Please keep in mind my recovery may look different to yours based what I did during pregnancy, and the birth I had. In a nutshell: I was induced due to low platelets (60s) with a foley bulb at 39 weeks and all things considered, had a very pleasant birth experience. I pushed for about 40 minutes (it was my favourite part) and had 1 stitch. I took both of those things into consideration during my recovery.
In this blog post I will take you through the steps I took during Weeks 0-6 of my recovery. Regardless of when you start, you can use this as a guideline on how to progress your postpartum workouts when YOU feel ready. Do not progress exercises while pain and/or bleeding is still present. Note: do not take my timeline as your go-to reference of when to introduce movements, especially if recovering from a C-section. I had a very active pregnancy, easy delivery and am Pre/post natal certified. However when you do start your return to fitness, a good guideline is to begin in supine, side lying positions (easiest), progress to hands and knees, kneeling or seated and then finally introduce standing, more dynamic (only once pain/bleeding/heaviness has stopped).
The Dr’s recommendations of ‘no exercise for 6 weeks’ is very conservative approach. The good news is is that there are safe movements that you can be doing to help with your healing prior to receiving the all clear for your core + pelvic floor. When you start and what you do also depends on; any pain you are experiencing, your fitness levels pre/during pregnancy, any complications you may have had during pregnancy and/or delivery, any other medical issues you may have. If you had a C-section, you will need longer to heal (it may even be closer to 8 weeks).
At the 6 week mark, it is totally okay if you are simply not ready for any form of exercise! The first month (especially) is SO HARD as you adjust to your new life, that you should feel zero pressure to exercise. Postpartum anxiety is no joke and adding to that because you feel pressure to ‘bounce back’ is likely going to create extra stressors. Do it when it feels right for you.
As you heal, its important to have awareness of where your body is at postpartum. Things may appear fine from the outside but remember:
- Your organs shifted to make space for your baby and need time to return to their normal position
- You have an internal wound the size of a dinner plate inside your uterus that is still healing and returning to its normal size.
- Your pelvic floor is stretched from birthing a baby. And even if you didn’t have a vaginal birth, pregnancy creates 9 months of stress on the muscles of your pelvic floor (+ core) that results in a lack of both strength and tone.
- Or if you had a C-section, you’re healing from a major abdominal surgery.
- You may also have a diastasis (ab seperation) at this point.
- Stitches that are still healing
- Pregnancy posture sticks around postpartum too.
For your long term health and performance, progressing slowly and intentionally is KEY for your success. Get into the mindset now that recovery could take anywhere from 6-18+ months. Let your body be your guide; if you experience pain, heaviness, leaking, discomfort, aches, trouble going to the bathroom, more bleeding – check in with yourself. You’re likely doing too much too soon. Dysfunction (like prolapse) don’t necessarily appear immediately after birth/during early postpartum and can appear months later in your recovery from introducing too much impact or weight to your pelvic floor before its fully regained the strength & tone it needs. For both my recovery and my clients, I factor in women’s health consideration, your body, your pregnancy, your birth and your postpartum.
Week 0-1: Breath
During my 1st week I really focused on staying off my feet as much as possible. I stayed in hospital for 2 days while my platelets reached a stable level (they wanted me at 80). On day 3 I started taking some short walks everyday around my neighborhood. I was mostly just desperate to take the stroller for a spin and the weather in Scottsdale in October is just so perfect that its hard to stay inside all day. I kept it under 15 minutes. I noticed that if I tried to do too much around the house during the day (housework, just being on my feet in general) I would start to feel some pelvic floor tension towards the end of the day. It was a good reminder my strength and endurance wasn’t even close to where it needed to be.
Around day 5, I started to include some diaphragmatic breathing. I could have started sooner, but mentally I wasn’t there. I would find anywhere from 5-10 minutes in the day when Theo was napping to focus on connecting my core and pelvic floor. Lying in bed, sitting on the couch, lying on the floor with a pillow under my hips. My focus here was on inhaling down and out, feeling that front, back and side body expansion and gently contracting my pelvic floor on the exhale.
Week 1-2: Breath, Gentle Core + Pelvic Floor
I gradually increased my walking over the next week. I felt pretty disconnected from my core and pelvic floor during the 1st week, but at this point I started to feel a connection. I let my bleeding be my guide (if there was ever any increase I would scale back) and by day 8/9 it was super light and by 14 it had stopped completely. Alongside this, that pelvic floor tension was a guide to how much I could tolerate being on my feet. It was still creeping up occasionally at the end of the day, mostly when I was having to stand around with Theo in the baby wrap while he slept. He often wouldn’t let me sit down while holding or wearing him. My posture wasn’t great when I would stand still and I would often find myself glute clenching to find that stability, therefore increasing that pelvic floor tension. Because of this, I tried to focus on my exercises being primarily in supported positions.
Exercises in my routine were now: side-lying breathing, supine hip switches, TA activation (adding in leg lifts, slides), bent leg fall outs, side lying ball squeeze, supine breathing with ball squeeze, thoracic rotation, thoracic extension, chest stretches. I chose gentle exercises and there was no rep scheme, I simply went with what felt good for my body.
Walking around this point had increased with no pelvic floor tension afterwards. Overall, I was feeling pretty good physically. This is when I started to introduce more challenging core exercises: side lying clam shell with ball press, glute bridges, bird dog variations, kneeling squats, band pull aparts. For mobility, I felt comfortable in deeper hip stretches; 90/90s + the hip extension, quadruped rock backs, thoracic extension, banded dislocates.
My biggest struggle was with TA activation in a supine position and rib closure. Week 3-4 I was still pretty conservative but week 4-5 I progressed a little more. Exercises over these weeks included; side lying hip lifts, TA activation (marches) with a pullover, bodyweight squats to a box (progressing to light goblet squats week 5), quadruped lift off, standing/kneeling pallof presses with a ball squeeze, seated pulls aparts + rows, suitcase carries (very moderate weight used around week 5), progressing glute bridges to hip thrusts on a bench, split squat row, banded good mornings. I continued to work on my internal and external rotation of my hips, glute strength, upper back mobility, chest stretches and breathing + pelvic floor contractions/release.
Adding weights around weeks 4/5 (around a 5/10 effort):
The general approach to your return to fitness should be:
-Rest & Recovery. Limit standing and walking, especially while pain is still present.
-Retrain a more optimal breathing pattern and sync that with movement. Rebuild from the inside out.
-Strengthen your pelvic floor. Learn how to properly contract your pelvic floor as well as release and let go. Leaking isn’t cool. Back pain sucks. And although it’s common, it’s certainly not normal.
-Retrain proper activation of abdominals & have a correct approach to healing a diastasis (if you have one at 6 weeks PP).
-Become aware of where you are holding tension in your body; ab gripping? Leaning back and glute clenching? Finding it hard to let go of your pelvic floor? Rib Flare? An understanding of posture and your tendencies will also help combat some of those postpartum discomforts.
-Intention now, add intensity later. You might be ready to exercise, but your healing is far from over. Your body needs to be challenged to aid healing however it’s important to do so progressively.
-Visit a pelvic floor PT!
Your cleared for exercise but not sure on how to begin your return to fitness? I offer customized postpartum programs. Schedule a call today!