Returning to Exercise - Women's Health after Motherhood

In this section, we will be exploring what women should think about before returning to exercise after having a baby. We will listen to mothers' experiences of returning to exercise, and you will have a timeline to plan your return to exercise.

Women who exercise regularly, and see it as a simple part of healthy living, have reduced risk of heart attack, stroke, diabetes, and have greater bone density, strength and reported quality of life as they get older.

Exercise is important for a healthy and strong body that is prepared for life's physical challenges, not only as you raise your children, but especially as you age.

There are a few things to think about before returning to exercise after having a baby.

Your exercise history

If you were active before and during pregnancy, be careful that you don't do too much too soon. Your body needs some time to recover. Be steady and patient, and build up to previous levels gradually.
If you did little to no exercise before and during pregnancy, don't try to jump into a vigorous exercise routine just yet. Start gently and build up.

Your birth

Women give birth in several ways.

Depending on how you birthed your baby, you might need to change your exercise routine.

Challenges

After pregnancy, the hormone relaxin can stay in your body for up to 4-6 months postnatally, leaving your ligaments and pelvic floor muscles more vulnerable to injury in the post-natal period.

You will have reduced core stability as your abdominal muscles have naturally stretched during pregnancy and require time and care to recover, particularly following a caesarean section.
Physical challenges may arise if you experience a separation of the abdominal muscles, this is also referred to as a diastasis rectus abdominus muscle (DRAM) and can be seen if your tummy domes or peaks when you move.
Other challenges arise if you have difficulty with bladder or bowel control following your birth or have back or pelvic girdle pain. If you feel pelvic floor discomfort or a sensation of something coming down in the vagina, leaking urine while exercising or your tummy muscles are still doming, you need to reduce the intensity of your exercise programme or change the exercises so that you are strengthening the pelvic floor and core at an appropriate level for you.

It is important for you to match the intensity of your exercise to the strength and control of your pelvic floor and abdominal muscles to avoid worsening your physical symptoms.

In the next step, we'll be looking at your timeline to exercise after birth.

Always listen to your body.

If you had any complications during pregnancy or while giving birth, or you have any medical problems, talk to your midwife, doctor or physiotherapist before beginning any type of exercise.

Timeline to Exercise

Let's take a look at a suitable timeframe to return to exercise following childbirth. This is a general guide for women in full health. If you have experienced health issues such as abdominal muscle separation, pelvic floor dysfunction or urinary incontinence, or if you have concerns about your postnatal recovery or symptoms, you should seek help from a women's health physiotherapist who is specifically trained and skilled in postpartum recovery.

Check with your maternity hospital, gynaecologist or doctor to find out how you can be referred to a women's health physiotherapist in your locality.

When to exercise

First few days after birth

For normal vaginal births, you can start very gentle pelvic floor exercises in the first few days after birth.
If you had a caesarean section, wait until your catheter (tube in your bladder after surgery) has been removed before you begin pelvic floor exercises. Remember, a caesarean section is a major surgery and you shouldn't lift anything heavier than your baby up until 6 weeks after birth.

Safe exercises

Exercises to engage your core (deep abdominal muscles and pelvic floor)

Lie down on your back with your knees bent.
Gently draw in the lower abdominal muscles as if hugging the baby when pregnant. Hold for up to 10 seconds. Keep breathing during the exercise
While lying on your back, flatten your lower back against the bed and release. Do these pelvic tilts five times x 5.
While lying on your back, engage lower tummy muscles by gently turning and twisting your knees side to side. Do this five times.

Exercises to avoid

Sit-up type movements
High impact activities
Weight lifting activities

Wait until after your 6-8 week check-up before returning to light, gentle exercise.
Avoid abdominal crunches and curl-ups, if your tummy muscles have separated. Visit a women's health physiotherapist before starting or re-starting exercise, if you have muscle separation.
If you experience any pain, heaviness, dragging or incontinence while doing these low impact exercises, contact your women's health physiotherapist or physician.

Low impact exercises

Long walks
Low impact aerobics,
Gentle stretching
T'ai chi
Stationary bike
Swimming (when you have had 7 days in a row without vaginal bleeding).

If you have had a caesarian section, and you are considering going back to the gym or exercise class stop exercising if you feel any discomfort, pain or a pulling sensation on your scar, and try again in a couple of weeks.
Do not return to high impact sports, such as running, before 3 months postpartum or if you have any symptoms of pelvic floor dysfunction.

Moderate impact exercises

Postnatal Pilates
Yoga
Cycling
Power walking
Zumba
Ballroom dancing.

High impact exercises

Running
Circuit training
Rope skipping

While you can return to high impact sports from 3 months postpartum, (provided you do not have any symptoms of pelvic floor dysfunction) remember that up to 4-6 months postpartum the hormone relaxin may still be present in your body, which increases your risk of injury.
Use proper posture and technique while exercising and think about your safety if you enjoy activities where falls or impacts can occur.
Hiking
Rock climbing
Mountain biking
High intensity sports, such as weight training, martial arts, rugby.

Motivate yourself

Make a list of your exercise goals and your reasons for exercising. Keep the list of motivations somewhere visible.
Set aside time to exercise and set a reminder on your phone.
Focus on your short-term goals, such as improving your mood and reducing stress, instead of goals such as weight loss, which may take longer for results.
Make exercising fun and pick an exercise you enjoy. Do it with a friend, join a mum and baby exercise class, and listen to music or a podcast while you exercise.
If you skip a few days, don't get discouraged. Just start again, and build yourself up slowly.
Think of the benefits that exercise has on your long-term health goals. What do you want your physical health to look like as your children reach adulthood? Can exercise help you with these goals?