You’ve gone through your pregnancy, you’ve given birth, and now you’re itching to be physically active. When should you get back to it? The postpartum period is a critical transition time, yet for some women, the fatigue and stress they experience after giving birth remain a barrier to returning to physical activity and incorporating a balanced diet. Pregnancy and giving birth bring an enormous range of changes in women both physical and emotional.
Physical and Emotional Changes The Body Goes Through After Delivery
Common physical changes after delivery
1. Changes In The Breasts
Breasts will be swollen, tender and extremely sore as the body is producing colostrum (the first milk that a mother’s breast produces), where lactation may be difficult at first. Once milk starts producing, the swelling and soreness will subside. Breasts tend to start sagging, and milk may leak for several weeks. (Fleming, 2016).
Breastfeeding and Exercise Recommendations
Lactic acid does increase in breast milk following intense exercise, however mild to moderate exercise does not increase lactic acid significantly. Even in elite athletes, there is no evidence increased lactic acid levels in breast milk is a concern for your baby’s health and growth (Fleming, 2016).
– Breastfeed prior to exercising (empty breasts are more comfortable)
– Wear a supportive bra for increased support and comfort
– Focus on hydration and drink lots of water
Related Article: Exercise in the Postpartum Period: The Practical Applications
2. Changes In The Vaginal Region
Women who had a vaginal delivery commonly experience tearing of the perineum or had an episiotomy (surgical incision of the perineum). Healing can take up to 6 weeks. Following pregnancy, the vagina is stretched and tender, and there will be discharge made mostly of blood and uterine lining (Nelson-Piercy et al., 2016).
Vaginal Region Exercise Recommendations- Pelvic floor exercises: ease back in
- By tightening and then releasing the muscles surrounding the vagina, Kegels strengthen the pelvic floor. Stop the flow of urine the next time you’re emptying your bladder, squeeze and hold those same vaginal muscles for 10 seconds and then slowly release.
- Squeeze again and release quickly. Do 20 10-second holds 5 times a day.
- Stand in an upright position, feet slightly wider than shoulder-width apart and toes slightly pointed out.
- Bend your knees and push your hips and butt back as if you’re going to sit in a chair. Keep your chin tucked and neck neutral.
- Drop down until your thighs are parallel to the ground, keeping your weight in your heels and knees bowed slightly outward.
- Straighten your legs and return to an upright position.
Complete 15 reps.
- Lie on the floor. Your spine should be against the ground, with knees bent at a 90-degree angle, feet flat, and arms straight at your sides with palms facing down.
- Inhale and push through your heels, raising your hips off the ground by squeezing your glutes, hamstrings, and pelvic floor. Your body, resting on your upper back and shoulders, should form a straight line down from the knees.
- Pause 1-2 seconds at the top and return to the starting position.
Complete 10-15 reps and 2-3 sets, resting 30 to 60 seconds between sets.
3. Changes In Body Weight
The body eliminates all the extra water retained during pregnancy along with extra water retained in the cells starting in the first week after pregnancy. Majority of the weight loss would be seen in the first week of pregnancy due to the absence of amniotic fluid, placenta and the baby’s weight. Weight gain will vary in women depending on genetics, age, and activity during pregnancy (Hodgkinson et al., 2014).
Recommendations- Reduce stretch marks and with abdominal exercises, as well as exercises found above such as squats and the bridge.
The Pelvic Tilt:
- Lie on your back with your knees bent with a pillow under your hips and another between your knees.
- Feet flat and your arms at your sides, inhale, then exhale and draw your abs in and tuck your pelvis under slightly, squeezing your buttocks as you do a Kegel. Hold 5 seconds and release for 10 reps.
Now that you know how to exercise after giving birth, when can you exercise?
It depends! The physiological changes of pregnancy vary in each woman and persist for 4 to 6 weeks, indicating that the recommendations of returning to exercise need to be individualized. No matter if the birth was a normal vaginal delivery or a caesarian delivery, postpartum women are encouraged to increase their physical activity gradually (Roy, 2014).
Recommendations after a normal vaginal delivery – do you really have to wait 6 weeks if feeling good with a normal delivery?
Women who consistently exercised before pregnancy and remained physically active throughout pregnancy often can return to exercising quickly after pregnancy. In women who experience a normal vaginal delivery, who remained physically active during pregnancy, can be given medical clearance to exercise as early as 4 weeks after birth (Roy, 2014).
Those who were inactive previously and those who were sedentary during pregnancy will need to start and progress more gradually and are recommended to wait until after the 6-week period with very low-intensity activities.
Recommendations on returning to exercise after a C-section
A caesarian birth can take as long 6 weeks to fully heal. Visit your healthcare provider postpartum for recommendations on returning to physical activity. Usually, after 6 weeks, you can start to do exercises for your abdomen as well as your pelvic floor. Avoid exercises that upset the scarred area, such as sit-ups and crunches.
After the 6-8-week mark, start to walk and gradually increase your speed and time. Progress to walking daily for 30 minutes, and when you’re feeling strong and comfortable, you can progress safely to other exercises.
Related Article: Baby and Me Workout Plan
Can you return to exercise earlier than 4-6 weeks postpartum?
An Elite Athlete Study
Sandbakk & Solli (2018) investigated the training characteristics, physiological capacity, and body composition of the world’s most successful cross-country skier. The study lasted over the course of her 40-week pregnancy, and the 61-week postpartum. They sought to determine if training and physiological capacity return back to pre-pregnancy values postpartum, and what kind of training loads a high-level athlete can tolerate during pregnancy and postpartum.
During the first and second trimester, the average training volume was approximately 80–85% of pre-pregnancy values, but then progressively decreased to around 50% during the third trimester where training was gradually reduced throughout.
The participant performed low-intensity training and moderate intensity training during all trimesters but refrained from high-intensity training after gestational week 5 (Sandbakk & Solli, 2018).
Postpartum, the participant had a quick return to training and was training 11 hours per week by the end of the first week. She returned to strength training from at the 3-week mark, but experienced a fracture in the sacrum, most likely due to progression that was too rapid.
However, by reducing the overall training load, slower progression and utilization of alternative exercise modes after the fracture was discovered, the participant had a successful training development and return to competition. Due to this finding, the authors recommended a more gradual increase to strength and high-intensity training, following 4-5 weeks after giving birth.
The participant went on to win four gold medals in the subsequent World Championships, following her pregnancy and birth (Sandbakk & Solli 2018).
International Guidelines For Physical Activity Following Pregnancy
An international summary of findings (Brown et al., 2014) identified postpartum exercise practices from Australia, Canada, Norway, the United Kingdom, and the United States. All five countries recommended physical activity during breastfeeding and identified sports activities and moderate exercise as safe and appropriate. Norway went a step further and identified moderate to vigorous physical activity as safe for women breastfeeding.
Only Australia, Canada, and the UK included postpartum physical activity recommendations following a caesarian birth. Australia and the UK guideline implied this would occur after the first postpartum visit with a healthcare provider, while the Canadian guideline indicated that women may slowly increase their aerobic and strength training, depending on the level of discomfort and other complicating factors.
Recommended physical activities all included aerobic, pelvic floor exercise, strengthening, stretching, and walking, but differed in recommended intensity. The Australian guideline cautioned against activities that cause high gravitational load on the pelvic floor (i.e., running, aerobics).
However, both Canada and the UK recommended pelvic floor exercise in the immediate postpartum period in order to reduce future urinary issues, whereas the Norwegian guideline specified the importance of pelvic floor training for women who have given birth. None of the guidelines discussed sedentary behavior.
The physiological changes of pregnancy vary in each woman and persist for 4 to 6 weeks, indicating that the recommendations of returning to exercise need to be individualized. Postpartum women are encouraged to increase their physical activity gradually, and those who experienced caesarian delivery must visit their healthcare provider postpartum for recommendations on returning to physical activity. Women who experience a normal vaginal delivery, who remained physically active during pregnancy, can be given medical clearance to exercise as early as 4 weeks after birth.
Brown, W., Evenson, K., Mottola, M., Owe, K. & Rousham, E. (2014). “Summary
of International Guidelines for Physical Activity Following Pregnancy.”
Obstetrics & Gynecology Survey, 69(7): 407–414.
Fleming, K. (2016). “Breastfeeding? Why you should keep (or start!) exercising.” Sunnybrook Hospital, Available online:
Fleming, A., Lonstein, J., & Pawluski, J. (2017). “The Neurobiology of Postpartum
Anxiety and Depression.” Trends in Neurosciences, 40, 2, 106.
Hodgkinson, E., Smith, D., & Wittkowski, A. (2014). “Women’s experiences of
their pregnancy and postpartum body image: a systematic review and
meta-synthesis.” BMC Pregnancy Childbirth, 14, 330.
Nelson-Piercy, C., Soma-Pillay, P., & Tolppanen, H. (2016). “Physiological
changes in pregnancy”. Cardiovascular Journal of Africa, 27, 89-94.
Roy, B. (2014). “Postpartum Exercise.” American College of Sports Medicine,
Health & Fitness Journal, 18,6,3-4.