Postpartum exercising decisions
When it comes to post-baby exercise, evidence-based information is lacking
When Amanda Clark returned to her Crossfit gym two months after an unplanned caesarean section, she knew she would have an uphill climb to get back to her pre-pregnancy fitness level.
What the 36-year-old Maryland mom of two didn’t know, however, was that her challenges would include pelvic floor dysfunction and a severe separation of the abdominal muscles, or diastasis recti, during the pregnancy that didn’t heal.
Clark’s coaches at the gym “were a couple of young guys with no experience helping postpartum women.” The regimen left Clark feeling frustrated. She also received no guidance from her physician when it came to postpartum fitness.
Her story is not unusual. In a small study of postpartum physical and mental health, Jaime Deluca, associate professor and chairman of the department of kinesiology at Towson University, found that 90 per cent of participants reported receiving no guidance from their physicians beyond “take it slow.”
Increasing numbers of women are active during pregnancy, but it’s not clear what’s the best and safest way to get fit once the baby is born.
And while the federal government’s recommendations say exercise is important — “studies show that moderate-intensity physical activity during the period following the birth of a child increases a woman’s cardiorespiratory fitness and improves her mood” — they don’t provide much detail.
“We’re still far away from good, evidence-based data for postpartum exercise,” says Jaclyn Bonder, medical director for Women’s Health Rehabilitation at New York Presbyterian-weill Cornell Medical Center. “OBS generally see women at six weeks postpartum and clear them for exercise because there is little evidence to support or negate that advice.”
With little to go on, women don’t know what’s normal or abnormal in their journey.
Being pregnant and delivering a baby is hard on a woman’s body. Many face conditions such as Clark’s diastasis recti, which one study suggested is experienced by 60 per cent of women, or uterine prolapse, incontinence or generalized pain in the pelvic girdle.
“Women accept these conditions as normal, and if they don’t get the help they need, they won’t get better,” Bonder says.
Nicole Paterson experienced frustration with her postpartum return to fitness. “With my first pregnancy, I dealt with early contractions and was put on bed rest for my final six weeks to avoid preterm labour,” the 34-year-old says. “I still went into labour early and at five days postpartum, I tore an abdominal muscle.”
Paterson’s road back to fitness was long. For the first eight months, she did little other than the occasional yoga class.
When she became pregnant for a second time, she was determined to stay strong and active. She turned to a coach/physical therapist who also specializes in postpartum fitness. The difference was noticeable.
“I wanted to avoid the feeling of disempowerment I felt with my first pregnancy,” she says. “I still went into labour early, but this pregnancy and recovery was a cakewalk compared to my first.”
At four weeks postpartum, she was back in the gym with her coach Ryan Smith, who has trained with physical therapists who focus on women’s health issues.
“The typical postpartum advice is to rest or do what you feel up to doing, neither of which is ideal,” he says. “Complete rest doesn’t address the tasks that come with being a new mom, like feeding, carrying the baby and other physical demands in her life. The flip side — going by feel — is difficult because there is misinformation everywhere. New moms have the demands of a baby, work and sleep deprivation, among other issues. They forget to care for themselves.”
Smith believes more therapists and gyms are recognizing the need for programs for postpartum women. “Women in general are strength training more and realizing they don’t need to feel awful after giving birth,” he says.
Bonder recommends that struggling postpartum women turn to physiatrists with a specialty in diagnosing pelvic health dysfunction. “Get an accurate diagnosis and then a referral to a (physical therapist) who can help treat you,” she says.
In a case such as Clark’s in which the diastasis recti isn’t healing, a trained PT can prescribe the proper set of exercises and measurements to turn things around.
In general, says Deluca, the sixmonth mark should be the point where women can start looking for light at the end of the tunnel.
But a 2016 study by Deluca found this is often the point where women actually feel worse. “A return to work, an inability to return to pre-pregnancy weight and less time for leisure activities may have set in by this point.”
If, however, postpartum women have enough time to exercise and can find and afford a knowledgeable trainer or PT, their outcomes can be much better, Deluca says.
“I had to take a step back at first (and reduce exercise), which was tough,” says Clark. “But we’ve gradually reintroduced exercises and I’ve improved.”
I wanted to avoid the feeling of disempowerment I felt with my first pregnancy ... this pregnancy and recovery was a cakewalk compared to my first.