Training Through Pregnancy (Part 4): Postpartum Recovery and Returning to Exercise
Approximately 11 Minutes Reading Time
Brief Article Overview
- The road back to regular exercise after giving birth should be encouraged and celebrated, not feared and avoided. Having said that, rushing the process without a strategic plan and unrealistic expectations could end up doing more harm than good.
- In this article, we provide a strategy and highlight areas of focus along the way based on the latest research and our own experience.
- This journey back to training is broken down into 3 stages:
- Recover (0-6+ weeks after birth) – Allow the body to heal, connect with your newborn, establish new routines and re-establish healthy habits.
- Rebuild (7-18 weeks after birth) – Regain proper core function through specific postnatal exercises, then engage in light resistance and cardiovascular training to build base level strength and endurance.
- Return (19-42 weeks after birth) – Once you’re ready, start to progress your training for specific goals and test your limits again in a safe and effective manner.
Returning to regular physical exercise after birth can be confusing and stressful. It can be difficult to find fitness professionals who are experienced and competent in training postnatal clients. We understand it’s difficult to search for help and engage in open and honest conversations about your birth experience and anxieties about returning to exercise.
We’ve written this article to highlight some key points and dispel some myths when it comes to returning to exercise after pregnancy. We hope that by becoming better informed, we can help make the transition from birth to training as safe and effective as possible.
Phase 1 (0-6+ weeks after birth) – Recover
At Common Purpose we advise our clients to rest for a minimum of six weeks after birth. If the birth went without complication, then six weeks is the standard recovery time suggested by medical practitioners. If any surgical procedures (like a caesarean section) were performed, then doctors will usually suggest extending your recovery time to at least 8 weeks. These recommendations are general and individual’s recovery times will vary. But all this to say, don’t feel discouraged if you’re not back in the gym for at least two months after giving birth.
There are two important reasons why at least six weeks is recommended. Firstly, welcoming a new life into the world is an amazing and important part of your life that you’ll never get back, so we highly recommend you give yourself time to spend with your baby to connect with them, in all senses of the word.
Secondly, it must be understood that giving birth is traumatic (to say the least) and will create drastic changes within the body. Simply put, your body needs time to heal and recover. The majority of the trauma is internal and, unfortunately, it’s not unusual for medical procedures to be carried out in the process. It’s important to note that there will inevitably be scar tissue forming, which will be with you for life. For context, typical orthopaedic injuries take around 12 to 16 weeks to heal.
With all this in mind, it’s important to allow the body enough time to repair and recuperate. The priorities during the first six weeks are;
- Physically and emotionally recover from birth.
- Establish physical contact and emotional connection between the mother and baby.
- Establish new eating and sleeping patterns.
- Gentle movement (walk around the house with or without the baby).
- Start easy, low-level diaphragm-core-pelvic floor exercises in or beside the bed (if you have the energy or desire to do so!)
The Baby Blues and Postpartum Depression
The postpartum period is an inevitable rollercoaster of emotions. After such a life-changing experience, a huge shift in biological processes, routine and sleep (let alone being ultimately responsible for another life!), it’s common for postpartum mums to feel a bit down, tearful, or anxious in the first couple of weeks after giving birth;
“80% of women experience baby blues, 1 in 9 women experience postpartum depression” (1)
If the baby blues start to last longer than two weeks and/or start to get worse, then you may be experiencing postpartum depression. Here are some signs to look out for according to the NHS website (2);
- A persistent feeling of sadness and low mood.
- Lack of enjoyment and loss of interest in the wider world.
- Lack of energy and feeling tired all the time.
- Trouble sleeping at night and feeling sleepy during the day.
- Difficulty bonding with your baby.
- Withdrawing from contact with other people.
- Problems concentrating and making decisions.
- Frightening thoughts; about hurting your baby, for example.
It’s important to reach out to those close to you for help should you need it and this includes your doctor or midwife too.
We gave the majority of our nutrition advice in the previous article “Pregnancy Exercise pt3: Nutrition Advice” and we’d encourage you to continue to follow the same healthy habits. The foods we eat are literally the building blocks the body uses to repair muscles and tissues, so try to revert back to your healthy habits as quickly as possible. However, there are a few things to know during the postpartum period that can help save precious time, reduce stress and support your body’s healing processes:
- Cook food in batches – Lasagnas, tray-bakes and slow-cooker recipes are all great ways to cook multiple meals that you can store in the fridge or freezer. Cooking multiple meals in one is a massive time saver.
- Buy healthy pre-prepared foods or ingredients that are pre-chopped and seasoned – again another time-saver in the long run.
- Outsource your cooking – Turning to family members or friends for some help in making some batch cooked food can really help. Also turning to a food delivery service that makes bespoke meals are really convenient and becoming more affordable.
- Order shopping online – it’s a simple suggestion but it will certainly save time.
- Slightly increase calorie intake (but don’t force it) – as mentioned in our previous article, an extra 500kcal a day whilst breastfeeding is recommended, but it’s important to listen to your body here as it’s likely your hunger will naturally increase anyway. Try and get these extra calories through healthy food sources (maybe add an extra healthy meal to your day).
- Stay away from alcohol – According to the Mayo Clinic, there is no safe level of alcohol a mother can drink during breastfeeding since alcohol consumed will be passed to the baby via the mother’s milk (3). Alcohol also decreases milk production and also the amount the baby drinks by about 20%. We’d advise you to err on the side of caution and remain teetotal whilst breastfeeding, however, we understand the choice is ultimately down to you. It’s relatively common to hear of people consuming infrequent, low levels of alcohol away from breastfeeding times and sometimes this helps following a long period of abstinence during pregnancy.
- Increase your calcium intake – Breast milk is rich in calcium and if a breastfeeding mother is deficient then her body will turn to her own calcium stores to ensure the baby gets enough (The National Academy of Sciences recommends that women who are pregnant or breastfeeding consume 1,000 mg (milligrams) of calcium each day). Dark leafy greens and dairy products are a great natural source of calcium however a good post-natal supplement will likely have increased levels of calcium too.
- Stay Well Hydrated – Due to the amount of fluid needed during breastfeeding, guidelines stipulate that 4ltrs of water is needed every day. We understand this is a lot, so use 4ltrs as a target but don’t let it stress you out too much if you come in just shy.
Phase 2 (7 to 18 after birth) – Rebuild
After at least 6 weeks you may consider going back to the gym. Before doing so, ensure you get the go-ahead from your doctor and, for complete ease of mind, get a full assessment from a pregnancy / postnatal physiotherapist. It’s useful to get your physio and trainer to discuss your training moving forward after this assessment.
It’s common to want to go straight back to the same level of intensity and focus as you were before pregnancy. However, we encourage that you give yourself a little leniency here since your body is still in recovery mode and the new baby will likely take up a lot of your time and energy. This will also reduce any risk of injury, frustration or general “bad vibes” during a stage of training that should be enjoyed and celebrated.
During phase 2, your exercise program should be very low intensity and focus on the following areas:
Rehabilitate pelvic floor-core-diaphragm function.
Integrate this functionality into fundamental movement patterns like squats, lunges, press-ups and rows.
Return to low impact, moderate-intensity cardio training.
Have fun and build confidence!
Remember, it’s important to take it slow and build up steadily rather than expecting to jump back to your previous prenatal or even preconception routine.
Diastasis Recti Abdominis (DRA)
There is a lot of misinformation out there about diastasis recti. It’s a complex subject and the research can be quite confusing. So, what is it and what do we do about it?
“Diastasis recti is the separation of the abdominal muscles and this occurs as a normal response to a growing baby.”
Pretty much every woman will have DRA of greater than 16mm by weeks 35 to 39 of pregnancy (4). It was once believed that diastasis recti had a link to pelvic floor dysfunction and lower back pain but the causal mechanisms are proving to be more complex. There is good evidence to suggest that DRA can weaken your core strength (seems kind of obvious) and some women complain that they can’t lift as much as they used to or feel like their abdominals have less strength.
There isn’t a clear cookie-cutter program that is scientifically proven to “fix” DRA. The body’s an amazing thing and sometimes it’s just a case of facilitating (or not getting in the way) of mother nature doing her job. From our experience and research, it seems that an individualised and responsive training program that starts with restoring the pelvic floor, diaphragm and core function allows for the natural closure of DRA over time. However, it is worth reaching out to a doctor or health practitioner if you notice the following;
The separation is greater than 2 fingers in width
You have a deep diastasis of over 1cm
You notice bulging from your diastasis when bracing your abs
It’s crucial to know that your core is not just your rectus abdominis (those “6 pack abs” everyone talks about), it is all of the muscles that support your pelvis and spine including your pelvic floor (a hammock-like structure lying horizontally across your pelvis), the diaphragm (the umbrella-shaped muscle, responsible for breathing) and all of the internal and external musculature surrounding the spine itself! The correct position, coordination and function of these muscles are integral when it comes to building a robust core.
Did you know that we were all born with DRA? We’ve closed it once before, and we can close it again (shout out to Lindsay Mathews at BIRTHFIT for that little knowledge nugget). We can learn how to reintegrate our core (including DRA closure) by observing how babies do it in the first place. How cool is that?! Here are the key stages and transitions in a baby’s journey to movement;
- Babies start by lying on their back, from which they start to lift their arms and legs (dead-bugs).
- They can start to roll side to side (core rolling patterns) and eventually all the way over their front (cobra/sphinx pose) and back.
- They start to prop themselves up by either pushing themselves to an all-fours position (tabletop/bird dog) or pulling themselves up into oblique sit (think of the 1st post in a Turkish get-up).
- From these positions, they can sit upright (lotus pose) and crawl around (bear holds and crawls).
- As they build strength, they can start to explore planks, half-kneeling transitions (lunges), hip hinges (deadlifts) and squats.
- From a squat position, they can pull themselves up and use their hips and legs to stand upright.
- Once standing upright with two feet is mastered, they can then start single-leg stances, walking and finally, running.
Example Postpartum Core Exercises
Using this movement-evolution framework, we thought we’d share a few examples of some low intensity and safe-to-execute core exercises that you may want to consider including with your training regime. Be cautious in trialling these exercises and if you have any pain associated with these movements then please stop straight away and speak to your health practitioner.
- Dead-bug (click to view video)
2. Bear Hold (click to view video)
3. Bear Crawl (click to view video)
4. 1/2 Kneeling Paloff Hold (click to view video)
As you can see, we transition from the floor to an all-fours position and then up into a lunge shape, challenging the core at each stage. Remember, posture and position are important here, as well as integrating the pelvic floor and diaphragm for stability.
Phase 3 (19-42 weeks after birth) – Return
Once you’ve re-established proper core function, baseline functional strength and endurance, and you’re feeling more energised and confident; we can then start to progress the intensity, volume and variation of your training program. You may want to introduce HIT exercise back into your routine and consider some low-level reactive and dynamic exercises too.
Following the guidance of an experienced personal trainer is recommended, as they will know how to safely and strategically progress your fitness levels.
As an example, here are weeks 34-37 out of one of our postpartum training programs. It’s important to take a steady, gradual approach when increasing the difficulty of your training, especially in the postpartum period.
Note* Intensity (increasing the demand of the exercise) increases as reps decrease at week 36.
Food for thought? If this has encouraged you to think about your health, fitness & wellbeing, why not click this link and fill out our enquiry form. We’d love to see how we can help you on your journey.
Disclosure: This article is not to be used as medical advice. If you are currently experiencing physical or mental health issues, please seek professional advice from a fully qualified Nutritionist, GP or Physiotherapist.
- Ko JY, Rockhill KM, Tong VT, Morrow B, Farr SL. Trends in Postpartum Depressive Symptoms – 27 States, 2004, 2008, and 2012. MMWR Morb Mortal Wkly Rep.2017 Feb 17;66(6):153-8.
- NHS – Postnatal depression
- Breast-feeding and alcohol: is it OK to drink?[Internet]. Mayo Clinic. 2016 [cited 2017].
- Fernandes da Mota PG, Pascoal AGBA, Carita AIAD, bø K.Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6months portpartum, and relationship with lumbopelvic pain. Br J Sports Med. 2016 Sep;50(17): 1092-6