How and when should you start your exercise program after pregnancy?

             There are guidelines on how to train while pregnant. ACOG recommends 150 minutes of moderate activity, your OB will likely tell you to do whatever you were doing before you became pregnant, provided you are comfortable. The newest recommendation is, that you can start exercising when you are pregnant even, if you have never done it before. The “use your common sense” approach has becomes more popular now-a-days, and there are no strict guidelines anymore, however, you should always consult your OBGYN prior to beginning any exercise regimen. Do whatever feels good, do not exert yourself, do not overheat, and you and your growing bump will be ok.
What should we do after pregnancy? One piece advice that is common is, “take care of yourself and exercise”, but how? Our bodies change as result of pregnancy.
There is not that much research on how to train in the postpartum period. We know it’s good for us, but we also know it is extremely hard to incorporate exercise in the early postpartum phase. Women usually experience extreme fatigue, from the lack of sleep, anxiety around the new life situation, and physical trauma to their bodies. After a core, c- section scar, perineum, you’ll need time to recover. Let’s face it, muscle tissue and sometimes organs, often get damaged during delivery. Some women suffer from carpal tunnel and back pain in early months. Yet they are encouraged to exercise and take care of themselves. How do we do this without knowing what will be good for us? The pressure is on! Like we need more of it as new mothers!

When is it safe to start exercising?

According to ACOG, it’s as early as 4 weeks postpartum if there were no complications, and 6-8 weeks after a C-section. These guidelines work for some women, but for others they do not. Let’s be honest. 6 weeks into motherhood I was crying because my baby would not latch properly, and I still didn’t remember if I brushed my teeth that morning. Who can relate? And what exercise can you, and should you do, 4 weeks after delivery? That is not specified. Your body has changed and gone through trauma, therefore, you need specific-targeted training.
You need to be assessed for diastasis recti, and for muscular imbalances that you developed during pregnancy in your lumbo-pelvic hip complex.

Celebrity culture, Celebrity bodies

A lot of new moms aspire to get back in shape as soon as possible after giving birth. Some of this is driven by the “celebrity culture.”  We need to be realistic about losing weight or post pregnancy belly. It will all depend on your age, genetic make up, how active you were before getting pregnant and during pregnancy, how much weight you have gained, and other factors such as: sleep, stress level etc. It takes 9 months to make a baby, hence, it takes several months for your body to go back to its normal, physiological state. Also, how do you know that this celebrity mom doesn’t have pelvic floor dysfunction? A slender physique does not equal being in shape.

Here is how your body responds in the immediate postpartum period:

Let’s take a look at all the physiological changes in the postpartum period. Once  you understand the process your body goes through, you will have a clear picture of what you can do and when to start exercising again, without causing damage.

Higher cardiac output can continue for up to 12 weeks postpartum,  (Resnik 2004, Blackburn 2007) although most of the time comes back to a regular rate after 6-8 weeks post delivery.
What does that mean? A new mom will be out of breath for a while. Don’t start with high intensity cardio for at least 12 weeks after delivery.  If you come back to exercise 6 weeks or later you’ll have strengthening and corrective exercises to do first.  High intensity cardio will not be your 1st priority, it’s not good for your pelvic floor and core. These structures need to be protected from high impact that high intensity cardio often entails.

Steady weight loss after delivery continues for up to 12 weeks at a rate of 2-3 lbs. per month.

After that, 1 lb. a month, for 3-6 months. Which only suggest that you should take your time and recover, there is no need to resume any exercise for weight loss purposes.  I know this sounds like contradictory advice to what you may hear in the media, but the reality is, your body needs to heal on its own first. There will be time to loose a few extra pounds later.

How long were your hips wider than ever before?

The muscles and joints are still flooded in Relaxin several days after delivery. After that, the hormone subsides and ligaments and cartilage of the pelvis return to normal. This means that you need to regain stability in your pelvis and let it “shrink” back to normal size. I’ve heard many stories where women have said that their hips are wider after they gave birth. In my experience, it sometimes takes a few weeks for cartilage and ligaments to go back to normal.

Diastasis Recti

This is when the abdominal wall feels stretched, flabby and weak. This can continue for quite some time. Diastasis recti is common during this phase, and can still be felt in most women for up to 12 weeks after delivery. If your gap is wider than two fingers, you likely have diastasis. If not, then you are ok, and within few weeks your muscles will come closer to the midline. If you have diastasis don’t worry, with proper exercise you will make it functional. However, this means the gap will probably stay, but if you strengthen your deep core muscles and correct the muscle alignment, you will likely not suffer from any side effects of diastasis.

Core and Pelvic Floor

Pelvic muscular support is needed since the pelvic floor muscles are stretched during delivery and sometimes are even torn. Kegel exercises are recommended for some women, for others, trigger point therapy and massage. Pelvic muscles can get tight from the trauma as well. These are important muscles that should really be worked on by a physical therapist or postnatal personal trainer, with extensive knowledge and experience.

Later in life, a weak pelvic floor can lead to pelvic relaxation, which is lengthening and weakening of fascial support of pelvic structures (uterus, posterior vaginal wall, urethra, bladder and rectum) and often lead to prolapse. (Lowdermilk 457).
Kegels or perineal massage, hip bridges and belly breathing exercises are recommended in this early stage after birth.  Again, only for women who didn’t have episiotomies, which sometimes take up to 4 months to heal (Blackburn 2007). Natural lacerations might be less troublesome and heal faster, if they are small. Either way, perineal muscles are involved in walking, squatting, lunging and other functional movements, so let them heal before you start any exercise activity.
Do not carry your baby in front carriers in the first few weeks, that puts too much pressure on your pelvic floor and an abdominal wall that is likely still weak.

Did you wee a little?

The bladder is another organ that is affected by pregnancy, more than delivery itself. During pregnancy, the bladder has: increased capacity and decreased muscle tone. During delivery, the baby’s head may have further traumatized the tissue. Kidneys come back to normal function within 6-8 weeks (Blackburn 2007) and stress (pressure) incontinence, usually improves within 3 months of delivery. Again, high impact exercises are not recommended for new moms. The same with heavy weight lifting at this stage of recovery (heavy is relative).

Is 12 weeks truly a realistic amount of time for recovery from childbirth?

Some women feel better sooner, hence middle ground is 6-8 weeks of recovery. And this timeline works if you are gentle. Walking, breathing exercises, and pelvic floor exercises, are something that should start early. Hard-core workouts should probably wait until 12 weeks.

In the end, most first time mothers and half of second time mothers, experience pain in the first two months after delivery. Whether it’s a C-section incision, episiotomy, or pelvic pain, it is real and can be quite unpleasant. Even if you don’t feel pain, please, let your body heal before you start hitting the gym.

Try to relax, go for a walk, breathe… It’s not a sprint, it’s a marathon.