The postpartum period is a transformative and challenging time for new momma. After months of carrying and then delivering a baby, the body undergoes significant changes that require care and attention to recover. For many, the first 6 weeks postpartum mark a critical phase of healing and adjustment, both physically and emotionally. While the excitement of resuming exercise and physical activities may tempt some mommas to get right back in, understanding postpartum recovery and the importance of gradual reintroduction to exercise is key to long-term pelvic floor and physical health.
Let’s talk about the changes that happen during the first 6 weeks postpartum, why it’s important to not just immediately get back into exercise, and how to safely reintroduce exercise with a focus on core and pelvic floor health to prevent issues later down the line.
The First Six Weeks Postpartum: What Happens to the Body?
During the first 6 weeks postpartum, your body undergoes significant healing and adjustments as it transitions from pregnancy. Here are some key changes to understand:
1. Healing of the Perineum or Cesarean Incision
• Vaginal delivery: For those who experience a vaginal delivery, perineal tears or episiotomy incisions need time to heal. These wounds involve layers of tissue and sometimes muscle and require careful monitoring for signs of infection. Scar tissue can be formed and cause inequalities throughout the right and left side of the pelvic floor muscles and sensitivity throughout the perineum. Not only that, but your pelvis just had to shift and adjust to accommodate a baby moving out of it, so your bony pelvis and body are finding a new position to adapt to any any injuries that may have occurred must be treated with caution.
• Cesarean delivery: A c-section involves major abdominal surgery. The incision through multiple layers of tissue takes weeks to recover, requiring limited movement and lifting restrictions as it is healing. Scar tissue restrictions are to be expected in the healing process and are important to work on mobilizing after medically cleared and fully healed to allow the muscles underneath to contract and work in the most optimal way.
2. Closure of the Cervix
After delivery, the cervix gradually closes and becomes more firm. This process typically takes about 6 weeks, and until the cervix is fully closed and back to its firmness pre-pregnancy. During this healing time there is an increased risk of infection while the cervix is more flaccid and open.
3. Uterine Involution
The uterus, which expanded significantly during pregnancy, begins the process of involution—shrinking back to its pre-pregnancy size. This involves shedding the uterine lining, resulting in postpartum bleeding (lochia), which can last several weeks as the uterus is moving back down and the organs that had to be pushed up into the diaphragm are settling down into a new position in the pelvis.
4. Hormonal Shifts
Hormone levels, particularly estrogen and progesterone, drop significantly postpartum, which can affect mood, energy levels, and tissue healing. Many woman feel as if they are going through perimenopause during this time as the hormone drop is very similar to it. This change in hormones can cause muscular guarding and non-optimal tightening in the pelvic floor muscles. This can also cause weakening of bone integrity which can place postpartum mommas at risk for bone breaks/ fractures without proper rest and recovery for hormone regulation.
Why We Shouldn’t Just Hop Back Into All Exercise Even After 6 Weeks:
While many mommas are eager to “bounce back” after giving birth, prioritizing rest in the first six weeks is vital for physical and mental health.
1. Physical Deconditioning
During pregnancy, the body naturally deconditions as it adapts to support the growing baby. Postpartum, the musculoskeletal system needs time to regain strength and stability. Jumping back into exercise too soon can increase the risk of injury, including joint pain, ligament sprains, and possible pelvic floor dysfunction.
2. Cardiovascular Deconditioning
Pregnancy places additional demands on the cardiovascular system. Postpartum, the heart and blood vessels need time to adapt back to pre-pregnancy conditions. Engaging in high-intensity exercise too soon may strain the system, especially if we have not been participating in cardiovascular activity during the end of pregnancy and postpartum.
3. Impact of Sleep Deprivation and Breastfeeding
New mommas often face interrupted sleep and the physical demands of breastfeeding, both of which affect recovery. Lack of sleep impairs healing, while breastfeeding requires significant energy, further depleting the body’s resources.
A Gradual Return to Exercise: Building a Strong Foundation
Once cleared by your birth provider, a gradual and intentional approach to exercise can help prevent future issues like pelvic floor dysfunction and other injuries that can happen from returning to exercise too quickly or intensely.
First, Start with Breathing Mechanics in Postpartum Recovery
Breathing mechanics play a critical role in postpartum recovery. During pregnancy, the rib cage moves upward and outward to accommodate the growing baby, and the diaphragm can become stiff due to these changes. Relearning how to coordinate the diaphragm and pelvic floor is essential for effective recovery. The diaphragm and pelvic floor muscles work together and coordinate through movement as they mirror each other anatomically. By having stiffness in one, we can have stiffness in another, therefore working on improving breathing mechanics and connection can directly improve pelvic floor muscular mobility.
Breathing exercises help improve rib cage mobility, restore diaphragm function, and enhance pelvic floor coordination through movement, reducing the risk of pelvic floor dysfunction. You can typically begin these within your first 6 weeks of recovery.
Ways We Can Begin Breath work:
- Lie on your back, feet supported on a couch or pillows with your hands on your belly. With each inhale you can work on filling various parts of your rib cage. Work on expanding the lateral portions of your rib cage first, moving to filling front to back portion of your rib cage, expanding diagonally through your rib cage, and eventually moving to filling through your rib cage 360 degrees. As you exhale let the air passively leave you lunges. You can practice this in child's pose, lying on your sides, seated, on all 4’s, and even standing as you become more comfortable with it.
- In the same position on your back or in a seated position after breast feeding. Have one hand on your lower belly and another on your upper belly. Work on inhaling and gradually filling the air into your belly, filling into each hand. As your exhale, let the air passively leave your lungs. Try and move your air all the way into your lower belly as you inhale in. With each inhale, work on imagining a balloon filling into your belly, all the way into your lower pelvis, between your 2 sit bones, while imagining your pelvic floor muscles relaxing and expanding. Again, as you get comfortable in more supported positions, you can practice in all positions you may find yourself in throughout the day.
Second, Begin Light Core and Pelvic Floor Strengthening
Postpartum recovery begins with re-establishing core stability and pelvic floor strength. These areas are the foundation of the body’s movement system, and neglecting them can lead to issues like:
• Pelvic heaviness or dragging sensations.
• Bladder or bowel leakage.
• Hip, low back, and pelvic pain.
Strengthening these muscles and learning to connect them through movement and exercise helps build a supportive base for resuming more intensive activities.
Using our breath work we can begin light core and pelvic floor engagement. We want to use how the diaphragm and pelvic floor mirror one another to work on engaging our muscles in the most optimal way. Again, these can typically begin within that first 6 weeks postpartum as long as you are having no increased bleeding or pain while completing.
How it works:
• Inhalation: The diaphragm moves downward, and the pelvic floor muscles elongate and relax.
• Exhalation: The diaphragm moves upward, and the pelvic floor muscles contract and lift.
How we can begin:
- Pelvic floor engagement: In a supported position on your back, with knees bent and feet flat: We can work on taking a gradual inhale, staying relaxed. As we exhale we can work on lightly engaging our pelvic floor muscles as if we are picking up a blue berry with our labia and pulling it inside, or imagining we are holding gas and urine back. As we inhale, we can relax. Make sure to fully relax before engaging these muscles again. If you are struggling with engaging these muscles, you can work on exhaling with a light “ssss” as you engage your pelvic floor muscles.
- Deep core engagement: In a supported position on your back, with knees bent and feet flat: We can work on inhaling gradually again, staying relaxed, and then using a pursed lip exhale to engage our deep core muscles. You can do this by imagining pulling your 2 front hip bones together 2 cm or imagine zipping up your pubic bone to belly button gradually. Inhale and fully relax. You can use your hands on the front of your belly for feedback. Make sure you are gradually pulling in those muscles and tensing them as you exhale and NOT pushing out or bearing down.
Third: Light Postpartum Exercises for Core Stability and Control
The following exercises focus on light strengthening and core stability:
1. Bridges with Pilates Ball
• Lie on your back with knees bent, feet flat on the floor, and a small Pilates ball between your knees.
• Exhale as you engage your deep core and pelvic floor muscle, push your knees lightly into the ball, and lift your hips
• Lower back down and relax. Repeat for 8-12 repetitions.
2. Bent Knee Fallouts
• Lie on your back with knees bent and feet flat on the floor.
• Slowly lower one knee to the side while maintaining core and pelvic floor engagement.
• Return to the starting position and alternate sides keeping back from wobbling back and forth. Perform 8-10 repetitions per side.
3. Arm Lift Regressed Bird Dog
• Begin on hands and knees in a tabletop position. Use your exhale to engage your deep core and pelvic floor lightly for stability.
• Extend one arm up to your ear level while engaging your core and pelvic floor to keep your body from wobbling, to progress this you can also move your opposite leg but make sure you are very stable through your core.
• Return to the starting position and alternate sides. Perform 8-10 repetitions per side.
4. Single-Leg Balance
• Stand on one leg, engaging your core and pelvic floor to maintain stability.
• Hold for 10-15 seconds per side, gradually increasing the time as balance improves.
Listening to Your Body: Signs to Watch For
When returning to exercise postpartum, pay attention to symptoms that indicate you may be overdoing it:
• Pelvic heaviness or dragging sensations.
• Bladder or bowel leakage.
• Pelvic pain, low back pain, or hip pain.
• Persistent or increasing vaginal bleeding.
If you experience any of these symptoms, stop exercising and consult a healthcare provider or pelvic floor physical therapist.
Avoiding Over-Exercising and Energy Deficiency
Postpartum Mommas are at a higher risk of relative energy deficiency due to the demands of breastfeeding, disrupted sleep, and caring for a newborn. Over-exercising during this time can exacerbate fatigue, slow recovery, and negatively impact milk supply.
Focus on nourishing your body with nutrient-dense foods, keeping calorie count up especially while breast feeding, staying hydrated, and allowing time for rest and recovery.
Conclusion: The Importance of a Gradual Return
The first 6 weeks postpartum are a time of healing and rebuilding and the after 6 weeks is a time for gradually returning to exercise. By prioritizing rest, reconnecting with your core and pelvic floor, and gradually reintroducing exercise, you can set yourself up for long-term health and fitness.
Remember, postpartum recovery is not a race. Listen to your body, and if you experience any symptoms of pelvic floor dysfunction or pain, seek guidance from a pelvic floor physical therapist or healthcare provider.
For guided postpartum fitness programs, check out my app, which is designed specifically for postpartum mommas to safely and effectively rebuild strength.
If you would like to explore our Postpartum Fitness Programs CLICK HERE
