You have just had a baby, and your body has experienced huge physical changes. You may feel as if you have been pulled and stretched in all directions. Your stomach seems to have disappeared. Bladder control may be a problem. You may have pain in your back and pelvis. Though many Canadian women ask how they can return to pre-pregnancy shape after pregnancy and childbirth, few get definite answers.

In some European countries, rehabilitation starts before women go home from hospital. A physiotherapist specializing in pregnancy sees new mothers in the first few days after childbirth. Pregnancy stretches and weakens muscles in the pelvis, low back, and abdomen. The goal is to teach new mothers how to move and strengthen these muscles.

Unfortunately, this service is not funded in Canada. Most mothers are told to take it easy, let time do the healing, avoid heavy lifting, and learn to live with the changes.
This advice is not necessarily wrong. Still, women can do so much more to help reclaim core strength and bladder control. A focused rehabilitation program will help women in the short term, in the first year after childbirth. It also makes a difference to long term health, 10 to 15 years or more down the road.

Even women who are not noticing any problems can benefit from a targeted exercise program. It becomes particularly important as a woman has her second, third, or fourth baby.

How do I get started?

Book a visit with a pelvic floor physiotherapist, for about six weeks after delivery. This is a very good idea for every woman, regardless of whether she has had a vaginal birth or a Caesarean delivery. The pelvic floor therapist will assess muscle function in your stomach as well as in your pelvic floor. The therapist will teach you how to properly engage these muscles.

The Pelvic Floor

The pelvic floor consists of a group of muscles extending from the tailbone to the pubic bone. They support your pelvic organs – the bladder, bowel, and uterus. These muscles, along with the diaphragm and the deep back and abdominal muscles, make up the core.
During pregnancy, muscles may start to work differently. The weight of the baby pulls on the abdomen, tilting the pelvis forward. This strains the low back, buttock muscles, and hamstrings.

While these changes improve after the baby is born, women are often left with weakness. Pain may appear soon after delivery or years down the road. A physiotherapist can help identify changes in movement patterns and help you to correct them.

The pelvic floor is a group of muscles similar to a sling, running roughly from your sit bones in back to your pubic bone at the front. The deep abdominal muscles are also part of the pelvic floor. Together, they control your bladder and bowel.

Does my ‘exercise after baby’ class do the same thing as a physiotherapist?

Every woman has unique physical needs that are best assessed in a one-on-one situation. Some exercises offered in classes may not be appropriate for you. Done incorrectly, they can make your pelvic floor worse, not better. See a physiotherapist first, so that you understand how to engage the muscles properly. Once you know what you need to work on, go to the class.

I want to start running two weeks after my baby is born, like my friend did. Should I?
No! Many women want to start participating in their usual activities right after the birth of a child. After months of watching, it seems like it would feel great to get out for a run, or for a game of soccer or hockey. Women often compare notes about how soon they were able to play soccer after delivery, or marvel at another woman who ran a marathon less than a year after the birth of her child. While exercise can boost a woman’s confidence, striving to wear this badge of honour is not a wise choice. Why?

High-impact activities like running and jumping put the most strain on the pelvic floor muscles. After delivery, these muscles need several months to heal. Significant damage, such as a big tear or forceps delivery, requires even more time. Jumping places substantial downward pressure on muscles that are already stretched. That pressure does not allow for healing. It is like jumping on a trampoline that has no spring. You may not notice the lack of pelvic floor support right away, but in five or ten years, you may feel the effects. Symptoms include a heaviness or pressure in the vagina and a lack of bladder control.
In team sports, ligaments must respond quickly to sudden changes in direction. However, pregnancy hormones soften your ligaments. This allows a full-term baby to move down through the pelvis during delivery. The same hormones relax other ligaments, including those in your arms and legs. This puts you at higher risk of tearing key ligaments, such as the anterior cruciate ligament (ACL) of the knee. A study of Australian soccer players showed that ACL tears are up to five times more common in women playing after childbirth. Dislocations of the shoulder and kneecap are also more common in women after childbirth.

If team sports and running are off limits, what can I do?

Generally, the best activity is walking. Whether you have had a vaginal or a caesarean delivery, walking is safe to do as soon as you feel ready. Start slowly and add a few minutes each day. Pushing a stroller can increase the intensity. Pushing it uphill can be as intense as running. Cycling and swimming are also low-impact, pelvic floor-friendly forms of exercise for women after childbirth.

The best time to return to high-impact activities like running, jumping, and team sports is once your physiotherapist gives you the green light. This will likely be at three months if you have had an uncomplicated birth. If the delivery required a caesarean or forceps, or you had a large tear, it could be six months. Waiting this long may prevent future pelvic floor and bladder issues, not to mention back and pelvic pain. Think of it as a low cost insurance policy. During these early months, work on low-impact activity, core muscle strengthening, and pelvic floor exercises. You can work very hard during this time and improve your fitness hugely while still avoiding high-risk activities.

Is it safe to lift weights?

Although you can lift weights, get a go-ahead from your doctor, midwife, or physiotherapist first. Weight lifting is only safe if your technique is perfect. Lift a weight that allows you to repeat the motion at least 10 times. Only the last repetition or two should feel difficult. Be sure to tighten your pelvic floor before you lift. To do this, squeeze the muscles as if trying to stop the flow of urine. Do not hold your breath or grunt while lifting.

Tips after delivery

Do:

Don't:

Give yourself time to heal and recover. Plan to do very little in the first three weeks after delivery. This means minimal housework and no heavy lifting. Start pelvic floor exercises right away. You can do them as you feed your baby. Ask your doctor, midwife, or physiotherapist for specific advice.
Start walking as soon as you feel comfortable, even during the first three weeks after delivery.
See a pelvic floor physiotherapist about six weeks after delivery, even if you feel great.
Engage in low-impact activities, such as cycling and swimming, until you get the go-ahead to do more.

Run during the first three months after your baby’s birth.
Sign up to run a marathon before your baby turns a year old.
Jump!
Push yourself to earn a ‘badge of honour.’ Give yourself time to heal and strengthen. It may take longer than you think.

It is never too late to start working on your core. Strengthening these muscles can help even if your baby was born two years ago, or if you have had several children and have never worked on them. See a pelvic floor physiotherapist to get on the right track and prevent future problems.

How Do I Get Back Into Shape After the Baby Arrives? Take it slow and restore your core