Ask the Expert: How to Safely Exercise After Pregnancy

I spoke to an expert about how to get back into exercising after pregnancy.I spoke to a pre- an post-pregnancy exercise specialist about how to get back into exercising after pregnancy.

Whoa, workout queen! Take it easy, you’ve just had a baby!

One of the most common questions I get about self-care in the early postpartum period is about how soon exercising can resume. For some, it’s about the exercise itself but for the vast majority, it is about being unhappy with the new shape of their body and wishing it looked different — more like it did ‘before.’

I won’t pretend I’m above it, but I want to be. I’m a feminist and I hate those pictures of supermodels three weeks postpartum looking like they’ve never even been in the same room as a cookie. But, I’m a flawed, sheepish feminist and I also look down at my soft mummy muffin top and secretly wish I could angrily rail against unrealistic body expectations while still being as taut as all hell.

I’m working on getting better but, in the meantime, let’s all try to be kinder to our bodies and to cut them some well-deserved slack after pregnancy. Let’s try to not put too much pressure on our healing, recovering bodies to erase all evidence of pregnancy as quickly as possible.

That said, it is a great idea to do exercises after pregnancy to help promote healing, in the way a physiotherapist helps after your body has sustained some sort of trauma or injury.

Related: How to Recover and Move Forward After Childbirth

I spoke to prenatal and postpartum fitness expert Samantha Montpetit-Huynh, a certified pre and postnatal exercise specialist with over 15 years experience, and the co-founder of Bellies Inc. and its Core Confidence Exercise Program, about how to safely and smartly exercise after pregnancy.

Q: Why is exercising postpartum different than exercising pre-pregnancy?

A: Pregnancy creates both physical and physiological changes in the body, and they do not immediately return to a pre-pregnancy state after birth.

  • Most women get some degree of Diastasis Rectus Abdominis (abdominal separation) during pregnancy and only 1/3 of them fully recover postpartum.
  • The pelvic floor goes from supporting an approximately 3-lb uterus to supporting 20 lbs  (whoa!) and, consequently, many women who birth vaginally leak urine afterwards.
  • Your internal organs were displaced during pregnancy, and the hormone relaxin has loosened your ligaments and joints, making you hyper mobile and more susceptible to injury.

Alas, these changes do not magically disappear once the baby is born. It takes time to recover and restore. Focusing on rehabilitative exercise is key to rebuilding a foundation that has been altered during those nine months.

Whether you had a straightforward pregnancy and easy delivery or had some interventions or a cesarean delivery, the entire experience is hard work and physically traumatic to the body so, just like you would rehab a knee after surgery, you need to rehab after birth.

Q. What are the challenges/risks of exercise in the early postpartum?

A. Unfortunately, there is no pre-hab or rehab for pregnancy and birth. Women are often given the green light to resume normal activities at their six-week postpartum appointment.

Remember there are a LOT of changes that happened to your body. You need to honor it for everything it has endured and done for you. Going too hard too fast puts you at risk for many things such as chronic back pain, hip pain, pelvic pain, incontinence and pelvic organ prolapse – just to name a few.

If your goal is to get back to running, go to an exercise class, or lift weights, you must re-train before you train.

Even if you exercised throughout your pregnancy right up to the day of birth, you’ve still experienced the hormonal influences, physiological changes, and the weight on the pelvic floor. It all has to be rehabilitated in order for you to return to ‘sport’ without injury.

If it’s an option for you, before resuming exercise after pregnancy, I highly recommend seeing a pelvic floor physiotherapist after to ensure that everything is working and healing well.

Q. When can a woman safely start exercising after having a baby?

A. After birth, it is important to listen to your body and not push yourself.

Try ten to 15 minutes of gentle walking within the first week. If you had a cesarean delivery, you will notice how much you need your abdominal muscles just to do this. You can increase by five minutes each week as long as you feel comfortable doing so.

Be cautious, as this can also be the time when adrenaline is at a high and eventually you will crash. The general rule is for every hour of exercise, you need an hour of rest – and that does not mean doing the laundry!

You should also begin gentle core breathing. This will encourage you to be mindful of your posture and start recruiting those deep core muscles that are begging for attention.

Your diaphragm, transverse abdominis (deep abdominal muscles), multifidus (deep spinal muscles) and pelvic floor make up the ‘core 4’ and are needed for optimal strength and stability. If you feel good, it is perfectly safe to start with some deep core breathing within 24 hours of birth to wake up those muscles and get them working again.

I have to reiterate that, for at least the first eight weeks postpartum, the exercises you are doing should be gentle and restorative to encourage recovery and support. If possible, seeing a pelvic floor physiotherapist at eight weeks postpartum is the next step before increasing intensity.

Q. Is there a difference on recovery depending on whether it was a caesarean (planned or after some laboring) or vaginal birth?

A. The difference between vaginal deliveries and cesarean births might not be what you think. While both pregnancies have the same physical and physiological changes, the vaginal delivery impacts the pelvic floor muscles much more. However, a cesarean section is major abdominal surgery that impacts the function of these muscles during recovery.

Diastasis Rectus Abdominis shows up more in women who have had cesarean births, and have a more difficult time recovering.

Q. What should the focus be on in the early postpartum period?

A. The two biggest issues that moms struggle with after pregnancy and birth are their abdominals and pelvic floor dysfunction (leaking when they cough, sneeze, laugh or run).

Those first eight weeks postpartum are the most important for spontaneous of healing the abdominal wall. Each pregnancy and delivery is different so what works for one, may not for someone else. Take your time and go slow. Trust that you will eventually get there, but be smart in your journey so when you want to up the ante, you can do so and feel good at the same time.

Q. What are some simple exercises to start with when easing back into working out?

A. Here are some safe, restorative exercises that can be done during the first 6-8 weeks postpartum before being given the green light from a professional to start on a regular exercise program. These exercises focus on the biggest issues that new moms struggle with and aim at recruiting the ‘core 4’ at the same time.

1. Core breath: Coordination of the core 4: diaphragm, transverse abdominins, multifidus and pelvic floor.Proper alignment is needed to connect the breath with the pelvic floor. Inhale to expand sideways into your ribcage (diaphragm, not your belly) and expand in your pelvic floor. Exhale and return your ribs to resting and gently lift your pelvic floor.

2. Bridge – Lie flat on your back with knees bent and spine neutral (no flat back). Inhale to expand and as you exhale, slowly lift your bum off the floor without thrusting your hips up.

3. Clam shell – Lie on your side with legs bent, feet aligned with bum, neutral spine and shoulders stacked. Inhale to expand and as you exhale, slowly lift your top knee off the bottom, keeping your feet together and not rotating your spine.

4. Side lying bent knee lift – Lie on your side with legs bent at 90 degrees and spine in neutral. Shoulders stacked. Inhale to expand and as you exhale, lift the entire top leg off the bottom without rotating your spine.

5. Seated march – Sit tall on a stability ball with pelvis untucked and feet together. Inhale to expand and as you exhale, lift one foot 1-2 inches off the floor keeping hips stable.

6. Squat – stand tall with feet hip width apart and neutral pelvis. Inhale to expand as you sit back into a squat position. Exhale and return to standing without tilting pelvis under at the top of the squat.

7. One leg stand – Stand tall with feet pelvis width apart. Inhale to expand and as you exhale, shift your weight to one side and lift the opposite foot off the floor without dropping or rotating your hips.

8. Lunge – Stand tall with neutral pelvis and extend one leg behind you and keep the heel off the floor. Keeping your torso tall, inhale to expand as you bend the back leg into a lunge. Exhale and return to starting position.

Start, in the order above, with one exercise at week one and add one exercise each week so at the end of eight weeks, you have the full program.

However, this has to be based on comfort level, energy level and what works for you. There is no cookie cutter approach, but it is important to focus on the deep core muscles that support you from the inside so the outside can move better. This is not the time to sign up for your first 5K, or attend a strenuous or high impact exercise class. Think slow and steady as this always wins the race.

Q. What are common mistakes that people make when resuming exercise in the postpartum period?

Going too hard too fast. Although pregnancy and birth is hands down, the most amazing and physically challenging thing a woman can do, she can feel weak and quite vulnerable after birth.

With images of models and airbrushed women showing their six-pack a week after having a baby, it’s no wonder women feel pressure to get ‘back at it’ as soon as possible. The problem is that no one is reminding them of what their body just did.

Again, even if it was the dreamiest pregnancy and delivery possible, you still can’t take away the amount of stretch and (some) nerve damage that was caused during a vaginal birth.

Their pelvic floor went from supporting 3 lbs. to 20 lbs. and their organs were pushed out of the way. Some doctors will say that it takes upwards of 18 months for everything to fully “recover “after birth, and we certainly know that things are just not the same “down there” or anywhere for that matter so it does not make sense to treat it as such.

Instead of focusing on getting your body to look like it did before, take the the time to rest, recover and restore. Even if you get the go-ahead to exercise at six weeks postpartum, remember that this is not the end of the healing process, but the beginning.

Samantha Montpetit-HuynhThe Expert: Samantha Montpetit-Huynh

She is a certified pre and post-natal exercise specialist with over 15 years experience and the co-founder of Bellies Inc., the creators of the AB Tank Complete System, the most comprehensive, holistic system that combines restorative exercises and abdominal wrapping to help women build core confidence from pregnancy through motherhood.

Samantha has appeared on Breakfast Television, CTV News, Canada AM, CHCH and Rogers Daytime. She was also the resident fitness expert on the Marilyn Denis Show, a national award winning lifestyle show across Canada, from 2013-2017. Samantha also helped to create the Today’s Parent Healthy Pregnancy Guide.


4 thoughts on “Ask the Expert: How to Safely Exercise After Pregnancy”

  1. Many of the exercises listed above work the legs, hips, and glutes as prime movers and are not the best place to start postpartum rehab. These moves require a foundation of core stability to do properly. All new moms need to not only strengthen the transverse abdominis (TvA), but perform specialized pp rehab moves that train the muscle to function properly as a stabilizer, such as heel slides, and toe taps.
    All new moms have what is called a kyphotic/lordotic posture, meaning that the pelvis has tipped (which places strain on mid line, preventing mid line closure) and the upper spine has become overly round. Omitted from this workout are exercises that recenter the pelvis and realign the spine, both crucial elements of pp rehab.
    Moves like squats and lunges increase intra-abominal pressure on both the pelvic floor and to some extent the belly, and should not be performed until a foundation of strength has been reestablished in the PC’s and TvA.
    Lastly, studies show that for all but sedentary women, cardiovascular capacity actually increases after delivery as compared to before pregnancy. This makes the advisement to limit walking only 10 to 15 minutes only appropriate for sedentary women.

  2. Hi Helene,

    Thank you for your comment. However, many of these exercises have proven to be very effective during the early stages of postpartum recovery in that women need to strengthen their hips and glutes as the glutes often become inhibited by poor posture and the posterior pelvic tilt that occurs later in pregnancy. A lot of people assume that women have a lordotic curve in the lumbar spine during and after pregnancy when it’s more commonly their thoracic spine that compensates. All of the above exercises were put together through research and most of them recruit the pelvic floor with movement. Dr. Bruce Crawford used bio-feedback in many of these exercises to find that automation of the pelvic floor occurred during clam shells, side lying bent knee lifts, bridges, squats and lunges. Because the core 4 works synergistically, by doing many of these exercises, TVA is used. Our core confidence program is based on research and recruiting the diaphragm, TVA, multifidus and pelvic floor as these are what make up the core and are required in the early stages of recovery on which to build. And I would have to disagree with your comment about squats and lunges (as long as no prolapse is present) as long as they are taught properly. This is a very normal function in a mother’s life and needs to be trained how to do them properly so she can safely pick up her baby, laundry etc.The cardiovascular recommendation is for new mothers who have just come home with baby and are slowly returning to movement. If you want more information, feel free to read our research here: http://www.belliesinc.com/studies/

  3. Weakness in the glutes is directly caused by the anterior pelvic tilt that ALL postpartum experience due to the weight of the uterus and shift in the center of gravity. Pregnancy causes an anterior tilt of the pelvis, not a posterior tilt. The anterior pelvic tilt causes a lordotic posture.
    Kyphosis commonly occurs during the pregnancy and postpartum period too, in response to the anterior tilt as well as increased breast size.
    I’m in total agreement that functional capacity of the “inner unit” needs to restored, but your exercises don’t address that with the exception of the first diaphragmatic breathing exercise.
    All postpartum women have a weaken pelvic floor, non-functioning abdominal wall, and structural laxity throughout the body, and posture deviations.
    Restoring neutral posture, by stretching muscle groups that have tighten during pregnancy and building strength in opposing muscles, is a necessary first rehab step.
    Because weakness in the glutes is caused by postural deviations, strengthening the muscle without addressing the root cause (pelvic alignment), or stretching the hip flexors, (the opposing muscle group) is not the most effective strategy.
    Squats place tensile forces on the pelvic floor, which is why they are used as a birth prep exercise. You say that they are OK if no prolapse is present and if taught correctly. But it’s better and safer to restore pelvic floor and core functioning before doing movements that place tensile forces on the muscle group.
    Lunges require functional stability to do well. No newly postpartum woman has functional stability in her body.
    All postpartum women need to establish a foundation of strength in the transverse abdominis and perform postpartum functional stability exercises before progressing to exercises such a lunges. Ligament laxity commonly lasts for up to six months postpartum. It’s difficult to grasp the impact of postpartum laxity, if you’ve never been postpartum.
    The cardiovascular recommendation is outdated and does not reflect research that demonstrates increased cardiovascular capacity in response to pregnancy.
    All this is not to say that your exercises are unsafe, simply not step one in postpartum rehabilitation.
    See:
    Clapp, “Exercising Through Your Pregnancy.”
    Anthony, “Pre-and-Post-Natal Fitness” ACE
    Noble, “Essential Exercises for the Childbearing Year”
    Kisner/Colby, “Therapeutic Exercise, Foundations and Techniques”

    1. Helene,
      Thank you for sharing your thoughts. Could you tell me the years of those articles you quoted in your reply? I am familiar with Noble; are you referencing a more recent article or her textbook from 1976?

      I am a Pelvic Health Physiotherapist and support what Samantha has said in this article. I use these exact exercises in my postpartum recovery protocol. By using the Core Breath to engage the deep inner unit, or Core 4, the post partum woman is not only rehabbing her transversus abdominis (TvA), but IS restoring her functional stability. It must be understood that the TvA is only 1 muscle and no muscle in the body acts alone. TvA must be synergistic with the diaphragm, multifidus and pelvic floor. (Hodges, Sapsford, Lee). Focusing on one muscle does not attain functional stability (McGill). That’s why it is crucial to integrate the Core 4 into movement that the new mother will be performing day in and day out. As such we get specificity of training at a very gentle pace. I, as recommended in the article, dose the exercises at the woman’s pace. Most of my patients average out to about 1 exercise per week. I have the distinct advantage over personal trainers, that I can be 100% assured she is recruiting her pelvic floor by using internal palpation during the actual movements. The exercises you mentioned: heel slides and toe taps are also good exercises, but not very many moms do laundry from a supine position. In a typical post partum program, I do add those and other Sahrmann type exercises in, but seeing as they work the anterior slings, and these are often overworked in pregnancy I tend to bring them in later in favor of the posterior chain.

      Many people incorrectly diagnose the pelvic tilt as anterior. In fact, in early stages the pelvis is drawn forward into anterior tilt, however as the body tries to compensate for the growing uterus and changing centre of gravity, the pelvis is then posteriorly rotated, the thorax is translated back and the lordotic curve shifts from L3 to T12, resulting in the appearance of an increased lordosis but in fact it is a sway back with the pelvis posteriorly rotated. This results in a relative nutation of the sacrum, decreasing the effectiveness of multifidus, and with the lumbar spine in flexion, creates a neural inhibition of the glutes. This also shortens the pelvic floor, and as muscles that are not at their ideal length ( too short or too long) do not work as effectively. It is quite easily tested by having them do a Core Breath, then untucking their bums (ask them to blossom their buttocks) and get the thorax forward and ask them to Core Breath again. You will see a much bigger diaphragmatic expansion/excursion. I keep adjusting them until they find the position/posture that gives them the easiest breath. So now they know how to get into alignment, and with the Core Breath, they are engaging their Core 4 in synergy and then they add it to movement.

      To your point of the squats causing tensile forces, this is true, and a good thing. When I assess for squat, I am internal, palpating the Pelvic Floor muscles and monitoring for downward descent of the pelvic organs (prolapse) to ensure they are safe to do it. During squat the PFM engage gently. The patient goes as low as she desires, but most stop around 90 degrees. In order to stretch and strengthen the pelvic floor we need gentle, graded loading. Actually this goes for all musculature, ligaments, connective tissue, and soft tissue. The squat we use to prepare for birth is a deeper squat and is normally sustained. There is quite a difference between the two movements.

      Lunges are last on the list, because by 8 weeks or more of exercise, she is ready to start. Once most women master one leg stand, they can move into lunge. Sometimes we start with static lunge, then progress to back lunges to elicit the posterior chain, then front lunges. I typically see the PFM automate (meaning it comes on without active/conscious recruitment) in back lunges before front, but again each woman is different. And I have treated women after subsequent pregnancies and births and their recruitment patterns can be different after each birth.

      We want to get women moving but we want them moving with awareness. I actually recommend women start their recovery exercises while still pregnant so that motor patterning is better postpartum. Taking advantage of muscle memory while the brain is so exhausted from lack of sleep and the huge learning curve becoming a mom brings on all on its own.

      I think it is important that while we need to be cautious post partum and take it slow, and rehab the system, we must be careful about instilling fear in women that they are fragile post partum. They are not fragile, they just need a little more TLC and some time to regain those synergies so they can go back to the exercises they love when they are ready.

      In short, Helene, while we may differ in opinion, I can say with confidence that these exercises have helped my clients retrain their core immediately post partum, and even years after birthing a baby. I even use them for rehab with my spine patients! They are gentle and safe for the post partum woman.

      Kind regards
      Julia

Leave a Reply

Your email address will not be published. Required fields are marked *