Just this morning, I got the email from a client — the same email I get every time someone crosses the rainbow bridge from preggo to postpartum.
“I had my baby! Uh…. what happens now?”
Because I live and work in Boston, i.e. the overachiever hub of the world, many of these folks add something like “I’m kind of desperate to get back to working out. Help?”
I got you, babe.
Here’s the tl;dr:
Having a baby, no matter how it goes down, is a big effing deal. Rest is key. Rest is king. While I’ll be writing about what to do postpartum, I cannot over-emphasize that maybe it’s worth considering embracing your inner slacker during this time (trust me, keeping a child or two alive isn’t a joke, and you aren’t actually slacking).
It’s not sexy, but breathing is the way. Walking, too. You know, good old fundamental human basics.
Improving lymphatic drainage to the belly and pelvis while also gently (GENTLY!) re-engaging the core is the primary foundation of re-establishing solid movement strategies.
Prioritize your mental health — whatever that means to you.
The deep dive:
Okay, so you had a baby. Whether the birth was idyllic, meh, traumatic, or anywhere in between on that wild spectrum, the fact that you are now on the other side indicates that you a true rock star of a human.
The first thing to do is to assess how you really feel. No — like, how you REALLY feel. If you are in the first three months postpartum and physically overwhelmed, it’s a good time to chill the F out. Bounce back culture is a capitalist scam, so please, for the love of all that is good and holy, do not pressure yourself into moving for any reason other than “it feels good” and/or “my mental health depends on me exercising.”
And yet. There is little research on rest. While the first two to six weeks postpartum are termed the “subacute postpartum period” wherein we acknowledge that “the body is undergoing major changes in terms of hemodynamics, genitourinary recovery, metabolism, and emotional status”, the American College of Obstetrics and Gynecology (ACOG) recommends returning to exercise “as soon as [is] medically safe”, adding that for some birthing people, this can be within days (days!) of delivery.
This feels like a big conflict, IMO. The lack of specific recommendations creates a huge information gap for both providers and birthing people alike. In my clinical observations, the subsequent effect is a chasm between exercise devotees and rest enthusiasts. My strong suspicion is that ACOG is leaving space for individual healing — an easy, breezy vaginal delivery is a very different than an emergent c-section with associated medical complications — but without specific guidelines, we end up at that “You’re cleared to exercise!” moment during the six week checkup.
But what the fuck does that even mean? Can you go back to running marathons at six weeks? Ninety minute yoga classes? Or should you “play it safe” and keep log rolling out of bed without any plan to get a sweat in?
Of course, exercise is good for you. It is correlated (albeit weakly) with reduced rates of postpartum depression, and for many folks, it is a self-reported lifeline to sanity. Deep core stabilization has been shown to decrease the rate of diastasis recti and improve quality of life outcomes.
So, in a relative absence of information, what should one do in those immediate weeks postpartum? Here are my thoughts:
Weeks 0-2: Holy shit, you just had a baby (or two, or — god bless you, more). Focus on sleep, eating, figuring out how to feed your kid (whatever that looks like). To help set both your and your babe’s circadian rhythm, get early morning sunlight if you can. Walking should be a possibility at about the week mark — if a short walk is painful, that’s a red flag to reach out to a provider.
Weeks 2-4: Begin exploring breath work that connects to your core and pelvic floor. I can’t over-emphasize how important this is — don’t skip it! (For video tutorials, scroll to the end.) Simple dead bugs, transverse abdominis engagement, and tabletop work (think the slowest bird-dog you ever did see) will all work here. Additionally, begin to explore rotation: spinal rotation, specifically thoracic rotation, as well as hip rotation, both of which can be negatively impacted by pregnancy and delivery.
Weeks 4-6: Continue to play with these concepts and add reps and time as feels good. If you’re itching to get moving and add challenge, start taking longer walks with hills. Doing so will support hip extension and glute activation, which are super helpful to pelvic floor health!
At the six week mark, you’ll likely get that “good to go!” stamp from your OB. This is the part where I plug that everyone with access should go to a pelvic floor provider to get assessed and create a plan that works on an individualized level. With that said, here are some general do’s and don’t’s:
Do continue to load the abdominal wall; gently. One of my favorites for this is crawling. You can place a yoga block, book, or weighted ball on your low back and try to keep it as steady as possible to emphasize pelvic stabilization.
Do continue to walk. You can play with speed and incline, as well as carrying a babe or pushing a stroller to make it more challenging.
Do begin to slowly incorporate squats and lunges of any stripe, as they are awesome for your glutes and pelvic floor and functional AF for parenting. My fave hack is to either squat or lunge whilst holding and/or soothing your baby, which you can christen as the cutest kettlebell ever. For more on the glory of squats, check out this article.
Don’t start running until at least 3 months postpartum unless it is absolutely critical for your mental health. I wrote about running extensively in this article and this one, but research points to waiting 3-6 months for running specifically.
Don’t “just keep going” if you have any of the following symptoms with exercise: leaking pee, poop, or farts (yes, that’s a thing), a feeling of pressure (like a tampon or cup is falling out), or significant pain in your pelvic girdle beyond normal post-workout soreness. Reach out to a pelvic floor provider. Hell, reach out to me and I’ll help you find someone.
Here’s the take-home:
To state the obvious, having a baby is a super big deal for your bod. It’s worth taking the time to treat the experience as such, and have a team of providers who can tailor support to your specific journey and needs.
What I often like to say to clients is that feeling sore, tired, and achey is all normal. Feeling like utter shit is not. You deserve care and support, particularly if you consider your birth to have been traumatic in any way. So be kind, assess where you’re at, and get help as needed.
To that end, a common question I get is “When should I come in to see you?” The answer is that if you’re feeling great, I recommend a follow up after that six week appointment in order to get cleared from a wound healing perspective (regardless of delivery mechanism).
However, if you’re in pain, reach out sooner. I’ve seen people as quickly as two days postpartum to address pain. Most providers, myself included, will wait until OB clearance (at about the six week mark) to do internal pelvic floor work, but there is so much we can do externally to support the healing process.
Similarly, if your mental health absolutely depends on vigorous exercise, request an appointment sooner to get assessed and make a plan. This can help optimize outcomes long term.
Hang in there, you birthing hero, you. Never hesitate to reach out — I’m at cait@ritualpelvichealth.com.
Paying subscribers can access a collection of breath and movement exercises I’ve put together below. It has 15(!) video tutorials that cover hip rotation, thoracic rotation, breath, and deep core stabilization. This is a great way to support my work and yourself!