Postnatal Exercises
Date issued: November 2022
For review: November 2024
Ref: C-438/VWH/Physiotherapy/Postnatal Exercises v2
PDF: Postnatal Exercises final November 2020.pdf[pdf] 2MB
Introduction
This leaflet aims to provide you with exercises that are safe to do after your 6-week postnatal check with your GP. It is important to start exercising slowly and progress gradually, listening to your body along the way. If at any time you feel dizzy, pain or unwell please stop and if symptoms continue speak to a health professional.
Postnatal changes
The weight of the baby and the softening and stretching of your soft tissues in pregnancy will have changed your body shape and posture in many ways. This takes time to return to normal, sometimes as long as 3-5 months postnatally.
The healing of your perineum will vary depending on the amount of trauma. Healing of any stitches and swelling you may have had would have taken about two weeks. Recovery of your pelvic floor muscles will take a lot longer.
Your ribcage circumference returns to normal to some degree, but you may notice differences throughout your body.
Your tummy (abdomen) often remains soft and poorly toned for a few weeks/months. You may have also noticed a ridge down the middle of your tummy, or a midwife may have told you that you have a DRAM.
What is a DRAM?
DRAM stands for Diastasis (or divarification) of the Rectus Abdominus Muscle. It is a condition where the rectus abdominis (‘six-pack’) muscle spread apart at the stomach midline (linea alba) to allow room for the growth of your baby. This can happen in 90% of pregnancies during the third trimester and spontaneously recover within the first 6-8/52 postpartum.
Benefits of exercising postpartum
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Prevention of incontinence
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Weight loss/ prevention of obesity
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Strengthening abdominal muscles
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Recovery of a DRAM (if you have one)
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Maintenance of bone density
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Improve fitness
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Social interaction
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Psychological well being
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Reduce anxiety and postnatal depression
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Increase energy levels
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Avoid physical problems later on
Postpartum exercise guide
This is just a guide and should be considered on an individual basis. Factors such as type of delivery, vaginal tears and infections (in stitches or mastitis) should all be considered.
0-6 Weeks
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Pelvic floor exercises
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Pelvic tilts and transverse abdominis exercises
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Walking
6-12 Weeks
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Low impact exercise
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Gradually introduce cardio like static bike, walking faster, but not running yet
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Yoga/Pilates
12 Weeks +
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Gradually increase impact and cardio as per individual assessment
Warning signs to slow down
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Increased fatigue
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Heavy vagina
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Feeling of ‘pushing down’
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Muscles aches and pains that continue beyond days
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Vaginal bleeding
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Doming of the tummy muscles
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Incontinence or urgency of urine
Anatomy of your abdominal muscles
The main muscles involved in supporting your trunk especially during pregnancy are shown in the diagram below. You might hear us refer to them as the ‘core’ muscles or the primary/local sling.
Neutral spine
Tilt your pelvis forward and then back. Establish where your natural midpoint is and maintain this whilst performing your exercises. During all exercises try to maintain activation of your transverse abdominis, pelvic floor muscles and keep a neutral pelvic alignment.
Transverse Abdominis (Deep tummy muscle)
These muscles span from side-to-side and form the front part of your deep trunk muscles.
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Sit, stand or 4-point kneeling
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Gently draw your lower tummy muscles (below your belly button) in towards your spine, maintaining a relaxed normal breathing pattern
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Hold the contraction 10-30 seconds and repeat up to 10 times
Pelvic Floor Muscle (PFM) exercises
It is important to train this muscle too as it works together with the transverse abdominis muscle. The pelvic floor muscle is like a sling/hammock that runs from inside the front of your pelvis to the coccyx. Like all muscles there are deep and superficial layers and fast and slow twitch muscle fibres that need to be worked differently.
Try these two ways of working the PFM, firstly trying in lying or sitting and then working towards standing.
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Tighten the back passage, close around the vaginal exit and lift the muscles at the front, as if you are stopping the flow of urine or squeezing tight inside your vagina
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Try to hold for as long as you can and then relax and repeat, aiming for 10 seconds and 10 repetitions
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Now try squeezing quickly then relax, repeat 10 fast repetitions.
Final word
The importance of this treatment and exercise programme is to enable you to improve strength and fitness during your postnatal journey. Please listen to your body and if in doubt ask your physiotherapist
Further information
If you are continuing to have difficulties with the recovery after giving birth, please be aware you can self-refer to the physiotherapy department at Derriford Hospital
