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How to Exercise After Giving Birth

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Postpartum fatigue is natural, given how hectic your life will become. Find out how relaxation techniques will help you adjust to this special time.
©2006 Publications International, Ltd.
Being rested enough to enjoy your baby is more important than catching up on chores. See more pictures of staying healthy.

The postpartum period is an exhilarating, exhausting, rewarding, tearful time of discovery. At the end of the 12-month cycle of pregnancy, delivery, and recovery, the physical and psychological aspects of the new mother -- body and mind -- have undergone a tremendous adjustment. Your body underwent an enormous effort to grow and give birth to (and perhaps now feed) your new baby. But you can be on your way to a new and better self! The following pages will show you how to gently ease your way back into a workout routine and regain your prepregnancy figure. In this article, we will show you how to exercise after you give birth, including:

  • The Importance of Rest After Giving Birth
    New mothers and fathers often find that they get only a few hours of sleep at a time for weeks after the baby arrives. These sleep disturbances can make you irritable and depressed, and erode your decision-making skills. Finding time to catch up on sleep is vital for your well-being. This page shows you how to make that happen.

  • Postpartum Exercises
    The good news about exercising after giving birth is that you can start the day of delivery, without even getting out of bed. Your body won't be ready for high-impact workouts for several weeks, but you can still enjoy light physical activity. On this page you'll learn many exercises you can start right away, so that you'll be ready for a stronger workout that much sooner.
Up Next
  • When to Begin Postpartum Aerobic Exercises
    It will probably take several months to lose the weight you put on during pregnancy, but starting an aerobic exercise routine will minimize that time. Of course, there are many factors that determine postpartum weight loss, and you should check with a doctor before starting a routine -- especially if you're breast-feeding. But this page will give you some guidelines on what you can do and when you can start doing it.

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A baby's first few months are a busy, hectic time that will put big demands on your schedule. But while it's very difficult to carve out free time for yourself right now, that's also why it's so important to do so. Being properly rested will help you meet the challenges that come with this new phase of your life.

The advice that you should get enough rest and relaxation seems impossible to follow during the postpartum period -- a time often associated with sleepless nights, postpartum blues, tears, and fatigue. Babies get hungry around the clock at two- to four-hour intervals during the first four to six weeks of life. So most mothers and fathers find they may get only two to three hours of sleep at one time, if that!

Ongoing sleep disturbances -- lasting for days, weeks, or even months at a time -- can leave you and your partner feeling cross, irritable, and depressed. When you are this tired, even little problems become difficult to solve, and you may find it hard to make decisions about even the smallest issues.

Yet the postpartum period can be a time for you to tune into your body. It may take some practice, but learn to use part of the natural scheduling of your day to help release the tension you feel. If friends or family offer help after the birth, let them take over the cooking, grocery shopping, and housework. (Have them cook a little extra each time and freeze it. With a bit of planning and thought, you and your partner might not have to cook for a week or more.) Allow friends and family to care for you, while you care for the baby.

It's extremely important to continue the relaxation techniques you learned in your prepared childbirth classes. You will have less uninterrupted time for yourself, so make the most of the time you do have.

During feedings, take a few deep breaths and clear your mind -- just enjoy this quiet time and free your body of tension. (If you breast-feed, keep a glass of water or juice nearby to sip.) As soon as you lay the baby down for a nap, lie down yourself; walk directly from the baby to your own bed or couch. Resist any temptation to clean up or catch up on chores or calls; otherwise, before you know it, the baby is up again and you won't have a chance to relax.

The postpartum period is a time to reset priorities and decide what is really important to you personally. You'll find that six months from now you won't remember how clean your house was or if dinner was on time, but you will remember if you were tired and frazzled or peaceful and rested, enjoying this special time.

Rest and relaxation are the complement of a fitness program -- you must have both to rejuvenate your strength and vitality.

Once you're well rested, you'll have the energy for a comprehensive exercise program. The next page will give you many easy exercises you can do in the first few weeks after delivery.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

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You won't be ready for strenuous exercise within the first few weeks of delivery. But your body will crave some sort of activity -- even something as simple as stretching while still in bed -- to tone your muscles and to relieve tension. Unless your doctor tells you otherwise, a series of gentle, low-impact exercises will be safe for you, and your body will thank you down the road.

You should start body conditioning and toning exercises in bed, the day of delivery. The sooner you start, the sooner your body responds with firm, toned muscles, especially pelvic floor and abdominal muscles.

Follow the exercises in "Exercises for Immediately After a Vaginal Delivery" or "Exercises for Immediately After a Cesarean Delivery," depending on the type of delivery you had. Unless you experienced multiple complications and find yourself extremely fatigued, you can begin performing these movements as suggested.

Once you get home, don't wait to exercise until the baby is asleep. Just lay out two blankets -- one for each of you -- and begin. The baby enjoys the movement, the music, and your smiles. If baby tires, she'll drop off to sleep.

If your physician says not to exercise for six weeks or more after delivery, show him or her the list of exercises you want to do. Do not just ask to "exercise" -- be specific. These exercises are so gentle and safe, your doctor will probably approve of them. If, however, your physician feels even these exercises are inappropriate for you just yet, of course, follow this advice.

Remember: When performing any exercise, you should slowly exhale as you are lifting or contracting and slowly inhale as you are lowering or releasing.

Exercises for Immediately After a Vaginal Delivery

Begin the day of delivery, while you're in bed. When you get home, perform these exercises on a thick blanket or exercise mat on the floor.

Head Curl-Up:

Begin with 5 to 10 repetitions twice daily; build up to 20.

  1. Lie on your back with your knees bent and your feet close to your buttocks. Press your back down against the bed or floor. Inhale slowly and deeply.

  2. Exhale slowly; at the same time lift just your head. Hold as you complete the outward breath.

  3. Relax.

  4. Repeat.

Note: Do this exercise as many times during the day as you can. Then progress to the "Head and Shoulders Curl-Up."

Head and Shoulders Curl-Up:

Begin with 5 repetitions twice daily; gradually increase to 20.

  1. Lie on the bed or floor, your knees bent and your feet close to your buttocks. Press your back down and inhale slowly and deeply.

  2. Exhale slowly; at the same time, lift your head then your shoulders. Hold as you complete the outward breath. Perform this exercise slowly and with control (no jerky movements). Keep your head in line with your spine; do not throw your head forward! The lift comes from the shoulders and should be straight up, about 6 inches maximum, with your face toward the ceiling.
    Diagram for postpartum exercises
    ©2006 Publications International, Ltd.

  3. Relax, return to the starting position, and repeat.

Pelvic Floor Squeeze:

Do 60 or more repetitions each day, in sets of 3 or 4.

  1. Sit or stand comfortably (you can do this exercise in most positions). To increase the challenge, move your legs farther apart.

  2. Tighten the pelvic floor as if to lift the internal organs or to stop urination in midstream. Hold as tightly as possible for a slow count of 3 (gradually work up to a count of 10). Be sure to breathe.

  3. Relax completely.

Note: Because these muscles fatigue easily, repeat in sets of 3 or 4 squeezes throughout the day anytime, anywhere. Concentrate on the sensations of tension and lifting, relaxing and lowering within the pelvis.

Pelvic Tilt:

Begin with 10 repetitions a day; gradually increase to 20.

  1. Lie on your back with your knees bent and your heels close to your buttocks.

  2. Inhale and press your back to the bed or floor. Hold for a slow count of 5 (work up to 10). Concentrate on pressing your back to the floor using your abdominal muscles -- do not push with your feet. For an extra benefit, squeeze your buttock muscles and the pelvic floor.
    Diagram for pastpartum exercises
    ©2006 Publications International, Ltd.

  3. Relax, then repeat.

Note: This is a wonderful stretch to help relieve a tired or achy back.

Bend and Straighten Legs:

Start with 10 repetitions a day; progress to 20. Start with Variation A. Using comfort as your guide, progress through Variations B and C to Variation D as quickly as possible.

Variation A

  1. Lie on your back with both legs bent, feet flat on the bed or floor.

  2. Slowly straighten your right leg then bend it back to the starting position.

  3. Repeat with the opposite leg.

Variation B

  1. Lie on your back with one leg bent and the other leg straight.

  2. Slide the bent leg out straight and then back to the bent-knee position.

  3. Repeat with the straight leg, returning to a straight-leg position.

Variation C

  1. Lie on your back with one leg bent and the other leg straight.

  2. Bend one leg as you straighten the other. (Both legs move at the same time, slowly, in opposition.)

Variation D

  1. Lie on your back with both legs bent.

  2. Straighten then bend both legs at the same time.

Exercises for Immediately After a Cesarean Delivery

Begin these exercises the day of delivery (as soon as you return from the recovery room). Perform them in bed.

Deep Breathing:

Perform 5 times every hour you are awake.

  1. Breathe slowly and deeply to expand the upper, middle, and lower portions of your chest. Count to 10 slowly as you inhale and again as you exhale.

Huffing:

Perform 2 or 3 times every hour you are awake.

  1. This exercise is especially important if you had general anesthesia. In response to the anesthetic, the lungs produce mucus, which, if not removed, can clog the small air sacs and breathing tubes of the lungs. Perform huffing instead of coughing.
  2. A huff is a quick outward breath. It is like saying "ha" -- a short, quick breath, with force, from the abdominal muscles. The outward breath must be quick, otherwise the force is not sufficient to dislodge any mucus. Spit out the mucus you bring up; don't swallow it.
  3. If huffing doesn't bring up any mucus and you still hear a rattle in your chest, try the "Deep Breathing" technique again to loosen it.
  4. With huffing, the abdominal wall is pulled in instead of out; therefore, huffing is more comfortable than "Deep Breathing." Still, you may want to support the abdominal wall with your hands or a pillow. Be reassured you will not pull the stitches out.

Foot Exercises:

Perform 5 times every hour you are awake.

  1. Without lifting your leg off the bed, do 5 ankle circles to the right and 5 to the left. Make them slow and big. Repeat with the other ankle.

  2. Slowly point and flex the foot. Repeat with the other foot.

Pelvic Floor Squeeze:

Do 20 repetitions a day, progressing to 60, in sets of 3 or 4. Begin when the catheter is removed.

  1. Lie or sit (later you will stand) comfortably with your legs apart. (To increase the challenge, move your legs farther apart. )

  2. Tighten the pelvic floor as if to lift the internal organs or to stop urination in midstream. Hold as tightly as possible for a slow count of 3 (gradually work up to a count of 10). Be sure to breathe.

  3. Relax completely.

Note: Because these muscles fatigue easily, repeat in sets of 3 or 4 squeezes throughout the day anytime, anywhere. Concentrate on the sensations of tension and lifting, relaxing and lowering within the pelvis.

Leg Squeeze:

Perform 3 times every hour you are awake.

  1. Lie on your back with one leg bent and the other leg straight, the foot flexed.

  2. Slowly press the straight leg to the bed and tighten all the muscles in that leg, gently pulling the toes toward your head.

  3. Repeat with the opposite leg.
    Diagram for postpartum exercises
    ©2006 Publications International, Ltd.

  4. With both legs straight and your ankles crossed, tighten all the muscles in your legs: Press your knees down, tighten your thigh muscles, squeeze your buttock muscles. Hold while you slowly count to 5. (Don't hold your breath!)

  5. Release, then repeat.

Hint: If needed, prop yourself up on pillows.

Pelvic Tilt:

Perform 3 to 5 times every hour you are awake.

  1. Lie on your back with your knees bent and your heels close to your buttocks.

  2. Inhale and press your back to the bed. Hold for a slow count of 5 (building up to 10). Concentrate on pressing your back to the bed using your abdominal muscles -- do not push with your feet. For an extra benefit, squeeze your buttock muscles and the pelvic floor.
    Diagram for postpartum exercises
    ©2006 Publications International, Ltd.

  3. Relax, then repeat.

Note: Slow, controlled movements are the key to success with this exercise. In the beginning, abdominal pain lets you do only a third or a half of this movement. That's fine; listen to your body. Improving pelvic circulation is important -- do the best you can with this movement. As your body heals more and more each day, hold the tilt longer and longer. Remember to breathe. Add a "Pelvic Floor Squeeze," too. On the third day after surgery, add "Bend and Straighten Legs." On the seventh day, add "Head-Up Lift."

Bend and Straighten Legs:

Add this exercise three days after surgery. Repeat Variation A 3 to 5 times, twice a day. Using comfort as your guide, progress through Variations B and C to Variation D as soon as possible.

Variation A

  1. Lie on your back with both legs bent, feet flat on the bed.

  2. Slowly straighten the right leg then bend it back to the starting position.

  3. Repeat with the opposite leg.

Variation B

  1. Lie on your back with one leg bent and the other leg straight.

  2. Slide the bent leg out straight and then back to a bent-knee position.

  3. Repeat with the straight leg, returning to a straight-leg position.

Variation C

  1. Lie on your back with one leg bent and the other leg straight.

  2. Bend one leg as you straighten the other. (Both legs move at the same time, slowly, in opposition.)

Variation D

  1. Lie on your back with both legs bent.

  2. Move both legs down and up at the same time.

Head-Up Lift:

Add this exercise seven days after surgery. Perform 3 to 5 times, twice a day. Add more repetitions as comfort guides you.

  1. Lie flat on your back with no pillows, your knees bent. Press your back down. Inhale slowly.

  2. Slowly exhale and lift just your head. Hold for a count of 3.
    Diagram for postpartum exercises
    ©2006 Publications International, Ltd.

  3. Lower your head and relax.

Note: Using comfort as your guide, progress to lifting both your head and your shoulders on exhalation. Concentrate on lifting them toward the ceiling as a unit but just an inch or two off the bed. Do not thrust your head forward on the lift. Keep your eyes on the ceiling; do not let your chin fall toward your chest.

Soon, you'll be able to return to a more intense workout. The next page gives guidelines for when to resume aerobic exercise.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

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You can get back to your prepregnancy figure relatively quickly. Find out when and how to resume aerobic exercise after delivering a baby.
©2006 Publications International, Ltd.
Daily exercise, even for 20 minutes a day, will eventually get you back into prepregnancy shape.

Much has been written on the benefits of aerobic exercise. The benefits we are most concerned with here are those specifically for a new mother. They are increasing stamina and endurance -- the ability to do more but feel less tired -- and decreasing body fat. And remember that if you can't manage aerobic exercise, regular nonaerobic exercise can help, too.

Decreasing Body Fat

After delivery and with exercise, your body slowly begins losing some of the fat it stored during pregnancy. How much you accumulated during the nine months depended on your percentage of body fat going into the pregnancy and the kinds and amounts of foods you ate during pregnancy. The leaner your body was, the less likely it is you laid down large fat stores. Hereditary factors also come into play.

After delivery, the fat stores gradually decrease over a period of four to six months. No miraculous changes occur within the first six weeks, as many sources may lead you to believe. You may notice a difference in your body during the first two weeks after delivery, when you lose much of the accumulated pregnancy-related fluid through urination. After that, loss of fat stores is up to you.

Breast-feeding women initially lose weight faster than women who bottle-feed. However, because of hormonal factors in operation throughout breastfeeding, their body fat level remains slightly higher, their breast tissue weighs more, and they retain a small amount of extra fluid beneath their skin as a reserve. As a result, breast-feeding women tend to weigh about three to seven pounds more than their prepregnancy weight during breast-feeding, regardless of efforts to lose weight.

Having taken this fact into consideration, if you still aren't losing the weight you expected to lose, take a good look at your diet and calorie intake. A diet full of excessive amounts of fats and sweets does not help you return to your prepregnancy weight easily.

Check with your physician before you plan a reducing diet while breast-feeding. Many breast-feeding women can lose weight on 1,700 to 1,800 calories a day and still maintain a good milk supply; others must have 2,000 calories a day to maintain an adequate milk supply. Making milk itself takes lots of energy (and hence, uses up calories). Add aerobic activity for 20 to 30 minutes a day, five to six days a week, and you will lose weight.

Do not regard breast-feeding as an impediment to recovering your prepregnancy figure -- or as an excuse for not trying to. On the other hand, don't let the fear of extra weight gain keep you from breast-feeding in the first place. The few pounds of weight that can be attributed to breast-feeding are with you only temporarily; the benefits of breast-feeding for you and your baby will be with you forever.

Remember, it may take four to six months for body fat to start dropping. A daily nudge with aerobic exercise starts events. Be patient. Many answers still lie ahead of us as more and more studies are undertaken to help us understand the mechanisms of the body that just gave birth to new life. One aspect is absolutely certain: Having a new baby is not an excuse for looking or feeling out of shape.

Increasing Stamina and Endurance

Women often say, "I already walk a lot just caring for the baby, and I'm very tired. The last thing I want to do if I have spare time is walk -- I just want to sit down and relax or nap!" But walking while caring for the baby consists of a lot of stop and start movements, not really going very far from one place to another.

What you need is slow, steady, rhythmic movement for 5 to 15 uninterrupted minutes. This kind of activity, after you get over the initial tiredness the first few times, actually gives you energy and releases you from feeling tired and sluggish.

When to Begin or Resume Aerobic Exercise

The time to begin or resume aerobic exercise depends on a number of factors, such as how fit you were before giving birth, whether delivery was vaginal or by means of a cesarean section, whether you experienced any complications, how much sleep you get, and your emotional reaction to the birth.

Some women take days, weeks, or months to work through unexpected or unpleasant birth-related events. They may feel sad, angry, or depressed. Emotional factors may sometimes prevent a woman from taking hold of her situation and following through with desired action.

General guidelines are as follows: If a woman exercised regularly for 8 to 12 weeks before delivery, she can safely resume moderate aerobic exercise 10 to 14 days after an uncomplicated vaginal delivery, or approximately 21 days after a cesarean delivery. If a woman had a high fitness level before pregnancy and exercised regularly all through pregnancy, she will probably find it comfortable to begin short, brisk walks during the first week after a vaginal delivery or during the second week after a cesarean delivery.

Whatever aerobic activity you choose to begin with, be sure to monitor your pulse; work at about 60 percent of your theoretical maximum attainable heart rate (TMHR) for the first few weeks. Do not start at a level of 70 or 75 percent. Remember that you have just had a baby (and, if by means of a cesarean, major surgery as well). Remember also that you are almost certainly getting less sleep than usual.

Start your exercise program at 60 percent, and if it feels good, work gradually to 75 percent. If you are new to exercise, take 12 weeks to make this transition. To develop stamina and endurance and for your body to burn fat as fuel, you never need to work at a pulse rate higher than 85 percent of your TMHR. The old "no pain, no gain" slogan is not true -- pacing, regularity, and persistence are the keys to successful (and enjoyable) exercise.

The very best guideline for resuming aerobic exercise is to tune in to your body. And remember, never exercise to exhaustion. If you feel yourself tiring, slow down or stop. End your workout at the point at which you feel you could go another ten minutes. Learn to pace yourself.

This is the time to think about joining (or rejoining) an exercise class. A pregnancy/new mother class is ideal. You have the support, advice, and caring of women in your same situation. Although you may not do all the exercises in the class during your first weeks of attendance, getting out of the house, forcing yourself to organize your schedule, being with other mothers, and being in a formal class can do wonders beyond the benefits of the exercises themselves.

Carrying a baby for nine months puts your body through some extreme changes. But now that you have the tools to get back to the physical shape you were in before pregnancy, you'll find it relatively easy and very rewarding.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

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ABOUT THE AUTHORS

Alvin Eden, M.D. serves as a Clinical Professor of Pediatrics at the Weil Medical College of Cornell University in New York, New York. He is Chairman of the Department of Pediatrics at the Wyckoff Heights Medical Center in Brooklyn. Dr. Eden is also the author of a number of child care book, including Positive Parenting and Growing Up Thin.

Dr. Elizabeth Eden, M.D. is a practicing obstetrician with her own private practice in New York City. She serves as an attending physician at the Tisch Hospital of the New York University Medical Center, as well as a Clinical Assistant Professor at the New York University School of Medicine.

 

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