As a Pelvic Health Physiotherapist, I see multiple clients a week navigating through the fourth trimester of pregnancy (the first 3 months post partum) and beyond. The fourth trimester is a HUGE time of change.  You, as a new mom, are likely learning how to be a Mom – navigating how to eat, sleep and nourish yourself and your new baby (or babies!). During this post partum time, your body is undergoing a huge amount of change as well – your organs and abs are re-learning where to live without Baby in the way, hormones are fluctating, and you may be healing from some stretching or stitches in the abdomen (from a caesarean birth) or pelvic floor (from a vaginal birth). You might have some leaking (incontinence) or maybe some back or pelvic pain. Or, you might be feeling really awesome! Now you are constantly juggling a floppy newborn Baby – standing, carrying, feeding in seated or lying down (or somewhere in between!), picking up toys, food, disregarded soothers, car seats, strollers, and all on 2-3 hours of sleep…. Phewf! You and your body are going through a lot! Fortunately, the reality is that our bodies are strong, reliable and so dynamic! Here is what you can do to support your recovery after birth.

Phase 1: Week 1-3: Adjusting to Motherhood and Getting Back to Basics

Focus #1 – Support for yourself as you support your newborn. Call on friends, family and postnatal Doulas (if you are able) to meal prep, clean/tidy, fold laundry or cuddle Little One while you shower or nap. Or, if you are instead feeling the need for some alone time with your newborn and find company to be exhausting, set up those boundaries and ask your family to support you by giving you the space you need to adjust and bond with your little one. 

Focus #2 – Rest, eat and sleep when you can! Cooked veggies and bone broths are great nutrient sources that promote healing while your body is recovering. Here is an awesome link to a tonne of freezer-ready post partum recipes for healing and recovery.

Focus #3 – Breathe deeply, move gently. This is not because your body is fragile – your body is adaptable and resilient, and is going through a lot of adapting right now! If you find you feel comfortable and have the energy, doing light tasks around the house, going for walks, doing some stretching or even just taking some deep breaths down into the belly while feeding can be little ways to nourish your body during your immediate recovery post partum.

Tip: after you put Baby down, move your neck and shoulders around, maybe do some swimming arm motions and gentle twists through the upper back. These movements are often limited when holding Baby and moving around often helps decrease tension sensations through this area.

Signs to indicate your body still needs some downtime – pain, pressure sensations, peeing (bladder leaking), bleeding increasing after activity and/or undue fatigue (going for a 20minute walk shouldn’t wipe you out for 3 days). Remember, big physiological changes are happening as your body adjusts to life with Baby on the outside and often sleep deprivation is very real. You may not have the energy reserves you had before, and you may need to respect tissue healing timelines (inflammation phase is 1-14 days) if you have any stitches. 

You can always check in with me during this early post partum recovery – we may not do an internal exam but we can go through your birth story, see how you are feeling and go through any questions you may have.

Phase 2: Week 4-12+: Returning to Activity

Around this time you might be starting to feel like you are getting into the groove at home, might be going a little stir crazy and/or want to do some exercise. (Or you might still be adjusting to new life with Baby – in which case take your time in Phase 1, no rush!). You might have your appointment with your OB or midwife where they might give you the go ahead to return to activity… with little instruction after that. Does this mean you can jump back in to running, Bootcamp, Body Bump, CrossFit, HITT, 21 Day Fix, etc?

The short answer is, it depends.

Did your OB or midwife look at your birth region (abdomen or pelvis) at your appointment? Maybe. Did they test for strength, relaxation or patterns of the ab muscles and pelvic floor? Probably not.

Imagine you injure your bicep. Your Doctor’s job is to tell you that you have an injury, stitch you up if needed, make sure you don’t have an injection, maybe give you some meds and refer you to an expert if needed. It is your Physiotherapist’s job to assess the biceps functionally (does it work so you can lift things?) and give you some stretching and strengthening to do to help you recover. This is what Pelvic Health Physios (like me!) do for your abs and pelvic floor (and back and hips, too). We take a look to see if you have Rectus Diastasis (abdominal stretch from being pregnant) and what that means for you, we help address any incontinence (bladder or bowel leaking) issues and address any concerns you have about prolapse (abdominal organ shifts). We also chat about why you might have pain with sexual activity and what you can do about it and help you get back to whatever form of activity you want to get back to – whether that is walking, yoga, power lifting, boxing, Crossfit, pole dancing… etc! This might be something you can get back to quickly or it might be something we will work up to as your body continues to change and recover – it really changes person-to-person.

In general, it is wise to start at a lower intensity and build up – for some this may start with short walks outside and build up to lunging and strength training, doing modified WODs with lighter weights. Current guidelines suggest not returning to impact activities such as skipping, jogging, running or box jumps until at least 3months after Baby. We can decide together, through an assessment, where this fits regarding your goals, depending on your body, birth and recovery. Your body is still adjusting to life with Baby on the outside, you might be allocating more body energy to breastfeeding, your hormones are still fluctuating and you are probably running on less sleep than before. 

What about sit ups, planks, Russian twists? What about CrossFit or HIIT?

We will definitely take a look at these movements in our appointments, assuming returning to these activities is a goal for you or is part of your aesthetic goal. Most women can start gradually loading with “ab exercises” within the first month after birth when they feel up to it, but this is really dependent on how your body is responding (and how you feel!) so it’s generally a good idea to get assessed for abdominal and pelvic floor functioning so you know what load and patterns are appropriate for you, based off of your goals. 

Overall, most people can return to their preferred form of exercise safely. How much time it will take to build you up to these activities varies from person to person. Let’s get together, see where you are and start working towards your goals!