Experts at the American College of Obstetricians and Gynecologists (ACOG) say it's okay to gradually resume gentle exercise if you were physically active until giving birth, and if you do not have any complications or conditions that might make exercise dangerous. Most physicians advise against resuming vigorous exercise too soon (to allow for recovery), but there are many gentle exercises that should be strongly encouraged for all mothers who had a normal delivery, whether vaginal or Cesarean. The first few weeks after delivery are busy and tiring, so rest is imperative. But it's also important to understand that exercise is vital-not only to help your body recover, but also to sustain your energy level. The guidelines below will help you return to exercise safely within the first six weeks after delivery.
- Diaphragmatic breathing (Abdominal tightening on outward breath): Lying on your back, place your hands over your abdomen. Inhale and allow your belly to rise as it fills with air. Exhale through your mouth as you tighten your abs, pulling them in towards your spine. Your stomach should flatten, not bulge, as you exhale.
- Pelvic Tilt: While lying on your back with your knees bent, tilt your pelvis backward as you tighten your abs and exhale. Try to bring your belly button to your backbone as you push your low back into the mattress/floor. Hold for 5 seconds, inhale, and relax.
- Pelvic tilt with head lift: Since crunches will worsens diastasis recti, head lifts are the highest level of abdominal work that should be done until the separation between the abs is smaller. To assist in pulling the abdominal separation together, place your arms across your belly or hold a sheet around your body. Exhale and tighten abs, do a pelvic tilt (see description above) and raise your head off the floor. Your belly should move inward. Continue with head lifts until you are able to do Phase 3 (see below) Curl Ups (with arms outstretched) without seeing an outward bulge on the abdomen. This takes a great deal of concentration and work, but it is important to avoid aggressive abdominal exercises if diastasis is not resolved! With disciplined work, the gap can be normalized within a week.
Begin with only a few repetitions of each exercise and increase as tolerated.
- Diaphragmatic breathing (Abdominal tightening on outward breath): Lying on your back, place your hands over your abdomen. Inhale and allow your belly to rise as it fills with air. Exhale through your mouth as you tighten your abs, pulling them in towards your spine. Your stomach should flatten, not bulge, as you exhale.
- Kegels (Pelvic floor contractions): Can be done in any position. Tighten and hold for 5 seconds. Do several times a day.
- Pelvic Tilt: While lying on your back with your knees bent, tilt your pelvis backward as you tighten your abs and exhale. Try to bring your belly button to your backbone as you push your low back into the mattress/floor. Hold for 5 seconds, inhale, and relax.
- Stretch out the kinks: Lie on your back with arms and legs out straight, palms up. Bend at the ankles so toes are aiming for the ceiling, tighten thigh muscles and push knees into the bed. Pull your abdominal muscles in and flatten your back. Squeeze your shoulder blades together and elongate your neck. Press your hands back into the bed and hold this for a few seconds, then relax. This allows your muscles to contract isometrically (without changing length), which is safe on the body and provides an easy readjustment to normal posture after birth.
- Active posture check: Standing - tuck your chin in to elongate the neck, pull your shoulders down and back, tighten your abdominal muscles while pulling your belly into your backbone, tighten your pelvic floor, keep knees soft, and increase the arch in your foot.
- Bridges: Lying on your back with knees bent, contract your abdominal, buttock, and pelvic floor muscles, and raise hips up off the floor. Hold for 5 seconds and relax down slowly. The farther your feet are from your buttocks the more challenging it will be. Bridging can also be progressed by lifting one leg while up in bridge position - but you must be able to keep hips level to do this.
- Heel Sliding: Lying on your back, tighten your abdominal muscles and do a pelvic tilt. Slowly slide out one leg at a time while tying to maintain your pelvic tilt. You can progress to sliding both legs out together as long as you can keep the pelvic tilt and not allow the back to arch. Always bring legs back one at a time.
- Leg lifts
- Arm exercises: Use a light weight (typically three to five pound dumbbells) for lateral raises, bicep curls, triceps exercises, and push ups on your knees or against the wall. You can find several demonstrations of these exercises in the Resource Center.
- Curl ups: Lying on your back, begin with arms outstretched, exhale, and pull your belly into your spine as you slowly reach with your hands towards your knees. Only roll up until your shoulder blades lift off, then inhale and slowly lower. Be sure your stomach flattens (not expands) as you rise. Also, do diagonal curl ups by reaching right arm past left knee as you curl up, and vice versa. Increase difficulty by changing arm positions, from easiest to hardest - arms outstretched, arms crossed across chest, and arms crossed behind head.
*See Instructions above
- Diaphragmatic breathing*
- Huffing: This is important if general anesthesia was used - it helps clear mucous out of the throat and lungs. Take quick forceful outward breaths while tightening the abdominal and pelvic floor muscles.
- Ankle/foot movements help prevent blood clots after anesthesia.
- Pelvic Tilt*
- Bridges with a twist*: While hips are elevated, drop one hip toward mat, then the other, so that you are gently twisting your hips. This helps alleviate gas pain as well as working your core.
- Kegels*
- Curl ups* (if no diastisis present)
- Active posture check*
Move on to exercises listed below as tolerated.
- Single leg lowering: Lying on your back with knees bent, do a pelvic tilt and lift one leg up. Straighten out the leg, maintaining pelvic tilt as you return leg. Progress by lifting both legs and doing a bicycle motion. Your abdomen should be flattening with exhale, not bulging.
- Double leg lowering: Maintain pelvic tilt as you lower your legs, starting with knees bent and straightening legs out as you lower. Only lower as far as you can maintain your pelvic tilt. Once you feel your back begin to arch, return legs one at a time to starting position. Double leg raising will work your hip muscles and is too much pressure on your spine and abdominal muscles - LOWER with both legs but RAISE one at a time.
- It is OK to begin driving as soon as you are off pain medication.
- When walking, maintain good posture. While you may feel the incision "pull" the stitches will not pull out! Walking is a great way to resume your exercise program. Start off with 10 to 15 minutes and gradually increase as your body feels able.
- Wait until after your six-week checkup to resume any strenuous exercise.
