Pregnancy is a time of change. It’s a time of “new life” and “expansion” - physically, emotionally, and spiritually. All women, no matter what age, shape, or fitness, experience incredible physical changes during pregnancy. It takes some time to return to your pre-pregnant fitness level and shape. If you are working on getting back into shape after the birth of your baby, it is essential to exercise at a safe postnatal level. Consider the following advice.
1. Regular exercise after your pregnancy can help you to return to your pre-pregnancy weight more easily, reduce back pain, improve or maintain muscle tone, reduce leg cramps, swelling and constipation and improve sleep patterns. Women who exercise regularly often feel better about themselves and can cope more easily with the demands of motherhood.
2. Appropriate exercises during the first four to six months after the birth of your child include walking, swimming (once bleeding has stopped), postnatal exercise classes, water aerobics (low impact to start with), and low impact aerobics. Your fitness professional may be able to provide you with a light weights program that allows you to maintain your posture and does not involve holding your breath.
3. You can gradually increase the intensity of your exercise program as you feel able to, provided you do not experience any pain or discomfort.
4. It is very important that your pelvic floor and abdominal muscles have regained sufficient strength before you recommence sport, aerobics, running, or heavy lifting. Most women will require a minimum of twelve to sixteen weeks of exercise to strengthen their pelvic floor and abdominal muscles before they return to their normal exercise routine.
5. You should not experience any back pain, pelvic or vaginal heaviness, or urine loss during or after exercise. If you do, slow down or reduce your intensity level. If pain or discomfort persists consult your doctor or continence and women’s health physiotherapist.
6. Women often incorrectly believe sport and other high-impact exercises will take care of their pelvic floor muscles. Participating in sport, running, or other high-impact activities during pregnancy and early after childbirth may actually reduce pelvic floor muscle strength and cause long-term bladder and bowel problems, including the risk of prolapse requiring surgical repair.
7. Always wear a good supportive bra while exercising – check your bathing costume for support too if you are doing water aerobics. You may wish to wear a bra under your costume.
8. Always maintain correct form and posture during exercise. Use postnatal abdominal muscle bracing, drawing in your pelvic floor and lower abdominal muscles, making sure that you continue to breathe easily. Be aware of your back at all times. To maintain good posture when standing, lift yourself up tall, stand with your lower abdominal muscles drawn in, your shoulders back, and gently nod your chin in. Aim to maintain this position regularly during the day.
9. Nothing should hurt! Exercise should make you feel good, gently increase your fitness and be fun. If any exercise causes pain, stop it immediately or advise the instructor if you are in a class.
10. Take care not to overdo it! The disruption of your sleep pattern due to your baby means you are often tired before you start to exercise. Stop exercising before you reach exhaustion. Have a rest during exercise if you feel you need one. Remember to work at your own pace.
11. Always take a water bottle with you when you exercise, even in a pool - dehydration can still occur in water even though you don’t notice it as much. Drink small amounts of fluid regularly before, during, and after exercise.
Pelvic Floor Muscles
12. The muscles that make up your pelvic floor provide support for your pelvic organs and help prevent poor bladder and bowel control and incontinence. These muscles are stretched and weakened during pregnancy and childbirth. After you have had your baby, your pelvic floor muscles may be weaker and harder to feel.
13. Aim to start to do pelvic floor exercises within the first few days after the birth to strengthen these muscles again. Even women who have had stitches can do pelvic floor muscle exercises.
14. Choose some activities from your daily routine which will remind you to do your pelvic floor exercises, for example when sitting to feed your baby.
15. If you are not sure you are doing your pelvic floor exercises correctly, a physiotherapist with special skills and training in women’s health can assist you.
16. You should seek the advice of your doctor or a physiotherapist working in the area of women’s health if you experience ongoing vaginal slackness or lack of feeling, vaginal bulging, or leakage of urine, wind or feces after the birth of your baby. Treatment is available to help reduce these problems.
17. Keep up your pelvic floor muscle exercises even after your muscles feel like they are back to normal. This will help them to stay strong and to prevent any problems developing with further pregnancies or as you get older.
18. Sometimes sexual intercourse can be painful after the birth of your baby following stitches due to the scar tissue. If this happens, speak to your doctor and seek treatment from a physiotherapist working in the area of women’s health.
Abdominal Muscles
19. After pregnancy your stomach muscles are stretched and do not protect your back as much as usual. Your lower back and pelvis need to be supported and stabilized by muscles to protect your spine from being injured when lifting, moving, and carrying objects, including your baby.
20. Your deepest abdominal muscle layer is like a living corset. It helps to stabilize your spine before any movement or action. This is known as the Transversus Abdominus (TA) muscle.
21. Since the TA muscle stretches during pregnancy, it is necessary to work this muscle soon after the birth to return it to normal function. It takes at least eight weeks after childbirth for your abdominal muscles to regain enough strength to effectively stabilize your pelvis and protect your spine.
22. Strong abdominal muscles support your back and help prevent the development of low back pain. Going back to sport before the abdominal muscles stabilize and support the spine properly increases the risk of a back injury.
23. The pregnancy hormone Relaxin, which softens your joints, still has effects after birth, which may increase the risk of injury. ‘Pick up’ your pelvic floor and draw in your abdominal muscles when lifting and maintain good posture.
24. Sit-ups and curl-ups do not work the TA muscle correctly. Stomach curls and crunches should cease as soon as you are pregnant and should not be performed until your deeper abdominal and pelvic floor muscles have regained their strength after the birth. Your physiotherapist or fitness professional can help you learn pregnancy and postnatal abdominal bracing exercises to provide support to the baby during pregnancy and to tone your abdominal muscles up after the birth.
25. Effective exercise for restoring the TA muscle after childbirth can be fitted into the daily routine of caring for a new baby more easily than making time to do sit-ups, which do not promote the stability of the spine.
26. A range of postnatal abdominal muscle exercises are available – choose the level that is right for you.