You have brought your baby home, and now you can’t wait to get back in shape. However, pregnancy places an enormous load on the body, especially the core that consists of four major muscles: the diaphragm, pelvic floor, multifidus (little muscles in the lower back) and the deep abdominal muscle called the transverse abdominis (TA). And in spite of being regular with exercise through pregnancy, you may find that it is hard to locate these muscles after birth. So, where do you begin?
Respecting the changes
Work on improving core strength before focusing on weight loss. Return to exercise gradually, so you don’t injure yourself. Gentle pelvic floor and breathing exercises in the first 6 weeks will keep core muscles from forgetting what they are there for. Breathing exercises are calming and will also help with breastfeeding. The American College of Obstetricians and Gynecologists (ACOG) recommends an early return to exercise with a normal vaginal birth, as soon as a mum is comfortable. This could be at about 6 weeks, with gentle walking. Yoga and Pilates are best to start with between 8-12 weeks. Weight training and high-impact exercises such as running can be initiated at 12 weeks after sufficient core strength has been built up.
The ACOG recommends at least 150 minutes of aerobic exercise per week. This can be divided into 30-minute workouts on 5 days of the week. Since it is hard to find time away from a newborn, you could break it up into smaller 10-minute sessions per day. Since a C-section is a major abdominal surgery, you need to exercise under supervision, with a physical therapist specialising in women’s health, before you start on your own, and begin at 12 weeks.
Before hitting the gym…
You may want to hold out on the ab crunches and jump squats until you get screened for Diastasis Recti and stress incontinence. The former is a condition where the abdominal muscle splits right down the middle. In fact, all women have a Diastasis towards the end of their pregnancy, and in most cases it resolves within 8 weeks after birth. However about 40% of women continue to have a separation six months after delivery, according to a study published in the journal of manual therapy in 2015. This separation is responsible for the post-pregnancy paunch or ‘mummy tummy’ that refuses to respond to regular exercise. In fact, abdominal crunches and planks can cause the internal organs to protrude through the gap and result in a hernia.
Stress incontinence is the inability to control the bladder when intra-abdominal pressure increases. Simply put, you could pee a little when you cough and sneeze. These issues are not reported often, because the new mom is either too embarrassed to talk about it or thinks it’s normal after childbirth. It is not. In fact, stress incontinence after childbirth is a significant predictor of pelvic organ prolapse at an older age. If you suspect you have stress incontinence, six weeks of physical therapy focussed on functional rehabilitation of the pelvic floor will help you transition to the gym.
The author is an American Board Certified physical therapist with a doctorate in Rehabilitation Medicine and specialises in women’s health. She is also a childbirth educator and a lactation consultant.
