Returning to Exercise after Birth

There is a common misconception that the 6 week visit after having your baby is when you are cleared to exercise. Let me debunk that myth.

Your body will not be ready to return to the type of exercise you did prior to birth after only 6 weeks, and that’s okay. It is still healing from the physical changes it made through pregnancy and rigors of birth. The most significant change is your pelvic floor and abdominal muscle length.

During pregnancy these muscles stretch to accommodate your growing baby. As they do, they adjust how they contract and relax to maintain as much function and stability as possible. They are meant to be able to do this.

A vaginal birth then further stretches the pelvic floor and a cesarean further stretches the abdomen. So not only does your body need to heal and adjust from pregnancy but the birth process.

Since it took roughly 40 weeks to create this change, 6 weeks is not enough time to “revert” back. This makes your pelvic floor and abdomen more vulnerable to injury in this time and the months (or years) after.

The thing about exercise after having a baby is that it can start day one. It just looks and feels very different from what most people would consider exercise because it has a whole new purpose. It’s meant to help you fully heal from pregnancy and birth. It’s meant to bring balance to your body in it’s new normal.

Of course rest and sleep gives your body the grace it needs to heal, but intentional exercise can enhance this process. Bringing balance to your body through exercise comes in many forms. Here are my top recommendations for post-birth exercise.

PROMOTE WOUND HEALING

After giving birth your body is bruised, swollen, stretched out, maybe even torn or cut. For your body to heal it goes through the 3 stages of wound healing.The first stage begins with forming platelets and constricting blood vessels to halt bleeding (not including your uterus sluffing off the extra tissue used during pregnancy). Then the area is flooded with nutrients, white blood cells, antibodies, & enzymes to prevent infection, which can cause inflammation.

The second stage is tissue proliferation, when the area needs nutrients and oxygen to develop a new matrix of tissue, which can appear within 3 days. The third stage is tissue maturation when the new matrix is remodeled to improve tensile strength, which can take up to 2 years. (check out this article to learn more, https://advancedtissue.com/2014/08/understanding-healing-stages-wounds/)

One of the critical components to wound healing is blood flow to the effected area. It removes inflammatory chemicals, unneeded medications, and toxins and brings nutrients, oxygen and healing cells to repair the healing tissue. That is why I recommend starting with gentle breathing exercises, restorative yoga poses, pelvic tilts and hip movements. Done in a safe way you:
-oxygenate your body
-massage your lymph system and organs
-improve blood flow to your pelvis

You can perform a pelvic tilt in many positions but here is an example of a pelvic tilt lying down. Create an inclined surface with blankets or pillows to reduce the anterior flare in your ribs. Lie on your back on the incline with your knees bent, hands on your pelvis so your pinkies are in the crease between your legs and pelvis or one hand on your pubic bone and the other at your belly button.

Inhale through your nose with relaxed jaw, slowly and with control allow your pelvis to flow towards your feet. You’ll feel your low back lifting from the surface you’re lying on as your pubic bone dips (lower hand drops as upper hand rises or your pinkies get folded). Then exhale out your mouth with a open “ha” sound, to slowly tilt your pelvis in the opposite direction. You’ll feel your pubic bone rise and your belly button sink as your low back flattens (your hips open around the pinkies). Do this whole movement with the least amount of muscle contraction as possible. Keep your muscles soft, keep your breath slow and gentle. Feel the movement, rather than forcing it.

RESTORE ORGAN POSITION AND FUNCTION

You may not know but your pelvic organs influence how your pelvic floor & core functions and vice versa. After birth your uterus continues to contract back to it’s -non-pregnant size. During this time your other organs, including your bladder, intestines, stomach, liver, and lungs return to non-pregnant positions.

These resting positions (or home positions) are where they function most optimally because they are under less stress. For example, when your bladder is compressed under the weight of baby it’s filling capacity is reduced increasing your need to pee more frequently. Making sure to limit strain on your organs during this time of position restoration will improve healing, return of function and avoid injury.

A great way to promote organ positioning and function (and in turn muscle function) is diaphragm breathing. This is NOT belly breathing. Breathing using your whole diaphragm expands your ribs in a 360˚ pattern with more movement in the sides and back ribs. Achieving this type of breathing gives your body the chance to balance the internal abdominal pressure that can cause a [worsening] diastasis recti and prolapse by:

-restoring natural rib and spine movement which reduces neck and shoulder tension
-synchronizing your respiratory diaphragm with your pelvic floor diaphragm (muscles) to promote natural movement of the pelvic floor
-massaging your organs & lengthens your psoas (hip flexor that attaches to your spine) ushering the organs into a more normal position
-reducing extra pressure downward into the pelvis that can occur with a shallow breath
-keeping a slight tensioning in the abs & pelvic floor with inhale to avoid over filling (path of least resistance) and helps the organs know where to stay

You can practice diaphragm breathing in any position, but a great way to do it frequently is pairing it with every time you feed your baby. As much as rounding your back over extended periods of time can be a problem, it can also force you to breath more into your back. So support yourself and baby with pillows to reduce the strain on your body. Place something under your feet or cross your legs. Round your back thinking about elongating your spine in both directions, creating space along both sides of your body, slightly pressing your mid back/ribs into the back of what you’re sitting on, while keeping your shoulder soft and open (don’t pinch either way). As you inhale expand your back ribs further outward and upward without raising your shoulders and letting your chest and belly come along for the ride. As you exhale let your ribs settle back down and in without squeezing them in. If you do this on your side make sure your ribs are tucked before having baby latch.

In addition to diaphragm breathing, exercises like gentle stretching, yoga and restorative poses eases guarding, tension and discomfort around your organs, which can be especially helpful in guiding them back to pre-pregnancy position.

RESTORE MUSCLE FUNCTION

Since the most effected area of your body is the abdomen and pelvis. This is the group of muscles that need the most work. And since these muscles control bowel, bladder sexual function, and posture, as well as contributing to all over mobility and stability to total body function, it is crucial to make sure they heal properly and fully after birth.

One of the most effective exercises to start with for this goal is core breathing. Taking diaphragmatic breathing one step further by adding a muscle contraction to facilitate your exhale. When you begin core breathing the pelvic floor always leads the contraction on exhale.

Here's what I mean, inhale filling your ribs and letting your chest, belly, pelvic floor come along for the ride (your belly inflates slightly and feel your perineum gently stretch/expand). As you exhale contract your pelvic floor muscles (you know the bottom of your pelvis that was just holding your baby up for 9 months, around your vaginal) thinking about pulling the muscles in from all four corners (pubic bone, tail bone and sitz bones) like a jelly fish [or vending machine claw] then continue that contraction into your belly by creating a smile from hip to hip and drawing your lower ribs toward your center. Then fully release on inhale and repeat. That is core breathing. Always starting off super soft on contraction and knowing that you may not feel anything initially. As long as you are not bulging your belly and perineum when you are trying to contract, don't hold your breath and fully relax on inhale (without bearing down) keep trying.

Core breathing is also the basis of most other exercise you will do after birth to restore whole body function. You can begin with smaller movement patterns and coordination to build up your control. Then as your become stronger, add in more complicated movement patterns, coordination, and force/intensity that the core needs to withstand.

Core breathing can also be applied to functional activity. Such as moving in your bed, standing from sitting, lifting your baby and gear, when you sneeze or cough, etc. Doing this will restore your natural reflex and coordination against forces your body regularly deals with. Thus improving your coordination and providing more support to your pelvic organs, bones/joints and whole body in a holistic way.

As you begin to exercise after having a baby remember it’s about healing and restoring function at first. You want to avoid over taxing your body with strenuous exercise initially, because it’s already working hard just to get you out of bed to use the toilet. Start off slow and gentle, building up your strength and endurance in a smart way.