For many women exercise during pregnancy is determined by sleep, energy, nausea and any discomfort. You’ll most likely have done what you could around how you were feeling as the weeks progressed and hopefully have found a coach or class teacher who specialises in pregnancy. GP and hospital appointments also provide the opportunity to ask questions and recommendations on classes aren’t usually in short supply.
After the baby is born the focus tends to be more on the baby than on the baby and mother. Anecdotally, the focus on the mother at a standard 6 week check up can be as brief as ‘and how are you, all okay?’ which is a clear juxtaposition when our generation values self care and we know where attempting to pour from an empty glass can get us. While exercise during pregnancy often involves a reduction in intensity and frequency along with small changes in specific exercises and likely adding in a pregnancy class, exercise postnatally may seem like a complete unknown of how to begin, what it might look like and where it could fit in the day.
For many of us, training (when we measure performance and have goals) and exercise (movement solely for the sake of wellbeing and enjoyment) is a strong part of our identity. Feeling that we’ve lost that identity along with a new, utterly dependent human, a body that we don't recognise in the same way and less sleep than we thought possible can be a challenge for some, overwhelming for many.
Whether you’re experiencing some, none or all of the above, if training and exercise were constants in your life pre pregnancy and something you’re keen to return to, the following are my recommendations:
Treat your body like you’d expect a close friend to treat hers
Body image is a massive part of our mindset. So massive that I’m not going to attempt to cover it fully here but in writing about postnatal exercise it would be remiss of me to ignore it. People comment on our bodies and major life stages don’t change that (they exacerbate it if anything). The majority of those people mean well but it can be very difficult to hear any comments and let them pass without a care in the world. During pregnancy we help clients to shift from a mindset of performance when they’re in the gym to a mindset focused on exercising for the physical and mental health of mum and baby. The same applies in the postnatal period. Whether you’re walking slowly around the house after a c-section or back in the gym doing classes, do it for the purpose of moving again and for mental and physical health. Giving yourself that time initially means you’ve got a much greater chance of being back at a place where you feel you can do it for a level of performance in 8, 12 or 24 months. Spoiler: Everyone is completely different in their postnatal experience, your body needs the time it needs.
Give your body professional care
A comprehensive pelvic health examination will leave you confident that you’re giving your body the care it needs following what’s likely its biggest achievement to date. Find a women’s health physiotherapist or a chiropractor for reliable assessment and treatment (I can recommend Greystones Chiropractic and Drake Chiropractic in Sandyford). By examining your body in the context of the changes and challenges it’s experienced during pregnancy, birth and the postnatal period to date a physio or chiropractor can identify the movement and exercise that’s best for your body. You wouldn’t return to training after an injury without assessment and treatment and the postnatal period is no different.
It’s important to remember that it’s still very worthwhile even months and years after your first or most recent pregnancy. Equally, a qualified coach in a gym will know that the effects of having a baby don’t magically disappear because you’ve waited months or years to return to regular training or exercise.
The postnatal body
There are many changes and challenges we can face with our bodies after having a baby. Diastasis and pelvic floor are covered here but this is by no means an exhaustive list. Speak with your postnatal coach, pelvic health physio, postnatal chiropractor, GP or consultant if you’re unsure about anything you’re experiencing, as trivial as it may seem.
Diastasis Rectus Abdominus
Generally known as diastasis, abdominal separation or ‘mummy tummy’. The muscle we stereotypically refer to as abs or a six pack is the rectus abdominis and diastasis refers to two parts which are normally together but have become separated. The line in the centre is connective tissue called the linea alba. During pregnancy the linea alba becomes stretched as the abdomen creates space for the growing baby. Following pregnancy the two sides of the muscle take time to return to their original position. Everyone is different on three things,
- How much separation occurs
- Exactly where the separation occurs (for many it’s more prevalent around the naval but this isn’t always the case)
- Whether our body brings the two sides back together itself (12 weeks is a reasonable time period) or if we need to work with a qualified coach or pelvic health physio.
A key aspect to understand is that it’s not a simple case of diastasis or no diastasis.
Firstly, some of us (both men and women) have a small separation there anyway but we tend to not give it any consideration until pregnancy. So what’s normal for one person isn’t normal for someone else.
Secondly, all muscles of the abdomen along with the muscles of the pelvic floor and diaphragm work as a system to create and hold intra-abdominal pressure (IAP). IAP is what you felt before pregnancy when you did a tough plank hold and forgot to breathe for a few seconds. When we have a diastasis following pregnancy we’re unable to hold that IAP because the abdominal wall gives way immediately rather than containing that pressure. (Please trust me and do not try to do it now). The same is true of the pelvic floor which is covered below. So when your coach or pelvic health physio checks your diastasis it’s not just about the width of the space, it’s about the tension in that space and how it changes over time. Ideally it progresses from spongy (i.e. when palpated the person checking can press down easily into the space) to springy (i.e. there is some resistance when palpated). The benefit of having this done by a pelvic health physio is that they will assess it in multiple ways to gain a greater understanding of where you’re at and progression over time.
From a practical point of view in the gym, diastasis means that going straight into full plank holds or sit ups makes about as much sense as doing a few 20 minute walks to prepare for a 10km race. Whatever core exercises you do, they should be very gradual and with a steady breath. An example of what this initial progression might look like is below.
NB: This is to give an understanding of how gentle that initial core work might be, description alone is never enough to do an exercise safely.
Hip tilts lying on your back > Glute bridges > Lying on your back stretching one leg away from your body > All 4s slowly reaching one leg out behind you > All 4s slowly reaching one leg out behind you and one arm in front of you.
This progression over a few weeks might be just right for one person, too much for another, and too gentle to be useful for someone else. Whatever we’re doing in the gym we have to give our body enough stress so that it responds. That means always pushing a little but easing off at the right time. It really is a case of Goldilocks.
Pelvic Floor Function
Whether you have a vaginal birth or not, the muscles of the pelvic floor are under significant load and pressure during pregnancy (see image below for location). While the word trauma can sound extreme, there can often be trauma to the muscles of the pelvic floor during a vaginal birth - whether that’s tearing, an episiotomy, or a birth assisted by instruments for the health of you and your baby. While diastasis can be initially assessed by a qualified coach, we can only guess what’s going on with your pelvic floor whereas a pelvic health specialist will perform a full exam. It’s a bit like having a hamstring injury - we can give you general hamstring strengthening exercises but a physio will prescribe exactly the exercises you need to begin with along with sets and reps and what to progress to next.
Normally we work on pelvic floor breathing where we squeeze the pelvic floor on the exhale and relax it on the inhale. Once you can do that sitting or lying and standing, we’ll incorporate it into exercise. When you pull during a TRX row for example and squeeze your shoulder blades together, you’ll also squeeze your pelvic floor. And then relax the pelvic floor as you straighten your arms. I often find that taking something like the breath and actively thinking about it can be more tricky than it sounds so if that’s you, stay patient, it will come. The great news is that pelvic floor squeezes, or Kegels, have a positive impact on improving symptoms of diastasis. Pelvic floor work is also important away from the gym and can be done with an app like Squeezy from the NHS in the UK.
Aside from Kegels, pelvic floor dysfunction is an area that for some reason hasn’t yet become mainstream. Yes, it’s common to avoid plate hops or jumping jacks for fear of leaking but no, it’s not normal and not something we should live with or just try to work around. Various types of dysfunction are relatively common during and following pregnancy and include symptoms such as heaviness or dragging, leaking or experiencing pain during sex. Always let your coach know if you experience any of these symptoms.
You never thought you could miss burpees so much did you?! Or maybe it’s a 5km run you’re craving. Either way, it’s important to do what you enjoy and to do it safely. To call a spade a spade, the level of scientific research around pregnancy and postnatal exercise and training is minute in comparison to the wealth of information available to rugby coaches or anyone coaching competitive or recreational athletes. (Particularly for those coaching male athletes but that’s another day’s blog post). To help with this gap in the evidence base, a guideline was put together recently by a group of physiotherapists based on the research that does exist and their professional experience. This guideline is very useful as it can be applied to any exercise that we need to progress towards. So the word running below can be swapped out for your preferred mode of impact (e.g. burpees or TRX squat jumps as part of a gym session or class).
The guideline recommends that:
- Running should not be done prior to 12 weeks postpartum, again this is a general guide and every woman is different.
- There are specific strength exercises which we should be capable of before beginning running.
- Any lumbopelvic (i.e. hips and low back / abdominal area) issues will affect the suitability of running (e.g. pelvic floor dysfunction)
- The couch to 5km programme is a useful guide on progression although working with a coach is ideal.
- Sleep, nutrition and energy in general (i.e. things we may have taken for granted in the past) will impact our ability to run or perform any relatively high intensity exercise.
For some, a C-section was always the plan, for others it’s a decision made due to complications. Whatever the reason, it involves abdominal surgery and is something for which we need to allow time for recovery. Self massage of the scar is important in allowing normal movement to return to the abdomen. It’s often something we don’t particularly want to touch so working gently near the area with your fingers using the oil you prefer is a great starting point. In terms of specific exercises, it will be down to what feels comfortable for you with core exercises likely taking a little longer to work through. Low back discomfort is impacted by the strength of our abdominal muscles and can be felt longer into the postnatal period following a C-section so gradually building up endurance in the core is hugely important.
Sleep and nutrition
- It’s all well and good for people to joke about getting sleep while you can before the baby arrives but it’s a different matter when you’re the one experiencing the exhaustion. Sleep affects our ability to perform physically and our ability to recover as well as protecting us against injury. Get it when you can and engage in self-compassion around exercise and training (and everything for that matter) when you haven’t had enough.
Equally, adequate nutrition can be lower down our to do list when feeding the baby is our natural priority. Prep food in bulk where possible and have easy snacks ready, again, where possible. Remember nutrition plays a huge role in physical performance so do your best to give your body fuel that will serve it best.
To finish, I’ll leave you with a few key reminders:
- Be kind. Your body has done something incredible. Nourish it with gentle exercise and food.
- Make an appointment with a women’s health physiotherapist and/or chiropractor even if you don’t have a specific complaint.
- Work with a personal trainer or coach who is qualified in postnatal training.
- Commit to a gradual return to exercise. It will serve you well short and long term.
If you’re looking to return to exercise after pregnancy, whether it’s in the first few months or longer, contact myself (firstname.lastname@example.org / @aoifemacneill) for training on Leeson St, Dublin 2 or my colleague Sinead (email@example.com / @brophysinead) for training in Ivy Exchange, Dublin 1.
We also both offer Online Postnatal Small Group Training or Online Personal Training if training from home via video is your preference.
See more blog posts relating to pregnancy and postnatal period on the FFS Gyms Blog and get information about training at FFS during and after pregnancy on the FFS Gyms website.