When should you return to fitness in the postpartum, and what considerations should you have when approaching fitness after childbirth?
When returning to fitness in the postpartum, you will need to consider the type of delivery that you had. Did you have a vaginal birth or cesarean birth? Did you have any vaginal tearing? How do you generally feel in the postpartum, both physically and mentally? There are a lot of considerations when returning to fitness in the postpartum.
Medical All-Clear
In either type of delivery, vaginal or cesarean, you will want to at least wait until you have been cleared by your provider before starting any sort of workout program. While most of our postpartum check ups are fairly minimal and probably not an optimal method to determine if you are ready to return to fitness, it is a good starting point. The reasons being that generally you are 4-8 weeks postpartum, so at least you have waited a few weeks before starting a return to fitness, and if there are any stitches that you are healing from (vaginal or cesarean), the provider can evaluate the healing of either location to ensure the wound has properly healed.
Another provider that you could consider making an appointment with is a pelvic floor physical therapist for a functional evaluation of your body in the postpartum. Generally, a pelvic floor PT will not want to see you until after you’ve been cleared by an OB provider, so the 4-8 week window, but contact your local PT to see what their preference is on when to see you in the postpartum.
A pelvic floor physical therapist can do an assessment on your overall function in postpartum; there have been a lot of changes in how you stabilize, balance, pelvic floor function, and so on that, a PT will have a better capability to access than your medical provider. Unsure of your local PT recommendations? Ask local birth workers, your OB, your friends, your mom group, and the list goes on.
Your Postpartum Bleeding AKA Lochia has stopped
The next consideration is whether or not your postpartum bleeding, lochia, has ceased. This tends to happen in the same 4–8-week window postpartum but may be shorter or longer depending on your individual healing process. Once lochia has ceased, this generally means that where your placenta detached is healed.
We recommend going for a short walk when this occurs and assess for any new bleeding. If you have new bleeding, rest a few days and then try again. Once you have gone for a walk and notice no new bleeding, it is probably safe to start a postpartum exercise program.
What if you experience bleeding during workouts after lochia had already stopped?
What we generally recommend if you start to experience any spotting in the postpartum several weeks after lochia had already ceased is to decrease the intensity of the workouts you’re doing and see if that helps. If bleeding is also accompanied with pain, then we recommend stopping your workouts all together still the bleeding also stops and probably seek a referral to your OB or pelvic floor PT for an evaluation.
How should the return to fitness look like?
In our postpartum fitness programs, we have two separate protocols for a vaginal delivery postpartum return to fitness and a cesarean delivery postpartum return to fitness.
Weeks 4-8 Postpartum (if you started working out at 4 weeks postpartum with medical clearance)
In both programs, we first focus on stabilization for about 4 weeks. This first starts with a re-learning process to breath properly and then sync that breath with movement. Movements are generally bodyweight and/or fairly low weights, maybe 40-50% of your 1RM. Our program has high repetitions of very light loading superset with a stabilization exercise to increase your balance and core stabilization.
We want to focus on being able to maintain our posture and positioning, while coordinating our breath to movement, while we move and do life. That is the initial main focus of the first phase of training; this is what will set up the foundation for future weeks of training.
We are also focused on re-learning movement patterns in a new postpartum body! Things are different in the postpartum with how you move, so we need to re-explore how to squat, deadlift, do yoga, etc.
For example, in this phase, our squat progression includes kneeling unweighted squat, assisted squats, unweighted box squats, and air squats. All our squat movements are body weight movements progressing through limited joint movements, range of motion, and then difficulty before progressing to loaded movement.
For cesarean delivery, the first four weeks are lower volume than vaginal delivery programming and is very focused on the anterior oblique sling reconnection. The anterior oblique sling runs from your oblique to opposite adductor (inner thigh) and crosses the pubic symphysis and your C-section incision site. This sling stabilizes your pubic symphysis and helps with movement between the upper and lower body. Unfortunately, when the incision for your C-section was done, it severed this sling and interfered with it’s function. So we focus a lot of our C-section specific programming on the anterior oblique sling reconnection along with stabilization training.
If you have a cesarean birth, scar mobilization is important to integrate into your workout routine, particularly the warm-up.
Weeks 9-12 Postpartum (if started working out at 4 weeks postpartum)
The next phase of training is a continuation of stabilization with more loading and weights. We are beginning to increase the weights and movement progressions back towards pre-pregnancy movements. We are continuing with movement progressions, but now have added weights to movements.
For example: our squat progression during this phase includes: box squats with dumbbell squats and goblet kettlebell squats then to dumbbell squats and goblet kettlebell squats without a box. So we are adding loading, but have not made it to a barbell yet. We are also working on a decrease in the range of motion at first with the new loading variation, and then adding more of motion with a the new loading technique.
This is where our postpartum programs combine in both the vaginal delivery and cesarean delivery programs.
Weeks 13-20 Postpartum (if started working out at 4 weeks postpartum)
The final phase of our return to fitness protocol is strength endurance with movements that look fairly similar, if not the same, to pre-pregnancy. We have returned to the barbell (or your preferred loading variation), but weight is still on the lighter side (60-70% of 1RM). We spent the past 8 weeks focusing on your stabilization, and now we can progress towards increasing our strength endurance.
For example, in this phase our squat progression is to the barbell back squat at repetitions between 8-12 with a stabilization exercise (usually some sort of step up) superset with the squat.
This phase also introduces higher impact movements, such as running and jumping. Research supports a return to running around 16 weeks postpartum and our program follows this recommendation by including a workup to return to running, such as jumping planks and ball taps, single leg strengthening, and overall stabilization.
These are our recommendations in how we move our clients through their return to fitness in the postpartum, and it may look a little different depending on your preferred sport. If you have more questions, feel free to send us a message!