Postnatal training | When can you start exercise after birth?

Getting back into exercise after giving birth seems pretty straightforward. You allow your body a bit of time to rest and heal, and off you go back to your normal routine! Right?

Not so fast…

In my experience, as a prenatal personal trainer and yoga teacher with a background in physiotherapy, it’s not as simple as it may seem.
Even before pregnancy, many women have a weak core and pelvic floor and are generally not very good at moving and breathing the right way. The pregnancy puts the body through a lot of stress, and in regards to the muscles supporting our organs during exercise, especially the abdominal muscles, low back and pelvic floor have to deal with a high amount of pressure. The high intra-abdominal pressure that is intensified when moving the wrong way, makes it even more difficult for your abdominal muscles and pelvic floor to work correctly. Often I see it resulting in a weak pelvic floor, hypermobility and joint pain around the pelvis, diastasis recti (abnormal separation if the abdominal muscles) and low back pain, both during pregnancy and after birth. The delivery in itself can also lead to certain complications, depending on how it goes. A woman who has a straightforward vaginal birth will fully recover faster than a woman who had an assisted birth or a cesarian section.

In any case, shortly after giving birth (within 24 hours) you can begin doing pelvic floor exercises to regain contact and rebuild strength in your abdominal muscles and pelvic floor. I wrote this post about exercises that have been shown to reduce diastasis recti when performed in two sessions during the first 24 hours after birth.
Those exercises are the most important to start doing, and focusing on regaining strength and function in your core for the first few weeks (or months) will benefit you in the long run. These exercises will prepare your body to get back into an exercise routine by activating and strengthening your pelvic floor muscles, the muscles stabilizing your pelvis (especially important if you suffered from low back pain or pelvic pain during your pregnancy) and help your abdominal muscles come back together.

Beyond that, when you’re ready to begin will depend a lot on how active you were before and during your pregnancy and what type of delivery you had.

I’ve had moms doing postnatal personal training sessions with me as little as 2 weeks after giving birth. Other women need 6-10 weeks, or even longer before their bodies are ready for more than the above-mentioned exercises and walking.

So how do you know when you’re ready?

The first thing to remember, when getting back into a fitness routine, is to be realistic and patient. If you push too hard in the beginning, you can actually be setting yourself back from recovery. Always start light and be guided by how you feel, and if you’re in doubt, don’t hesitate to ask your doctor or postnatal trainer, to make sure everything is working as it’s supposed to.

I know a lot of women want to tighten up their tummies after giving birth, but doing a lot of exercises increasing intra-abdominal pressure (such as crunches, sit-ups and other types of direct ab-work) can put too much pressure on your pelvic floor an inhibit healing, cause or worsen stress-incontinence and further separate the rectus abdominis and increase diastasis recti.

As a general rule, I recommend that you don’t try to return to any training, other than pelvic floor exercises and walking until your bleeding has stopped.

You need to be extra careful about exercising if you:

• Didn’t exercise before or during your pregnancy
• Had an assisted birth or experienced complications in labor
• Had a cesarian section
• Have issues with hypermobility, pelvic organ prolapse, pelvic floor disorder or hernias following pregnancy and delivery

If you’ve had a c-section, you should wait at least 6 weeks before starting exercising, to allow your body time to heal from the surgery. Wait until after your post-natal check-up at around 6 weeks, before taking up any exercise apart from pelvic floor exercises and walking.

What’s the best type of exercise to start with?

For many reasons I recommend moving as much as you can, even shortly after delivery. So what is the best way to do it?

By now I’m sure you know that you should be doing your pelvic floor exercises. In addition, going for walks is a great and low impact way to get back into exercise. Getting outside in the fresh air will help protect you from postnatal depression, too. As your strength returns, you can walk faster or go for longer walks. Just remember to listen to your body and don’t overdo things. Let this be the first step and don’t try to push too hard because you’re in a hurry to get “back in shape”. It took your body about 40 weeks to reach its current state and you have to allow the process some time.

I recommend starting with strenght training, but avoiding crunches and being careful with planks and other loaded bent-over exercises if you have a diastasis recti. If you’re not sure if you’re abdominals have split or how much, you can have a physiotherapist or your doctor examine you at the 6-week check-up.

If you don’t have a diastasis and don’t experience any issues with pain or a weak pelvic floor (i.e. stress incontinence) you can slowly go back to your usual exercise routine. Just remember that you release the hormone relaxin during pregnancy, and it causes your joints to be less stable for up to six months after birth. So keep in gentle for the first few months and don’t do anything high impact for the first few months, especially if it doesn’t feel good.

If you do have a gap between your abdominals, you have to progress with some caution. It’s all about activating your core in the right way and allowing your abdominal muscles to come back together. For that, I recommend strength exercises where you’re lying on the floor such as pull-overs, flys, presses, scull crushers, heel drops, glute bridges, dead-bug and superman variations. You can also add squats, step-ups, lunges, pull downs, seated rows, bicep curls*, face pulls*, sitting shoulder raises* and shoulder presses*.
*Do sitting variations with lower weights, focusing on drawing your ribs in and activating your core before considering doing standing versions with higher loads.

Only when you have full control with these exercises and you don’t experience “doming” of your abdominal muscles when doing a crunch movement, do I recommend doing bent over exercises such as bird-dog, planks, push-ups, bent over rows, bent over flys etc. At this stage, you can usually also safely begin with minor crossover crunch movements.

Need more help?

If you have developed significant diastasis recti during pregnancy, it might be advisable to consult with a physiotherapist or a personal trainer specializing in postnatal training.
As much as I want to offer free advice through my blog, some cases are not as straightforward and need more tailored guidance to achieve the best results.

If you live in Dubai, feel free to contact me for a free consultation. I am a personal trainer specializing in postnatal training and I have a B.Sc. in Physiotherapy from Copenhagen University College in Denmark.

I offer personalized postnatal online coaching for anyone outside Dubai interested in my help.
Contact me today to secure your spot.