Dr Brandi: Postpartum exercise, recovery & the effect on breastfeeding
Returning to Exercise after your baby
Resuming exercise activities after you have your baby or incorporating new exercises routines into your life supports lifelong healthy habits and sets a good example for your children growing up.
Studies show that women’s level of participation in exercise reduces after childbirth, which can lead to obesity and increased risk of disease. The postpartum period is an opportune time to initiate or continue healthy lifestyle behaviors including participation in physical activity. Advantages of exercise in the postpartum period include improvements in emotional well-being, reduced anxiety and depression, improved physical conditioning and faster return to pre-pregnancy weight.
Most anatomical and physiological changes that occur during pregnancy will return to the pre-pregnancy state by 4-6 weeks after delivery.
There is no absolute time frame prior to returning to exercise but 6 weeks is a good ballpark figure for those in no rush, to allow time to settle into your routine with your new baby.
This being said, you can resume gradually earlier than this, as soon as it is medically safe. This will depend on mode of delivery (vaginal verse cesarean section) and any medical or surgical complications of pregnancy (consideration of damage to pelvic floor and abdominal muscles).
Some women, particularly competitive athletes who participated in high levels of exercise prior to and during pregnancy, can resume training within days of delivery with no adverse effects if there were no medical or surgical complications.
What to do straight away
Pelvic floor exercises should be initiated in the immediate postpartum period by every mother.
Does exercise affect breastfeeding?
Regular exercise in women who are breastfeeding can improve maternal cardiovascular fitness without affecting milk production, composition or infant growth.
Women who exercise to moderate levels of exertion don’t have changes in milk composition or infant acceptance of breast milk, however exercise at maximal levels can be associated with short term increase in lactic acid levels in breast milk. This is not harmful to the baby but may affect infant acceptance.
Breastfeeding before exercise or expressing prior to exercise and feeding afterwards can help avoid this problem and also prevent any discomfort of engorged breasts while exercising. Otherwise postponing feeds to one hour after exercise will allow removal of most of the extra lactic acid from the breast milk naturally.
It is important to ensure adequate hydration before commencing physical activity and ongoing appropriate food and fluid intake to allow production of adequate milk volume.
What you can do
After clearance by your health provider to ensure an absence of medical or surgical complications of delivery, the best way to start increasing your activity is by a gradual walking program in the first few weeks following birth.
You can start with 10 minutes at a time, several times per day and progress as tolerated to regain your cardiorespiratory fitness. Aim through gradual progression to get 30 minutes of moderate activity per day at least 5 days per week.
For C-Section Delivery
There are specific concerns related to lifting and abdominal wall healing after cesarean delivery. Temporary abstinence from lifting objects heavier than the newborn is recommended for most mothers in the first 6 weeks post cesarean delivery.
For advanced recreational or elite athletes, the wound healing process of the abdominal wall will determine time for return to more strenuous exercise.
How long does recovery take?
The abdominal fascia regains 50 – 60% of its original tensile strength at 6 weeks and 70 – 90% at 4 months.
Significant low back or pelvic pain, ligament laxity, pelvic floor injury or abdominal rectus diastasis will require a longer recovery time and a modified exercise routine.
Return to high impact activities (where both feet leave the ground at the same time such as jogging or jumping) or those that cause high gravitational load on the pelvic floor should occur gradually, when you have adequate pelvic floor strength and control.
What other specialists can I speak to?
If you have any concerns regarding return to exercise following childbirth, it is wise to consult a specialist women’s health physiotherapist (physical therapist) who will assess your pelvic floor function and prescribe and monitor a program to ensure return to full pelvic floor function.
Find Brandi online:
Check out the Strong Friends Interview with Dr Brandi Cole
Podcast, Facebook and website: coming soon!
By letting me know what topics are important to you in terms of pregnancy and post-pregnancy, we can make this series as frank and relevant as possible. Thank you!
1. ACOG Committee Opinion No. 650: Physical Activity and Exercise During Pregnancy and the Postpartum Period. Obstet Gynecol 2015; 126:e135.
2. Ceydeli A, Rucinski J, Wise L. Finding the best abdominal closure: an evidence-based review of the literature. Curr Surg 2005; 62:220.
3. Evenson KR, Mottola MF, Owe KM, et al. Summary of international guidelines for physical activity after pregnancy. Obstet Gynecol Surv 2014; 69:407.