Updated: Feb 17
I have big plans for the next couple of years. I want to get back to long-distance running. I’d love to find the time to return to triathlon. And very high on the list is completing a StrongFirst kettlebell certification that was not in the cards between baby #1 and baby #2.
But first, recovery, rehab, retraining.
I DO have big plans. And to protect them, I have taken a slow and deliberate approach to my postpartum strength training (slow is fast!). Below I’ll outline the same approach that I took during my first three months postpartum (often referred to as the Fourth Trimester) and that I use to coach my early postpartum clients.
A full physical (and lets face it, emotional) recovery from pregnancy can take 6 months to a year, or even longer. Exact timing probably depends to some extent on the type of delivery you experienced and whether or not there were any complications or injuries. It’s a tall order to expect to return to pre-pregnancy levels, or even pregnancy levels, of activity in the first few weeks after giving birth.
So how soon after giving birth can you begin to exercise? And what should the process look like?
In the first days and weeks postpartum, whether talking about a vaginal or cesarean birth, the birthing parent’s big picture priorities should include rest, recovery and care of baby. Some people use the 5-5-5 rule to guide their initial postpartum recovery: 5 days in the bed (spend most of your time laying down, sleeping when you can, etc), 5 days on the bed (sit up more, nurse the baby in bed if you can, limit your time on your feet), 5 days near the bed (plan to still be in your home, continue to rest as frequently as you can).
If you are absolutely itching to do SOMETHING during this time, it is usually safe and appropriate to begin breathing exercises and gentle pelvic floor work during the first days after delivery. If these gentle exercises cause pain, discomfort or increased bleeding, please stop and get in touch with your medical provider.
The first rehab priority should be retraining the breath and coordination of the diaphragm, pelvic floor and innermost abdominal muscles using the Connection Breath. If you’re unfamiliar with this breathing technique, try these suggestions:
1) Practicing diaphragmatic breathing. Focus on expanding your rib cage 360 degrees (such as into your bra strap) during your inhale breath.
2) Practice gentle pelvic floor contractions (kegels) to bring awareness back into your pelvic floor and perineum (and I’m talking a few sets of 10, not 500).
3) Coordinate your breath and pelvic floor contraction through the Connection Breath. On your inhale think: expand your ribs 360 degrees, relax and release abdominal muscles and pelvic floor. On your exhale think: gentle pelvic floor contraction.
During weeks 2-4, begin to practice the Connection Breath (if you haven’t already). When you feel ready, begin introducing short bouts of gentle walking (5-20 minutes, start on the shorter end and progress longer). If you are feeling well, want to move more and it doesn’t exacerbate any symptoms (bleeding, pelvic floor discomfort, fatigue) it is also safe to begin introducing some exercises that roughly align difficulty-wise with your activities of daily living. These might include stretching (of chest, hamstrings, hip flexors or glutes) and body weight exercises (such as glute bridges, squats, heel slides and banded pull-aparts). As you reintroduce these simple exercises, incorporate a Connection Breath (exhale + gentle pelvic floor contraction) just before or on exertion to help cue coordination of your breath with your movement.
As you begin to move more, make sure you “listen to your body”. Look out for the 3 Ps: peeing (any unwanted leaking), pain (in vagina, pelvic floor, tailbone, or anywhere else) or pressure (in pelvic floor or through abdominal midline). Click here to read more about the signs and symptoms of core and pelvic floor stress and what to do about them.
Around 6 weeks, you will go for a standard postpartum check up with your OB or midwife. Please keep in mind, that the “all clear” that they provide you simply means that your body is recovering well and bleeding has likely stopped. Primary care providers are not trained to evaluate the condition of your pelvic floor or to advise in its rehabilitation (unless they’ve received special training) and so before beginning high impact activity you should check in with a pelvic floor or women’s health physical therapist. Even if you had a cesarean delivery, a trip to the pelvic floor PT is still highly recommended.
If the first 6 weeks are considered “rehab and retraining” of breath and basic motor patterns, the next 6 weeks can be thought of as “return to exercise”. Barring contraindications from providers, most new parents can begin adding in structured strength training, although resistance should still be provided by bodyweight, resistance bands or light weights (no heavy lifting quite yet). Cardio can take the form of longer walks (progress slowly to 45 minutes – 60 minutes in length), swimming or biking.
During this phase, really focus on learning to control your movements and coordinating them with your breathing (for example, exhale on exertion). Continue to look out for the 3 Ps.
During the second half of the Fourth Trimester, rest remains a high priority. Before increasing your exercise intensity, consider not only your physical comfort and pelvic health symptoms, but your overall stress, nutrition and sleep. Until you are sleeping well, eating well and have a handle on your life-stress, it’s a good idea to keep your exercise stress moderate.
Beyond the Fourth Trimester
Everyone’s postpartum trajectory is unique and so it is difficult, if not impossible, to provide an exact roadmap to your specific return to your sport or activity of choice. If you follow the guidelines here, if you’ve reconnected to and begun to rehab your core and pelvic floor, if you’ve begun to reintroduce strength training and longer bouts of sustained moderate-intensity cardio, you are well on your way. As you progress, think “slow is fast”. Remember your goal is not to run a marathon at 3 months postpartum, but to be able to run a marathon in 5 years. Or 10. Progressively increase the demands of your strength training and other activity and seek help if you notice any pelvic health symptoms or setbacks.
The fourth trimester is considered early days with respect to postpartum healing. Even if you had the easiest pregnancy and a complication-free delivery, your body needs time to recover. During this phase, you want to rebuild slowly and intentionally, to set yourself up for success in the long term.
My mission is to make sure that having a baby is not a reason why you can’t do all the things. Contact me if you have questions about your own Fourth Trimester fitness plan, if you’re local (Seattle's Eastside and surrounding areas) and interested in working with me on a custom postpartum personal training plan, or if you’d like help finding a qualified postnatal personal trainer near you.