Exercising after giving birth - How to Start
Marianne Ryan PT was recently featured in an article written by Jessica Grose and featured in the NYT Pregnancy Guide entitles How to Start Exercising after giving birth
- If you had an uncomplicated vaginal delivery, you can start gentle exercise almost immediately after delivery. Just be sure to clear it with a medical professional first.
- If you had a cesarean or if you had any kind of birth trauma, you may need to wait longer before resuming exercise. Be gentle on your body and confer with a doctor before you begin.
- Walking 30 minutes a day, breath work and abdominal exercises are a good place to start.
- If you think you’re ready for running, try the “jump test.” If you can complete 20 jumps in a row, and four coughs after jumping, without leaking urine or any other complications, you may be ready for the treadmill.
- Exercise does not interfere with breastfeeding.
- Making your daily tasks into a workout (squat three times instead of one when picking up toys), signing up for mommy-and-me fitness classes and trying 20-minute streaming workout videos at home are great ways to fit in exercise.
I was about six weeks postpartum with my second child when I tried running again. I had an uncomplicated vaginal delivery, and within a week of giving birth, I was out power-walking with the stroller in the very early morning (I was up anyway) and starting to do core strengthening exercises. After several weeks, I felt ready to break into a trot one morning … until about three minutes into that slow jog, when it seemed like my pelvis was going to spin off its axis and hurl itself into some nearby bushes.
According to Susan Clinton, P.T., a physical therapist in Pennsylvania who has done research on pelvic pain in postpartum women, my experience wasn’t unusual, and it happens because muscle tissue stretches a great deal during pregnancy and delivery. Muscles are longer and softer for a period of time postpartum, which can lead to pain in the joints of the pelvis and pubic bones. “The whole pelvis in general can feel like it’s loose and clunky,” Clinton said.
But with time, and by listening to my body, I was able to get back to running at my pre-pregnancy rate and pace (a couple times a week, not very fast). That’s the key to exercising postpartum, said the two physical therapists and two obstetricians I spoke with for this guide: accepting that every person recovers from birth at a different clip, paying attention to your body’s cues and consulting with a medical professional before you begin any exercise regimen.
WHAT TO DO
If you delivered vaginally, you can start gentle exercise immediately.
Dr. Raul Artal, M.D., chairman emeritus of the department of obstetrics, gynecology and women’s health at St. Louis University, and author of the postpartum exercise guidelines for The American College of Obstetricians and Gynecologists, said that if you’ve had a vaginal birth, “one could return to exercise at her own pace — in consultation with a medical provider — the day after delivery.” The benefits of exercise postpartum are similar to the benefits at any other time of life: It promotes better sleep, can increase energy and relieves stress. In the postpartum period in particular, exercise can help strengthen abdominal muscles, which are weakened by pregnancy and birth.
The degree of trauma you experienced giving birth will determine the kind of exercise you do, just as the degree of trauma with any other injury would affect your exercise program. “A man who fell down on his buttocks and has trauma on his buttocks and perineum — they will get the same advice,” Dr. Artal said.
If you have severe anemia, high blood pressure, a heart or kidney condition or diabetes, you may need to delay the start of an exercise routine, said Dr. Julia Jaffe, M.D., a clinical assistant professor in the department of obstetrics and gynecology at NYU Langone Medical Center. Always check with your doctor before you begin.
If you delivered via C-section, you may need to wait a bit longer.
If you’ve had a cesarean, you may have to wait longer to hit the gym. Immediately postpartum, many women who’ve had major abdominal surgery are told not to lift anything heavier than their babies, though they are also encouraged to start walking as soon as they are able. There’s not much reliable data on exercising post C-section, though the existing research suggests that women who have had cesareans are more likely to report having had pain that interfered with their activity at eight weeks postpartum than women who delivered vaginally. Existing guidance recommends that women who have had C-sections should wait eight to 10 weeks before trying “vigorous exercise.” As with vaginal deliveries, the amount of time it takes for a C-section to heal varies by woman. “Some people handle scarring better than others,” said Clinton. Confer with your medical provider before starting any course of exercise.
Start with walking, breath work and ab exercises.
All the experts I spoke with said that walking up to 30 minutes a day is the way to get back in the game. If you can’t walk 30 minutes straight, try six sets of 5-minute walks or three sets of 10-minute walks.
To help increase abdominal strength, learn how to exhale upon exertion, said Marianne Ryan, P.T., a New York City-based physical therapist and the author of “Baby Bod,” because holding your breath while exerting yourself can weaken your abdominal and core muscles. Practice breathing during all sorts of everyday activities. “If you’re passing a bowel movement, try to support your tummy with your hands and also exhale as you’re passing it,” Ryan said.
Clinton added that motherhood is a “contact sport”: You’re picking up the baby, feeding the baby, and if you have older kids, you’re dealing with their running, jumping and throwing tantrums. You’re doing small exercises throughout the day whether you realize it or not. Clinton recommended holding your baby — and anything else you might be carrying — close to your body and not off to the side in order to protect your weakened core muscles.
Even though you’re doing tiny exercises throughout the day, you can take your core strengthening a step further by doing basic abdominal exercises as soon as you feel able. The National Academy of Sports Medicine recommends doing breath work, heel slides, leg extensions and toe taps. Start with repetitions of one to five, and then try to build up to repetitions of 10 to 20.
Before you start vigorous exercise, take stock.
Clinton said that if you are feeling any of the following during gentle activity, you may be a good candidate for physical therapy:
Leaking urine or feces. It’s a common postpartum joke to talk about how you pee every time you sneeze. This is actually not O.K.: It’s a sign that your pelvic floor muscles are out of alignment and that you could use physical therapy to get that system of muscles back in line. “Urinary incontinence will only worsen with age” if left untreated, Clinton cautioned.
Feeling a heaviness in your pelvis or something dropping into your vagina.This could be a sign of pelvic prolapse — when your uterus, bladder, vaginal vault or rectum falls into your vagina because of a weakening of the supporting tissues during childbirth. While a prolapse can correct itself without intervention in some cases, you may also need physical therapy, or a device called a pessary,which can be inserted to support the sagging organ. Consult a medical professional if you have symptoms.
Pain, especially in the joints of your pelvis. If you’re experiencing pain, it may mean you just need to cut back on whatever exercise is causing pain. If you’ve been running, try walking again; and spend more time recovering. But if you are experiencing extreme pain, contact a doctor or physical therapist.
If you want to run, try the jump test first.
To assess whether her postpartum patients are ready to run, Ryan gives them a “jump test,” which you can easily do at home: Stand with feet hip-distance apart, with a full bladder. Jump up and down 20 times in a row, and then cough four times in a row. If you did not leak any pee, if you didn’t feel a heaviness in your pelvis and if your belly is not bulging, congratulations — you’re ready for the treadmill.
If you’re worried exercise will affect breastfeeding, nurse or pump before.
There is not much research on the influence of exercise on human milk. But Dr. Artal said that there’s no good evidence that exercise is bad for breast milk or breastfeeding in general. However, he advised that if a mother is worried about the effects of exercise on her milk supply or quality, she can simply nurse or pump before exercise. This has the added benefit of being more comfortable, said Clinton: You don’t want to get engorged while you’re out on a walk.
Find time to exercise.
New parents are short on time, and finding the space for your exercise regimen can be a trial. Clinton recommended turning your own life into an exercise program. “Can you squat down three times instead of one time when you’re picking something off the ground? Can you park the car a little further to get those extra steps in?” Clinton asked. She also recommended, for those who have parental leave, searching for mommy-and-me exercise classes in your area.
There are also plenty of streaming exercise programs that are either free or reasonably priced, so you don’t have to leave the house to fit in a workout. I personally love Yoga Glo (yoga classes); Body By Simone (dance cardio); and Booya Fitness (which includes all different kinds of fitness classes). They have options that are 30 minutes or less; they are between $10 and $20 a month and most of their offerings require very little space and gear. I can do all of these programs easily from my bedroom with just a yoga mat.
WHEN TO WORRY
Severe pain, fever, dizziness, weakness, vision changes, chest tightness, shortness of breath, vomiting, heavy bleeding and leg pain or swelling can all be signs of postpartum complications, according to Dr. Jaffe. If you are experiencing any of these symptoms, stop exercising and get medical help immediately.
Jessica Grose is the lead editor of NYT Parenting and the mom of two girls (who were each 9 pounds at birth).