The common perception based on physician recommendations after childbirth is that a woman should not exercise for 6 weeks, or until she is seen for her postpartum check up.
This recommendation is designed to protect women from injury, and to allow healing of the damaged perineum, pelvic floor, and abdomen. Caution is even more important if birth was complicated or a cesarian section was performed.
Minimizing physical strain on healing tissues is crucial to allowing women to recover well from childbirth, and in fact women in American society feel far too much pressure to get their “beach body” back ASAP after childbearing. However, in the question of “exercise” after birth, we have to consider that:
- Women HAVE to use their bodies the minute the baby is born and every minute after that – to roll over, stand up, lift and carry a 6-10lb newborn, breastfeed for long periods in various positions, and often care for older children and tend to their normal daily duties, whether or not they are “exercising.”.
- The deep core muscles that have been overstretched, overloaded, strained and torn during pregnancy and childbirth often do not simply resume their perfect pre-pregnancy function and coordination. They often require careful, intentional retraining to function normally again. This does not magically happen at the 6 week time point.
Every move we make as a human body requires a functional deep core system. Even something as simple as rolling over in bed requires the effective coordination and activation of more than 10 different muscles, and most of all the core muscles, including the diaphragm, transverse abdominis, pelvic floor, multifidi, and more superficial spinal and abdominal muscles.
So the question is not whether we need these muscles to turn back on or get stronger after pregnancy (babies get bigger, helpers go home or back to work, older children forget you just had a baby…). It is how to progress appropriately in this delicate healing period, to restore normal core function and begin strengthening while promoting tissue healing and preventing injury. (for my online postaprtum recovery program, click here.)
As a postpartum rehabilitation specialist, this is my passion. After any injury or surgery, the first task is to assess the muscles that are most impacted and restore their normal mobility, tone, and activation. In France all mothers are prescribed 6-8 weeks of postpartum rehabilitation from a pelvic physical therapist. Pelvic PT helps women manage and navigate pain, identify any red flags, ensure that the pelvic floor, abdominals, and other core muscles are functioning well, and that mothers are educated on proper body mechanics, posture and breathing for postpartum tasks like breastfeeding and carrying baby. In the U.S. most women are unaware such a service even exists, and are very rarely referred to pelvic PT after childbirth. I assure you we are here, and we are ready to help you! (to make an appointment, click here.)
After the trauma of childbirth (with about 25% currently ending in surgery), pelvic floor therapists assist mothers in careful retraining of the muscles most impacted by pregnancy and birth – the pelvic floor, transverse abdominis, superficial abdominals, and diaphragm. There are postural changes and altered breathing patterns during pregnancy that need to be corrected to allow a woman’s body to function in optimal alignment and avoid injury. There are overstretched, fatigued, strained, and torn muscles that need to be reactivated and retrained before aggressive activity can begin.
If a woman goes home from her birth experience and does nothing to strengthen her deep core muscles, retrain her pelvic floor, restore normal posture and mechanics, then the likelihood she will NOT be ready to resume exercise at the 6 week mark is pretty high. On the flip side, if she goes home and gets antsy and frustrated and starts up with her “normal” core exercises again at week 3 or 4, she is extremely likely to hurt herself and further damage the healing soft tissues of the pelvis and abdomen. There is a safe, intentional way to restore the core and return to exercise, and it is imperative that women who want to return to rigorous exercise after their 6 week clearance take the necessary interim steps to rebuild the pelvic floor and core muscles, retrain the appropriate postural responses and breath patterns, and learn how to move optimally prior to resuming impact exercise, heavy lifting, or aggressive abdominal exercise.
My #1 recommendation is for EVERY new mother to visit a pelvic physical therapist at least once after childbirth to learn the risks and benefits of the type of exercise you want to do, and what the appropriate timeline and steps are for returning to that activity. Your therapist can assess the state of YOUR individual pelvic floor and abdomen, and you and your therapist can then decide whether further care is warranted, or whether a bit of education is enough to get you where you want to go.
The #2 option if you are unable to see a pelvic floor therapist is to participate in my online postpartum rehabilitation program, which is designed to be as close to the therapy experience as possible within the limitations of a remote online platform. You can see details for the program and register at www.mombodyrehab.com, or under the Programs tab on my website. (Email me for a special offer when you mention this blog post!)
Third, there are a few things that most women will find beneficial to begin as soon as you are physically comfortable doing them, as they are natural ways to promote initial retraining of the deep core, including the pelvic floor and transverse abdominis muscles.
The first one is walking. As soon as you are physically able (within a few days if you are having a normal recovery) start walking a little more each day, preferably outside where you gain the added benefits of sunshine and fresh air, which are good for your mood provide much needed vitamin D! Walking should activate the transverse abdominis and pelvic floor, and even more so when you focus on good posture, and deep breathing. (as with any exercise postpartum, if you have any increased bleeding or pain, stop the activity and consult your doctor.) Preferably, your partner or another helper will tend the baby while you walk – this is your time to unload and revitalize your body.
The second and third initial steps are optimizing your posture and breathing. When you sit, sit up straight. When you stand, stand up tall. And at all times remember to breathe evenly and deeply – not holding your breath, and trying to get the breath to descend back down into the abdomen and lower ribcage where it was before your baby/uterus pushed it way up into your chest and neck. As you practice your posture and breathing, focus in the gentle expansion of the abdomen and ribcage with inhale, and the gentle contraction of the abdomen and pelvic floor with exhale. This focused awareness will help you get back in touch with these muscle groups while also focusing on restoring normal posture and alignment to your body.
For more detailed descriptions of the anatomy referenced, you can read my blog on Anatomy of Pregnancy, and watch my Facebook or Instagram pages for weekly tips on pregnancy, postpartum and safe recovery after baby. For thorough expert guidance through your own postpartum recovery, I would love to see you in my office, or serve you online through the Mom Body Rehab Program!
Yours in good health,
Dr. Sheri DeSchaaf, DPT