A Personal Trainer’s Guidelines for Returning to Exercise Postpartum
Many women are eager to get fit after having a baby, but doing too much too soon can backfire. Here’s why it’s important to take a slow and steady approach to your postpartum workouts.
Congratulations — you just had a baby! Your body conceived, grew, and developed a baby over the better part of a year, and then to cap it off, endured labor and delivery to bring that baby into the world.
It’s no secret that pregnancy and delivery can be tough on a woman’s body. In fact, researchers have confirmed that pregnancy can be as hard — or even harder — on the body than running a marathon.
One study compared pregnant women to highly-trained endurance athletes and found their exergy expenditure was similar, but over a longer, more prolonged period of time. What’s more, researchers at the University of Michigan found that pelvic injuries and conditions sustained during pregnancy and delivery are similar to the overuse injuries of endurance athletes, including severe muscle sprain, muscle tears, and stress fractures. It is true — pregnancy and delivery is a marathon of epic proportions.
When you’re a highly trained athlete who sustains an injury, you work with athletic trainers and physical therapists to rehabilitate, building your strength and stamina back up slowly so as to avoid making the injury worse. Sadly, this is not often the case with postpartum women.
Despite the superhuman feat of bringing a baby into the world, and despite the toll it takes on your body, women are left to fend for themselves in the postpartum period. Think about it: if you have surgery on your shoulder, you get more rehabilitative services and therapy than you do when you have a baby — even if you had a C-section, which is major abdominal surgery.
Until postpartum rehabilitative care is standard practice, it’s up to us to seek out the information that will help us heal, and ultimately thrive, after having a baby. To that end, we’re bringing you the most up-to-date information on returning to exercise postpartum, and why it’s crucial that you give yourself time to heal.
Forget bouncing back
Here’s something that may come as a surprise: up until 2019, there was very little research about how to return to exercise safely in the postpartum period. Now, thankfully, science is catching up to all of us who were told ad nauseam that we needed to “bounce back” after having a baby.
But before delving into what the research says, let’s talk about changing the bounce back narrative. Birth trauma, injury, or postpartum conditions aside, even the healthiest pregnancies and easiest deliveries change the very structure of your body. Everything from your hormones to your biomechanics and brain are altered in some way.
That’s why getting fit again after birth isn’t about picking up where you left off pre-pregnancy, because the body you have now is different from the body you had pre-pregnancy — in more ways than just a few added pounds.
For that reason, when you get the clearance to exercise again after birth, one of the most important things you can do is start with a blank-slate mindset. What does that mean? Well, try not to compare yourself now to any other version of yourself before. The early postpartum period is a time of rehabilitation and re-learning that must happen before you can go hard with your workouts.
Accept your body as the new body you have now, and take a curious and mindful approach to getting to know her. Begin with foundational exercises that will teach you how to engage your deep abdominal muscles, help you refine your movement patterns, and learn to work with the new structure of your body. Once you build back the foundation, brick by brick, you’ll eventually get more out of the breathless cardio and high intensity strength exercises you’ll perform later on.
Try not to expect unrealistic results in this period, and avoid going to extremes with diet or exercise. Your body needs carbs to help manage mood and hormone shifts in the postpartum period, and your movement should help you recover, not cause more stress or injury.
The early postpartum period is a delicate time of rehabilitating and rebalancing. Trust that you will be fit and strong again, but in the early months postpartum, it helps to lead with curiosity. Learn what your new body has to teach you, and you’ll set the stage for a stronger version of you.
Guidelines for postpartum exercise
A few studies published in 2022 offer the most detailed return-to-exercise protocols to date. We’ll summarize their findings here, for easy reference.
Postpartum exercise for 0 to 6 weeks postpartum
Begin with walking around the house, and progress to 10 to 15 minutes walking at a time.
Focus should be on diaphragmatic breathing, posture and alignment, and light pelvic floor exercises, so long as no symptoms are present.
Work on transverse abdominis contractions in several positions, including lying supine, on all fours, and standing.
Postpartum exercise for 7 to 12 weeks postpartum
Walking may increase in duration and distance, so long as no symptoms are present. Begin with walking 10 minutes at a time, increasing 5 minutes per week until you can walk 30 minutes at a time without pain or leaking.
Begin closed-chain strength exercises. In other words, start with exercises that have two feet on the ground and minimize instability.
Start with bodyweight exercises like squats, bridge, clamshell, and side leg lift series and pay special attention to executing with good form.
Before beginning plank exercises or exercises that flex the spine, get checked for diastasis recti. As you start to integrate more core work into your routine, begin with incline planks and abdominal draw-in exercises with your spine in neutral. Watch for doming or protruding along the midline of your abs, and stop if you experience pain or protrusion.
Postpartum exercise for 3 months - 9 months postpartum
Begin adding weight to progressively add strength. Focus on building muscle mass and developing muscular endurance. Alternate days of low load and high reps, with days of high load and low reps.
Progress to adding instability or challenging your balance — for instance, performing bodyweight exercises standing on one leg (like a one leg squat) or on an unsteady surface, like incline plank on a BOSU.
If no doming or protrusion occurs, and if your diastasis recti has healed, you can begin spinal flexion exercises like ab curls and situps, and begin training for planks without an incline.
If no pelvic floor dysfunction occurs with hopping or jumping down from a box, begin the running protocol below.
Postpartum exercise for 9 months - 12 months postpartum
Begin to introduce speed and power workouts, like plyometric circuits and sprints, as long as there are no symptoms of pain, prolapse, or incontinence.
What to know about postpartum running
Running should not begin before 12 weeks postpartum. When you want to begin running, start with run/walk intervals with your running intervals no longer than .25 mile at a time, and only 2 cycles of running and walking.
Gradually increase your total mileage, only increasing 10% per week, max, as long as you can remain symptom free (which means no pain or leaking).
Before beginning a running program, ensure that you’ve built significant strength in your hips, abs, pelvic floor, and feet. It is beneficial to see a pelvic floor PT to assess your strength and running gait, and learn exercises to help you rehabilitate.
Some women note a slight incline helps when beginning to run, as it places the pelvis in less of an anterior tilt, allowing the pelvic floor to function more optimally.
Focus on distance before speed. Work on increasing speed and power between 9-12 months postpartum.
What to watch out for during postpartum workouts
From a fitness perspective, the two biggest concerns in the postpartum period are diastasis recti and pelvic floor dysfunction.
In an ideal world, every postpartum woman would have access to a physical therapist that is trained in both of these conditions, and could help her rehabilitate them effectively. It’s worth checking your insurance benefit for physical therapy sessions to see what is covered. Having a professional opinion as you begin your rehabilitation and return to fitness is invaluable.
Diastasis recti is a separation of the linea alba — or the midline of your rectus abdominis — that is very common during and after pregnancy. After your separation starts coming back together, learning how to manage the pressure in your core when exercising and breathing is imperative to strengthen these muscles, therefore protecting your back, hips, and pelvic floor.
Pelvic floor dysfunction is common in the postpartum period for obvious reasons, but even if you had a C-section, your pelvic floor has endured a lot of stress due to the added weight and pressure of carrying a child. Again, working with a qualified physical therapist or trainer who can help you learn to manage the pressure on your core will do wonders for your fitness journey going forward.
Lifestyle factors also play a big role in your postpartum fitness journey. Pay special attention to the following:
Your sleep quality and duration
Hormonal shifts when weaning or when menstruation restarts, or as your body recalibrates after birth
Changes in routine due to the baby or returning to work
Energy levels throughout the day, week, and month
Eating for energy, rather than restricting foods to lose weight
All of these things can have a major impact on your energy level, stress level, and individual workouts.
The bottom line
It may feel hard to find your groove with regular workouts for a very long time, but don’t beat yourself up over that. Consistent effort is the most important element of postpartum fitness.
If you only have time or energy for a walk, and that’s your workout for the day, that’s ok. Strength sessions are still effective when they’re just 20 minutes long. And if your body is tired, give it time to rest, so your next workouts will have a greater impact.
Your goal right now is to make movement a priority — without worrying about how long or what type of movement it is. Just keep showing up when you can, and have patience. Start slow and build back, bit by bit, listening to your body as you go. In time, you’ll surprise yourself — you may be stronger than ever before.
