There's so much to know as a new mum, but the information on what to do is often conflicting and confusing. Mums want to do the right thing by their families and their bodies. 10 years ago, when I'd just had my first child and was conducting my Masters in Sport and Exercise Physiotherapy dissertation research into post natal exercise, My main finding? Women wanted reliable guidance on what they should do and when to do it. They voiced their need for support from health and exercise professionals, childcare support and the encouragement and assistance of others, especially partners and family, in order to achieve this. Think back to 2010 - no official UK Public Health guidance, limited media (social or otherwise) talking about pelvic floor tears or tummy muscle separation.
I'm pleased to say there's alot more evidence and official guidance for mums was released in 2019 (1) to help us now, but it isn't very accessible. In the modern era of Instagram TV and celebrity post baby body stories, how do you get to the truth?
Here are some basic pointers.
When can you start?
If you have had a straightforward birth, you can walk and do pelvic floor exercises as soon as you fel ready. At your 6-8 week post natal check, you should be given some personalised guidance, tailored to whether or not you were active pre pregnancy and during pregnancy, accounting for the type of chidbirth you had and personal circumstances. Sadly, my research showed this was often not the case, and sometimes women were even incorrectly advised. The sign off from the GP is really to check if there are no problems, rather than give you the green light to pursue a programme of hundreds of sit ups and high impact exercise!
If you were active before, you can gently reintroduce physical activity at that point. These activities may need to be changed or adapted initially.
Not active before pregnancy?
Now is still a good time to start moving well. Start gradually. Walking with your baby in the pram is a perfect place to start.
You need guidance from a specialised Physiotherapist if you:
have had a caesarean section - this is major abdominal surgery. Not only have your abdominals and pelvic floor been stretched and under pressure for 9 months, they have been cut through and weakened. Specialised exercises are needed to strengthen the abdominals and pelvic muscles and give you the support you need to lift and carry your baby (and the baby related kit!).
have pelvic floor 3rd and 4th degree tears/episiotomy, pain, urine or other leakage. These are common problems but not something that should last or that you should put up with! For my blog on the pelvic floor, see here
Vaginal or other pelvic organ prolapse. This needs proper diagnosis, so don't ignore it.
have a significant rectus diastasis (separation of the abdominal muscles)
had a post partum hemorrhage
are new to exercise and want to do things safely and effectively
want to exercise to manage weight but also ensure you have enough energy to care for your baby and/or continue breastfeeding, work and take care of your family. We have tips to help you manage energy needs without constantly reaching for sugar and caffeine!
have pain or an injury
plan to return to doing high level or elite sport
This type of consultation is routine in some other countries. If you need help, make sure you are not missing out.
Doing the wrong exercises, the wrong intensity and at the wrong time in your post natal journey can do alot more harm than good, so advice helps!
Starting more intense exercise
Build a base before imposing too much pressure on your body. After doing to moderate intensity physical activities over a minimum period of three months. In the absence of any signs or symptoms of pelvic floor or problems such as abdominal muscle separation beyond recommended limits, pain or instability, more intense activities can gradually resume. Joining a group or guided session can help.
Why be active?
We all know being a new mum is tough going at times. The total change of lifestyle, sleep, priorities and relationships, not to mention shifts in physical shape, weight and hormones that you have been through in the last year or so will have been huge.
Fortunately, women's amazing bodies are designed for this, and research (1) shows exercise supports:
Reduction in post natal depression, which affects more than one in 10 women.(2) The NHS recommend a healthy diet and exercise to maintain positive mental wellbeing post baby.
Better physical conditioning
Less in postpartum weight gain and a faster return to pre-pregnancy weight
Better sleep - quality of sleep is improved, which has to be a help for any mother!
Ideally, we should gradually build up to accumulating 150 minutes of moderate intensity physical activity throughout the week. This should also do muscle strengthening activities involving all major muscle groups twice per week. Sounds like alot? The good news is that EVERY ACTIVITY COUNTS! There is no minimum required for some health benefits.
For the days when you are struggling
Sometimes, just getting out the front door can feel like a major expedition! Don't put too much pressure on yourself. It's what you do over weeks and months that matters.
My study showed that to achieve your goals and take care of your postnatal wellbeing, you will need the support and encouragement of others. It's ok not to be superwoman and to do ask for help from those around you and, if you need it, from health and exercise professionals. Other mums in the same situation can be a huge source of help too. Sometimes exercising at home may be easier: 10 minutes of specialised post natal exercises and feeling in control is better than overdoing it! Listen to your body and instincts too.
UK Chief Medical Officers' Physical Activity Guidelines, September 2019 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/832868/uk-chief-medical-officers-physical-activity-guidelines.pdf