Postnatal Exercise: When and How to Start

What is actually happening to your body

Ireland's HSE gives the clearest list of why postnatal exercise is not just pre-pregnancy exercise resumed. After having a baby, your “tummy muscles stretch”, your “posture is different”, your “pelvic floor muscles may be injured”, your “body tissue is more stretchy and less supportive”, and “joint stability is affected”. The NHS makes the same point about injury risk: “your ligaments and joints are also more supple and flexible for a few months after birth, so there's an increased risk of injury if you stretch or twist too much”.

None of that is a reason not to exercise. The NHS says regular activity “can relax you, keep you fit and help you feel more energetic. It can also help your body recover after childbirth and may help prevent postnatal depression.” ACOG lists the same benefits and adds better sleep and stress relief.

When you can start

The starting point depends on the birth you had, and the national bodies broadly agree.

• Straightforward vaginal birth. The NHS: “you can start gentle exercise as soon as you feel up to it. This could include walking, gentle stretches and pelvic floor exercises.” ACOG: if you had a healthy pregnancy and a normal vaginal delivery, “usually, it is safe to begin exercising a few days after giving birth — or as soon as you feel ready.”
• Forceps or ventouse birth. The HSE says to wait until 6 weeks after giving birth before starting the exercise programme.
• Caesarean birth. The NHS says recovery time will be longer and to talk to your midwife, health visitor or GP before starting anything strenuous. The HSE says to avoid lifting anything heavier than your baby, pulling yourself up into a sit-up position from bed, and high-effort exercise for at least the first 6 weeks — and that the wound takes around 12 weeks to heal properly. ACOG says to ask your ob-gyn when it is safe to begin.
• Any complication that slowed your recovery, such as an infection: talk to your GP before getting active (HSE).

For higher-impact work, the NHS advises that “it's usually a good idea to get advice at your 6-week postnatal check before you start any high-impact exercise, such as aerobics or running.”

The order that matters

Pelvic floor first, then posture, then load. The HSE's sequence is explicit: start with pelvic floor muscle exercises and posture, keep to low-impact activity for the first 6 to 12 weeks, and only then build. NICE NG194 requires that women be given information about the importance of pelvic floor exercises before transfer to community care and at postnatal contacts — it is a guideline recommendation, not an optional extra.

The NHS's technique for pelvic floor exercises: squeeze and draw in your bottom as if holding in wind; squeeze around your vagina and urethra as if stopping the flow of urine; do long squeezes, held for as long as you can but no longer than 10 seconds, then relax; and short squeezes, quickly squeezing and letting go until the muscles tire. “Aim to build up to 10 repeats of each exercise, at least 3 times a day.” Keep breathing normally and do not pull your stomach in while you squeeze.

The HSE's posture reset is equally simple: keep your knees slightly bent, bring your ribs over your hips, roll your shoulders back and down, tuck your chin in and keep the back of your neck long.

How much, once you are going

ACOG gives the only concrete dose in national guidance: “after having a baby, you should get at least 150 minutes of moderate-intensity aerobic activity every week”, which can be split into 30 minutes on five days or into 10-minute sessions through the day. Muscle-strengthening activity should be done on at least two days a week, in addition to the aerobic activity. When starting out, aim to stay active for 20 to 30 minutes a day, and “stop exercising if you feel pain”.

Moderate intensity, in ACOG's definition, means you are moving enough to raise your heart rate and start sweating: “you can still talk normally, but you cannot sing.”

What to avoid at first

The NHS advises avoiding sit-ups, planks and high-impact exercise to begin with, along with straining on the toilet and heavy lifting, while abdominal separation recovers. The HSE says to avoid high-effort activity — running, jumping, lifting heavy weights — if you have a leaky bladder or a heavy feeling or bulge in your vagina, because “if you do high effort activity with a weak pelvic floor, you could make prolapse or incontinence symptoms worse.”

After a caesarean, the HSE says high-effort activity, including swimming, needs 3 to 4 months, and should only start if “your scar is healing and has not been a cause for concern” and you have been building strength with gentle activity and pelvic floor work. Start at a beginner's level. For swimming after any birth, the NHS says to wait until 7 days after postnatal bleeding has stopped.

Practical things that make it possible

• Get measured for a new bra. The NHS: “do not rely on your pre-pregnancy sports bra. Your back and cup size are likely to have changed.” Your feet may also have changed size and shape, so new shoes may be worth measuring for too.
• Feed or express first. ACOG suggests feeding your baby or expressing before a workout to avoid discomfort from engorged breasts.
• Walk with the pram, properly. The NHS: keep your arms bent and back straight, with the handles at a height that puts your elbows at right angles. The HSE suggests starting walking without pushing the pram at all after a caesarean.
• Use a postnatal class. The NHS suggests postnatal exercise classes, many of which include your baby; if the class is not specifically postnatal, tell the instructor you have recently had a baby.
• Count the ordinary movement. Stairs instead of lifts, walking short journeys, running around with older children (NHS).

Abdominal separation

The NHS explains that it is common for the two muscles running down the middle of your stomach to separate during pregnancy, “usually about 2 finger widths”, and that the separation “will usually go back to normal by the time your baby is 8 weeks old”. If the gap is still obvious at 8 weeks, contact your GP, who can refer you to a physiotherapist — because there is a risk of back problems. Regular pelvic floor and deep stomach muscle exercises can help reduce it.

When to call

See your GP, or ask for a referral to a women's health physiotherapist, if:

• You leak urine when you exercise, cough or laugh (HSE, NHS).
• You have a heavy feeling or a bulge in your vagina — possible prolapse (HSE).
• You have pelvic girdle pain (HSE).
• The gap between your stomach muscles is still obvious 8 weeks after the birth (NHS).
• You are unsure whether you are ready to get active, or exercise is uncomfortable after a caesarean (HSE).

Stop and seek advice for pain, heavy or restarting bleeding, or a wound that becomes sore. The HSE notes that an increase in bleeding or a darkening in its colour after something strenuous “may be a sign that you need to take it easy”. Call your local emergency number (999 in the UK and Ireland, 911 in the US and Canada, 000 in Australia, or 111 in New Zealand) for chest pain or sudden breathlessness.