Tag: Postpartum

When can I return to exercise after delivery? That seems to be at the top of most people’s list of questions for providers.

A typical 6 week postpartum visit with your OBGYN or midwife is simply checking to see if your cervix is closed and any stitches are healed. This is not a full examination of muscle recovery and function. Even if your birth experience wasn’t traumatic, there is still a level of trauma that occurs to the body, especially the core and pelvic floor. Six weeks postpartum isn’t a magical healing time for these muscles. This is where working with a pelvic floor physical therapist for a pelvic floor exam and a qualified postpartum trainer to help guide you back into the movements you love will really transform your recovery and future progress.

Some areas to consider with postpartum exercise:

– Stress

– Diastasis recti

– Hormone changes

– Pelvic organ prolapse

– Incontinence

– Breastfeeding supply

– Fatigue

Fatigue and Stress

Exercise has many known health benefits. However,  when your body is already deeply stressed from birth recovery, lack of sleep, learning how to parent a new baby, and navigating adding another human to your household, adding more stress on top (even if it is “good” stress like exercise) could do more harm. In times like this, slowing down and prioritizing rest need to be key components of your fitness plan. This can look like prioritizing flow and mobility work, adding in rest days, increasing the rest time between sets, or decreasing the number of high demand movements within a single workout. This is one area where you will want to really lean in to listening to your body. Issues such as adrenal and thyroid dysfunction and hormone imbalances can sneak up on you during postpartum with the combination of hormone shifts, fatigue, and stress.

Exercises You Can Do Early Postpartum

You can return to fitness postpartum with the appropriate modifications and strategies. These four exercises are a great way to start rebuilding your foundation and get you back to the activities that you love.

Breathing

• Breathing is the foundation to your postpartum recovery and strength building process.
• Try 360 degree breathing

Kegels

• Not just a squeeze, a kegel is a contraction with a lift of the pelvic floor.
• Note: Depending on the amount of birth trauma, these may not be recommended. Consult with your doctor and request a referral to a pelvic health physical therapist to determine the appropriate pelvic floor exercise for you!

Mobility Work

• It feels good to move your joints after spending so much time sitting to hold and feed baby, especially after 9 months of growing that baby. Focus on shoulder and hip mobility with movements such as wall angels, good mornings, and shin box flows.

Walk

• Start with short trips around your house and progress to short trips around the block (Week 1= in/around the bed, Week 2= around the house, Week 3= around the block/outside). Gradually build distance and time.
• Feeling symptomatic when walking? Sometimes changing to walking on a slight incline can help your body get into a better position.

Gráinne M. Donnelly GM, PT, Brockwell E, Rankin A, Moore IA. Beyond the Musculoskeletal System: Considering Whole-Systems Readiness for Running Postpartum. J Wom Health PT. 2022;46(1):48-56.

Deering RE, Christopher SM, Heiderscheit BC. From Childbirth to the Starting Blocks: Are We Providing the Best Care to Our Postpartum Athletes?. J Orthop Sports Phys Ther. 2020;50(6):281-284. doi:10.2519/jospt.2020.0607.

Casey Thomas-Hardesty, MS, NTP & Jenny LaCross, PT, DPT, PhD(c), WCS, ATC, CLT-LANA

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Nutrition can play an integral role in your postpartum recovery. Below are some important nutrients for the fourth trimester.

Iron

Iron is ultimately responsible for transporting oxygen throughout your blood. This is an especially important nutrient to consume after blood loss. Managing your iron levels can also help battle fatigue.

Foods that are high in iron: red meat, liver, spinach, and lentils

Omega 3 Fatty Acids

Omega 3 fatty acids (especially DHA) are important for both mom and baby’s brain function. So even if you aren’t breastfeeding, it’s important for you to nourish your body with this nutrient. 

Foods that are high in omega 3 fatty acids: salmon, eggs, grass-fed beef, walnuts

Fiber

Fiber is essential for maintaining normal bowel movements

Foods that are high in fiber: raspberries, apple, green peas, quinoa

Zinc 

Zinc is important for immune health as well as the production of proteins in your body. Zinc has also been shown to be beneficial for wound healing.

Foods that are high in zinc: oysters, pumpkin seeds, lamb, cashews

Choline

Choline is essential to brain development and is especially important for breastfeeding moms.

Foods that are high in choline: eggs, fish, chicken, kidney beans

A note on breastfeeding. Breastfeeding is said to burn an additional 500 calories per day. At least in the beginning, I recommend listening to your hunger cues to make sure that you are properly fueling your body for breast milk production. If the reduction of calories for weight loss is desired, this would be something better adjusted after you have recovered from delivery and have a firm handle on breastfeeding. 

Casey Thomas-Hardesty, MS, NTP

Two Peas Wellness

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If you had a cesarean section or an episiotomy or vaginal tear during labor and delivery, the resulting scar tissue might become uncomfortable as it heals. As the scar heals, it can form adhesions (the layers of tissue bind tightly together) to underlying tissues, causing pain and soreness at the site. Over time, if the scar becomes tight and thick, it may make intercourse, elimination, and insertion of a tampon, menstrual cup, or diaphragm painful. 

Once your scar is fully healed (no redness, scabbing or drainage) and the stitches removed or dissolved, you can use this simple technique to help prevent scar adhesions from developing. The method uses massage to help keep the tissues below the scar from sticking together and will help the skin maintain elasticity and may even improve the appearance of the scar tissue. 

• Start by gently massaging along the length of the scar with an up and down motion with your fingers. You want to use the same amount of pressure that you would use to check the ripeness of a tomato (not just sliding across the skin but not pushing as hard as you can). If the area is tender, you can use light pressure until your scar becomes more mobile or you can start massaging the areas above and below your scar. You can apply a small amount of lotion or oil (vitamin e works well) to the skin to help with the massage.
• Switch back and forth between massaging in an up and down direction and back and forth along the length of the scar. You can also move your fingers in a circular motion in both the clockwise and counterclockwise directions as you move along the scar.
• As the scar becomes more flexible from massage, pluck up the scar and roll the skin between your thumb and forefinger. This technique is often referred to as “pill rolling”. Move across the scar length as you pluck and roll. You may feel areas of the scar that are thicker or do not move as well—focus on those areas by gently increasing the distance you pull the scar tissue away from underlying tissues as you gently roll it between your fingers.
• Work the scar every other day for several minutes and if the scar is sore, avoid massaging it until the no longer is painful.
• Be patient, it takes times for the scar to respond to this technique and a gentle, incremental approach is most effective.

If you’re experiencing continuing symptoms of decreased scar mobility, such as continued pain at the scar with movement, discomfort with intercourse, or tampon or diaphragm insertion, ask your healthcare provider for a referral to a physical therapist who specializes in women’s health. 

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After the arrival of your new baby, it is often very difficult to maintain or increase physical activity levels. There is a lot going on including a lack of sleep and a lack of consistent routines. Be easy on yourself- you are learning a new normal!  During the first 4-8 weeks (and beyond for some women), your body is recovering from labor and delivery. It is important to allow your body time to heal before jumping back into an exercise routine. That said, even during the early weeks, gentle stretching, pelvic floor exercises, and walking can be safe and helpful! Some women are able to resume physical activities such as these within days of delivery. Sitting for long periods of time may make you feel worse!  You should resume physical activities gradually as soon as you feel able! For some that may be days, for others, weeks. Talk to your doctor and pay attention to what your body is experiencing. If something hurts or is uncomfortable, do not do it. If an exercise makes you feel good, you should feel encouraged to do it. Exercise during and after pregnancy can help your recovery! Depending on the time of year, a great way to get exercise can be to take a walk with your baby. He/she will enjoy the fresh air, and so will you! 

So maybe we have you convinced to be active during postpartum, but you are worried about how exercise during pregnancy could impact your ability to breastfeed. Regular exercise for women who are lactating improves maternal fitness and health without affecting milk production, milk composition, or the infant’s growth! The “myth” that exercise during pregnancy will impact your ability to feed your baby is NOT true! However, it is important, as always, to stay hydrated and eat enough to maintain your milk supply. Lactation does require more calories to be eaten, so if you exercise, you will need additional calories. Further, lactating women who exercise should consider feeding their infant or expressing milk just before beginning exercise to avoid discomfort. Lactating women should also consider wearing more supportive active wear/sports bras to provide additional support.

https://www.acog.org/en/Clinical/Clinical%20Guidance/Committee%20Opinion/Articles/2020/04/Physical%20Activity%20and%20Exercise%20During%20Pregnancy%20and%20the%20Postpartum%20Period

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When breastfeeding your baby, you need around 500 extra calories per day. This is more than when you were pregnant! This amount could be a little less or a little more depending on how much milk you are producing. For example, if you doing a combination of formula-feeding and breastfeeding your baby, you likely do not need the full 500 calories; Or, if you are breastfeeding your baby and also pumping additional milk, you may need more than 500 extra calories. Try to get the extra calories from high-quality food sources (See list below). 

It is also important to remember than when producing milk, your body may want you to keep a couple of extra pounds on you in order maintain milk supply. Do not worry about a few extra pounds! It is also not unusual for some women to lose weight when breastfeeding. Everyone is different. Don’t compare yourself to anyone else! Focus on keeping a healthy weight for you and your baby! 

List of important nutrients for breastfeeding, and where to find them. 

• Calcium: milk; cheese; yogurt; fish with edible bones; tofu processed with calcium sulfate; bok choy; broccoli; kale; collard, mustard, and turnip greens; breads made with milk.
• Zinc: meat, poultry, seafood, eggs, seeds, legumes, yogurt, whole grains (bioavailability from this source is variable).
• Magnesium: nuts, seeds, legumes, whole grains, green vegetables, scallops, and oysters (in general, this mineral is widely distributed in food rather than concentrated in a small number of foods).
• Vitamin B₆: bananas, poultry, meat, fish, potatoes, sweet potatoes, spinach, prunes, watermelon, some legumes, fortified cereals, and nuts.
• Thiamin: pork, fish, whole grains, organ meats, legumes, corn, peas, seeds, nuts, fortified cereal grain (widely distributed in foods).
• Folate: leafy vegetables, fruit, liver, green beans, fortified cereals, legumes, and whole-grain cereals.

https://www.ncbi.nlm.nih.gov/books/NBK235579/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5104202/

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