Postpartum exercise… Where should you begin?
Hi, my name is Anna!
I teach yoga, strength and movement for Mama’s. I have created this space to help you to recharge, nourish your body and mind and to reconnect with yourself on this crazy journey of motherhood.
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Postpartum exercise… Where should you begin?
Training has always been such an important part of my life and one of my main coping mechanisms. But after the birth of my daughter, I had no idea what I should or shouldn’t be doing and I just felt broken.
I was dealing with the emotional rollercoaster of being a new mum, a healing episiotomy with ALL the stitches, sleepless nights, and urinary incontinence. I was told not to do any exercise or heavy lifting for 6 weeks, then when that check-up rolled around I was given the greenlight to go back to any exercise I wished, with only a few general questions on how I “felt” I was going. No follow-up on my pelvic floor or core function, no physical examination, and absolutely no guidance on what types of exercise would be safe or beneficial.
I thought back to my Mum joking about never being able to jump on a trampoline again and thought well maybe this is just how it goes after kids.
Over time, with a lot of patience, assistance from a pelvic floor physio and a growing love for my own movement practices, I was able to heal from my pelvic floor dysfunction and get back into the training I enjoyed. But I know that this is not the case for many women, and it is still a topic that is full of stigma and shame, covered up with bad pant wetting jokes.
I’m on a mission to change the narrative…
So what the heck should you be doing after your baby is born?
1 - Breath & Pelvic Core Connection
This is so so important, and is often overlooked in many mainstream mums and bubs or postpartum body programs. Let’s take a quick look into how interconnected the pelvic floor, core and diaphragm are.
So to put it simply, when you inhale your diaphragm contracts and moves down as the rib cage moves up and out and the lungs fill with air, as you exhale the diaphragm relaxes and moves up, the ribs move in and down and the air leaves the lungs.
When the diaphragm moves downwards with inspiration, the intra abdominal pressure increases and the pelvic floor also shifts downwards, you can feel this by placing your hand over your vulva and vaginal opening and feel the movement as you take a deep inhale. This shift in pressure also affects the core system, causing the abdominal muscles to shift outwards.
Pregnancy places extra strain on the pelvic floor muscles and the core. As the baby grows, there is more pressure on the pelvic floor and the linea alba (the connective tissue between your rectus abdominal muscles or six pack begins to stretch as these muscles part to make room). Stretching of the linea alba causes the majority of women to experience Diastasis Rectus (DR) or abdominal separation during pregnancy. For some women this naturally heals postpartum, but for many others it does not and requires focused core work.
Breathing can become more restricted, and a common adaptation is to breathe more into the chest and to use scapula elevation (shrugging the shoulders) on inhalation to help you breath. Postpartum, this can continue to be an unconscious habit. Hopefully during pregnancy you practiced diaphragmatic breathing, but if not don’t worry it’s not too late!
Learning to breathe diaphragmatically helps you to reconnect to the pelvic floor, rebuilds that awareness to the area and helps the body to move away from that high chest breathing and shoulder elevation. It also helps you to learn how to do 360 breathing, so you are not just breathing into the belly and placing unnecessary pressure on your linea alba, which could contribute to diastasis recti (abdominal separation).
The breathe is also so important when learning how to properly activate your core during exercise and daily tasks. When you are doing an exercise like a squat or pushup, or even picking your baby up of the ground, you want to exhale on the most difficult part of the movement (exhale on exertion), usually the concentric portion or the “up” , as this is the portion of the movement that places the most stress on the core and PF. Exhale, gentle engagement of these areas then move.
2 - Pelvic Floor Exercises: Strength & Length
Everyone knows about kegels, but there is so much more to pelvic floor training then squeezing like buggery at the traffic lights.
The added pressure on the PF during pregnancy can weaken these muscles leading to issues like incontinence, pain and pelvic organ prolapse. This can occur in c-section deliveries too, because of the impact over the course of the pregnancy not just due to the impacts of vaginal delivery.
Postpartum, comprehensive pelvic floor training should involve diaphragmatic breathing, a progressive build up of longer PF contractions in a variety of positions, strengthening of supporting muscles (such as glutes, hips and core), stretching of supporting muscles and focused PF lengthening and relaxation exercises.
A bit different from just squeezing as hard as possible when it comes to mind and hoping for the best right?
This might sound overwhelming but it doesn’t have to take loads of time. You can incorporate this type of training into your movement routine, and that can be just 10-15 minutes a day.
3 - Core/Abdominal Exercises
Training your core postpartum is vital in rebuilding strength and function, as well as improving a DR or that lower abdo bulge that is often called the “mum tum”. However there is a lot of misinformation out there about what is safe and how you should be doing it. Signing up for a 6 week summer abs challenge is probably not the best approach right now.
We often think of the core as only the rectus abdominis or the 6 pack, but our core is so much more than that. It incorporates our transverse abdominis, obliques, deep multifidus, pelvic floor and diaphragm. In simpler terms, think of it as a container, it wraps around your abdomen, including the muscles of your back and spine, is topped by your diaphragm and at the base is your pelvic floor. Core training must incorporate all of this!
Building back up slowly and progressively is key here. You want to have the diaphragmatic breathe, proper core activation and PF engagement dialed in before ramping up the intensity of your core workouts. However, gradually increasing the difficulty is a must for actually seeing results.
In the postpartum period women might experience coning/doming during certain exercises, which is when the linea alba cannot support the pressure being exerted on it and you will see a bulging out of tissue in the midline. Some women also describe an urge to hold onto their abdomen to provide extra support (more common in pregnancy). For the most part, doming should be avoided as it can increase DR.
Currently, as with most things related to pregnancy and postpartum exercise there is very little research. From what we do know, the most effective core exercise program incorporates progressive overload (gradually gets harder) and includes core stability exercises like planking and crawling, isolated core contractions, static holds like v-sits, and crunching or sit-up type exercises combined with breath work and core engagement.
These are the foundations of your return to training, and please remember that you can heal, get strong again, feel good in your body, but it does take time and patience. This is the long game, you have this body for life, so let’s switch the mindset to longevity over a quick fix. This is not the sexy abs in 7 days approach, but it actually works.
REFERENCES
Bordoni B, Sugumar K, Leslie SW. Anatomy, Abdomen and Pelvis, Pelvic Floor. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2022. PMID: 29489277.
Ribeiro, Maria Margarida, Andrade, Ana and Nunes, Inês. “Physical exercise in pregnancy: benefits, risks and prescription” Journal of Perinatal Medicine, vol. 50, no. 1, 2022, pp. 4-17. https://doi.org/10.1515/jpm-2021-0315
Thabet AA, Alshehri MA. Efficacy of deep core stability exercise program in postpartum women with diastasis recti abdominis: a randomised controlled trial. J Musculoskelet Neuronal Interact. 2019 Mar 1;19(1):62-68. PMID: 30839304; PMCID: PMC6454249.