With the rise of the yummy mummy and celebrities pinging back into their size 0 figures with seemingly little effort, there is immense pressure on the modern mum to follow suit. Some will take drastic measures with their diet and some will try to fit straight back into their exercise routine. That may have been suitable pre-pregnancy but is it now? When is it ok to return to exercise after having a baby and what type of exercise is most appropriate?
There are a number of issues to consider when deciding which exercise routine is right for you and when:
- Relaxin. The hormone that enables your muscles, ligaments and joints to relax and soften allowing room for your baby to grow and be born. The effects of this hormone can continue for up to 6 months postnatally, affecting all your joints, leaving them unstable and more susceptible to injury.
- Our amazing pelvic floors that did all the carrying and then pushing are severely weakened. This is true even if you had a caesarean. They need to repair and strengthen so they can continue to support the internal organs. Exercising too hard or too soon can increase the likelihood of prolapse and incontinence. According to the National Institute for Health and Clinical Excellence, 25-45% of women suffer from urinary incontinence. The NHS says that up to half of all postnatal women are affected by some degree of pelvic floor prolapse. If you had multiple births, ventouse or forceps, spent over 1 hour in the second stage of labour, severe perineal tearing or had a baby over 4kg you may be more at risk of pelvic floor problems.
- The stomach muscles have stretched massively to allow for the growth of your baby. For up to 60% of us, our stomach muscles will have split. These will need to come back together so that our backs are supported and additional pressure is not put on the pelvic floor. One study reported that 66% of women with diastasis rectus (split in the stomach) had support-related pelvic floor dysfunction as well i.e. incontinence and pelvic floor prolapse (Spitznagle et al, 2007). Any traditional abdominal work and twisting moves done whilst the stomach muscles are separated can cause these muscles to stay apart and can lead to doming of the abdominal muscles, making the mum still look pregnant.
- Any pregnancy-related conditions you experienced can continue postnatally – pelvic girdle pain, carpal tunnel and sciatica. These may also affect your exercise choice.
So given these considerations, when can you get back to exercise? Most health professionals will require you to have had your doctor’s check before you can resume an exercise program – 6-8 week check for vaginal birth, 10-12 weeks for a caesarean. This time is given to allow the uterus to shrink, stomach muscles to heal, ensure bleeding has stopped and the perineum is healing. Stitches may need to be removed and cases of anaemia dealt with. Once you’ve had your check-up, this does not necessarily mean you are ready to start where you left off. Given that every woman’s pregnancy and birth are different, there can be no hard and fast rules, merely guidelines. You need to listen to your own body – it has gone through a lot physically and emotionally. Determine which of the factors listed are still applicable and therefore what is appropriate for your postnatal body – it can be 6-12 months before you’re ready to resume your previous exercise intensity.
You need to avoid the following exercises before your check-up and only gradually add them to your exercise repertoire once your pelvic floor is strengthened and any diastasis is healed:
- Running and impact exercises
- Oblique twists
In the meantime, there are some exercises that you can do soon after having your baby which will help to repair the pelvic floor and abdominal muscles. These can (and should) all be done in a variety of positions – standing, sitting, side-lying and lying on your back. Try to avoid kneeling on all fours to do the exercises in the first 6 weeks:
- PELVIC FLOOR FIRST – working the pelvic floor will also help to flatten the abs. It brings blood supply to the perineum so is good for healing even if you’re still feeling sore.
Pelvic floor lifts – quick pulses and long holds. Working from your back passage to the front, lift and release. Try and maintain a good posture, no tucking the bum under or squeezing it; don’t hold your breath.
- Pelvic tilt – from a neutral position, tuck your bum under, drawing the hip bones towards the ribcage. You should feel your lower back flatten and your stomach muscles start to engage. Try not to squeeze the bum and concentrate on the pelvis only moving.
- Abdominal bracing – keeping your body in a good posture, think of drawing your hip bones towards each other. Don’t tilt the pelvis, don’t suck in or hold your breath. It is a small movement where you should feel your stomach muscles start to tighten, but no change in your back muscles.
You can also target the pelvic floor in the last 2 exercises by breathing out and drawing up the pelvic floor just before you start the movement.
By starting slowly and targeting key muscles first, you should be well on the way back to your regular exercise routine.