Many of the physical and physiological changes that occur during pregnancy persist for up to 4 – 6 weeks after giving birth. During this time it is especially important to consider the effects of exercise on the recovering post partum woman and her pelvic floor.
Pregnancy and childbirth both have significant impact on the maternal musculoskeletal system. Vaginal birth could be likened to an acute sports injury and caesarean birth involves major abdominal surgery. Most people who experience acute injuries or abdominal surgery wouldn’t jump back into exercise and sport without rehabilitation and a graduated return to activity program. Neither should the post partum woman.
Caesarean v vaginal delivery
Women who’ve had a caesarean delivery will have abdominal pain post partum. The pain along the incision may require analgesia for 5 -10 days. They are more likely to report extremes of tiredness at 6 and 12 months and back pain at 6 months after a caesarean delivery but less likely to report urinary incontinence at 3, 6 and 12 months post partum (compared to vaginal delivery).
The decision to return to exercise after a caesarean depends on factors such as blood pressure, anaemia, fatigue, pain management and wound healing. Women should be made aware that it could take 6 months or more for their abdominal connective tissue to regain its normal strength.
Recovery of the pelvic floor muscles after pregnancy can take 4-6 months. Recovery may take even longer after a vaginal birth. Even a woman who has had a caesarean section will need varying degrees of pelvic floor recovery depending if she went through labour prior to an emergency caesarean or if she had a planned caesarian.
The pelvic floor
There is no clear evidence whether resuming strenuous physical activity early in the post partum period, at the time where muscles, nerves and connective tissues are recovering from the trauma of vaginal birth, impacts future pelvic floor health. In theory, pelvic floor muscles could be overloaded if the mother resumes strenuous exercise to quickly. Just as we give our tissues time to heal after an acute sports injury, women should be encouraged to give their pelvic floor time to heal after childbirth.
Women whose deliveries were complicated by risk factors for pelvic floor injury (3rd degree tears, forceps delivery, prolonged second stage of labour, large baby) should minimise activities that stress the pelvic floor, including exercises that generate large increases in intra-abdominal pressure (for example breath holding during weight lifting) and repetitive impact activities for several months post partum (but more research in this area is needed).
There are many favourable cardiovascular and respiratory adaptations that occur during pregnancy and they can persist up to 2 months post partum. High levels of cardiorespiratory fitness may be maintained throughout pregnancy and into the post partum period. In contrast to this there can be a reduction in muscle strength (in certain muscle groups) due to a detraining period towards the end of pregnancy and in the first few weeks post partum. Even a 15 – 30 day detraining period is long enough to cause muscle atrophy significant enough to warrant a graduated reconditioning program.
Practical tips for returning to exercise after birth
- Strength training of the pelvic floor muscles can start directly after birth
- Anyone with symptoms of urinary or foecal incontinence or a feeling of a bulge in the vagina should be assessed and supervised in their pelvic floor retraining and avoid any activities that makes their symptoms worse in the short term
- A graduated return to both aerobic and strength training exercises can begin once the mother is fully recovered, usually around the 6 week mark
- Best practice is to have a pelvic floor assessment from a qualified physiotherapist prior to resuming an exercise program
- Pre-pregnancy exercise routines should be resumed gradually, with an early emphasis on muscle recovery and strength, correct movement patterns and low impact activities before progressing to more skilled and dynamic movements and higher impact activities
- Moderate and vigorous intensity exercise will not negatively affect breast milk volume as long as there is sufficient fluid and food intake
- Breastfeeding women need approximately 600kcal extra intake per day to meet the needs of breast milk production
- Exercise doesn’t affect breast milk composition or the growth and development of the baby but the taste of the milk may be slightly changed immediately after intense exercise due to transient lactic acid accumulation
- If a baby is unsettled during feeding immediately after maternal exercise, it may be best to time feeds for an hour prior to or after exercise or express milk prior to exercise for feeding afterwards
- Ensure that the intake of calcium during the breastfeeding period is sufficient to meet the combined needs of the baby and mother. During breastfeeding, higher oestrogen levels can exacerbate bone resorption and increase the risk of bone stress injury
- Exercising mothers, especially those who are still breastfeeding, may benefit from wearing a professionally fitted sports bra. The bra should offer support rather than compression to increase breast and bra comfort during exercise
If you are a woman wishing to return to exercise or sport after your pregnancy, Shire Sports Medicine has specific post partum consultations for individualised advice and assessment regarding your return to physical activity in a safe and healthy way.