Postnatal Exercises

Having a baby changes a woman’s body. Your body has carried and nurtured your growing baby for the past nine months and so it is to be expected that returning to its pre-pregnancy state won’t happen overnight. Similarly, getting back into shape after the birth takes time and effort, which can be quite tricky when you are also providing around-the-clock care for your newborn. However, it is an important investment in your time and will be well worth the effort.

This article provides some helpful advice and guidance on how to gently get back into shape after your baby’s birth. It is advisable to try and start these exercises as soon as it feels comfortable to do so; preferably within the first 24-48 hours after your baby’s birth.

Leg and circulatory exercises

This exercise helps to improve the blood circulation in your legs, aids the absorption of any surplus fluid (oedema), reducing swelling, and helps to relieve varicose veins and tired legs. If you have had a Caesarean birth, you will be advised to wear support stockings that aid blood circulation in the veins of your legs and help prevent blood clots forming during the early weeks post birth. The following exercise can be done at regular intervals throughout the day as well as, at night when you’re up with your little one:

Avoid crossing your legs
Keep your legs elevated whenever possible by either doing this exercise on the bed, or while resting your feet on a stool or chair opposite you
Move both ankles up and down briskly, and in circular motions
Avoid pointing toes downwards as this can induce muscle cramp.

Caring for your back

It is extremely important that you consider your posture and look after your back post birth. This is because the hormone Relaxin, which softens the ligaments of your pelvis to assist child birth, remains in the body for six months after the birth. For this reason, it can be very easy to strain or pull your back muscles when lifting, twisting or moving awkwardly. Similarly, because your abdominal muscles have been stretched during pregnancy, they will have been weakened and are providing less support for your back.

Relieving back pain

When standing, try to stand upright rather than stooping forwards. Try to gently draw in your lower abdomen (tummy) to maintain this posture. Doing this won’t harm any stitches that you have and will help to strengthen and tone your abdomen and prevent backache
Avoid bending your back and use your knees instead
Kneel or squat down to perform low-level tasks such as, picking toys up from the floor, or bathing your baby
Keep a straight back when pushing your baby in their pram/buggy; you may find carrying your baby in a sling is helpful too
When feeding your baby, always sit upright with your back well-supported. A pillow or cushion in the small of your back (behind your waist) can help to ease any back ache. If breastfeeding, consider using a pillow or two on your lap or under your arm to support the baby; this will prevent you leaning/hunching forward and over stretching the muscles in your shoulders and neck
Try to avoid lifting heavy objects until you have assistance, but if this isn’t possible and you need to lift an older child, carrycot etc. always keep your back straight and bend your knees, so that the muscles of your legs and thighs take the strain of the load; NOT your back. Keep the object you are lifting as close to your body as possible.

Getting in and out of bed

The following advice is designed to remove unnecessary strain on your abdominal muscles and ensure that you feel as comfortable as possible when getting in/out of bed. If you have had a Caesarean birth this will also help to reduce any discomfort from abdominal stitches:

Lying on your back, bend your knees keeping them both together
Gently draw in and support your lower abdominal muscles, then roll onto your side. You may find it helpful to use your hands to support your lower abdomen while you do this
Using your elbow and hand, push yourself up to a sitting position, at the same time allowing your legs to drop over the edge of the bed so that they act as a counterbalance.

If you’ve had a Caesarean birth

Where your baby was born by Caesarean section and you have an abdominal wound, it is important that you avoid any heavy lifting or driving (the car seatbelt will sit very close to your scar) for the first six weeks after the birth. This gives your uterus (womb), and abdominal muscles the time that they need to heal properly. For this reason, the hospital midwives and physiotherapist will advise against certain exercises until after this time. This time period tends to coincide with your postnatal check around six to eight weeks after the birth; this means your GP or hospital doctor will be able to confirm that everything has healed as it should have. You should start doing postnatal abdominal exercises gently and progress slowly at a pace that suits you. See also our article ‘Recovering from your Caesarean birth’.

Pelvic floor exercises

The good news is that you can do your pelvic floor exercises even if you’ve had a Caesarean birth. These exercises are essential for taking care of your pelvic floor and building up the strength of the pelvic floor muscles after pregnancy and your baby’s birth. Pelvic floor exercises can help to safeguard against urinary incontinence – more commonly called ‘stress incontinence’ – this is where you can leak urine when you cough, sneeze and laugh. Keeping your pelvic floor muscles toned can also help prevent bladder and uterine prolapse later in life.

When you’ve just had a baby, the area around the vagina (birth passage) can feel very bruised, swollen and sore, especially, if you’ve needed stitches. Exercising these muscles can understandably, feel like the last thing you’d want to do. However, pelvic floor exercises can help to reduce discomfort and swelling, and promote healing. This is because this area of your body has a very rich blood supply, so tightening your muscles pushes the blood away and relaxing them allows a fresh supply of blood to come into the area and promote healing. For this reason, it is recommended that you start doing gentle pelvic floor exercises the day after your baby’s birth. The only exception is if you have a urinary catheter in place, in which case, pelvic floor exercises should only be started once the catheter has been removed and you have fully emptied your bladder on at least two occasions.

NB. Once you have identified the muscles of your pelvic floor and feel confident doing pelvic floor exercises, you should continue to exercise them daily for the rest of your life.

How to do pelvic floor exercises

Sit comfortably
Squeeze the muscles that you use to stop yourself passing urine; this action pulls the vagina and rectum upwards and backwards
Hold for up to 10 seconds and then release
You may feel that you want to instinctively hold your breath while tightening your muscles; however, it is important that you breathe regularly throughout
Aim to do around 50 pelvic floor exercises a day; perhaps five sets of 10 pelvic floor exercises ensuring that you rest in between each set. You can do these whilst feeding your baby or watching the TV.
You should not contract any other muscles at the same time eg your stomach, thighs, or the muscles of your buttocks.

Abdominal exercises

Where your baby was born vaginally, even if this was an assisted birth using forceps, or the ventouse (vacuum extraction), you should start to tone up your lower abdominal muscles (Transverse Abdominis) as soon as you feel well enough to do so. This will help tone up your lower abdominal muscles and improve the stability of your lower (lumbar) spine.

There are two types of muscles that you will need to exercise and tone up:

Deep Recti muscles – These are the deepest muscles of your abdomen, which act like a corset, flattening your abdomen, drawing in your waistline and stabilising the bones of your spine and pelvis. Toning and strengthening the recti muscles will help to reduce the strain placed on your back and pelvic floor
Outer muscles – you can start exercising these once your deep muscles are toned and stronger.

Exercising the deep Recti muscles

It is essential that during the first six weeks’ post birth you perform these exercises in a comfortable position. This can be either lying on your side with a pillow between your slightly bent knees, or lying on your back with a pillow under your head, both knees bent and your feet placed flat on the bed or floor.

Begin by letting your abdominal muscles relax and sag
Breathe in gently
As you breathe out, gently draw in the muscles of your lower abdomen (narrowing your waistline), while at the same time, tightening the muscles of your pelvic floor
Hold for a count of ten seconds and then gently release
Don’t move your back at any time while doing this exercise; you should also be able to breathe and talk normally throughout
Repeat this action 10 times, allowing a few seconds rest between each one.

Exercising the outer muscles

Once you are comfortable exercising the deep abdominal muscles, you can progress to additional exercises that help tone and strengthen the outer muscles:

Pelvic Tilt

Lie on your back and perform the deep stomach exercise
While gently squeezing your pelvic floor and buttock, tilt your pelvis up and flatten your back onto the bed or floor
Maintain this position for a maximum of 10 seconds and then release gently
If you have had abdominal stitches, this exercise will not harm them.

Head Tilt

Perform a pelvic tilt (as above)
While squeezing your pelvic floor muscles, lift only your head – keep breathing throughout
Hold this position for a few seconds, then gently release
Rest for a few seconds between each exercise
As you feel more comfortable performing this exercise, you can prolong the head hold up to a maximum of 10 seconds
As you progress further, you could raise both your head and shoulders

Divarication (separation) of Recti (abdominal) muscles – called DVR

In some women, the long supportive abdominal muscles may come apart from each other and separate during pregnancy. This is called a divarication and not unusual, particularly, where women have had a high number of babies. It can be resolved with specialist input and management from a physiotherapist. A sign of DVR is where the abdominals muscles bulge or ‘dome’ when getting in or out of bed and/or the bath. Your midwife can check for DVR and refer you to a physiotherapist for specialist management where this is indicated.

Activities and exercises to avoid if you have a DVR

Until your DVR has been assessed by a physiotherapist, it is sensible to avoid the following:

Unnecessary heavy lifting eg carrying carrycots, car seats etc. Try to use a baby sling, pram or buggy instead
Avoid exercises that involve head lifts or sit-ups
Avoid exercises or activities that involve abdominal twisting.

You may find it helpful to wear support briefs, leggings, cycling shorts or a maternity support belt. The obstetric physiotherapist may supply you with a maternity support belt.

Exercising safely

You should not exercise if you are feeling unwell or overly tired. If you notice that your stomach is bulging when doing any form of abdominal exercise, you should not continue and should contact your midwife, health visitor or GP for advice. They may recommend that you are referred to a physiotherapist for specialist advice and input. Getting into a routine of performing your pelvic floor and abdominal exercises regularly should help you to get back into shape quite quickly; however, if you experience any persistent problems, you should always seek the advice of your GP and/or a physiotherapist.

Exercising after six weeks post birth

Swimming is a great all round form of exercise and can be beneficial once your vaginal bleeding (lochia) has stopped for a week and any perineal sutures (stitches) have healed. If you have any lower back or pelvic pain (eg Symphysis Pubis Dysfunction or Sacroiliac joint Dysfunction) you should avoid using breaststroke.

You can also take part in postnatal and/or aquanatal classes after six weeks’ post birth. Doing exercises in a group is a great incentive as well as an opportunity to socialise with other new mums.

Any return to heavy impact sports/leisure activities such as jogging, horse riding, racquet sports or high impact aerobics should however, be deferred until 10-12 weeks post birth. This is particularly the case if you still notice signs of pelvic floor weakness ie stress incontinence when coughing, sneezing or laughing etc. You should also avoid performing double leg lifts when exercising, as this action places significant strain on the abdominal and back muscles, and can also further weaken the pelvic floor.

References and suggested further reading

Burrows L (2005). Postnatal exercise: the mother’s wellbeing is important too. New Zealand Medical Journal 118(1217): u1541.

Citak N, Cam C, Arslan H et al (2010). Postpartum sexual function of women and the effects of early pelvic floor muscle exercises. Acta Obstetricia et Gynecologica Scandinavica 89(6):817-22.

Day J, Goad K (2010). Recovery of the pelvic floor after pregnancy and childbirth Recovery of the pelvic floor after pregnancy and childbirth. British Journal of Midwifery 18(1):51-53.

DiFiore J (2010). The Complete Guide to Postnatal Fitness 3rd ed. A&C Black Publishers Ltd: 246 pages.

Gillard S, Shamley D (2010). Factors motivating women to commence and adhere to pelvic floor muscle exercises following a perineal tear at delivery: the influence of experience. Journal of the Association of Chartered Physiotherapists in Women’s Health 106:5-18.

Herbert J (2009). Pregnancy and childbirth: the effects on pelvic floor muscles. Nursing Times 105(7):38-39.

Jeffcoat H (2010). Postpartum urinary incontinence. International Journal of Childbirth Education 24(2):11-12.

Jones C (2009). Back care and beyond – a guide. Practising Midwife 12(6):50.

Logan K (2005). Incontinence and the effects of childbirth on the pelvic floor. British Journal of Midwifery 13(6):374-377.

Mason L, Roe B, Wong H et al (2010). The role of antenatal pelvic floor muscle exercises in prevention of postpartum stress incontinence: a randomised controlled trial. Journal of Clinical Nursing 19(19-20):2777-2786.

Maternity Coalition (2006). A healthy pelvic floor after childbirth. Maternity Coalition: 1 page.

Polden M, Whiteford B (1992). The Postnatal Exercise Book: A Six Month Fitness Programme for Mother and Baby. Frances Lincoln Publishers Ltd: 128 pages.

Saunders M (2011). Reflecting on pelvic floor education in practice. Essentially MIDIRS 2(7):47-49.

Tupler J, Gould J (2004). Lose Your Mummy Tummy: Flatten Your Stomach Now Using the Groundbreaking Tupler Technique. Da Capo Press Inc: 160 pages.

What you should know about: strengthening pelvic floor muscles: kegel exercises (2010). The Female Patient 35(11):55.

Whitehouse T (2012). Managing stress incontinence in postnatal women. Nursing Times 108(18/19):16-18.

Whitehouse T (2012). Patient motivation in managing stress urinary incontinence. Nursing Times 108 (18/19):20.

Whitford HM, Alder B, Jones M (2007). A longitudinal follow up of women in their practice of perinatal pelvic floor exercises and stress urinary incontinence in North-East Scotland. Midwifery 23 (3):298-308.

Whitford HM (2002). Pelvic floor exercises, incontinence and pregnancy: knowledge, motivation and behaviour. Dundee: University of Dundee.

Useful websites

Association of Chartered Physiotherapists in Women’s Health. www.acpwh.co.uk

Chartered Society of Physiotherapists (CSP) www.csp.org.uk