Women's Health

Postpartum exercise: A guide to easing back in after birth

Reviewed by

The human body is quite amazing, isn't it?

When it comes to pregnancy, we're able to adapt instinctively to the demands of our growing bubs — the abdominal wall lengthens, the uterus expands up to one thousand times its normal size, the ligaments of the pelvis soften to allow space for baby to grow, and the pelvic floor has to stretch up to three times its normal length if a vaginal delivery is had.

It's a lot for one body to go through in nine months, and the months following birth can be just as challenging.

That's why postpartum exercise is so important for reconnecting with, and conditioning, your body for the demands of motherhood.

In this expert-approved guide, we'll help you discover all you need to know about postpartum exercise.

With exercises from specialist women's health physiotherapist, Jessie Miladinski, we'll help you start to feel strong again, just like the superhero you are.

Why post-pregnancy exercise is good for you

Prior to having a baby, our lives are quite upright. Then suddenly, we're spending a heck of a lot more time bending over, getting on and off the floor, lifting a pram or capsule in and out of the car, and reaching for or lifting things whilst also holding a baby - a bit awkward!

Not only are we moving around in ways unfamiliar to our bodies, but we're doing it with a body that's just been through a huge amount of change during pregnancy and birth.

In order to prevent injury in a time when we really need all our strength, ensuring we rebuild the stability in the abdominal wall, pelvic floor, gluteals and legs, and postural muscles is key.

For many women, exercise is also a great way to gain some mental 'space' and carve out some time for themselves in a day.

Exercise has even been shown to help reduce postpartum depression, and results in better sleep and lower stress levels - so the benefits go way beyond just physical health benefits.

Postpartum exercise timeline: When should you start exercising again

First six weeks

The first six weeks postpartum  is really a time for rest. Too often we see women putting too much pressure on themselves to begin exercising and 'bounce back', without truly respecting the process that their body has just been through during pregnancy.

First of all, it takes six weeks for the cervix to fully close, however, it takes a lot longer for the pelvic floor muscles and/or incision site of a caesarian to recover.

Unless otherwise directed, you're welcome to start walking and gradually increase your walking distance in the weeks after giving birth, as well as beginning basic pelvic floor and abdominal strengthening exercises.

Seeing a women's health physiotherapist during your pregnancy will ensure that you know how to correctly activate these muscles, and establish a 'mind-to-muscle' connection that you can tap into after you deliver.

After six weeks

If your goal is to get back to running or vigorous exercise, then between six weeks and 12-16 weeks is when you'll need to start to focus on strengthening your lower body again — remember, postnatal recovery is not just about the pelvic floor and abdominal muscles!

If you have been given the go-ahead from your doctor or women's health physiotherapist, then starting some squats, lunges, bridges, and calf raises will help prepare you for higher intensity exercises.

Many women also return to lifting weights, which is a great way to maintain and build bone density as well as muscle strength.

Three months postpartum

High-impact exercise such as HIIT classes, or running should be avoided until at least three to four months postpartum. It takes the pelvic floor muscles at least that long to recover after the stretch required for a vaginal delivery.

In the case of a caesarian section, this allows for adequate recovery of your incision. Some women will take a lot longer than 12-16 weeks to be ready for high impact exercises. Every mum is different, and if you're at all unsure, it's best to visit your doctor or a women's health physiotherapist to get the all-clear before diving into your pre-pregnancy exercise regime.

Before returning to high-intensity exercise

Prior to returning to high-intensity exercise in the postpartum period, there are a few things you want to make sure you have ticked off.

First - no leaking or prolapse symptoms (heaviness in the vagina) and able to walk 30 minutes with no pelvic floor symptoms

Second - you have done some lower body conditioning for the major muscle groups, and can do so with no pelvic floor symptoms - these can include: 10x single leg sit to stand, 10x single leg hops, 60 seconds jogging on the spot, 10x forward bounds.

A good way to start running may be to follow an app such as the 'couch-to-5K' running app - this is a graduated return to running exercise program.

postpartum exercise timeline
It's important to return to exercise slowly and gradually after giving birth.

Types of postnatal exercises

The type of postnatal exercise you do is all dependent on what you want to do!

According to women's health physiotherapists, there is no right or wrong as long as you follow healing timelines and listen to your body.

The first six weeks should involve gentle abdominal and pelvic floor exercises, as well as walking.

After clearance with your obstetrician, midwife or women's health physiotherapist, a Pilates, body weight or light weight-based exercise program can begin if you feel ready.

Gentle abdominal exercises for the postpartum period

Abdominal muscle separation (known as diastisis rectus abdominus) occurs in almost 100% of pregnant women. It is a normal part of pregnancy and it happens specifically to allow room for a growing baby and expanding uterus.

Some natural healing and closure occurs in the first eight weeks after giving birth, and following this, it is likely that some structured exercises will be needed to bring the two edges of the abdominal muscles back together, as well as regain the tension through the midline.

Individual assessment is really important here, but you can start some simple postpartum exercises to close the abdominal muscles.

Here are an easy at-home exercise designed to help activate the core after birth.

  • Lay on your back with knees bent, and feet flat. Keep the spine neutral (no arched or curved back). Take a deep breath in and as you breathe out, imagine a tension wire wraps around your lower belly. You might like to use your belly muscles to gently pull your belly button towards your spine. Release this as you breathe in again
  • Try and coordinate the above with squeezing a small ball or rolled up towel between your knees
  • Try the same while  standing or in four-point kneeling (hands and knees on your mat)
  • Perform 15-20 repetitions in each position

This helps to activate the deeper abdominal muscles as well as the pelvic floor in preparation for other exercises that are more challenging.

Postpartum tummy exercise – stage two

Once you have mastered the basic activation above, you can try and add in some simple movements to further strengthen your abdominal muscles.

Again, an individual assessment with a physiotherapist who has good knowledge of postpartum exercise is recommended.

Breathe in to prepare, breathe out to activate the wire tension across the lower tummy. Maintain this now, keep the spine neutral, and breathe normally as you try the following exercises:

  • Single knee float - lay on your back, knees bent. Lift one leg to a tabletop position (90-degrees) keeping the spine neutral. Lower and repeat up to 8 times for each leg
  • Single leg slide - lay on your back, knees bent. Slowly slide one leg along the floor keeping the spine neutral. Return and repeat on the opposite side up to 8 times for each leg
  • Chest lift - lay on your back, knees bent. With your hands behind your head, lift your head and chest off the floor in a slow and controlled crunch - repeat 10 times
  • Oblique chest lift - lay on your back, knees bent. With your hands behind your head, curl your head and chest off the floor and bring one elbow to the opposite knee. Alternate sides to achieve 5 lifts on each side
  • Bird Dog - Starting in a four-point kneel, reach one arm away, slowly lower and repeat on the opposite side, then try the same with the legs. Eventually, coordinate the opposite arm and leg lifting at the same time. Alternate arms and legs to achieve 10 on each side
  • Side lift - Start by lying on your side, knees bent and resting on the bottom elbow or forearm. Lift your hips up, hold it for 10 seconds, then repeat 2-3x/side. Gradually increase hold time as your core becomes more stable.

Pull back if you experience any pain during the above exercises. And be sure to monitor for doming with these exercises.

Doming occurs when the pressure in the tummy is too much for the tissue. You'll know if you are experiencing doing or tenting, as it's sometimes called, if you can see a bulge form down the centre of your abdominal muscles.

This is just your body's way of saying you are not ready for that exercise yet.

Pelvic floor exercises after birth

Studies have shown that pelvic floor strength decreases significantly after birth (lasting up to 10 years after delivery!) with increased risk of ongoing issues if your delivery involved an episiotomy, forceps or vacuum.

That's why pelvic floor muscle exercises — sometimes called kegel exercises — should begin as early as day one postpartum.

A consultation with a women's health physiotherapist during your pregnancy to learn how to correctly activate your pelvic floor is really important (because it may surprise you to know that 50% of women will activate their pelvic floor incorrectly when asked!).

According to women's health physiotherapists, one of the best directions given to help women activate the pelvic floor properly is to lift around the anus, as if you were trying to hold in wind.

For new mums, coughing, sneezing, laughing and lifting items can cause a little bit of leakage. It's totally normal, but it can also help to consciously activate the pelvic floor prior to doing any of these things to reduce urinary leakage.

Easy postpartum pelvic floor exercises

For new mums, a good place to start is to aim to do 10 on/off contractions during each feed.

The length of time held should be based on the number of weeks old your baby is. For example:

  • 1 week old = 10 x 1-second squeezes
  • 2 weeks old = 10 x 2-second squeezes
  • 3 weeks old = 10 x 3-second squeezes  

It is important to have these exercises progressed as time goes on to meet the demands of your day-to-day, or exercise goals. The demands on the pelvic floor muscles of someone who does cross-fit are vastly different than someone who does yoga, and therefore the strength of the pelvic floor needs to match.

Postpartum exercise after a C-section birth

Postpartum workouts after a C-section delivery follow similar principles to that of a vaginal birth.

In a C-section birth, the pelvic floor has not been through the same stretch, however, has still carried the weight of a baby for nine months during pregnancy.

It can be more common after a C-section to experience hypertonic (tight) pelvic floor muscles - so watch out for pain with sex and tampons, or leaking of urine (yes - a tight pelvic floor can cause this too!).

Once your incision site has healed, you might like to try doing a scar massage. This can help break down any sticky scar tissue, reduce swelling and can help you connect with your tummy again.

Using a neutral oil or cream, perform gentle up/down, side to side and circular motions across the length of your scar for a few minutes after a shower.

Postpartum exercise to reduce tummy

A lot of women want their abdominal wall to return to its pre-pregnancy appearance.

Often women find that it can be challenging to target the lower abdominal region with exercise, and there are a lot of things that influence this including:

  • Abdominal separation
  • Extra weight following pregnancy
  • Reduction in skin integrity and tone of abdominal muscles

A targeted abdominal strengthening program will help gradually tone abdominal muscles as well as the introduction of moderate-intensity aerobic activity, such as stair or brisk walking, cross-trainer and bike as soon as you feel ready or you are given clearance.

The key is to continue to progress your load over time, incorporating exercises in standing, functional and more complex movements — muscles can only get as strong as you challenge them to be! — however, choosing appropriate exercises and listening to your body and monitoring energy levels is essential for recovering without injury.

Too much tightness in the upper abdominal muscles or upper back muscles and spine can also act as a pressure system (imagine if you squeezed the top of a water balloon — the pressure bulges out the bottom!).

This is sometimes referred to as a 'pressure belly' causing the lower part of the tummy to push forward.

Addressing these things will also help you to improve the appearance of the lower abdominal wall, while simultaneously helping you to feel stronger.

Warning signs to slow down

When easing back into exercise after giving birth, you'll need to watch out for a few warning signs that it might be time to slow down. These are:

  • Any unexplained bleeding - vaginally or from your C-section scar
  • Leaking of urine or feces whilst exercising
  • A feeling of vaginal heaviness, or a vaginal bulge - this can be a symptom of prolapse
  • Experiencing pain - whether back pain, pelvic or other joint pai

Many new mums are keen to return to exercise after pregnancy, and as much as we want to encourage women to stay active postpartum, symptoms like these are your body's way of telling you it is not coping with the load.

Thats not to say that it will never be able to cope, but any of these symptoms are a sign to pull back and reduce your load. You should make sure to consult with your women's health physiotherapist or doctor if you are experiencing any of the above.

Too often symptoms like urinary leakage, pain with intercourse, and a weak pelvic floor are casually brushed off. While these are common, they don't have to be normal — especially with the right treatment and support.

References

https://www.acog.org/womens-health/faqs/how-your-fetus-grows-during-pregnancy

https://pubmed.ncbi.nlm.nih.gov/28589648/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6877697/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3681819/