Congratulations! You’ve had a baby! As an active mom, you might be wondering how and when you can get back to your exercise routine.
First of all, it’s important to always discuss your return to exercise plans with your healthcare provider. Some pregnancy and birth-related concerns like cardiovascular health, wound healing, and postpartum complications can mean that your personal fitness journey may require special adjustments. Aside from these special circumstances, you will probably hear some general guidelines from your healthcare provider, such as to wait until about 6-8 weeks postpartum to allow early healing to take place, and then gradually build back up to your desired intensity.
That is sound advice, of course. We should absolutely take it slow, listen to our bodies, and be gentle with ourselves as we get back to it after birth. But what does that really mean? What exactly should we be listening for? The reality is that postpartum recovery can be difficult. Pregnancy and birth can leave moms feeling disconnected from their bodies and weak in their core structures. On top of the physical challenges, we are also faced with societal norms. Moms are blasted with images of fit friends and celebrities “bouncing back” and happily hopping into the gym at just a few weeks postpartum with no apparent issues or discomfort (though who knows what’s going on behind the camera?). With all of that conflicting input, where, when, and how do we even begin? Let’s get into the details of timelines, safe movements to start with, and how to know when you’re ready for more.
Generally, postpartum recovery can be broken down into three phases: early recovery, setting a foundation, and a gradual return to intensity.
Early recovery covers the first 2-6 weeks and encompasses the early stages of healing from pregnancy and birth. During this time, your body needs rest. After any type of delivery, be on the lookout for increased bleeding, heaviness, discomfort, pain, or changes at your incision or stitches including redness, heat, or delayed healing as you gradually increase your activity during the first 6 weeks postpartum. Depending on the type of delivery, you will also have specific components of healing to keep an eye on:
- After a vaginal delivery, you may continue bleeding for the first several weeks postpartum as the lochia sheds and your uterus shrinks back down to pre-pregnancy size. Once bleeding slows, you can use it as a signal: if you’re starting to bring in more activity, watch for any increase in bleeding. This could indicate that you’re doing too much, too soon. It may help to slow down, let the bleeding subside, and then ease back into movement at a more gradual pace. With any increased or excessive bleeding, it’s always a good idea to check in with your healthcare provider.
- After a c-section you’ll be recovering from a surgery as well as from pregnancy, so you’ll need to keep an eye on protecting your incision as it builds up strength and scar tissue during the early weeks postpartum. Consider using some c-section bandages from Motif Medical to help support healing and protect your incision. Walking is an excellent way to support your recovery and prevent post-surgical complications, but start slowly and build up as you’re able without pain, heaviness, or discomfort at your incision.
- Regardless of the type of delivery you’ve had, you can also begin moving through a few other basic exercises to help your body reconnect to the core and pelvic floor and establish optimal movement patterns. After all, caring for a newborn requires a whole lot of movement, even if you have an excellent support system. You’ll be getting up and down out of chairs and couches, rolling over and sitting up in bed, and picking your baby up out of their crib or bassinet at all hours of the day and night.
- Though we don’t want to bring back too much intensity with core exercise in the early weeks of the postpartum period, we can certainly keep an eye on the quality of our movements and establish a foundation of core awareness that will serve us well once we’re back in the gym or lacing up those running shoes later on. Try the movements that follow, but keep in mind that their whole purpose is connection, not just strength. Start slowly and focus on the muscles you want to be using, not so much how much weight you can lift.
- Diaphragmatic breathing with pelvic floor coordination:
- This movement is one of the most basic core connection exercises, and you can start as soon as you feel ready after birth. To start, take a deep breath. You can follow your breath for cues to reconnect with those deep layers of the pelvic floor. As you breathe in, relax your abdominal muscles, your lower belly, and your pelvic floor muscles. As you breathe out, gently lift the pelvic floor and follow by drawing in your abdominal muscles, as though you were blowing up a balloon. Try not to move your spine as you do this; this is a small, subtle movement and all your other muscles should feel relaxed. You can practice this throughout the day in various positions like lying on your back, sitting up, or hands and knees. This is a low-intensity exercise with a focus on simply connecting with these muscles, so it should feel like you’re only using around 25% of your maximal effort. Heads up: this might feel different from before birth and it may be challenging at first, but keep practicing and you should start to feel improvement in a couple of weeks. If you’re having trouble identifying these muscle groups or coordinating your breath, you may benefit from a checkup with a pelvic physical therapist to get you on track with your post-pregnancy recovery.
- Exhale as you stand:
- As you’re moving around caring for your baby, you’re likely getting up and down out of chairs, couches, and beds quite often throughout the day. Though we don’t want to launch back into squats right away post-baby, we can use the movements we’re already doing to optimize movement patterns and bring those core muscles back on board. Often, when we’re not feeling strong, we tend to rely on compensatory strategies like holding our breath, shifting our hips to the side, and rounding our spines to get up off a low surface. These strategies are fine to use now and then if you really need them, but they can put a lot of pressure on the pelvic floor, lower back, and knees, and can lead to discomfort down the road. It’s worth taking a moment to adjust your positioning and optimize your movements with this essential daily function so that you can bring all of your muscles back on board and get a little stronger every day.
- Breathing out as you do something physically challenging is a great strategy to live by for difficult movements, including getting up out of a low chair, rolling over in bed, and bending over to pick up your baby. By focusing on an exhale during exertion, rather than holding your breath, you are cueing your core muscles to activate at exactly the moment you need them the most. This strategy will carry over into a pelvic floor and core-safe exercise program for the first months to years postpartum.
- To set up your sit-to-stand, start by scooting close to the front edge of your seat. With tall posture and a long spine, hinge at your hips to lean slightly forward until you feel your weight shift off the seat (think “nose over toes”). Breathe out slowly as you press into your heels and push through your legs to come to standing (think “blow as you go”), while keeping your spine long the whole way. This strategy works well, even if you’re holding a baby in your arms - just make sure to keep their head supported as you lean forward!
Setting Your Foundation
Setting your foundation is the next step in the process. This stage varies between individuals, depending on your birth, recovery, and support systems, and generally encompasses the time frame between the first 6 weeks and the end of the fourth trimester, around 12-16 weeks. This stage is a great place to start, even if you’re years into motherhood, as long as you’re through the early recovery window. This step will see you through a gradual return to exercise, with low-impact and moderate-intensity exercise as the primary emphasis.
Your focus for this time period will be building up strength and coordination, and gradually resuming a low-impact exercise program. Some key components to this step include coordinating your breathing, core, and pelvic floor with movements, so that you’re truly moving with your muscles and not relying on compensations like holding your breath. Let’s go through a few examples and how you might progress them to really get rolling into a complete fitness program.
- Start by lying on your back with your knees bent. Gently exhale as you squeeze your buttocks and lift your hips up in the air. Inhale as you bring your hips back down to the floor. Try to keep your low back and shoulders relaxed, and focus on the glutes as the primary muscles you’re using.
- A squat is a natural progression from the sit-to-stand movement detailed above. Continue with the same movement, but take away the chair. Inhale as you squat down, and exhale as you push through your feet to stand.
- Side Plank
- Though planks have a bad reputation in the world of postpartum fitness, when done correctly they can be an excellent way to safely challenge postpartum core muscles. Start lying on your side, propped up on your elbow. Bend the bottom knee to modify the exercise so that you lift up onto your knee instead of your foot. Take a deep breath, and exhale as you draw your core in and lift up onto your knee and elbow. Access the muscles you want by pretending to (or actually do!) blow up a balloon. As with any postpartum exercise, you can keep this diastasis recti-safe by making sure you’re drawing in and using your muscles, rather than pushing out and bracing. If you’re noticing that you don’t have control over these muscles or you’re not able to exhale throughout, try making it a little easier by propping yourself up on a countertop or the edge of your bed instead of the floor.
- This exercise coordinates the core, pelvic floor, and hip muscles all while building balance and control. It’s an excellent way to prepare for running, as well as most other activities you’ll need to be ready for as a parent of growing kids. Start with feet together, standing tall. Bring one leg back behind you and drop into a lunge, keeping most of your body weight over the front foot. Exhale, draw in your pelvic floor, and press through your front foot to return to standing. Repeat on the other side.
- Elastic bands, lightweight dumbbells, or even cans of food from the pantry can work well for this exercise. Moms spend a ton of time in a rounded forward position as they carry, feed, pump, and rock their little ones. To keep that essential upper back strength, bring in a basic row. If you’re using bands, you can loop them around something sturdy like a doorknob or a railing and stay upright. If you’re using dumbbells or cans, you’ll need to hinge over at your hips and let your arms hang toward the floor. Start with your arms extended, then squeeze your back muscles between your shoulder blades to draw your arms back toward you in a row. Try to relax your neck and jaw, and focus on allowing your back muscles to do the work, as though your goal was to pull your shoulder blades together. As you do this, your chest will open up. Try to avoid rolling your shoulders forward; if you’re feeling this way, you may be trying to pull too far back.
- Low-Impact Cardio
- Lean into those long walks, stationary bicycles, and elliptical machines during these early weeks. These types of exercises are pelvic floor safe, and allow your body time to continue the rebuilding process before adding the intense challenge that impact exercise like running brings.
Return to Intensity
Return to intensity. When you’ve mastered these movements and you’re feeling strong, coordinated, and able to move through low impact exercise without heaviness, incontinence, pressure, increased bleeding, or pain, you may be ready to progress into the next step of returning to your full athletic ability during your postpartum workouts. As you begin to add impact, including running, watch out for all the symptoms mentioned above. If these symptoms appear during a workout, it’s recommended that you stop, rest, and go back to your foundational movements while slowly building back the intensity your body can handle symptom-free. This step in the process can get tricky to navigate, so it’s a great time to check in with a pelvic physical therapist to help you get to where you want to go in a safe, efficient manner. In the meantime, consider some tips for returning to running and getting yourself set up for a lifetime of healthy exercise.
- Give it time. The recommended window for initiating a return to running program is 12-16 weeks postpartum. It may seem like a long time to wait, but keep in mind that you can be setting up your foundation, working on muscular strength and low-impact cardiovascular exercise, and allowing your body the time it needs to recover fully before adding stress to the system.
- Try a couch to 5k. There is no better time to consider yourself a beginner again. Even if you ran well into your pregnancy, you have still had several weeks of rest and recovery since your birth, plus a major impact to your core and pelvic structure. A couch to 5k (even a modified version) will help you ramp back up and prevent injury along the way.
- Symptoms? Check in with a professional. It can be confusing to know what to do if you’re having symptoms with exercise. Should you stop completely? Scale back? Do some Kegel exercises? Symptoms might include pain, pressure, heaviness, a sensation that something is falling out of your vagina, increased bleeding not associated with a menstrual cycle, or urinary incontinence with activity. The resolution is not always clear-cut and might not involve completely cutting out the exercises you love, but these symptoms are always worth addressing early on. Look for a pelvic physical therapist near you for a complete evaluation and plan to get you back out there. If your symptoms are mild or you just need some basic guidance, a prenatal and postpartum fitness professional may also be able to guide your progress effectively.
These strategies can help support your system whether you're in your first months postpartum, the first year, and even if you’re years down the road. Taking the time to build back up from the inside-out as you get back into exercise will serve your body and help you stay strong and supported throughout the rest of your life. Take your time, build your foundation, and get back into what you love to do slowly and intentionally, and reach out for support from a pelvic physical therapist and/or a postpartum fitness professional to guide your progress and help you stay on track to feeling strong and amazing in your postpartum body.