Postpartum Exercise: What You Need To Know From A Women's Health Physio
As many of you know, I recently welcomed my beautiful baby boy into the world! If you follow me on my instagram @nourish_naturally, you would have seen that I have slowly and safely been getting back into training and exercise under the guidance of my Women's Health Physio Ciaran Fox (nee Williams).
I've received hundreds of questions about postpartum exercise but this is not my area of expertise! So I've enlisted the help of my Women's Health Physio Ciaran Fox to answer all your postpartum exercise questions!
What You Need To Know About Postpartum Exercise
When it comes to postpartum exerciseguidelines there can’t be a “one-size-fits-all” approach. Every pregnancy isdifferent, every labour and birth is different and as a result every woman’spost-partum journey and recovery need to be different!
Let’s take two women who were both healthyand active before they fell pregnant…
Jill suffered very little morning sickness and continued to run and lift weights into her third trimester, in the final few weeks she didn’t feel comfortable running anymore, but was able to continue walking and swimming.
Sara had terrible sickness for the first 18 weeks of her pregnancy, she felt terrible every day and only had enough energy to go to work and do short activities around the house. Sara also had placenta previa and her doctors didn’t want her doing any weights or running. She was cleared to start some walking and when her nausea subsided she started walking through her second and third trimester.
Both of these women want to return to high-impact exercise like running or sport after their pregnancy. Remember that Jill only had 4-weeks where she didn’t run or lift weights towards the end of her pregnancy, whereas Sara had around 9 months without running, high impact exercises or weights. These two women (without even looking at their labours, births and postpartum status) are going to have to approach their return to exercise in very different ways… Sara in particular will need to slowly build up her strength, fitness and impact tolerance because she has been away from activity for a longer period!
When we look at the labour and birth process, there is the obvious difference between a vaginal birth and a caesarean section. Women who deliver vaginally will often experience trauma to their perineum (the area between the anus and vulva), including the skin, muscles and connective tissues in this area. Whereas, women who deliver via caesarean section will experience trauma to their abdomen including the muscle layers, connective tissues and skin in this area. Other factors like the time spent in labour, how fast (or slow) the “pushing” phase of labour was, how large the baby being delivered was, if the assistance of forceps or vacuum were needed and the extent of any tearing in the perineum can all affect the recovery needed from the labour and birth.
Exercise In The Early Postpartum Period (<6 Weeks)
“Listen to your body”, there has never been a truer phrase when it comes to the early postpartum period.
In that early postpartum period, your bodyis trying to recover from the end of your pregnancy (when you were carryingaround extra weight and often experiencing sleepless nights) and your effortsin labour.
You are often in pain (from your c-sectionsite and/or your perineum), you are also learning how to look after a new baby,functioning on reduced sleep and possibly even attempting to breastfeed.
During this early phase, it is importantto give your body adequate rest and time to recover!
Women who deliver via c-section are given the same instructions as any abdominal surgery:
- Avoid lifting, driving andany abdominal loading exercises for 6-weeks inorder to allow the abdomen to heal and avoid overloading the stitches.
I would give women who have delivered vaginally similar advice:
- Reduce the loads throughyour pelvic floor in those first 6-weeks in orderto allow healing in the perineum and avoid overloading the tissues!
Keep in mind that your pelvic floor is under load or working for you whenever you are up against gravity! So it’s being loaded whenever you are sitting and standing throughout the day and more so with walking or carrying bub!
Answering Your Questions About Postpartum Exercise
Many of your questions have asked about what exercises to avoid or start in the early postpartum period.
It is important that before you commence any strength or cardio exercise that you seek an assessment and advice from a physiotherapist experienced treating women in the post-partum period.
Your physiotherapist assessment should include the following:
- Assess your body as a whole, looking at key areas like pelvic, hip and trunk strength and control depending on what activities you are looking to return to.
- Assess your pelvic floor, which will generally involve an internal examination to determine pelvic floor muscle activation and strength and connective tissue integrity in the perineum.
- Assess your abdominal strength and any abdominal separation.
By assessing all of these areas and takinginto account your activity levels before and during your pregnancy, yourphysiotherapist should then start you on an individualised exercise program toaddress any activation, coordination and strength deficits. They will also giveyou advice on what level of activity you could begin returning to and how itwill be progressed over subsequent weeks to help you to return to what youlove!
Most physiotherapists will assess yousomewhere between 4-8 weeks post-partum. This should allow your body to startsome of it’s natural recovery and healing and will ensure that you’re not toosore for an assessment.
In the early postpartum period (before your assessment with a physiotherapist) many women find that they need to return to some light activity, more for their mental well-being than fitness or strength! I encourage women that if they feel up to a light walk or (once you have been cleared by your doctor that your stitches have healed) a light swim may make you feel more human during those first few weeks!
It is important that you monitor your ownbody for symptoms that the exercise you have started might be too hard, theseinclude:
- Any pain in your body inresponse to the exercise e.g. hip pain, lower back or pelvic pain, foot pain,pelvic floor pain
- Any feelings of heaviness orbulging in your perineum
- Any incontinence (leakage) ofurine, faeces or flatulence
* Keep in mind that most prams weighupwards of 10kg (and this isn’t including the weight of your newborn and a babybag!), so in the first few weeks pushing the pram when walking may be tootaxing for you! Also be wary of doing long walks with your baby in a carrierbecause this is akin to doing a walk with a weight vest on and may also be toomuch in the early postpartum period!
* Even if you delivered vaginally you maynot be ready to start any abdominal exercises in the first 6-weeks. Even somesimple abdominal exercises like a crunch or sit-up put a lot of downwardpressure on your pelvic floor and this can overload your perineum in the earlypostpartum period! Make sure you check with your physiotherapist beforereturning to abdominal exercises!
Pelvic Floor
You have all askedquestions about pelvic floor exercises after birth, which is GREAT! The factthat more women are aware of their pelvic floor and the need to rehabilitate itafter pregnancy and birthing babies, means that less women should be sufferingin silence and we might even be able to prevent women having issues likeincontinence (leakage) and prolapse in the future!
Remember that inthe early postpartum period, your pelvic floor may be swollen and tender (ifyou gave birth vaginally). This means that any exercises you do in this earlypostpartum period should aim to reduce swelling and get the muscles to switchon again (rather than gaining strength)! Look to start with small pulses ofyour pelvic floor muscles i.e. “squeeze and relax” and only small numbers ofactivations before having a rest.
Reducing Pain
The following can help to reduce pain and swelling in your perineum:
- R – REST: try to give yourself periods of time in the day where you lay down to give your pelvic floor a rest from working up against gravity
- I – ICE: many postnatal wards will have small ice-blocks in the freezer to be used for icing your perineum. Remember not to put the ice directly onto your skin, but rather wrap it in paper towel or create a hole in your panty-liner to put the ice-block in.
- C – COMPRESSION: you may choose to wear recovery garments, like recovery shorts, that give your perineum some support and compression to reduce swelling
- E – ELEVATION: again try to have lying breaks so your pelvis is elevated to allow swelling to move away from the area.
Pelvic Floor Exercises
Whilst many women are keen to start their pelvic floor exercises as early as possible in the postpartum period, it is also important that you are doing them correctly!
Studies thatlooked at whether women can perform an effective pelvic floor musclecontraction with only verbal instructions found that 30% of women didn’tactivate their pelvic floor muscles at all but were instead using their legmuscles to “squeeze”. Some women (25%) were even pushing down and out withtheir pelvic floor muscles rather than squeezing in and lifting up!
In your postpartumphysiotherapy assessment, your pelvic floor will be assessed to ensure that youare activating your pelvic floor muscles correctly. Often your physiotherapistwill need to try different “cues” til they find the one that helps you toachieve the best activation or “squeeze” of your pelvic floor.
Once you canachieve this correct activation of your pelvic floor, your physiotherapist canthen work out your individualised program of pelvic floor exercises. Dependingon what your pelvic floor needs e.g. more strength in the squeeze or moreholding time, will then effect the type of exercises you are given! Yourphysiotherapist will also tell you exactly how many repetitions you should aimfor in each session, in my experience a lot of women are told to do 10x10second holds, but most struggle to do 5x 2second holds in the earlypostpartum period.
PART 2 on Prolapse and Abdominal Separation (Rectus Abdominus Diastasis) COMING SOON!
About Ciaran
Ciaran Fox (nee Williams) is a physiotherapist based in Caringbah, Sydney. Ciaran has a strong background in musculoskeletal, sports and women’s health physiotherapy.
Having started her career working on thesidelines of women’s sports fields and within private practice locations, shedeveloped an interest in helping women with both musculoskeletal and pelvicfloor issues! She has completed postgraduate courses in pregnancyphysiotherapy, hip, pelvis and rib pain and women’s health management ofincontinence, prolapse and return to sport screening!
She is passionate about working with womenthrough their pregnancies and into the postpartum period, to help them remainactive or return to the activities that they love!
Outside of the clinic, Ciaran has her handsfull with 8-month old Owen. She is also a keen runner and loves a goodsandhills session or more recently a run with Owen in the running pram!
Contact Details and to book an appointment with Ciaran:
Ph: (02) 8544 3680
6/345 Kingsway Caringbah, NSW 2229
Editor's Note: This post is for information purposes only. Always consult your health care professional for personalised advice.
