration. When you are tired and your energy is low, you are at a higher risk of injury. Nourish your body as best you can, not only to support your return to exercise but also your healing.

• Mental health

  • Mental health is extremely important in the postpartum period. Talk to your healthcare provider if you are experiencing symptoms of depression and/or anxiety.

• Lactation

  • If you are lactating, consider timing exercise after pumping or feeding. Getting properly fit for a supportive sports bra can reduce breast discomfort during exercise. You should take special care to drink enough water, as both lactation and exercise can make you dehydrated.

Posture

• After giving birth, you will find yourself in the same postures and positions over and over again. Try to vary your positions as much as possible throughout the day and get in some daily exercises that take you out of your habitual postures.

• Lifting

  • Keep weights in a range where you are not inclined to hold your breath

  • Remember to avoid holding your breath when you exert an effort, even if the load is smaller (e.g., picking up your baby or the car seat). Instead, gently exhale as you do so.

  • Gently tighten the pelvic floor and abdominal muscles as you lift to make sure there is adequate support for your tissues

This guideline should not be used as a checklist for what you ‘should’ be doing. Postpartum healing is your own individual journey; listen to your body.

0-3 Weeks

• Walking - start with short distances, around 10-20 minutes and gradually increase. Consider using a stroller rather than a baby carrier for longer distances.

• Pelvic Floor and Abdominal Wall Coordination exercises (see resources below).

• Basic core exercises: pelvic tilts, marching bent knee fall outs, pillow squeezes between knees or hands, getting up off the floor.

3-6 Weeks

• Continue to progress your walking distance/time.

• Pelvic floor muscle training – start to increase the duration of hold time 2-5 seconds, adding repetitions and sets and doing this in different positions.

• Depending on how you feel, how your birth went, and how your recovery is going, you may start with low impact exercise at low resistance such as exercise bike or elliptical.

• Start doing more functional exercises like body weight squats, lunges, and bridging exercises – remember to breathe and not hold your breath.

• Start mobility focused exercises: cat/cow, chest openers and ribcage mobility.

• Progress core exercises: variations of bird/dog, single leg extensions, dead bug, knee lifts sitting on an exercise ball, and standing balance work.

6-9 Weeks

• Continue to progress your walking by increasing your pace and possibly seek out some hills or stairs.

• At this point you may start to gradually increase the intensity of your other low impact activities – with speed, resistance, or time.

• Start adding weight to functional exercises that match the demands of you daily tasks – for example lifting the weight of your baby in a car seat (10-20 lbs) while doing a squat, lunge, or deadlift – remember to breathe and not hold your breath.

• Beyond basic core exercises, consider getting your abdominal muscles checked to create a program tailored to your individual needs.

9-12 Weeks

• Continue to follow and progress cardiovascular and resistance exercises from the previous weeks by gradually increasing the intensity by adding weight, increasing the number of reps, sets, speed, time, and changing positions (e.g., out of the saddle on a spin bike).

12 Weeks and Beyond

• If you are looking to progress to higher impact activities (e.g., running, jumping) consult with a pelvic health physiotherapist, if possible.

  • Running: follow a Couch to 5km program or gradual walk:run program to progress appropriately.

  • Jumping, skipping: gradual return to jumping activities, and follow up with a pelvic health physiotherapist if symptoms arise.

The following are examples of some advanced core exercises which may lead to increased pressure on the pelvic floor in some people and may require some modifications. If you are interested in doing these or similar exercises, consider working with a pelvic healthcare provider who can guide you and ensure that your muscles are working in an appropriate and coordinated manner and performing at a level that is suitable for you.

• Planks

• Double leg raises

• V-sits/boat pose

• Mountain climbers

• Crunches, sit-ups

• Weighted abdominal exercises

• How to include your pelvic floor in common exercises

• Mental health after birth

• Postpartum Depression

• Pelvic Floor and Abdominal Wall Coordination exercises

  • The Core Breath