By Emily Koester and Robin Truxel
All of us who have had a baby experience changes in our bodies - from the hair on our heads (getting thick during pregnancy and then losing shockingly large clumps of hair in the first months postpartum) down to our feet (the swelling and even going up a shoe size). And then there is everything in between: breasts, belly, hips, thighs, and last but not least, our pelvic floor!
Soon after the baby is born, we realize that some of these changes don’t disappear. We wonder, “When will I get my body back?” If you were physically fit or very active before getting pregnant, or during pregnancy, you may bounce back from birth (vaginal or C-section) quickly, feel energized physically, and emotionally ready to start exercising again. Or you may feel eager or anxious to get moving, to do something, to change the pace of life or the repetitive routine of life with a newborn. But in this time it is important to remember to be gentle with yourself. Take the time you need to recover from the months of pregnancy and the experience of birth whether vaginal or C-section and settle into a new you and a new way of life in the first year after birth.
It takes plenty of time for our bodies to adjust to no longer being pregnant. Many of these changes are hormonal and muscular. Understanding the role of hormones and certain muscles can help us relax into our new bodies and shift our thinking into a more realistic view of the first year postpartum. With some understanding and practical tips on exercise in the first weeks and months, you can “step into your new mom body, safely and confidently, and get strong!”
Two of the most significant changes that affect your return to exercise:
- Relaxin, a hormone, begins producing from the day of conception until 3-6 months AFTER you stop breastfeeding.
- Pelvic floor and abdominal muscles stretch and support more weight.
The role of relaxin is to soften the ligaments, tendons and cartilage around your pelvis so the bones of your baby’s skull can make it out: A very important benefit! However, in your postpartum body, it can put you at a higher risk for injuries: going back to high intensity exercise too quickly can cause SI (sacroiliac) joint, pelvic and lower back injuries from overstretching and not enough stabilization.
During pregnancy, the floor of your pelvis (diamond shaped muscles that run between your two bottom bones and between your pubic bone and your tailbone) supports the extra weight of your uterus and baby. In effect, your pelvic floor and abdominal muscles have been stretched and worked for 9 months and need re-education of how to work again and support you before high intensity exercise can resume (unless you don’t mind peeing your pants!).
During delivery, these muscles can be strained and overstretched and need proper time to heal to help support your trunk again. Many women (over 50%) experience a separation of their “six pack” abdominal muscle - the diastasis recti. This muscle needs appropriate exercise so as not to worsen. Doing sit ups, crunches, full planks, running and high intensity exercise too soon or without proper instruction of pelvic floor and deep abdominal muscles can lead to a worse separation, weakening and pain of lower back and pelvic areas and other dysfunction. Every woman should have an assessment of her abdominal muscles to check if this separation has occurred as waiting too long to work on it can be disastrous down the line.
What can I do and when?
From the day after delivery you can begin to work on deep breathing exercises, inhaling all the way down into your pelvis and abdominal area and exhaling to relax and release any tension in your jaw and face. In general, but especially when feeding baby, avoid slouching and use props and pillows for nursing and/or bottle feeding so you are not hunched over your baby. Better yet, get laid back while feeding. You should be relaxing your body - and mind - whenever possible during these first weeks postpartum. This is a priority! As you move around try to think of gently lifting your ribcage up off your pelvis - this will help to properly re-educate your trunk muscles and keep your posture lengthened. If you had a vaginal delivery, practice lying on your stomach (perhaps right after nursing so it is more comfortable on your bosom). This will help your internal organs to return to place. If you had a C-section, do this as soon as you are cleared by your doctor.
For the first week, just rest and recover as your body has been through a lot! Keep practicing your deep breathing and if you can feel those diamond shaped pelvic floor muscles, try to draw them together and up, being sure to fully relax them each time (this is best practiced with an empty bladder in the beginning).
Learning how to engage and relax your pelvic floor is quite complicated as the muscle sensations are very subtle. Information can be found in books and online, but much of this information is incorrect. It takes only 15-20 minutes to learn how to find and feel these muscles. And it is imperative that you also know how to fully relax them. It can be extremely helpful to see a women’s health Physical Therapist or Pilates Instructor (see list of local resources at the end of this post) specifically trained in pelvic floor work - let her be your guide in learning these exercises. This technique is critical for connecting to your deep abdominals, improved sex and urinary continence!
In your second week post babe, continue to keep it easy and relaxed. If you do too much too soon and get injured, it can be very hard to care for your infant and also to get the treatment you need. At the 2 week mark, begin to add in some walking, starting with 10-15 minutes at a slow, relaxed pace and increasing in 5 min increments. Walking is an excellent exercise, quite under-rated. Enjoy the experience of being outside and moving your body through space - it is wonderful for your baby, too!
Continue with the walking/deep breathing/gentle pelvic floor engagement/relaxation through the next weeks.
At 6 weeks your uterus for the most part has shrunk back to your pre-pregnancy size. You will have a 6-week appointment so the doctor can check your healing. If all is well and the doctor clears you for exercise, resist the urge to go back to what you were doing before you got pregnant.
To increase your strength building and toning your muscles, Pilates is safe, gentle, and effective. Search for a Pilates or yoga studio that has instructors trained specifically to work with post-pregnancy bodies. Their focus is on educating your pelvic floor to work with your abdominals so your strength begins at the very bottom of your pelvis. Instruction emphasizes how to use these muscles during your normal day of lifting and caring for your baby, so you can be doing Pilates all day long. You will walk taller, have decreased back pain and develop this wonderful strength from the inside out! This is a critical time to get the appropriate muscles working in the right sequence and to not get hurt. If you are careful and appropriate, you will end up much stronger and happier with your body as a new mama. Continue to focus on your posture, your breathing, relaxing, and gentle stretching. Remember that your new mom body has special needs that are specific and different than the 60 other people in your group exercise class, so it is important that you get the appropriate instruction, even if you only do a few sessions and practice it yourself at home.
For at least the first 6-9 months continue with more gentle exercise: Pilates, yoga, walking, swimming.
9 months and beyond. Save the running, jumping, high intensity stuff after your muscles have regained some strength and stability - around 9 months postpartum. Your body (especially your low back and pelvis) will thank you for the re-conditioning time and energy you spent with your pelvic floor and deep abdominals!
Remember to be gentle with yourself. Give yourself permission to relax, let others do things for you (not necessarily always, but be open to receiving and/or asking for help!), choose sleep over exercise when you feel tired, eat to fuel your body. Remind yourself not to feel pressure to return to prepregnancy weight, pants size, bra size or body shape before your body is ready.
Embrace the idea of “stepping into your new mom body.” You can have a strong, nimble, flexible body by taking good care of it. These are lessons you can also pass on to your children - and you can incorporate your children into your exercise activities as well! If a mom moves through her world with happiness, strength and confidence, she raises happy, strong, confident kiddos!
Local Pilates and women’s health Physical Therapists
tru PILATES trupilates.com
Passages Physical Therapy
Lewis Pelvic Floor Therapy