Postnatal exercise guidelines

Returning to exercise after having a baby is a daunting time. You’ve maybe been out of the way for a while, or at least from your pre-pregnancy exercise schedule, your body has adapted to pregnancy and then continues to change postnatally. Postnatal exercise guidelines can help you return to exercise safely to ensure your body is rehabilitated and allowed to build back to exercise without over straining, stressing or causing injury.

These guidelines have been recently updated and are the current best practise at time of publication. Always check what you are doing is in line with the most recent evidence and if in doubt seek advice from a qualified postnatal physiotherapist. 

When to start?

Pelvic floor muscle exercises should begin as soon as comfortable in an uncomplicated birth delivery and in the absence of pain. Gentle core muscle activation can begin early on too, even in the case of a C-section. You can also read my specific post on Exercise after a C-section and how to get started here.

Walking is excellent to aid circulation and promote healing post-birth, and can commence when doctors/midwives approve, but usually is encouraged gently from the very beginning too. Walking should be gradually progressed as able and is a great, safe way to begin building some aerobic and strength conditioning.

Impact exercise is not advised until the pelvic floor & core have regained their strength.

But most importantly, begin when you are ready! Life as a new mum is hectic enough not to add any further pressure on yourself. Sleep deprivation, hormones, bleeding, and ligament laxity all need to be considered before you commence more strenuous exercise.

Pelvic floor & core

Early initiation of these exercises should occur to restore muscle tone and muscle function and can be effective in reducing urinary incontinence. Those who are more likely to develop problems here and should seek extra help are those who had: a complex vaginal delivery, chronic constipation, >3 deliveries, high birth weight >4kg, advanced maternal age, chronic respiratory problems.

How to do your pelvic floor exercises:

Draw your pelvic floor muscles inwards, upwards, and forwards from your back passage to your front. Perform a set of slow and fast contractions and repeat these 4-6 times per day.

SLOW: 10 second holds x 10

FAST: x10

For a more detailed read on all you need to know about your pelvic floor, click here. 

Strength training 

Strength training and resistance training can commence from around 6 weeks postpartum (in the absence of any complications/contraindications). This should begin with body weight exercises first and progress to weights when ready. Caution should be taken with heavier lifts such as squats and deadlifts which demand a good level of technique and strength & stability throughout the body. Exercises that cause increased intra-abdominal pressure (internal abdominal pressure) should also be avoided initially as these place excess stress on the abdomen where there may be weakness from diastasic rectus abdominis (abdominal splitting). This may include exercises where you feel you have to strain to complete them, exercises that are too heavy or too difficult, or you tend to hold your breath to complete them, exercises that involve bigger movements such as lifting weights from the floor upwards, or lifting them up above your head, or exercises that are performed in similar forms to sit-ups.

Aerobic exercise

Low impact exercise such as walking can be started immediately and progressed as you feel fit to. Power walking and walking uphill can all build aerobic exercise. Cycling can commence when you feel able to sit on a saddle and when your pelvis and hips feel comfortable. This should not start yet if there is/has been pelvic pain or previous pubic symphysis dysfunction. Swimming can commence when lochia has stopped (postnatal bleeding). Breaststroke may be avoided initially to reduce pelvic strain.

Impact exercise should be delayed for at least 3 months postpartum according to guidelines. This is because it takes approx. 2 months post-birth for the substantial change in cardiac and respiratory changes to return to normal levels.

Ideally your pelvic floor would be able to sustain the endurance test below prior to running to ensure there is less risk of pelvic floor problems. Research has shown that the nerve innervation of the pelvic floor had returned to normal in only 35% of women at 6 months postpartum, suggesting how important a good pelvic floor prior to impact exercise is.

Pelvic floor muscle endurance test

• 10 x fast contractions
• 8-12 x of 6-8 second maximal contractions
• 1 x 60 seconds 30-50% contractions

I previously wrote an in-depth post on the new guidelines for Returning to Running Postnatally here. This talks you through all the tests that you can do to get a better idea if you should be participating in impact exercise yet.

How much?

Following pregnancy the guidelines suggest you should aim to get at least 150 minutes of moderate-intensity aerobic activity every week. You can divide the 150 minutes into 30-minute workouts on 5 days of the week or into smaller 10-minute sessions throughout each day. For example, you could go for three 10-minute walks each day. This should also be accompanied with 2 strength training sessions per week. These guidelines follow similar to the “normal” recommended exercise guidelines for adults. To read more about exercise guidelines in how much is enough exercise, click here. 

Contraindications & watch points

These warning signs suggest that you should slow down:

• Increased fatigue
• Muscular aches & pains
• Postpartum bleeding (lochia) changes colour, heavier flow, or starts again after stopping
• Heaviness/dragging feelings in your vagina region
• Leaking at any stage of exercise, or afterwards too
• Bulging/doming/straining at your abdominal region; or any discomfort afterwards
• Pelvic pain (at the front, back, or sides) or lower back pain
• On-going or an increase in blood loss >8 weeks postnatally

 

When to seek help

If any of the above warning signs persist then you should seek further assessment with a Women’s Health Physiotherapist, or ask to be referred to one via your G.P. They can examine you and carry out specific tests to identify weaknesses, as well as providing treatment and exercises to help these areas.

References:

• mail chi.mp/38feb9423b2d/returning-to-running-postnatal-guideline. Authors Tom Goom, Emma Brockwell, Grainne Donnelly.