Postpartum fitness

July 6th, 2008  |  Published in Pregnancy and postpartum  |  11 Comments

No matter how joyful an event it is, in physiological terms the later stages of pregnancy and birth are a trauma to the body. Connective tissues are forced beyond their normal limits, the body’s weight distribution shifts wildly, and delicate parts are damaged. Contemplating a postpartum workout must take into account that the mother, especially if this is her first child, probably feels as if she has just spent thirty hours excreting a watermelon (Krista’s note: I had an expectant first-time mother email me after reading this article to complain about my choice of language. She felt that birthing would be a joyful experience. I hope for her sake that she was right, but the birth I witnessed as a labour coach involved a whole lot more pain and ucky stuff than beatific euphoria. Let’s just say that if you’re in the birthing room, especially if you’re in the vicinity of the mother’s lower body, don’t wear your best clothes. Make of this what you will…)

The first immediate, and hopefully self-evident, concern postpartumis recovery from the delivery. This will vary depending on the difficulty of the birth. Quite likely, mothers will be too distracted by episiotomy stitches and feedings every two hours to do much of anything at first! It is important to allow time to recover from the acute effects of this physically challenging event.

The second concern is gradual re-introduction of physical activity in a way that is appropriate for each woman. Everyone is different, so even if one hears apocryphal stories of women who are back to running half-marathons a week after delivery, it probably doesn’t apply to most women! It is essential to re-start slowly, and within one’s limits, as well as to tailor physical activity to one’s individual abilities and needs.

I created the workout that follows for a first-time mom who had a somewhat high-risk pregnancy during which she was confined to bed, and unable to exercise for the later stages. Though lengthy and difficult, delivery was normal and not C-section. She experienced a great deal of back and pelvic pain, and some laxity of the knee joint. Her program had to be a gentle re-introduction of activity which emphasized regaining torso strength and postural awareness, as well as strength for everyday tasks such as carrying the baby in a Snugli. The mother was also instructed to do daily Kegels in order to assist with regaining tone of pelvic floor muscles, as well as to go out walking whenever she felt up to it, increasing pace and distance as she felt able.

I relied a fair bit on the Swiss ball and bodyweight-only exercises for the initial stages. Later, dumbbells were included for additional resistance as desired. A bench could be subsituted in certain places but she didn’t have one, so the Swiss ball was a stand-in. This workout is meant to be a collection of ideas aimed at a particular trainee, not set in stone. It may be modified depending on the needs and existing fitness level of the individual trainee.

For example, “week 1″ does not mean “first week after giving birth”, unless you are one of those superwomen who are back in boot camp or board meetings two days after popping out the sprog, and then you probably don’t need my help anyway. Week 1 means the first week you start back with feeling up to organized physical activity and conditioning work. You may find that for the first few weeks, your training goal will be to get an hour of uninterrupted sleep. Go at your own pace, and if you need to take longer with the gentler stuff, by all means do so.

Get outside and walk with the baby as well, whether that’s in a stroller or with the baby in a carrier. As you get back into shape try a bit of running with the stroller, or climbing up some stairs (or a hill) a little more vigorously with the baby carrier. Getting some sunlight is important for helping manage the risk of postpartum depression, as happiness hormones respond to light levels. It helps rehab the low back and improve your cardiovascular fitness. It also often helps the little screamer sleep. Everyone wins.

week 1

To be done every other day.

1. Swiss ball work:
a) sitting on swiss ball, move hips from side to side, repeat 10 times each side
b) sitting on ball, move hips front to back, 10 times each side
c) sitting on ball, leg lifts, 10-20 times each side. This will strengthen the muscles around the knee joint. While sitting, extend one leg out straight in front of you. Lift it up slightly, a few inches, and hold it for 5 seconds, then lower. Do these unweighted, and aim for endurance.
d) lie on floor, face up, feet on ball. Hips should be bent a bit. Squeeze your butt, and lift it off the floor till your whole body is straight like a plank. Hold for 5 seconds, then lower. Do as many as you feel comfortable with.

2. Floor exercises:

a) Quadruped: get on hands and knees on the floor. Slowly lift right arm and left leg off the floor until they are straight in front and behind you (arm and leg are parallel to the floor). Hold for 5 seconds, then lower. Repeat on other side. Do 5-10 each side.

b) Modified plank position: get on to knees and elbows on the floor. Slowly straighten knees until body is straight and rigid, and your weight is resting on your toes and your elbows, as shown. Hold for as long as you can.

week 2

Do this every other day.

1. Swiss ball work: same as week 1.

2. Floor exercises:
a) Quadruped: Do 10-15 each side.
b) Modified plank position: Do 5 times.
c) Pushups from knees: as many as you can do, as shown (not shown in photo: put a towel or mat under your knees). If you cannot do pushups from knees, substitute pushups against the wall. Stand about two feet from a wall, facing the wall. Place palms on wall at chest height. Lean in to the wall to perform the pushup.

d) Calf raises: holding the wall, stand on the edge of the step to your living room. Slide your heels off the step so only your toes are on the step. Lower heels as far as they will go, then stand up on your toes. Lower heels again, and repeat. Do as many as you like.

week 3

Do this every other day.

1. Swiss ball work: same as first week, with one change to exercise d), as follows:
d) lie on back on floor, feet on ball. Squeeze butt and make body straight, like a plank. Then, keeping body rigid, bend knees and roll the ball towards your butt. Straighten out legs again, lower butt to floor. That’s one rep. Try for 10.

2. Floor exercises:
a) Quadruped: Do 10-15 each side.
b) Modified plank position: Now do these while resting on hands, not forearms, like the top position of a pushup. Do 5 times.

c) Pushups from knees: as many as you can do.
d) Calf raises, try them now one-legged.

weeks 4-8

1. Standing warmup:

a) standing pelvic tilt: while standing, place hands on hips and feel where the top of the hipbones are in front. First, tilt hipbones forward and arch lower back, sticking belly out, as far as you can. Then tilt pelvis in the opposite direction, top of hipbones going back, curling pelvis under and trying to bring bellybutton to your spine. 10 times each direction.

b) Shoulder circles: bring shoulders up, forward, down, then back. Repeat 5 times. Then go the other way: down, forward, up, back. Repeat 5 times. This is done without weight. This “scapular clock” can help alleviate “baby carrier back”.

2. Swiss ball wall squats, 3 sets of as many as you like, aiming to work on gradual improvement of depth and stability. Stand facing away from a wall, and place swiss ball between your back and the wall, holding the ball in place by leaning into it. Then, squat down, rolling the ball down the wall. Go only as deep as you feel comfortable with at first. Once you can easily do 3 x 15 with full depth, hold light dumbbells at your sides. More experienced lifters could start with unweighted squatting if they preferred.

3. Standing overhead press, 2 x 15. Holding dumbbells, stand with good posture. Be conscious of keeping abs and lower back tight, like you know someone’s about to punch you in the gut. You don’t need to suck in, just be aware of them and don’t let the midsection sag. Press dumbbells overhead smoothly.

4. One-arm row on Swiss ball, 2 x 15 each side. This is the same as a regular one-arm dumbbell row, except the ball is substituted for a bench.

5. Pushups from knees. 2 sets of as many as you can do. If you start feeling like that’s too easy, try them from your feet.

6. One-legged calf raises, as before, off the step of your living room. 2 sets x 15, hold a dumbbell in one hand for more resistance. Hold the wall with the other hand.

7. Floor exercises:

a) Swiss ball bridge and ball roll, as in week 3. 2 sets, as many as you can do.

b) Quadruped: Do 10-15 each side.

c) Modified plank position: Now do these while resting on hands, not forearms, like the top position of a pushup. Do 5 times.

d) Superman: lie on floor, on your tummy, arms straight above head. Raise legs and arms off the floor at the same time, so you look like Superman flying. Hold as long as you can. Repeat 2-3 times.

After 8 weeks (again, this varies), after having been assured that a base level of conditioning had occurred, I would then move to a more conventional type of weights workout.

Responses

  1. Dave N says:

    March 20th, 2009at 10:38 pm(#)

    I just love your weblog! Very nice post!

  2. Ida says:

    August 22nd, 2009at 10:32 am(#)

    Tsk, episiotomies are an antiquated & interventionist technique with no clear benefits to the mother or baby in the vast majority of cases, and make about as much sense as flouncing about with pink dumbbells and “toning”. I’m nipicking, but seeing episiotomy stitches mentioned as a perfectly normal result of giving birth is frightening. I love your evidence-based take on exercise and fitness; perhaps try some of the same with childbirth?

    Henci Goer put together a pretty impressive collection of research on obstetric myths vs research realities, here’s the free online chapter from a book by the same name on episiotomies: http://www.hencigoer.com/obmyth/epis.html

  3. Mistress Krista says:

    August 22nd, 2009at 7:03 pm(#)

    Ida, I’ve been at two births, and there were stitches involved both times. I wouldn’t say it’s normal, but as a labour coach with a crotch-eye view I’ve seen some very exciting loss of perineal integrity.

  4. beth says:

    September 19th, 2009at 1:05 am(#)

    Although episiotomies are rightly going out of style, natural tearing is pretty common. (In fact, one of the reasons for not cutting an episiotomy is that tears heal better than cuts). Even at my midwife’s practice, where they avoid episiotomies as much as possible, only 30% of women keep an intact perineum.

    Thanks for this post! I’m 38 weeks pregnant now, and will be bookmarking this to use later.

  5. moonlady says:

    November 12th, 2009at 9:54 pm(#)

    Krista,

    I gave birth to my son by cesarean a week ago. I’m not even allowed to drive for two weeks, so it will be a little while before I can do any lifts again. Do you have any recommendations on how to recover after a cesarean? Would that incision through my abdominal muscles require a change in the routine you posted here?

    Thanks!

  6. Charlotte says:

    February 9th, 2010at 10:26 pm(#)

    Thank you Mistress Krista! I have enjoyed reading your advice for years, and this is very timely for me, as my son is 3.5 months old.

    I have been back to work since the beginning of January, and am in the middle of carving out new workout times, as crack of dawn workouts don’t work so well right now.

    I credit strength training that I only gained 12 lbs during my pregnancy, and I am already down 25 below my pre-pregnancy weight. (only 100 more to go! go me!)

    Your philosophy of weight training has been awesome, and has allowed me to fight off the sea of bad ‘advice’ that I get from all directions. Thank you.

  7. Mistress Krista says:

    March 12th, 2010at 8:21 am(#)

    Moonlady: A C-section means a longer recovery time for sure. The advice for rehab would be the same as any major abdominal surgery. Generally this is about 8 weeks before you can return to the basics of exercise activity; probably 3-4 months before you can start any serious strengthening work. Start with work on abdominal bracing and endurance, and increase the resistance slowly.

  8. Christine says:

    September 14th, 2010at 12:22 pm(#)

    I am not sure what kind of labor coaching you are doing, but if you are going to support women in labor I definitely second Ida’s recommendation to do some research on evidence based birth practices.

    As mentioned, there is a difference between an episiotomy and tearing naturally, and there are many other interventions that take place in modern obstetrics that can lead to complications in the birth.

    If you haven’t seen it, Ricki Lake’s documentary The Business of Being Born gives an overview of the issues facing birthing women today. http://www.thebusinessofbeingborn.com/

    Christine
    certified labor doula

  9. Christie Lawson says:

    September 16th, 2010at 9:28 am(#)

    Great article. I just want to say that I worked out my whole way through pregnancy. I did mostly weight training and HIIT, but yes, I brought the weights and the intensity level down quite a bit. Regardless, maintaining an exercise program while pregnant was the greatest thing I could have done. I worked out prior to getting pregnant, which most likely helped me throughout my pregnancy as well. I am 5 months post-partum and I am stronger than ever and my recovery time was super fast. I only gained a minimal amount of fat and lost all my fluid pretty quickly in my first weeks of recovery. I had a c-section but began working out 5 weeks post. I love that you are encouraging women to stay fit and healthy while pregnant. No one should have to sit around or be confined to kegel exercises while pregnant. I was doing weighted back squats with the barbell 38 weeks pregnant! You can do much more if you would like without harm, as long as you are smart about it. Anyways, love your site!

  10. mamazee says:

    August 19th, 2012at 3:45 pm(#)

    Love your advice, esp on getting started! I was lucky and my husband had the time, ability, and patience to baby step me along the way.

    Two things, though… the bad language on the site makes me hesitate to recommend it to mom friends

    and

    Having had eight children (the last three unassisted at home with my husband), week one is a little too soon to start working out. Even with my first, an uncomplicated vaginal delivery in a hospital, the first week was better spent establishing nursing and getting used to being a mom and general recovery!

    Many many women have something called abdominal diastasis and need to at the least splint that until the muscle has come back together. It is very fixable, but without purposeful intervention will result in a belly pooch that will not respond (in fact will get worse) with situps.

    One other hazard for postpartum women is symphysis pubis dysfunction – this is mainly due to hormones, and is a widening of the space(s) around the pelvis which open up a little bit to get baby out. In some women, there is too much widening, and there is pain when they walk – a “looseness” that results in shooting pain and feels like you’ve been kicked between the legs. In this case, women need to avoid any exercise that puts more weight on one leg, and I’ve found using compression shorts (the tightest you can find!) after delivery helps this heal up faster and allows for workouts sooner :)

    It’s worth mentioning these two hazards as they are fairly common and can be so frustrating for new moms who are so ready to see positive changes after that baby is out!

    Loving the site otherwise, though! Thanks for all the great information!

  11. mamazee says:

    August 19th, 2012at 3:50 pm(#)

    oops! just read it again – week one meaning the first week you start exercising… sorry!


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