WATCH INTERVIEW

1. ANNA: When can new mothers return to low impact exercises?

DR. JILL GAMBERG: New mothers can return to low impact exercises at around 6-8 weeks.  If the delivery was complicated or there were any birth injuries, recovery time may be longer, and the return to exercise may be delayed. 

It is important to check with your GP, midwife, physiotherapist or obstetrician before returning to exercise after childbirth. Mothers who have issues with incontinence, or develop incontinence once re-starting low impact exercises, should seek professional help before continuing.

There are general guidelines from the Australian Continence Foundation to follow to help plan your return to post childbirth fitness:

1. 0-3 weeks after delivery:

   1. gentle walking

   2. abdominal muscle bracing (tightening your abdominal muscles without movement)

   3. pelvic floor exercises

1. 6-8 weeks after delivery (wait until your six-week doctor/midwife check before starting a group exercise program or going back to the gym):

   1. walking

   2. low impact aerobics or post-natal classes

   3. low intensity water aerobics class and swimming (once vaginal bleeding has stopped)

   4. gym program (light weights)

   5. abdominal muscle bracing

   6. pelvic floor exercises 

1. 8-12 weeks after delivery:

   1. follow the same guidelines for 6-8 weeks, gradually increasing your intensity and weights

   2. progress your postnatal abdominal muscle bracing

   3. continue pelvic floor exercises

1. 12-16 weeks after delivery:

   1. consider seeing a women’s health physiotherapist for abdominal and pelvic floor muscle testing before returning to high-impact exercise, running, sport or abdominal exercise programs

1. 16 weeks and more after delivery:

   1. you may be able to return to previous activity levels IF your pelvic floor muscles have returned to normal and you are not experiencing any back pain, vaginal heaviness, or urinary incontinence during or after exercise

2. ANNA: When can new mothers return to running, jumping, and jogging?

DR. JILL GAMBERG: The return to running, jumping and jogging will be a lot longer than return to exercise in general.  The pelvic floor is very weak after carrying a baby for 9 months, and will need time to recover post childbirth.  Returning to impact exercise too early can cause damage to the pelvic floor.  It may also cause or worsen incontinence of the bowel or bladder. 

The return to impact or intense exercise may be as early as 16 weeks (if there are no medical issues) but may take up to 6 to 12 months to strengthen the pelvic floor and abdominal muscles enough to return to exercises like running, dancing, skipping or jumping.    

Intense exercises like sit-ups, planks, hovers, and curl-ups are not recommended exercises for mums after childbirth, as they can place pressure on the recovering lower abdominal muscles and pelvic floor muscles.

A review with a women’s health physiotherapist for abdominal and pelvic floor muscle testing before returning to high-impact exercise, running, sport or abdominal exercise programs, is a great idea.

3. ANNA: When can new mothers start strengthening our pelvic floor and core again? Which abs should we start with?

DR. JILL GAMBERG: Mothers can start strengthening their pelvic floors as early as is comfortable.  The best way to start is to have an awareness of the urine stream and when they are starting and stopping the urine flow.  Usually by two weeks, most women are feeling more comfortable and confident, and any areas that have been stitched are starting to heal. They can start thinking about contracting and relaxing those pelvic floor muscles at this time.  

Women can start strengthening the traverse abdominals in the early days.  Then the abdominal obliques can be worked on next.  The best abdominal exercise in the early days is “bracing” the muscles without movement of the body.  Then finally after at least 6 weeks, women can start easy exercises with rectus abdominals.  

Abdominal exercise may be complicated by a separation in the front or rectus abdominals (called Diastasis Recti).   This is very common and up to 2/3 of women have this after birth.  Abdominal separation may slow down the return to exercise after childbirth.  Getting advice from a physiotherapist or doctor may be necessary to aid recovery. 

4. ANNA: How can improving our pelvic floor and transverse abs help flatten our tummies post childbirth?

DR. JILL GAMBERG: During pregnancy and childbirth our abdominal and pelvic floor muscles become stretched out and weakened.  This is completely normal.  That is because of the weight and size of the baby growing inside.  Once women are able to start retraining their muscles to work appropriately again post childbirth – this can help to flatten their “tummies”.  It is best to do this with supervision by a women’s health physio or doctor, and following the recommended guidelines for “exercise after childbirth”.

5. ANNA: It’s a taboo topic... but how can strengthening our transverse abs and pelvic floor keep us from accidentally wee-ing when we sneeze, cough, jump, etc.

DR. JILL GAMBERG: Women need a certain amount of pelvic floor strength to maintain continence.  There are two main types of urinary incontinence.  When your bladder is full, you feel the urge to go to the toilet, and you do not make it to the toilet.  This is urge incontinence.  Stress incontinence is when you lose control of your bladder when you sneeze or cough.  Women can have one type or both post childbirth.

Strengthening the pelvic floor and transverse abdominals can help prevent incontinence and it can also improve incontinence.  If incontinence is an ongoing or worrisome issue, please see your GP or obstetrician.  

6. ANNA: Do you recommend patients who are new moms see a women’s physiotyherapist post-childbirth? If so, which types of patients?

DR. JILL GAMBERG: Every woman should see a women’s health physiotherapist post childbirth, if they can.  It is important to educate themselves regarding what happened to their bodies during pregnancy and childbirth.  It is important for mothers to learn which muscles to strengthen and at an appropriate time in the months following childbirth.  Physiotherapy is especially important to help with recovery from any muscle weaknesses, birth injuries, incontinence issues, and/or prolapse problems.  You need to rehabilitate your pelvic floor and abdominal muscles after childbirth, just like you need to rehabilitate an ankle after a sprain injury.

7. ANNA: Anything you would like to add?

DR. JILL GAMBERG: Women should not put pressure on themselves to return to their “pre-baby” bodies as soon as possible.  They need to rest and recover, and full recovery takes up to a year post childbirth.  Every woman is different and depending on their pregnancy, birth experience and the early months post childbirth – the road to recovery will be different.