The hot topic of getting back into shape after giving birth – when is it safe to “return” to exercise? Whilst there are guidelines on safe return to exercise, let's be honest, the body is being “exercised" naturally with the demands of life with baby. But there are targeted exercises that can help to bring the body back to its most optimal function.
We are all like onions – were made up of layers.
Ok, lame attempt to start talking about the various layers of muscles in the body – all of which need targeted attention to rebuild strength from the inside out. Some considerable changes that the body goes through during pregnancy is weakening caused by stretching of tissues and muscles, especially in the deepest layers. These deep layers are what we refer to as the “core" which is made up of:
The pelvic floor muscles: Attaching like a hammock at the lower opening of the pelvis, these muscles help with controlling the passage of wees and poos, holding up pelvic organs, and of course, with delivering a baby!
The transverse abdominis or TVA: a corset-like muscle who's muscle fibres run transversely (side-to-side: yep, makes sense) to provide stability through the trunk. The good ol' abs are more superficial to these muscle (meaning at a level more close to the top, not because those who want abs are superficial 😉)
The multifidus at the back: attach at many levels of the vertebrae to provide spinal stability at each section.
The diaphragm: a dome-like muscle that separates the abdominal space and chest cavity. It pushes down to allow airflow into the lungs, and releases upward as air is expelled from the lungs.
All these sections of the core work in a co-ordinated way to manage changes in pressure in the abdominal space, and provide optimal trunk stability when they are working together.
However, the natural changes during pregnancy, as well as being less physically active, can mean there is a weakening and a breakdown of the coordination between all these sections of the core, even with basic tasks like breathing. As baby grows, there is simply less 'give' as these structures become more stretched. So it makes sense why deep diaphragmatic, "belly breathing" becomes challenging, or even simple tasks take our breath away towards the end of pregnancy:
So, post natal recovery starts here: with effective breathing and coordination of core muscles.
New mums can usually start practicing full core breathing in the first 24 hours after birth, unless medically indicated otherwise. Where I like to start is by understanding the pelvic floor- knowing what we're referring to and how to engage these correctly is a pretty important step before trying to coordinate it with other elements like breathing. For more information on the pelvic floor see the previous blog post: Get on that pelvic floor!
Keep in mind, coordinating your breath and engaging your pelvic floor is not the same as holding your breath. Breath holding actually puts opposing pressure on the pelvic floor. And contrary to popular belief, you don't need to constantly squeeze your pelvic floor for dear life. It is actually important to have dynamic functionality of these muscles – meaning it can relax and lengthen when it is needed, as well as contract appropriately. After all, its role as part of the core is to effectively manage changes in intra-abdominal pressure whilst breathing, and during other everyday tasks like lifting and so on.
Practice this first in a comfortable seated or lying down position:
Inhale into the lower belly, allowing the chest and shoulders and pelvic floor to relax
As you exhale, draw upwards from the pelvic floor
This can often be a great place to start re-gain the coordination after delivering baby.
When it comes to progressing from there, everyone's recovery journey will be different. This can depend on:
The type of delivery: vaginal vs caesarean. Most guidelines will say that moderate to intense exercise can gradually begin around 2-6 weeks for a vaginal delivery, and 6-12 weeks for a caesarean delivery. However, this timeframes vary and are largely dependent on the individual.
The type of exercises that can be safely progressed to can also depend on the degree of abdominal muscle separation (Diastasis Recti), and integrity of these tissues no matter the size of the separation after birth.
Other factors that influence timely recovery of tissues: sleep, nutrition, hydration, as well as emotional health in the post-natal period.
This British Journal of Sports Medicine recently published a great article on progression to regular planned exercise, and the simplicity and visuals are just gold. Even though the article refers to the rehabilitation steps to returning to running, many of these principles can show how important graded progression can be even for women who were relatively active prior to or during pregnancy. For most people, larger movements or whole body exercises can be progressed to once core muscle coordination and stability is obtained, to reduce the risk of injuries, or complications like back pain and pelvic floor disorders. Generally, light activities like walking, or swimming (swimming - once bleeding has stopped and wound healing has been medically cleared) that gradually build up in speed and duration can be a great place to start to rebuild strength and stamina.
Keep in mind that everyone's progression is different, and you may need more specific exercise programming depending on your body – and so I would always recommend seeing a Women's Health Physiotherapist or Exercise Physiologist to help with what you need.
Some practical things that may help include:
Ensure that you are well hydrated and eating well, especially if you are breastfeeding.
Exercise after a breastfeed, or after expressing, for comfort.
Wear appropriate exercise clothing, especially a well fitting bra that accommodates your feeding needs.
Ensure that you are also getting enough rest, and don't feel the pressure to get it all right - you have enough to juggle as it is!
Aside from planned exercise though, it goes without being said that there are many tasks day-to-day that place demands on the post-natal body. The degree of difficulty can range from getting out of bed, to picking up baby, folding and picking up prams, and even transporting baby capsules with baby loaded (all whilst holding your breath in hope that they don't wake up!)
With all these tasks, correct movement and technique can help effectively strengthen the body and reduce the risks of pain and injury. Mummy Moves is the newest addition to the Pregnancy, Baby and Me blog, where we will be building a library of movements and exercises to help mum start to effectively move again. From effective breathing and engaging of the full core, to tasks like lifting baby with the right technique, and even progressive home exercises, we'll cover simple tricks and tools to help you gain confidence in moving well. Keep a look out for more over the next few months!
📸 Photo credit: @aminahtaha