Expert Postnatal Physiotherapist, Andrea Baker, gives her best tips including 2 must-do exercises

Exercise after having a baby must be gradual. Below I recommend two pelvic floor and abdominal exercises that should be performed directly after birth to strengthen weak muscles. Other than these two exercises I usually recommend one-two week of rest followed by the commencement of gentle exercise such as walking. For any other exercise, try to wait until after your postnatal check, between six weeks and eight weeks. Your body could require more time to recover if you’ve had a cesarean.

Up to 13% of new mothers are affected by postnatal depression however research has shown that postnatal exercise reduces this risk by as much as 50%, not to mention all the other health benefits of postnatal exercise such as weight loss and reduced risk of many medical conditions to name a few.

Walking is a safe and gentle exercise that does not compromise muscles that are weakened by pregnancy….and it’s free!! It is best to start slowly with say 5-10 mins and then gradually build up. Usually, by six weeks longer exercise sessions are fine.

In addition to this, there are more specific workouts that are necessary to strengthen weak muscles and safely return to normal exercise. Two of these specific workouts are PFM Contractions and TA Contractions and are described below.

The Pelvic Floor Muscles are a sling of muscles found at the base of the bony pelvic ring that supports our pelvic organs (bladder, bowel, and uterus) and surround the passages that exit these organs (urethra, anus, and vagina). They are the “floor” to our bodies!

These muscles become stretched and weakened during pregnancy as the weight of the baby increases. They are further weakened and stretched during vaginal deliveries. Unfortunately, we also know that certain exercises may contribute further to PFM weakness, such as:

• High-impact exercises e.g. running, jumping, netball, aerobics, etc.
• Heavy lifting e.g. weights >5kg

A weak PFM leads to an increased risk of leakage from our passages (incontinence) as well as poor support of the pelvic organs and possible slumping down of these (prolapse). See a women’s health physiotherapist if you are concerned about any of this.

As a result, it is imperative to include Pelvic Floor Muscle exercises as a part of any postnatal exercise regime.

A correct PFM contraction is a squeeze felt in the groin around the passages, as though you are stopping the flow of urine. You should not squeeze the buttocks, inner thighs or upper abdominals and you should not hold your breath. A mirror should show the muscles moving up and inwards.

Knowing these muscles will be weak, means we need to start in an easy position. The best place to start is lying down. Once you’ve confirmed you can correctly contract the PFM, the research suggests starting slowly, initially holding only 1-2 seconds, starting by repeating this 3 times throughout the day. (Build-up by adding a second and one more time per day, - this may slow them down if they can move ahead faster than one sec and I don't believe there's any need to add another 4th set per day) Progress every few days as able. You want to build up to a hold of 6-8 secs, repeated 12 times. Once you can reach this goal easily, you may begin the program in a seated position, and again, work up to the goal of being able to a hold of 6-8 secs, repeated 12 times. After which, performing the PFM contraction in a standing position, which is the most challenging, can be commenced. Eventually, you want to be able to perform that same hold of 6-8 secs, repeated 12 times in the standing position, 3 times per day.

PFM squeezes can and should be incorporated into everyday activities such as; coughing, sneezing, heavy lifting, or when returning to the sport that may risk PFM muscle weakness, such as mentioned above.
Walking is an excellent way to gently return to exercise without compromising PFM strength or undoing any benefits gained through doing PFM strengthening exercises.

Pregnancy stretches and weakens the abdominal muscles as the baby grows. This can compromise the abdominal support we would normally have for our backs both during and after pregnancy, putting us at risk of back injury.

This abdominal stretching can become so severe that a gap or diastasis can develop in the Rectus Abdominus (6-pack) muscles. This is commonly called a DRAM. This places postnatal women at risk of abdominal herniation though the gap, particularly when participating in exercises that utilize the 6-pack muscles and increase pressure in the abdomen e.g. sit-ups/crunches. The diagram below shows a normal Rectus Abdominus contrasted with Rectus Abdominus that has (an abdominal herniation -this is not exactly a herniation but just the separation) a DRAM.

Strengthening the core abdominal muscles i.e. the deep Transversus Abdominus (TA) muscle can help reduce this gap and create the support required to protect the spine against injury.

TA is best felt in the lower abdomen by locating the 2 side pelvic bones with the fingertips and then moving inwards towards the belly button about an inch. Press gently but deeply. To contract the TA, draw the lower belly backwards towards the spine, like you’re trying to get the zip up on some tight jeans. You should not hold your breath or suck in air. You will feel a tightening bulge under your fingertips if done correctly.

Begin by holding the contraction for as little as 3-5 secs and gradually over the days, try to hold it longer e.g. 10 secs, 30 secs, 1 min, 5 mins etc. Eventually you may be able to go for a walk while bracing your TA the whole time.

As with the Pelvic Floor Muscles, begin to use the TA bracing in everyday activities, particularly those which put the back at risk of injury e.g. heavy lifting.

It is important to ensure that the DRAM is no greater than 2 finger-widths wide before beginning any exercise which works the 6-pack muscles. A women’s health physiotherapist can check this for you.

N.B: For women who have had a cesarean section, the abdominals are further weakened by the incision and pain. Therefore heavy home duties are not recommended for the first 6 weeks e.g. vacuuming, mopping, lifting heavy washing/shopping, etc.