The steps to returning to exercise postnatally

Congratulations on being here, on giving yourself this time. It’s a gift.

This is step one in discovering how to re-strengthen after bub.

Returning to exercise after having your baby can feel daunting. How and when you do this will have a massive impact on your pelvic floor recovery and ability to avoid injury. The focus should be to return to exercise SAFELY.

And sometimes you aren’t even sure where to start… so let’s just start right at the beginning.

Your postnatal re-strengthening depends on many factors, including:

· Your fitness and strength during pregnancy

· Your birth experience and as such the recovery of your pelvic floor and abdominal muscles.

· Whether you have pelvic floor dysfunction or pain.

· Whether you have any other musculoskeletal injuries.

· Your energy levels.

There are no specific guidelines to return to exercise postpartum. The following is a general outline based on available evidence-based information and our expertise and experience.

The first 0-6 weeks (0-8 weeks following a caesarean):

We recommend that you focus on recovery

This means prioritising rest, especially horizontal rest in the early stages of your recovery. This allows your pelvic floor muscles or c-section scar to rest.

Wear a support garment such as SRC recovery shorts to support your abdominals and help minimise your separation, while also supporting your perineum.

Don’t lift anything more than your baby. This is not the time to start hitting the weights.

You should not have any vaginal heaviness or bladder leakage, pain, or abdominal doming during while exercising. If you experience any of those symptoms then the exercise you were doing was too much and you need to step it back. Rest more and modify the duration, frequency or intensity of the exercise you are doing.

Start pelvic floor exercises

Regardless of how you birthed your baby, providing you don’t have a catheter in situ, you can start your pelvic floor exercises within hours of delivery!

There are so many benefits to starting to strengthen your pelvic floor straight away. Getting started early will:

· Increase blood flow to the area

· Reduce perineal swelling

· Improve healing of your pelvic floor muscles and any tearing or episiotomy

· Help prevent prolapse

· Help reduce bladder leakage

· Improve your core strength and stability, the first step to return to exercise

The trick is to start off really gently!

In the early days, do 4-5 pelvic floor contractions per day. Focus on gently lifting the pelvic floor and then releasing completely.

As the weeks pass you can use your baby’s age as a guide to rebuild the strength in your pelvic floor muscles. When your baby is 1 week old, try holding the contractions for 1 second 4-5 times, when your baby is 2 weeks old try holding the contractions for 2 second 4-5 times, and so on.

As your baby gets older, you want to increase the number of repetitions, until you are able to do 10 x 10 second holds and 10 fast holds, 3 x per day.

It’s common for your pelvic floor muscles to feel weak or you may have reduced sensation due to stretching, strain or inhibition of the muscles or nerves. Your pelvic floor will probably feel tender, swollen and bruised. You may have tearing of your skin and perineum and you may have stitches. If you had a c-section then you have an abdominal wound that you need to support and protect. Just engage your pelvic floor muscles within your comfort level. If you can’t feel your pelvic floor muscles then sit with good posture, and imagine you are contracting them, lifting them up towards your heart. This will start rebuilding the neural pathway between your brain and those muscles.

We are often asked if it is still necessary to do pelvic floor exercises after having a caesarean section. The answer is YES! Especially if you laboured initially, before having an emergency caesarean section. The nine months of pregnancy places a great amount of pressure through your pelvic floor and these muscles are weakened, regardless of how your baby is birthed.

Consider your posture

What you are doing for many hours of the day will make a huge difference to how you feel. If you are sitting to feed your baby, it’s so important to look after your back. Consider the following postural tips:

Stand or sit tall, especially when you are feeding (avoid slouching).

Don’t let your chin poke out.

Keep your lower back in a neutral position. Try not to flatten or exaggerate the natural curve.

Sit in a comfortable chair. Use pillows or a breastfeeding pillow to support your lower/ upper back and under your arms where you are resting your baby. Make sure that you are adequately supported, as you will spend a lot of time doing this, especially in the early months.

Stretch and open through your chest to combat the extended periods of time spent leaning forward.

Start gentle walking

When you start walking it’s best if you aren’t carrying bub. Push baby in the pram or have someone else carry them. Aim to start with about a 10 minute walk on flat ground wearing supportive shoes and your SRC recover garment (to support your pelvic floor and abdominals). Don’t expect to get far. You will be surprised at how slow you are and at how easily you fatigue in the early weeks.

Pay attention to how you feel while walking as well as later that day and the next day. If you feel any vaginal heaviness, leakage, pain, or any other discomfort, then make sure you have extra horizontal rest over the coming days and adjust for your next walk eg. walk a shorter distance or reduce your speed of walking, or take extra rest before and after the walk.

Begin mobility exercises

You can start gentle yoga or stretching. It is especially beneficial to gently stretch and movement through your upper back to counter all the time spent forward caring for your baby.

Don’t push into any pain or discomfort and listen to your body.

The next 6-12 weeks (8-12 weeks following a caesarean):

At 6-weeks postnatal it is time to have your 6-week OB/ GP check up. We also always recommend seeing your pelvic floor/women’s health physio for your 6-week postnatal consultation, where your pelvic floor will be assessed and you will be guided with a specific post-natal restrengthening plan.

Providing you gain clearance from your medical and physio team, now is a time to start increasing what exercise you are doing.

Pelvic floor exercises and add deep abdominal exercises

Continue with your pelvic floor exercises and now also start to strengthen your deep abdominals. To engage through your deep abdominals find a comfortable position to get started. You can start lying on your back with your knees bent. Imagine the bony points at the front of your hips have magnets on them. Take a breath in and as you gentle exhale imagine the magnets are drawing together. This should be gentle. You should still be able to breathe normally. Hold for as long as you can, then rest.

Start low-impact exercise and light strength training

Now is the time to start low-impact core-focused exercise. You can join a Postnatal Pilates class (preferably run by a physio) or a postnatal yoga class. Light strength training, using light resistance bands or weights are now ok to try, as is swimming.

Start slowly and gently. Listen to your body. Make sure you are getting plenty of rest. If you feel any pain or discomfort after doing any exercise then it is too soon for you to be doing it. Stop for a couple of days or even 1-2 weeks and then try again.

Walking

Around this time you can increase the distance you are walking, aiming for a 20 minute walk most days of the week, with a 5 minute warm up and cool down. You can increase the intensity so that you are getting a bit ‘huffy puffy’ but you can still maintain a conversation.

Stretching/ Mobility

You can increase the intensity and duration of your stretching or yoga, making sure to open through the chest and mobilise through the upper back to reduce tension (and risk of injury) from caring for your baby.

From 3-6 months

You can now start to progress the exercises you have been doing, gradually increasing the intensity and duration of your Pilate/ yogas, low-impact cardio and strength training.

4+ months

If you are keen to return to jogging then you may now consider adding some light jogging to your walk, however, we always recommend seeing a pelvic floor/women’s health physio before doing this to check that your pelvic floor is ready for the repetitive impact. Have a read of our blog ‘When can you start running after having a baby?’

6+ months

Progress all of above. Commence higher-impact exercise like running, skipping etc

Please remember that these are rough timeframes, and everyone’s birth experience, postnatal recovery and pelvic floor are different. You may need a lot longer than the above to be ready to exercise.

· It is really important that you do not experience any vaginal heaviness, bladder leakage, pain or abdominal tenting during or after any exercise. If you do then it’s really important to follow up with your Women’s Health Physio, to avoid sustaining an injury.