Today the amazing Anna Cousins PT and online fitness coach provides her top tips regarding postnatal exercise. Take a read of this guest post to find out what you can do after having a baby and when, which exercises to avoid, which are safe to do and how to get that all important pelvic floor tip top again.
Anna’s postnatal programme is designed to provide a safe workout plan that will help new mums keep fit and healthy in the months following the birth of their baby.
Anna has specifically kept the workouts simple, effective and low-impact. She has designed this programme based on her experience with training postnatal women, including those who have had C-Section births. Anna focuses on breathing and activating the deep inner core muscles and pelvic floor and ensure that a new mum’s journey to recovery is safe and effective with lasting results.
This guide covers the following (all of which is also covered in her workout videos):
- Pelvic floor exercises
- Diastasis recti
- Exercises you shouldn’t do, and when you can start exercising
- C-Section exercise – do’s and don’ts
Take it away Anna!
Now that you have given birth, between feeding your baby and nappy changing, don’t forget that you have just gone through a life-changing experience – and your body needs time to adjust.
Carrying a baby for nine months and going through labour is bound to have an effect on your body. After giving birth, a new mum can experience problems such as a leaky bladder or back pain. There are ways to help deal with these, but remember that your body underwent many changes during those nine months of pregnancy and it can take just as long, or even longer, to help your post-pregnancy body return close to its pre-pregnancy shape.
Here’s a guide to help you understand what to expect from your body in the first days, weeks and months after giving birth, and when you can return to some of your usual activities.
As your body is returning to normal, there are a few precautions you should take:
Avoid exerting yourself
For the first two to four weeks after childbirth, your body will still have increased levels of the hormone relaxin – it’s job is to prepare your body for labour, for example softening the ligaments. During these first few weeks, avoid strenuous activities such as lifting anything heavier than your baby. Generally accepted advice is to wait at least four weeks if you had a Caesarean section. Even if you have a toddler who wants to be picked up, it’s best to sit down and let your child climb up on to your lap. Light housework is okay, but don’t push yourself.
If you did relaxation exercises during your pregnancy you can continue them, along with your pelvic floor exercises. After the first couple of weeks you can make a start by simply walking for 10 minutes three days a week, then gradually increase the length of the walk up to 30 minutes, or try fitting in 10-minute walks three times a day. However, the general recommendation is to wait until you have your six-week postnatal check before starting a proper exercise regime, and possibly even longer if you had a Caesarean section. Your GP or health visitor can give you the best advice.
When you’re ready to start exercising, do so gradually with low-impact exercises. This plan is designed specifically around this type of exercise.
You’ll need a new, well-fitted sports bra to provide adequate support and this will also help reduce stretch marks. Avoid a tight-fitting bra which can cause your breasts to become inflamed – this is known as mastitis. Because your feet may have become larger during pregnancy, you may need new trainers, especially to provide good ankle support in the first few months as your ligaments return to normal.
You should wait at least three to six months before starting high-impact exercises. Your body needs time to recover from the stress put on the back, joints and ligaments during pregnancy, and extra pressure on your pelvic floor can cause leakage.
After you’ve built up your strength, exercising four days a week can help you to lose about 1-3.5kg a month, as long as you are also following a good, healthy diet. You’ll need to be patient – it may take up to 12 months to reach your target – and follow a regular regime for the best results.
Pelvic Floor Exercise
During antenatal classes, you would have been advised to do pelvic floor exercises, as some women experience some loss of bladder and bowel control after birth. It’s important to continue them for a number of reasons. These muscles:
- Maintain control over your bladder and bowels whenever you sneeze, cough or lift something heavy
- Support your internal organs, in particular your bladder, uterus and intestines
- Along with other muscles, help support your back
- Help your enjoyment of sexual intercourse
Continuing to do pelvic floor exercises after childbirth can have an important impact on your wellbeing.
To keep these muscles working well, make pelvic floor exercises part of your routine for the rest of your life. You can start during pregnancy and continue after birth.
- Sit and lean slightly forward with a straight back.
- Squeeze and lift the muscles as if you are trying to stop a wee.
- Hold the squeeze as you count to 8; relax for 8 seconds. If you can’t hold for 8, just hold as long as you can.
- Repeat as many as you can, about 8 to 12 squeezes. Repeat the whole thing 3 times.
- Keep breathing while exercising. Try not to tighten your buttocks.
Another good exercise is to use your phone number as a scale. Think of a scale of 0 – 9 with 0 being a light squeeze and 9 being a hard as you can squeeze and go through the digits of your phone number – squeeze to the scale for each digit. Whenever you get a text or call – repeat the digits of that person that called you.
How can I remember to do my pelvic floor squeezes?
It’s easier to remember if you do them at the same time as you do something else. Pick something from this list. Each time you do it, do a set of squeezes too.
- after going to the toilet
- washing your hands
- having a drink
- feeding the baby
- standing in line at the supermarket checkout.
- and remember the phone number exercise
Weaker pelvic floor muscles can make you break wind more – just in case you need another reason to get serious about strengthening them, these muscles also help close off the back passage (anus). Many women find that following the birth of their baby they have less control, and find it harder to control wind, or to hold when they need to open their bowel. If you do experience problems, speak to your midwife or doctor since early treatment can be simple yet effective in improving muscle tone.
If the condition is not improving, or it worsens within, say, 2 to 6 weeks of using simple pelvic floor exercises, seek an opinion from a general practitioner who may arrange a referral to a specialist health care provider in this area.
If you do happen to develop diastasis recti after giving birth, don’t panic. In fact, all women experience some abdominal separation during pregnancy – it’s just for many (if not most) this separation is temporary. For those who are left with diastasis recti, the key is to approach it intelligently. Do not freak out and start doing sit-ups and crunches like a crazy person. These types of abdominal exercises can actually be counter-productive and may make the diastasis recti worse. The focus needs to be on shifting the transverse abdominal muscle. This can be done with glute bridges, bodyweight exercises and also modified core exercises as well. Stretching and breathing techniques are also extremely beneficial.
How do I check if I have diastasis recti?
Lie down on your back with your knees bent. Place your fingers over the centre of your abdomen. Nod your chin to your chest and lift your shoulders just a little while contracting your abdominal muscles (you’re essentially performing an abdominal crunch). Feel the distance between the left and right halves of the abdominal muscles with your fingers, starting at the top and moving down the length toward your pubic bones. It will be separated less or more depending on where you are feeling along this line, so take your time to assess its whole length. Typically, the widest separation will be close to the belly button.
Is there a gap running down the middle of your stomach equal to or less than two fingers’ width? If so, then you have a mild separation that will probably resolve with correct conditioning. All workouts in this programme include exercise to help you rectify and prevent this happening.
Exercise you shouldn’t do.
As mentioned previously, during pregnancy your body produces relaxin. This hormone makes your ligaments stretchy and elastic in preparation for childbirth. Relaxin affects every joint in the body and it can take up to five months for your ligaments to get back into their original positions and stabilise. As a result, your joints may be weaker than usual, increasing the risk of your ankles, knees, hips, pelvis and spine weakening under impact.
If you had a caesarean birth you will probably need to wait a little longer than 6 weeks for your body to recover to get back into exercise. Again, wait until your sign off from your GP or midwife.
High-impact exercise is generally best avoided for at least three to six months after the birth of your child because of the effect on your joints. Whatever type of exercise you choose to do and whenever you choose to do it, listen to your body and try not to overexert yourself.
The abdominals can take time to re-align after your baby has been born, so avoid sit-ups for several weeks and indeed months (or for some, years) after birth.
What do sit-ups do? They strengthen and work the six-pack muscle. During pregnancy, we know that this muscle has lengthened and separated. If you don’t have a solid foundation underneath this six-pack muscle before you work it, then by doing crunches, you’re actually going to make your separation of these muscles worse. In other words, any separation you had after birth will now be wider, because you’re forcing the muscle to strengthen when it’s still in a weakened, separated state. The amount of abdominal pressure placed on the six-pack muscle when performing a sit-up, forces it to separate further apart.
Instead there should be a focus on pelvic floor strengthening and activating and working the transversus abdominis (TVA) muscles first.
Planks are a great exercise post-pregnancy but detrimental to your recovery and getting your stomach back to where it was pregnancy if you are not connecting with your deep core muscles as mentioned above.
So, leave these exercises out until you have progressed to the stage you are confident that you have nailed it with regards to your TVA activation exercises.
One way of knowing whether you are able to do this is to make sure you perform the workout for TVA and pelvic floor – so don’t fret it’s all in this plan.
Also, other spinal extension movements such as back extensions are also out. This is because they increase stress on the abdominal tissues, which again relates to the above – a weak TVA and pelvic floor will result in pain, injury and a prolonged recovery.
4. Overhead weight training
These can put downward pressure on the pelvic floor during a time where everything is working to heal up and in.
This is why I have used modifications within this plan, e.g. keeping lighter weights at chest height or lower. For example, if you want to work your shoulders, try upright rows or lateral raises instead of overhead presses. For triceps, instead of overhead triceps extensions, do bent-over triceps extensions.
5. HIIT training.
Since HIIT is an advanced training option, it’s not one that we want to start to jump right back into after we’re cleared to exercise again (even though I know, it’s really tempting). The impact can cause pressure on our pelvic floors (which are still weak and healing from birth) and the cardiovascular workload can be too high to jump back into. It’s smarter to work your way up to consistent moderate endurance training before jumping into intervals.
6. Wide heavy squats.
These can also put downward pressure on the pelvic floor. After the birth, relaxin is still present in the body, which can make us more susceptible to over-stretching and injury.
Great modifications which I include in this plan are glute bridges, lunges, hip raises and thrusts. These will still challenge your glutes and develop core strength, while at the same time facilitating healing.
As you are reading this, you may be thinking “but when can I start these?”
Every new mum is different and it all depends on how quickly you have recovered. For those that exercised throughout pregnancy and developed a strong pelvic floor, they will find they can get back in to the above a lot quicker than someone that has never exercised before and has a weak TVA connection. I always recommend that you wait at least 12-26 weeks (dependent on your recovery) before attempting to up your intensity too much – gradual increase is key to preventing injury. It is important to not push yourself when you think you can, as it may set you back and slow down your progress. Remember to listen to your body, if it doesn’t feel right – don’t do it!
Exercise and breast feeding
Many women have questions, concerns and doubts regarding exercise while breastfeeding. Is it okay? Will it affect my milk supply? Will it change the taste of my milk? Will it affect the baby? And the list goes on.
Here are four important facts to know that’ll put your mind at ease:
- Exercise won’t hurt your milk supply. As long as you maintain a healthy diet, your milk supply should not be affected by exercise. Your body burns about 500 calories per day to produce the milk your baby needs. If you are exercising a lot, you have to make up for the extra calories expended.
- It won’t change the taste, either. Some old wives’ tales caution against too much exercise because it makes your milk sour so that babies won’t want to feed. It turns out there may be some truth to that belief. Studies have shown that lactic acid levels in breast milk are significantly elevated for up to 90 minutes after maximal exercise, which may adversely alter the flavour of the milk. The good news is that there is no such elevation in lactic acid levels after moderate activity. So as long as you keep your aerobic exercise in the 80% of maximal heart rate range, your baby won’t notice a difference. Since you may sweat while working out, be sure to shower or at least wipe off your nipples or they may taste salty!
- Your breast milk is still as nutritional as ever – even after a workout. Studies show that exclusively breastfed babies of mums who exercise regularly grow just as robustly as those whose moms are sedentary. Those bonus immune-boosters in breast milk don’t seem to be altered with moderate exercise either. Another study showed that women who performed moderate aerobic exercise for 30 minutes three times per week had the same levels of the immune-boosting compounds in breast milk as those who didn’t exercise, and, not surprisingly, those women exhibited higher levels of cardiovascular fitness.
You’re going to need to be patient with the process and not “push through”. There is no rush. Heal well now and save yourself issues down the road in the short and long term.
Think of a C-section as you would another surgery such as an torn ligament repair in the knee. The rehabilitation for this is a nine to 12-month process. There are steps and checks along the way with the surgeon, the physiotherapist, and a set timeline of when it is safe to return to certain activities.
Although your doctor may “clear you for exercise” at six-weeks post, be certain that this means light and gentle exercise. The types of exercise that will be beneficial at this time are, for example, breathing, walking, core restoration, and bodyweight exercises, all of which are in my plan. The types of exercise that will not be beneficial at this time are much similar to those for natural births, for example, running, jumping, heavy weight training, crunches, leg raises, and other traditional “ab” exercises.
Keep in mind, the healing process is not done at six weeks. From the outside, your scar might appear healed, but the deeper layers inside still need time. Just the scar alone is many layers deep, the tissues that you can’t see are still recovering. Just because your scar appears healed from the outside, doesn’t necessarily mean the tissue on the inside is healed.
So, my pelvic floor should be fine then?
Although a vaginal birth can increase the risk of pelvic floor dysfunction post-birth, you still went through a pregnancy, regardless of the C-section delivery. Pregnancy in itself heightens your risk of pelvic floor dysfunction. We still must reprogram the core, which involves integration with the pelvic floor.
Here are some of the reasons why we still need to focus on the health of the pelvic floor after having a C-section:
- The downward pressure of your baby on your pelvic floor muscles can stretch these muscles and their connective tissues, leaving them more lax than normal.
- Your expanding uterus puts pressure against your other pelvic organs, including the bladder and rectum, and can disrupt their normal function.
- C-section scars can be tricky for pelvic nerve function, leading to such things as urethral burning, feeling like you need to pee all the time, and pain in the clitoris and labia.
- The alignment changes that happen during pregnancy and postpartum (for example standing with your bum tucked under) can affect the tone of your pelvic floor muscles, leaving them tight and short.
In the early days and weeks following your C-section you’re going to be focused on resting and relaxing as much as possible with your new baby. These are the main things you will want to do in the first 6 weeks postpartum:
- Ask for help.
You’re going to want to do things yourself, but try to reign yourself in. Allow yourself to receive help and offers from your friends and family – they really want to!
- Rolling over.
Every time you go to lie down or to move from your back to a seated position, you’re going to lie to your side first. This is so we can avoid big crunching and sit-up type movements that put a ton of pressure on the abdominals and scar. An example of this is getting into and out of bed. Get into the habit of lying on your side and then slowly rolling to your back when getting into bed. Getting out of bed, roll to your side, lower your legs off the bed, then use your upper body strength to push yourself up to seated. If you can, get someone to help you with this as well.
- Restorative breathing.
Core restoration can start within the first few days postpartum. You are going to start reprogramming your core to function from your diaphragm down to your pelvic floor muscles with connective breathing.
On your inhale breath, feel your ribcage and your belly gently expand and relax. On your exhale breath, gently exhale to encourage gentle activation through your pelvic floor and deep abdominal muscles. Before you do any exertion, say getting out of bed or picking up the baby, practice your connective breathing. Start your exhale breath and then begin your movement or lift.
In the first few days, you’ll want to stay off your feet as much as possible. As you begin to heal, slowly increase the amount of walking you’re doing around the house. Monitor your energy levels that day and the next, and if you’re feeling good, you can keep slowly increasing your movement. Start with short outdoor leisurely walking and gradually increase your time. Use this as a time to breathe, relax, and move.
- See a Women’s Health Physiotherapist/Physical Therapist.
Within the first six weeks (or earlier) after baby arrives, you should see a women’s health physio, even if you’re not having any discomfort, and assuming that your doctor has given you clearance. They can make sure you’re healing well, your pelvic floor is functioning on point, and start doing some really important scar mobilisation.
Depending on your healing process, you may begin core restoration exercises in addition to the connective breathing exercises, prior to your 6-week checkup. There really is no specific date for when you should begin adding in more activity, as everyone heals at their own pace. Some new mums can begin adding in exercises 6 weeks postpartum, but only after sign off from your midwife and/or physio.
Examples of beneficial core restoration exercises are:
- Glute Bridges
- Side Lying Knee Abduction
Again – don’t fret – all of this is in the plan and videos for you to follow!
Returning to Strength Training After C-Section
In your return to more traditional strength training (after your six-week clearance and a check-in with the pelvic floor physio), you’ll want to allow your body plenty of time to adapt to the increase in movement and a good deal of recovery time between bouts of exercise. If you have any bleeding or pain (scar, pelvic, back) at all during or after exercise, stop and consult your doctor.
It’s a good idea to start with two workout sessions per week of 15 minutes duration, and if you’d like, slowly increase from there. Increase your workout duration by five minutes bi-weekly. You can then increase this to 40 – 60 minutes, three to four sessions per week. You can slowly build up to this amount if that works for your lifestyle and needs.
You’ll want to use your bodyweight, resistance bands and light weights.
It is important that in each of the exercises that you perform, you’re keeping your body in “neutral alignment”. This means that your spine is kept in a long, straight line.
The return to exercise post C-section is very much similar to the return to postnatal exercise after a vaginal birth. Really pay attention to how your body feels during exercises. Above all, move in ways that make you feel safe, amazing, and energized during and after exercise.
On the “exercises to avoid list” (which is very similar to those for a natural birth) you’ll find:
- Crunches, sit-ups, leg raises, and front planks
- Running, jumping, step ups, HIIT
- Heavy overhead presses
- Heavily weighted exercises
- Anything with direct downward pressure on the pelvic floor, such as a barbell back squat.
Q1. Do I need to eat a special diet if I am breastfeeding?
No, you don’t need to eat anything special, but like all new mothers you do need to eat healthily. This means including five portions of fruit and vegetables a day, eating plenty of starchy foods such as wholemeal bread and pasta, as well as protein found in lean meat, fish, eggs and pulses. You should also include dairy foods such as cheese and yoghurt and drink skimmed or semi-skimmed milk as well as lots of water. Avoid drinking too many drinks containing caffeine while your baby is very small as it will be passed through your breast milk to your baby and will keep him awake.
Q2. Should I take extra vitamins?
You should be getting all the vitamins you need from a healthy diet. However, if you are breastfeeding it is recommended that you take a daily supplement containing 10mcg of vitamin D. Your GP or health visitor will be able to advise you.
Q3. How long will it take to get back in shape and lose weight after pregnancy?
You need to give yourself time to get back to your pre-pregnancy shape. It took nine months to make your baby and it can take at least six months to get back to your pre-pregnancy weight after the birth. If you put on a lot of weight during pregnancy it could take longer than this to lose.
Q4. When can I get back to exercise?
You should wait until after your postnatal check before starting any exercise routine, but this doesn’t mean that you can’t do gentle exercises now. The most important of these are pelvic floor exercises. These will help your perineum and vagina to heal more quickly and will strengthen your pelvic floor.
Walking, pushing your baby in the pram, is another good form of exercise for this postnatal period and it is a great way for both of you to get out in the fresh air.
Q5. How soon will I be able to start exercising after having a C-section?
A Caesarean is a major operation so it is important to give yourself time to heal. You should not to do any strenuous exercise or heavy lifting for at least two months. I have provided you with safe, gentle toning exercises you can do in this plan. Pelvic floor exercises are also very important after a Caesarean and you should start these as soon as you feel ready to do them.