When and how to get back in shape post-baby, part 2

Part 1 of our yummy mummy guide looked at the immediate post-natal period – the first six weeks. But what should you be doing to get back in shape after that time?

If you’ve managed to incorporate pelvic floor exercises, basic abdominal strength work and even some walking into your new hectic life so far, congratulations! It’s definitely worth continuing with both the pelvic floor exercises and abdominal work to help you regain tone and muscle control in these areas.

Making progress after pregnancy
As with any muscle, it’s important to increase the overload on the pelvic floor and deep abdominals in order to continue to make progress - which means that as the exercises you are performing become easy, you need to increase the level of challenge.

To up the ante with your pelvic floor exercise – you can lengthen the holds of the slow contractions, increase the number of contractions you do overall, or reduce the rest interval between them. There are even vaginal weights you can use. These small weighted cones are inserted into the vagina and then squeezed by the vaginal walls.

It’s important to continue with your deep abdominal work, too. Here are some slightly more difficult exercises to add to your repertoire.

Leg slide
Lie on your back with knees bent and feet on the floor. Inhale and as you exhale, draw your navel towards your spine and slide one leg out along the floor until it is straight. Inhale, then exhale again as you draw the leg back up, keeping the pelvis level throughout. Repeat with the other leg.

Bent knee fallout
Lie on your back with knees bent and feet on the floor. Relax the ribs and engage the TA by drawing in the lower tummy. Let one knee fall slowly out to the side, while keeping the pelvis still and maintaining the TA contraction. Don’t allow the pelvis to rotate with the leg. Repeat 10 times and then swap legs.

Knee lift
Lie on your back with knees bent, feet flat on the floor and core engaged. Pick one foot off the floor and lift the leg (keeping it bent). Stop lifting as soon as the pelvis starts to move or twist, lower and repeat. Repeat 10 times per leg.

Four point kneeling*

Start on all fours with hands below shoulders and knees below hips. Have your spine in a neutral position – neither arched or rounded, and let the tummy relax and hang down. Inhale, and as you exhale, pull the pelvic floor muscles ‘up and in’, and then draw up the lower part of the tummy, keeping everything else perfectly still. Hold for 6 seconds, breathing freely. (*Do not adopt the four-point kneeling position until six weeks after delivery.)

The other goal, once those first six weeks are over with, is to shorten the rectus abdominis – the six-pack muscle – which will have lengthened as a result of your pregnancy. Research shows that the best way to do this is to work in the muscle’s ‘inner range’, in other words, when it is in a shortened position. But first, you need to ensure that the two sides of the rectus abdominis are knitting together properly.

The rec check
Six weeks after giving birth, the separation along the linea alba should be the width of two fingers or less. Exercising your abdominals with standard ab exercises (like curls and crunches) if the gap is wider than this can impair recovery of the muscles and result in doming. So how do you know? Your doctor should be able to tell you from a quick examination. You can also try this test yourself:

Lie on your back with your knees bent up and feet flat on the floor. Place two fingers on the abdomen, around your navel and press down gently. Now inhale and as you exhale, slowly raise your head and shoulders off the floor, keeping the pressure on your navel. As the head and sholders ift you should be able to feel the two portions of the rectus abdominis muscle closing in around your fingers. You will almost certainly feel a gap of some description (a gap of 1.5-2cm post-pregnancy is normal) but you don’t want the gap to be more than the width of two fingers.

When you have passed the rec check, try the exercises below to start retraining your abs.

Kneeling pelvic tilt
Start on all fours with hands belowshoulders and knees below hips. Have your spine in a neutral position –neither arched or rounded, and let the tummy relax and hang down. Inhale,and as you exhale, curl the tailbone under and tilt the pelvis. Hold, thenrelease back to the start position and repeat. Avoid using the buttocks toinitate the tilt – focus on using the muscle at the front of yourtorso.

Shoulder raise
Lie on the floor with knees bent and feet flat, arms beside you. Inhale, and as you exhale, draw your navel to spine and curl your ribcage towards your hips, allowing the head and shoulders to come off the floor. Hold in this position, keeping the abdomen flat, and then slowly lower.

Half rolldown
Sit upright with knees bent and feet flat on the floor. Place your hands under your thighs. Inhale and as you exhale, draw your navel to your spine and tilt the pelvis, scooping the abdominals and curling up the pubic bone as you roll off your sit bones on to the upper part of the buttocks. Don’t pull on the thighs with your hands. Hold this curled position, breathing freely, and then return to upright sitting. Gradually increase the length of time you hold the position.

Getting active
Now that the primary post-natal period isover is the time when most doctors will give the green light as far asgetting active again is concerned. (If you’ve got the energy, that is!)Experts recommend aiming for low to moderate intensity workoutsthat last for 20-30 minutes, 3-5 times per week.

So what should you choose? Personal preference is a key factor, as well as considerations about what type of activity you did before your pregnancy. But in general, lower impact activity is recommended over higher impact options. Walking is a great option, because it’s something you can do with your baby. A walking workout with your pram (or baby carrier) is the perfect way for you to do some aerobic exercise, with a little added resistance. To increase the challenge, be sure to include some hill climbs and descents on your route. And to ensure good technique, as you push up a hill, don’t stick your bottom out – walk tall, with abdominals gently drawn back to your spine and torso upright. Down the hills, do the same, but also keep your arms bent rather than letting the pushchair stray too far from your torso. A 1-hour minute walk with a pushchair, taking in a few hills, can burn around 260 calories.

Other good options are cycling (a home-based exercise bike can be invaluable) swimming, aqua fitness classes and gym-based machines such as the cross trainer or stepper. What about running? Many doctors will tell you to avoid running for the first few months after pregnancy, but Ingrid Kristiansen, the Norwegian distance runner was back to her pre-pregnancy training levels within a month of giving birth and many women feel that getting back to running is very important for their own sanity and health. However, if you weren’t a runner before having a baby, you should wait a few months before starting, as your body has not had previous experience to build on.

Strength training should be avoided for the first five months after delivery, until the effects of relaxin are long out of the system. But in the meantime, you can still work with light weights, using high reps and low resistance, to help restore muscle tone and endurance.

If you weren’t active before, one of the best activities to start with is Pilates. Its focus on the core muscles, pelvic floor and abdominals is just what you need post-pregnancy. Make sure you tell the instructor you’ve recently had a baby, to ensure the exercises you do are all safe and effective. Yoga can be great, too – but it’s best to opt for a specific post-natal class that eliminates the potentially problematic postures.

Factors to consider on your return to exercise

• Ensure you are taking in sufficient calories and fluids if you are exercising and breastfeeding. The body needs an extra 500-600 caloires a day to sustain breastfeeding.
  
  
• Your baby may not like the taste of your milk immediately after exercise. It’s a better idea to express milk before exercise. This will also make exercise more comfortable.
  
  
• Wear a supportive sports bra for all activities.
  
  
• Joint stability can still be compromised up to 5 months after delivery, so be extra vigilant about good posture and technique.

• Stretching to maintain flexibility and help restore correct posture is fine – but don’t stretch to increase flexibility – by holding positions for too long, or by stretching too far - until 16-20 weeks after giving birth – as relaxin is still abundant and muscles more vulnerable.
  
  
• Be flexible. This is one occasion when goal setting is inadvisable. Don’t force yourself to stick to a schedule or feel disappointed with yourself if you can’t do as much as you would like.
  
  
• Consider visiting an osteopath, chiropractor or physiotherapist to have your pelvic alignment assessed. Pregnancy can often tilt or twist the pelvis slightly, which may cause back and lower limb problems once you start exercising.
  
  
• If you feel breathless, dizzy or nauseous during exercise or extremely achy or lethargic as a result of it – ease off. These are signs that you are overdoing things.

Back to normal
As time progresses, you can increase the intensity and duration of your workouts and gradually work back to the level you were at before your pregnancy. There’s even some evidence to suggest that women’s sports performance improves following giving birth. It may be that the increased blood volume and accompanying red blood cell concentration enables more oxygen to be transported into the body. Or it may be, as many women believe, that the experience of giving birth raises your pain threshold, so that you can push yourself harder and reap the results of this more intensive training! Which ever is the case, it’s a heartening thought that your body can not only get back to normal after the rigours of pregnancy, but even end up fitter and stronger. And if you need a bit of motivation to get moving, bear in mind that women who don’t lose their baby weight within 6 months tend never to lose it at all!