One of the biggest challenges women face after birth is returning to exercise and doing so safely. These tips can help.
Our lifestyle changes dramatically with a newborn, and we have the challenges of “fitting it all in.” Plus, our sleep routines have changed, and we have the physical demands of nurturing a new life.
These are all valid reasons why returning to movement and exercise can be challenging.
A note from the editor: please ensure that your doctor has cleared you before beginning any exercise program or routine after birth.
The challenge for new mothers returning to exercise after birth is knowing “how much is too much” in pelvic health. Also, getting to know, reconnect with, and build a positive relationship with their body after birth.
During pregnancy and after birth, our bodies change dramatically in a short time. Add to that the new demands of motherhood, and we have a lot to navigate amongst what can seem like a whirlwind of change.
It is helpful to know a general progression of exercise, what postpartum exercise programs are safe, what exercises to avoid, and the warning signs of when you may be overdoing it.
But, ultimately, I believe none of this will matter if you don’t give yourself the chance to reconnect with your body and create the foundations for a positive relationship after birth.
Not taking the time to reconnect with and rebuild our bodies after birth can leave us feeling weak, like our body is failing us, frustrated with our slow progress, disappointed and exhausted.
Changes to your core and pelvic floor during pregnancy and birth
Understanding the changes occurring within the body during pregnancy, birth, and postpartum can help you know how to support yourself as you return to exercise. Some of the most significant changes happen within the deep core and pelvic floor. The deep core is the transverse abdominal muscles, the diaphragm, the deep spinal support multifidus muscles, and the pelvic floor muscles.
As our hormones change and the baby grows during pregnancy, our posture adapts, stretching to ligaments and connective tissues. The rectus muscles separate (also known as abdominal separation or rectus diastasis), and more weight is put onto the pelvic floor. Depending on the type of birth we have, more changes occur.
During a vaginal delivery, there is further stretching to the pelvic floor and potential perineal changes due to tearing/episiotomy.
In a C-section delivery, there is dissection to the abdominal wall muscles, which causes scar tissue to develop and changes to abdominal wall strength.
Caring for the body to recover well after birth means initially protecting the deep core muscles and eventually rebuilding and strengthening the deep core and pelvic floor.
What happens if you exercise too soon after birth?
If we return to exercise too fast or too soon after birth, we risk secondary complications that can be very difficult to rehabilitate. One of the main concerns women have when they return to exercise that is too rigorous too soon is pelvic organ prolapse.
Pelvic organ prolapse is the symptomatic descent of one or more of the anterior vaginal wall (that supports the bladder), the posterior vaginal wall (that supports the bowel), and the apex of the vagina (cervix/uterus) or vault after a hysterectomy.
Symptoms of pelvic organ prolapse include:
- A ‘bulging’ sensation in the vagina
- A heaviness or dragging sensation within the pelvis
- Lower back pain
- Difficulty initiating/completing a bladder/bowel motion
- Needing to support the vaginal walls to pass a bowel motion
- Incontinence or leakage from the bladder or the bowel
- A deep thudding sensation/pain with sex
A timeline for returning to exercise after birth
Although I’ve offered some timeframes in the following guidelines, it’s essential to know that these timeframes are based on uncomplicated births and that every woman will have her unique path.
These timeframes are not goals you need to meet, but they offer some information about what a gradual progression of exercise and movement can look like. The most important thing is that you listen to your body without creating expectations of where you should be by a particular point in time.
If you’re looking for a more guided experience, workout programs such as Every Mother offer tailored workouts based on your postpartum timeline. Their programs are also clinically proven to help close abdominal separation.
In the first six weeks after the baby is born, the most important thing to focus on is rest, recovery, and nurturing your needs as a mother. The focus is on protecting and connecting with the deep core and pelvic floor. Here are some tips to reduce the demand on the deep core and assist early deep core and pelvic floor recovery.
- Lay to feed your baby
- Accept help, particularly for heavy lifting
- When help is not available, separate lifting loads into smaller loads – for example, lift two smaller baskets of laundry rather than one heavy load
- Do short/er bursts of activity, followed by rest
- Rest in positions that help take pressure off the pelvic floor – for example, gently elevating the pelvis with a pillow while laying down
The following exercises are recommended at 0-6 weeks postpartum:
- Gentle walking
- Core awareness using the deep core connection practice offered at the end of this article
- Gentle pelvic floor exercise with a focus on relaxation as well as gentle strength/coordination/endurance exercises
6 – 12 weeks
At about six weeks postnatal, it is recommended that you seek advice from a pelvic floor therapist that offers internal pelvic floor assessments and therapy. A pelvic floor physio will be able to provide you with detailed and accurate information regarding:
- The strength, endurance, and coordination of the pelvic floor muscles and give a personalized exercise program.
- The size of your abdominal separation and any treatment that you may require
- How to improve and often resolve symptoms of pelvic organ prolapse, incontinence, and urinary urgency
- How to return to exercise safely after birth
- How to care for perineal or C-section scar tissue
From 6 weeks onwards, the following exercises are recommended:
- Low impact aerobics – preferably with a postnatal specialist
- Postnatal classes including modified circuit style/lightweight training, Pilates, or yoga
- Aqua programs including modified aqua aerobics or swimming (once bleeding has ceased and you are cleared of any signs of infection)
Three months and beyond
It is generally recommended that you avoid high-impact exercise (such as running and jumping) for at least three months postpartum.
You can introduce modified impact training using a progressive training approach from three months onwards.
With this approach, you’ll gradually increase the intensity, impact, and weight training, remembering not to ignore any signs of profound core imbalance or pelvic stress such as incontinence or pelvic heaviness.
Important warning signs when returning to exercise after birth
The following signs and symptoms act as warning signs from our body to tell us that exercising may be too strenuous for our deep core and pelvic floor.
If ignored, further changes to the deep core can develop. Often, these changes can be more challenging to rehabilitate than to prevent. If you experience these symptoms during exercise, it is recommended that you stop and modify your workout to make it easier in some way.
- Incontinence/leakage from the bladder or bowel
- A heavy sensation within the pelvis
- A bulging sensation within the vagina
- Low back pain
- Doming/tenting/or bulging of the linea alba (the middle of the abdomen)
Exercises to avoid in early postpartum
Here are some exercises that I recommend avoiding in the early postnatal period from birth to three months. This is not an exhaustive list, but it will give you an idea of what exercises have more significant risks of significantly increasing intra-abdominal pressure and developing pelvic floor symptoms.
- Abdominal exercises such as sit-ups and crunches
- Weighted abdominal exercises
- Exercises with both feet off the ground such as a V-sit, boat pose, Pilates hundreds, double-leg lowers
- Full plank position on hands and feet (e.g., hovers, plank holds, push-ups)
- Deep lunges, wide side lunges, wide-legged squats
- Heavy lifting
- Any exercise where you feel direct downward pressure on the pelvic floor
Try this: deep core connection practice
Deep core connection is a beautiful practice to help you reconnect with your body, particularly your deep core and pelvic floor after birth.
1) Take your preferred lying position.
- Flat on your back with the legs slightly wider than hip-distance, letting the feet fall softly outwards
- On your back with the knees bent and feet resting flat on your mat. Take the feet wide and let the knees fall into one another.
- Bring the soles of the feet to touch and let the knees fall wide into a butterfly position. Use pillows, rolled blankets/towel, blocks, or bolsters to support the knees if desired
If it feels comfortable, you can make the following hand gesture.
- Bring the thumbs to touch and press the tips of the index fingers together to create a triage with the hands. Bring the tips of your fingers to rest onto your pubic bone, and the heels of the hands to rest towards the hips.
2) Close the eyes and bring your awareness to your breath, breathing in and out through the nose.
- Begin to trace the breath as it enters the nose and travels down the back of the throat and into the lungs, sensing the movement of the rib cage.
- Particularly notice the front, side and back of your rib cage as it expands with each inhale and then gently recoils and relaxes with each exhale.
- Stay here for a few minutes, simply being in tune with the breath and the sensation of the movement of the rib cage with each breath.
3) Bring your awareness to the belly.
- Begin by sensing the movement of the belly with the breath.
- Allow the belly to bulge with each inhale and feel the abdomen gently deflate, feeling the belly button drawing towards the spine with each exhale.
- There is no need to force a contraction. Allow yourself to notice how your body moves with the breath with no particular effort.
If you find it challenging to bring the breath into the belly, you may like to try a gentle springing technique.
To do this, take one hand over the abdomen. Place a gentle pressure onto the stomach with each breath out by pressing the hand softly into the belly.
As you draw the breath in, focus on breathing into your hand. As you breathe into your hand, allow the pressure to gently build and then to be released – feeling a springing sensation at the abdomen.
Once you have done this a couple of times, place the hands back into the inverted triangle position (or chosen rest position) and continue to focus on belly breathing for a couple more breaths.
4) Bring your awareness now to your pelvic floor.
- Sense the diamond shape that is created by the muscles of the pelvic floor by imagining the pubic bone at the front of the pelvis, the coccyx at the back, and the sit bones on either side.
- Breathe deep into the pelvic bowl, focusing your breath all the way into the perineal space that sits between the vagina and the anus.
- As you breathe in, feel the muscles of the pelvic floor soften and relax. Sense how the pelvic floor muscles open and allow space for the breath. As you breathe out, sense the gentle movement of the pelvic floor as the muscles draw inwards and upwards.
- Again, no particular effort is required to contract the muscles, simply notice how the body moves with the breath.
A book on wellness and exercise after birth
Detailed guidance on safe return to exercise after birth, exercise modification, and the management of Rectus Diastasis, Pelvic Organ Prolapse, and Incontinence is available in Taryn’s book Body Conscious: A Woman’s Guide to Holistic Pelvic Wellness and Feminine Embodiment.
Rooted in an understanding that we are more than our physical body, Body-Conscious explores how our emotional, energetic, and spiritual health impacts our pelvic health and overall well-being.
Body Conscious respects the multi-layered and dynamic nature of female wellness and the pain we carry within – offering education, guidance, and practices, to help you reveal your unique healing path. Buy your copy now.