There is concern about when a mother should return to exercise after pregnancy. As a pelvic health and women's physio expert, I am offering you my opinion on returning to walking and running in the absence of a birth injury as a guideline only. There are a number of factors to consider regarding walking and running in the postnatal period.
Your fitness prior to pregnancy and birth determines your aims and your underlying fitness. It is reasonable to expect to return to that level of fitness – with patience and graduated effort.
Hormones definitely affect the integrity of the pelvic floor. Oestrogen is high during pregnancy and plummets postnatally to allow breastfeeding. Postnatally, the pelvic floor muscles and tissues lack this hormone to allow shrinkage of the vagina and uterus to return to its more normal size – but this also reduces muscle bulk. The muscles do much of the support work postnatally for internal organs. Pelvic floor muscles are at their best once periods and more normal levels of oestrogen return – typically this is when night-time breastfeeding ceases at 6-9 months – there is a lot of variation with this.
The internal structures
The ligaments of the pelvic organs are designed to lengthen during pregnancy and take time to reduce in length and increase consistency. “Remodelling” of the pelvic floor organs, muscles and other tissues is at initial maturity by three months. This affects wounds and all tissues.
Pelvic floor exercises
This is a big consideration. When upright, 100% of your weight goes through your feet, and 60% passes through your pelvic floor. Movement increases the downward force on your pelvic floor. Walking increases the downward force up to 4 times your body weight and high-speed running 8 (or more) times your body weight – through your feet and through your pelvic floor.
Pushing a pram after pregnancy
Avoid additional loads on your pelvic floor in the first six weeks, as much as you can – this includes pushing prams and lifting up toddlers (go down to your toddler’s level and cuddle them rather than picking them up).
Later on – perhaps beyond four months, the pram helps you to slow down when you run. Speed increases the load on your pelvic floor – and so does a full pram. Ideally, you would run without a pram to have good form and be aware of the sensation of your pelvic floor. However, perhaps you only have time to run if you include the pram and babe(s). Please run slowly and have lots of walking intervals.
Workout advice on online
Although there are plenty of workout opinions on "Google Land", Google is not your personal expert health advisor. It is always useful – I would suggest essential - to consult a pelvic physiotherapist who understands your personal journey through pregnancy, birth and postnatally and can see you move and provide appropriate guidelines and feedback.
Low-Risk exercise after pregnancy
Walking
In the first week – walk around the house, maybe out to the letterbox and perhaps around the block.
In the first six weeks – concentrate on walking a little further each day. Keep the exercise periods short. It is far better for your recovering abdomen and pelvic floor to do three lots of 10 minutes than one lot of 30 minutes. Extend the period just a little each day – possibly by a minute or two. Aim for a 30-minute walk by six weeks.
Plan to increase walking by 5 minutes a day as possible.
Aim for a 60-minute walk in 12 weeks.
Jogging and Running
From 4 months, and if you have no pelvic symptoms – you can include a “tiny” run while walking – this is a 3-step run-through intervallic with walking for 10 steps, done a few times during a walk (3-4 times)
If running is your aim; spend 1-2 weeks at each level of exercise and only increase if there are no symptoms as described above
When ready, increase the number of steps for both the run-through and the walking interval only by 1/3 at each level – staying at that level for another 1-2 weeks or 5-10 training sessions.
Hospital guidelines for postpartum care
Combining all these factors into one formula for every mother is impossible.
Accept these points only as a guideline and not as a personal prescription:
STOP exercising if you have any issues. Seek help from a physiotherapist who specialises in postnatal care ASAP – a vaginal bulge or pelvic pain, leakage of urine, bowel motion or wind. It won’t improve on its own. Do not accept any level of these symptoms without further exploration by an expert
DO WEAR supportive underwear or outerwear for every run
It may take 4-6 months to get to your target run of 30 minutes
Have someone with you to push the pram for the first 2-3 weeks or longer if possible
Monitor your symptoms as you increase your activity – during the walk/run, that evening and the next day
Intermit your running and walking: i.e. walk, jog and run
Progress to the next level only when the current level is easy
Do your pelvic floor exercises daily unless you have been advised not to.
A physiotherapist who is a specialist in these conditions in the postnatal period can assess you thoroughly and help you with your exercise plans.
Enjoy your baby and your return to fitness.
Annette is our Parents You've Got This Pelvic Health and Women's Physio Expert and presents at our Baby Basics Masterclass. To learn more parenting skills and how to nurture your child's development, check out the Parents You've Got This Masterclasses.
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