Postnatal Return to Training

The postpartum period presents unique challenges for returning to exercise. The body has undergone significant changes during pregnancy and delivery, and recovery time varies widely between individuals. This chapter covers guidelines for safely guiding postnatal clients back to training.

Understanding the Postnatal Body

What Happens After Delivery

Immediate postpartum period (0-6 weeks):

• Uterus contracting back to pre-pregnancy size
• Lochia (postpartum bleeding) occurring
• Hormonal shifts (estrogen, progesterone dropping)
• Breast changes (milk production if breastfeeding)
• Initial tissue healing

Extended recovery period (6 weeks - 12 months):

• Continued tissue remodeling
• Hormonal stabilization
• Core and pelvic floor recovery
• Gradual strength return
• Body composition changes

Factors Affecting Recovery

Recovery timeline is influenced by:

• Type of delivery (vaginal vs. cesarean)
• Complications during pregnancy or delivery
• Pre-pregnancy fitness level
• Activity during pregnancy
• Breastfeeding status
• Sleep and nutrition
• Support system
• Mental health

Medical Clearance

Standard Clearance Timeline

Traditional recommendation:

• 6-week postpartum checkup before resuming exercise

Current thinking:

• Earlier gentle activity may be appropriate for uncomplicated deliveries
• "Return to exercise" is a progression, not a single event
• Individual assessment matters more than arbitrary timelines

What Medical Clearance Should Include

Encourage clients to ask their provider about:

• Any exercise restrictions
• Pelvic floor and abdominal wall assessment
• Clearance for specific activities
• When to progress intensity
• Warning signs to watch for

Cesarean Section Considerations

C-section recovery requires additional considerations:

• Incision healing (typically 6-8 weeks)
• Abdominal wall integrity
• Potential for adhesions
• Often longer before returning to core exercises
• Avoid exercises that stress incision site

Diastasis Recti Assessment and Management

Understanding Diastasis Recti

What it is:

• Separation of rectus abdominis muscles at the linea alba
• Affects most women to some degree after pregnancy
• May or may not cause problems
• Often improves naturally, sometimes needs intervention

Basic Assessment

Note: Formal assessment is best done by a pelvic floor physiotherapist

Self-check technique (can teach clients):

1. Lie on back with knees bent
2. Place fingers horizontally at navel
3. Lift head slightly (like mini crunch)
4. Feel for gap between muscle bellies
5. Check above and below navel as well

What to note:

• Width of separation (finger widths)
• Depth of separation
• Tension in linea alba when engaged
• Presence of doming or bulging

Training Considerations for Diastasis

Exercises to avoid initially:

• Traditional crunches and sit-ups
• Exercises that cause visible doming
• Loaded spinal flexion
• Heavy lifting without proper core engagement
• Planks (until appropriate)

Exercises to emphasize:

• Diaphragmatic breathing
• Gentle core activation (transverse abdominis)
• Pelvic floor coordination
• Supported movements
• Gradual progression based on tissue response

Signs of inappropriate loading:

• Visible doming or bulging of abdomen
• Unable to maintain core tension
• Increased separation
• Discomfort or pain

Referral for Diastasis

Refer to pelvic floor physiotherapist if:

• Significant separation (>2-3 finger widths)
• No improvement over time
• Functional limitations
• Pain associated with diastasis
• Client is concerned or anxious

Pelvic Floor Recovery

Why Pelvic Floor Matters

The pelvic floor undergoes significant stress during pregnancy and delivery:

• Supports growing uterus for 9 months
• Stretches significantly during vaginal delivery
• May be weakened or injured
• Affects bladder and bowel control
• Impacts core function

Signs of Pelvic Floor Dysfunction

Common issues:

• Urinary incontinence (leaking with activity)
• Urge incontinence (sudden need to urinate)
• Heaviness or pressure in pelvis
• Pelvic organ prolapse
• Pain during intercourse
• Difficulty with bowel movements

Training implications:

• Leaking during exercise is NOT normal or acceptable
• Don't "push through" pelvic floor symptoms
• Refer to pelvic floor physiotherapist if issues present
• Avoid high-impact activities until pelvic floor is ready

What Fitness Professionals Can Do

Within scope:

• Teach awareness of pelvic floor during exercise
• Modify exercises that cause symptoms
• Encourage diaphragmatic breathing
• Avoid high-impact until appropriate
• Refer when issues are present

Outside scope:

• Pelvic floor assessment
• Internal examination
• Specific pelvic floor rehabilitation
• Treating dysfunction

Return to Exercise Timeline

Phase 1: Early Postpartum (0-6 weeks)

Goals:

• Rest and recovery
• Gentle movement as tolerated
• Begin reconnecting with body

Appropriate activities:

• Walking (short distances initially)
• Gentle stretching
• Diaphragmatic breathing
• Gentle pelvic floor awareness
• Basic posture work

Not appropriate:

• Structured exercise programs
• Core exercises
• Impact activities
• Resistance training

Phase 2: Initial Return (6-12 weeks)

After medical clearance

Goals:

• Rebuild core function
• Establish exercise habit
• Address specific recovery needs

Appropriate activities:

• Walking (gradually increasing)
• Basic core rehabilitation exercises
• Gentle bodyweight exercises
• Mobility work
• Light resistance band work

Progress when:

• No pelvic floor symptoms
• Core function improving
• Energy and recovery adequate
• Healthcare provider approves

Phase 3: Building Foundation (3-6 months)

Goals:

• Rebuild strength base
• Progress exercise intensity
• Return to regular training structure

Appropriate activities:

• Modified calisthenics exercises
• Progressive resistance training
• Moderate intensity cardio
• Continued core development
• Begin introducing more challenging exercises

Progress when:

• Core and pelvic floor functioning well
• No symptoms during activity
• Recovering well between sessions
• Feeling ready for more challenge

Phase 4: Return to Full Training (6+ months)

Goals:

• Return to pre-pregnancy activities
• Progress toward fitness goals
• Full exercise repertoire

Appropriate activities:

• Full range of calisthenics (as tolerated)
• Higher intensity training
• Impact activities (if pelvic floor ready)
• Sport-specific training
• Advanced skill work (with appropriate progression)

Note: Some women return to full training earlier, some later. Individual variation is significant.

Exercise Modifications for Postnatal Clients

Core Exercise Progression

Early stage:

• Diaphragmatic breathing
• Gentle TVA activation
• Dead bugs (feet down)
• Pelvic tilts

Intermediate stage:

• Modified planks (elevated)
• Bird dogs
• Side-lying exercises
• Pallof press

Advanced stage:

• Standard planks (when appropriate)
• More challenging variations
• Integrated core work
• Progress based on response

Push-Up Progression

Early stage:

• Wall push-ups
• Focus on breathing and core control
• Short holds at the bottom

Intermediate stage:

• Incline push-ups (high incline)
• Progress incline gradually
• Monitor for doming

Advanced stage:

• Standard push-ups (when ready)
• Full range of push-up variations
• Based on individual recovery

Lower Body Progression

Early stage:

• Bodyweight squats (supported if needed)
• Glute bridges
• Gentle lunges

Intermediate stage:

• Full squats
• Split squats
• Step-ups
• Hip hinge patterns

Advanced stage:

• Single-leg work
• Plyometrics (when pelvic floor ready)
• Full lower body program

Sample Postnatal Programs

Phase 2 Session (6-12 weeks postpartum, 30 min)

Warm-up (5 min):

• Walking in place
• Gentle mobility work
• Diaphragmatic breathing

Core Reactivation (10 min):

• Diaphragmatic breathing with TVA engagement: 2 x 10 breaths
• Dead bugs (feet down): 2 x 8 each side
• Glute bridges with pelvic floor awareness: 2 x 10
• Modified bird dogs: 2 x 6 each side

Gentle Strength (10 min):

• Wall push-ups: 2 x 10
• Supported squats: 2 x 10
• Standing resistance band rows: 2 x 12

Cool-down (5 min):

• Gentle stretching
• Deep breathing

Phase 3 Session (3-6 months postpartum, 45 min)

Warm-up (8 min):

• Walking (3 min)
• Dynamic mobility (5 min)

Strength Circuit (30 min): 3 rounds:

1. Incline push-ups: 10 reps
2. Goblet squats: 10 reps
3. Inverted rows: 8 reps
4. Romanian deadlifts: 10 reps
5. Pallof press: 10 each side
6. Glute bridges: 12 reps

Rest 60-90 sec between rounds

Cool-down (7 min):

• Walking (2 min)
• Stretching (5 min)

Special Considerations

Breastfeeding and Exercise

What we know:

• Exercise doesn't affect milk supply or quality
• Feed or pump before exercise for comfort
• Wear supportive bra
• Stay hydrated
• Some babies dislike taste of post-exercise milk (rare)

Practical tips:

• Schedule training after feeding when possible
• Wear breast pads if needed
• Bring extra water
• Be flexible with scheduling

Sleep Deprivation

Reality of new parenthood:

• Sleep is often severely disrupted
• Affects recovery, mood, energy
• Exercise may feel impossible some days

Training implications:

• Be flexible with scheduling and intensity
• Some movement is better than none
• Don't push hard when exhausted
• Short sessions may be more realistic
• Exercise can improve sleep quality

Mental Health

Postpartum mental health:

• Baby blues common (first 2 weeks)
• Postpartum depression affects ~15% of women
• Postpartum anxiety also common
• Exercise can help but isn't treatment

Trainer role:

• Create supportive environment
• Be aware of mood changes
• Encourage professional help if needed
• Don't minimize struggles
• Exercise as self-care, not pressure

Key Takeaways

1. Medical clearance is essential before returning to structured exercise
2. Diastasis recti and pelvic floor function should be assessed
3. Return to exercise is a progression, not a single event
4. Leaking during exercise is not normal—refer if present
5. Individualize timeline based on delivery, recovery, and symptoms
6. Progress core exercises gradually, watching for doming
7. Be flexible with scheduling given sleep and feeding demands
8. Create supportive environment acknowledging the challenges of new parenthood
9. Know when to refer to pelvic floor physiotherapist or healthcare provider