Post-natal Exercise: When and how can I start exercising again? PART 1
So you've delivered your baby and are now feeling ready to start your return to exercise journey. Here is what I am thinking and considering when I am helping someone answer this question.
I’ve decided to write a post on this because there is so much variance in the information about what is right/wrong, safe/unsafe, good/bad when it comes to getting back into exercise after you have had a baby. My aim by you reading this is for you to be more informed as to what me as a physiotherapist in the area of Women’s Health is thinking when I am considering your return to exercise.
I must first I apologise in advance and say I am not able to give you an exact week post delivery that it is now ‘safe’ to return to your exercise regime. I often hear that people attend their 6 week GP check and have been given the all clear for returning to your pre baby exercise regime. Unfortunately this is not always the right way to go about it (depending on what your exercise regime was like). The return to exercise path varies from person to person depending on your particulars. What I can do is increase your awareness of these particulars and what I am thinking about when I am considering if someone is ready to commence a particular exercise.
(The things that can impact what types of exercise would be best for you to start with)
1. Your labour and birthing experience Did you have a vaginal or caesarean delivery? If vaginal- Did you have to have an intervention such as forceps or ventouse to help your baby out? Did you push for over 2 hours? Did you get an perineal injury or an episiotomy? If so, how big was this tear (graze, first, second, third, fourth degree tear)? Has this healed well? Do you still have pain? How much did your baby weigh? How many babies have you had and has your body recovered between these pregnancies? As you can see so many factors of the labour and birthing experience can impact your return to exercise. 2. Pelvic floor health Have you done your pelvic floor rehabilitation? I cannot highlight the importance of completing pelvic floor rehabilitation after your delivery (yes those that have caesareans this includes you too). It is so important you are able to both contract AND relax your pelvic floor when you are exercising to reduce your risk of having or developing pelvic floor issues. Have a think about how your current pelvic floor function? Are you having any symptoms of weakness such as urinary or bowel incontinence or urgency? Any heaviness or pressure sensations? If this is the case we will need to ensure your exercise choices are not going to make this worse or risk further issues happening. 3. Abdominal wall recovery + core strength Have you had your abdominals checked? To ensure we give our abdominals the best chance to recover it is important we know how to correctly turn on our core muscles (pelvic floor, transverse abdominus, and diaphragm) and use this in our exercise. We don’t want to put extra pressure or force through your abdominals if you don’t have the strength to protect the area. This can lead to pelvic floor weakness and it can also hinder the healing of our abdominal stretching (recuts diastasis). 4. Your previous exercise tolerance A simple yet important factor that people often forget - You have just been pregnant so it is likely that your overall fitness has reduced. Often people will think they can pick up where they left off from their pre pregnancy exercise. Think about a rugby player that has been out for a season after a knee surgery- they don’t just suddenly start playing a full game first day back. The return is a gradual process. 5. Any current pain or history of pain with pregnancy The general recovery post delivery differs for all, I see mums who feel ok a few weeks post delivery then I see mums who feel ok months and months post delivery. Remember there is no right and wrong, each of you have had your own pregnant and birthing experience so we cannot compare ourselves! The saying no pain no gain does not apply here. You don't want to push through pain during your exercise. Remember pregnancy and childbirth is a big change for our bodies. 6. Breastfeeding status The hormonal changes associated with breastfeeding has an impact on softening in the ligaments throughout the body. The role of ligaments is to support our joints and also holds our pelvic organs (ie. your bladder, uterus, and bowel) in their correct place. We need those organs to stay where they are designed to be! This is another reason the return to exercise should be a gradual, gentle one.. to avoid these organs shifting downwards.
As you can see this is why it’s not as simple as reaching a certain week post-delivery then commencing exercise. In saying this I do not want to scare you or make you avoid exercise. Exercise is absolutely fantastic and we all know the benefits, I just want you to do it in the smartest way. A way that has the least risk of causing you issues with your healing or affecting your body in the future.
To put things in perspective I am going to give you an example of a situation I hear too often..
Claire, I think there might be something going on with my pelvic floor. I'm now 8 months post natal. I was feeling great so I started running again when I was 4 months post-natal and I've been running 2 x per week since then. It was all going well but then I did notice I would leak a little while running. This just made me increase my pelvic floor exercises but I did keep running because it wasn't that bad. Now I'm feeling this lump / heaviness sensation vaginally. It seems to be getting worse and now I'm feeling it during my normal daily activities. Can you check my pelvic floor and see what is going on??
^^ In this situation this person is having symptoms of prolapse, an issue where your pelvic organs shift downwards. Prolapse is something I want to protect people from developing and one of the main reasons the return to exercise journey should be considered by a professional who knows all about your history.
Continue reading PART TWO to develop further understanding how you can know if an exercise is appropriate for you.
Like always, if you have any questions visit the contact me page and ask away!