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Guide for a Healthy Pregnancy

POSTPARTUM EXERCISE

Most of the time it is okay to gradually resume exercising when you feel up to it, but your clinician may ask you to wait until your six-week postpartum check-up so she can see how you’re doing first.

Generally, if you exercised throughout your pregnancy and had a normal vaginal delivery, you can safely perform your pregnancy workout – or at least light exercise, such as walking, modified push-ups, and stretching – within days of giving birth. After your first postpartum week, slow to moderate 30-minute walks three times a week is fine. As you regain strength, you can increase the length or number of walks.

If you had a cesarean delivery, expect to wait about six to eight weeks to exercise. However, walking at an easy pace is encouraged because it promotes healing, will help move bowels, and helps prevent complications such as blood clots.

If you weren’t active during your pregnancy, or tapered off your fitness routine as the weeks went on, start slow and check with your clinician before you begin exercising.

In any case, remember that your joints and ligaments will still be loose for about three to five months, so watch your step to avoid spills. If you want to take an exercise class, try to find one taught by a postpartum exercise specialist or go for a low-impact class focused on toning and stretching. Many YMCAs, recreation centers, gyms, and yoga studios offer exercise classes for new moms.

Exercise is good for you, but in the first few months after you give birth, don’t overdo it. Your body needs time to heal, and you need time to adjust to your new role and to care for and bond with your baby.

Abdominal muscles

Most women develop a gap in their abdominal muscles as their belly expands during pregnancy and labor. It takes approximately four to eight weeks after giving birth for this gap to close.

If you start doing abdominal exercises before the gap closes, you risk injuring those muscles – so make sure your belly is ready before you start:

• Lie flat on your back with your knees bent.
• Place the fingers of your left hand, palm facing you, just above your belly button. Place your right hand on your upper thigh.
• Inhale, then exhale. As you exhale, lift your head and shoulders off the floor and slide your right hand up your thigh toward your knee. This will make your abdominal muscles tighten, and you should be able to feel the gap where the muscles have separated.

If the gap is three or more finger widths, you can gently begin to strengthen your abdominal muscles with towel crunches, leg slides and pelvic tilts. Once the gap narrows to only one or two finger widths, you can start doing crunches or sit-ups.

Towel crunches

Take a long towel and wrap it around your torso with the ends in front. As you perform a crunch, cross the ends of the towel in front of your belly button so that you are pulling your stomach muscles together during the crunch. Repeat 8 to 10 times. Also use the towel crunch for a sustained crunch – up for 10 seconds – release – repeat. Build to 30 seconds and repeat 8 to 10 times

Leg slide

• Lie with your back on the floor and your knees bent.
• Tighten your abdominal muscles and press the small of your back against the floor as you breathe out.
• Slide both legs away from your body slowly, using your abdominal muscles to keep your back flat on the floor.
• When your back starts to arch, bring your legs back to the start position – keep your stomach tight. Repeat 8 to 10 times.

Pay attention to your breathing throughout this exercise. Remember to tighten your abdominal muscles and flatten your back before you start sliding your legs away from you. As your stomach muscles strengthen, you’ll find you can push out your legs farther.

Pelvic tilt

This exercise encourages good posture and helps relieve backache.

Position: Lie on your back. Bend your legs and put your feet on the floor, a hip-width apart.

Exercise: Tighten your abdominal muscles and contract your buttocks. This will roll your pelvis backward and press your lower back against the floor. You can use your hands to guide you. Place one hand on your abdomen and the other at the outer edge of your back. You should feel your abdominal muscles tighten and your back push against your hand.

How many times: As you exhale, hold your position for 10 seconds. Repeat 10-15 times.

Warning signs during exercise

Stop exercising and call your clinician if you have any of these symptoms during exercise:

• Moderate or severe pain of any kind, including headache or pain in your back or pelvic area
• Significant increase in lochia
• Shortness of breath
• Dizziness or faintness
• Rapid or uneven heartbeat
• Difficulty walking
• Calf pain or swelling

If you have doubts about any problem while exercising, it’s always best to call for advice.

Kegel Exercises

If your symptoms of urine leakage usually happen after coughing, sneezing, laughing, or lifting heavy objects, your clinician may ask you to perform Kegel exercises. Kegel exercises are designed to strengthen the pubococcygeus (PCG) muscles located around the bladder opening. By exercising these muscles, you may improve your symptoms. In order to realize the maximum benefit from these exercises, it is very important that you perform them correctly.

You can identify the muscles located around the bladder opening by starting and stopping your urine stream. These are the same muscles used in Kegel exercises. Stopping your urine stream is only a way to identify the muscles used for this exercise. It is not advisable to perform Kegel exercises while urinating.

Another way to identify the muscles used for Kegel exercises is to tighten the rectal muscles (as when holding back gas or completing a bowel movement). Because they are part of the same muscle group, the rectal muscles always work with the muscles located around the bladder.

It may take several tries to locate these muscles. Try not to use your stomach, buttock, or leg muscles. Do not hold your breath. See your health care professional if you have difficulty identifying these muscles.

Once you have identified these muscles, there are different types of Kegel exercises: the quick Kegel and the slow Kegel. In performing the quick Kegel, these muscles are rapidly tightened and relaxed. During the slow Kegel, the muscles are tightened for 3 to 10 seconds and then relaxed for 3 to 10 seconds. Increase the time the muscles are tightened and relaxed for maximum effectiveness of the exercises.

Most people start by completing a set of 10 Kegel exercises four times a day. Each week, the number of contractions and relaxations – and the length of time the contractions are held – are gradually increased. Kegel exercises may be done with other activities, such as watching television, ironing, or relaxing. Because it may take several weeks to notice an improvement, it is important that you continue doing these exercises. Regular periodic follow-ups with your physician will assess the benefits of these exercises, as well as provide the opportunity to review your Kegel exercise technique.

If your symptoms do not improve, ask your clinician to help you. Many individuals need a healthcare professional’s help to identify the correct muscles to use.