Your body goes through a range of changes during pregnancy and it’s important to know how it may affect you before deciding when to get back to exercising. During pregnancy you have a lot of hormones circulating, you’re growing a baby which adds additional weight to your body, you adopt new ways of moving and your capacity and endurance for exercise decreases (due to the factors we just mentioned and more!).
Once your baby is born, these changes do not instantly revert back to your norm (unfortunately). For example, some of these hormones like relaxin will stay around in your system for quite some time meaning your ligaments will still be softer and more elastic for 4-5 months post pregnancy. Your body is also recovering from the birth itself, whether you delivered vaginally or surgically there are muscles, soft tissue and joints that may need time to recover.
Although there are a lot of factors that can go into what we can return to and when, including what types and amounts of exercise you were previously participating in, here is a sample postpartum exercise journey.
For the first six weeks
During this time, allow yourself time and space to let your body recover and bond with your baby and get used to the routine of being a new mum – whether that is as a new mum or a mum new to child number 2, 3 or more! In these first few weeks, we can begin performing gentle pelvic floor exercises and general physical activity such as walking if you feel up to it. Pelvic floor exercises have an important role to play when it comes to helping with urinary incontinence. Some studies have found that engaging your pelvic floor muscles sooner rather than later can help reduce symptoms at the 12 month mark by 40%!
The first 6 weeks are an important time for tissue healing and recovery so there is no need to over do things or try to rush back to what you were doing before falling pregnant! This is also the perfect time to book your first postpartum Physiotherapist appointment so that you can have any questions answered as well as your pelvic floor, abdominal muscles and pelvic control assessed. We also love to provide a structured plan for your rehabilitation and strengthening as well as create individualised goals together within these sessions!
6 week to 6 months
After the initial 6 weeks postpartum, you can start building up your walking, going further and more often than before. This is also the stage to work on gentle stretching/mobility exercises, supervised exercise classes that focus on core control and whole body strengthening programs. At this point we will be working with you towards your goals and will be able to guide you through times where you’re feeling a little flat and may need to back off as well as through times where you’re feeling on top of the world and you can do a little more!
6 to 12 months
This period heavily depends on the goals you set out, however may involve more dynamic, faster, more intense activity after having first set down the foundation work of control and strength through your first 6 months. During this period and beyond, we are looking to build you up to all of the activities you loved before getting pregnant and supporting you with any challenges you face along the way.
When returning back to your previous activity levels or sport, there are a number of factors involved. Here are a few questions to consider:
- What type of training or exercise you were doing prior to getting pregnant?
- What type of training or exercise you did throughout your pregnancy and how your body coped/responded?
- What is your history of previous injuries?
- What type of birth you had and how your postpartum recovery has been?
- What are your current/new exercise or fitness goals?
This is a very individualised process which is a great thing for you and your recovery! However at the same time, this means there is no simple or one size fits all answer.
Exercise for Lower Back Pain & Pelvic Girdle Pain
Although the majority of women who suffer from lower back pain or pelvic girdle pain after giving birth recover spontaneously soon after delivery, about 20% report persistent pain that can continue on an ongoing basis. Thankfully, exercise in combination with physiotherapy has been shown to have significant and long lasting positive effects on function, pain and physical health following the birth of your baby. The research around this showed great benefits when exercises were focused on dynamic control of the spine and pelvis (also called lumbopelvic control) along with strength and endurance training to manage the physical demands of being a new mum. A postpartum exercise program that is individually tailored to you should be performed for 30-60mins, 3 days per week to achieve the positive effects mentioned above.
Exercise and Diastasis Recti Abdominis (RADS)
Diastasis Recti Abdominis is a big subject in women recovering postpartum and there is a lot of conflicting information out and about. What we do know is that women with greater than 3.5cm separation have been found to have weaker abdominal muscles in the early stages of recovery, however by the 6 months mark, there seems to be little to no difference in strength, meaning that this aspect (the strength produced) gets better on it’s own most of the time. Along with decreased strength, there is some evidence to suggest that those woman with larger separations measured in the early stages postpartum may experience more lower back or pelvic pain, however this is due to a number of different reasons such as which type of birth you had and whether there were any complications that went with it.
Exercise and Breast feeding
There are sometimes questions or concerns around whether returning to exercise can affect milk production and nutritional qualities for breast feeding, however this isn’t supported anywhere in the research. In fact, some studies have shown the opposite, with aerobic exercise such as walking and jogging having links with greater quantity and quality of breast milk. Australian guidelines and recommendations encourages exercise and states that there are no consequences for breast milk volume and quality or infant growth as long as women keep up the appropriate amounts of food and fluid to match their physical activity.
Another aspect of postpartum exercise and breast feeding that is often talked about is lactic acid. Lactic acid builds up in our bodies as a by-product of high levels and intensities of exercise, and has shown to also increase within breast milk as well. Low and moderate levels of exercise have not shown to have any increases of lactic acid in breast milk, however even if it did, there are no negative effects of this for your baby.
Other tips for increased comfort with exercise and breast feeding are:
– Breast feed or use a breast pump before exercise
– Wearing a personally fitted sports bra rather than compression or encapsulation sports bra
Exercise and Post natal depression
The most common mental health condition in the postpartum period is postpartum or postnatal depression. This is where depression occurs within the 12 months after giving birth, and is experienced by approximately 20% of women. Depressive symptoms may include feelings of helplessness and hopelessness, problems getting to sleep or staying asleep, lack of energy and motivation, loss of interest in activities, irritability and changes in eating patterns. Postnatal depression is associated with negative parenting behaviours, poorer mother–infant bonding, and physical and emotional problems. Women who experience postnatal depression also have twice the risk of suffering episodes of depression later in life.
So what about exercise and post natal depression? Research suggests that physical activity and even leisure time prior to, during and after pregnancy may be important for reducing the risk of postnatal depressive symptoms. Along with helping to prevent it in the first place, exercise may improve the symptoms of postnatal depression as well.
What’s the take away message here?
Whilst child birth is something the female body is designed for, it is still a huge process of change and adaptation that the body goes through and therefore some aspects like your core, pelvic floor and pelvic control will need work to restore optimal function postpartum. Exercise and return to sport is best achieved with the guidance of a Physiotherapist who lives and breathes postpartum care so that you make a safe and effective return to the activities you love or the new activities you want to try!
The biggest and best advice we can give? Go and see your Physiotherapist so that you can get assessed, set goals and be prepared for this new phase of your life!