Birth of your baby - exercise and advice after the birth

It is important that you take care of your back and posture following the birth of your baby especially if you had a caesarean section. Your back can be vulnerable for five to six months after the birth because:

• Your stomach muscles, which normally help support your spine, are longer and weaker as they have been stretched during your pregnancy.
• Some changes in your posture during pregnancy may result in the muscles of the spine being tight, decreasing your flexibility when bending forwards.
• Some joints can be more flexible and at risk of damage, due to the increased hormones in your body. This effect can last up to six months following the birth of your baby.
• Caring for your baby will involve lifting, feeding, and changing, all these activities can put extra strain on your back.
• You will feel more fatigued in the first months due to recovery from the delivery, broken sleep and a change in your routine.

This page offers guidance on simple, safe and effective exercises that will help you get back into shape. It also gives guidance on correct posture which is essential during daily activities and will compliment your physiotherapy exercises. Exercise should always be undertaken gradually, particularly if you are not used to it, progress at a pace that suits you.

Regaining a good posture

Start by lying on your back with your knees bent, feet flat on the floor hip width apart. Find your “neutral” spine by putting the heel of your hand on your hip bones, and your finger tips lightly on your pubic bone. These three bony points should be level.  This positioning allows the muscles of your pelvic floor and abdomen to move and work efficiently and therefore reinforces the correct, normal posture

Breathing control

Pelvic floor muscles and the deepest abdominal muscles work most effectively when we breathe out.  When exercising the correct method to provide support for your spine, is to breathe out on effort, maintaining the tension in your pelvic floor and between your hip bones. You should breathe in to the bottom of your lungs. To test this, place your hands on your lower ribs, as you breathe in your fingers should separate, then return as you breathe out.  The abdomen should not rise and fall with your breathing. Do not hold your breath at any time whilst exercising. Once you can breathe in this way start your pelvic floor and abdominal exercises. 

This leaflet offers guidance on simple, safe and effective exercises that will help you get back into shape. It also gives guidance on correct posture which is essential during daily activities and will compliment your physiotherapy exercises. Exercise should always be undertaken gradually, particularly if you are not used to it, progress at a pace that suits you.

The Pelvic Floor Muscles

The pelvic floor muscles form a sling across the bottom of the pelvis, supporting the bladder, bowel and uterus. A weakness in these muscles could lead to loss of bladder control, prolapse and backache. The following exercises can help these problems.

Lie with a neutral spine then squeeze and lift the muscles inside the pelvis upwards and forwards from the anus to the vagina as if stopping yourself passing urine. Hold for a count of five seconds then slowly relax. Repeat ten times. Once you can easily hold for five seconds start to hold for longer, eventually holding for twenty seconds.

Once you can do the exercise above you can also start to do quick pelvic floor exercises. Use the same technique as above but lift the pelvic floor hard and fast then release. Repeat this exercise ten times. You should do the pelvic floor exercises three times a day; start to exercise in lying then progress to sitting, standing then during exercise and walking. Always tighten and hold the pelvic floor muscles firmly before coughing, sneezing or lifting your baby. 

Exercising your stomach muscles

In lying with your knees bent and feet on the bed find your neutral spine, build the tension between your hip bones gently drawing your belly button to your spine. Think of it as if you were tightening a belt between your two hip bones one notch. Hold for a count of ten maintaining your breathing. Then release. Practice this ten times three times a day. Once you can do it in lying practice in sitting and standing.

To progress your exercises start the exercises below do not try any strong exercises such as sit-ups or lifting both legs up when you are lying on your back as these may be harmful.

Pelvic tilt exercise

Lie with a neutral spine and engage the abdominal and pelvic floor muscles. Gently squeeze your pelvic floor and buttocks, tilt your pelvis up and flatten your back on to the floor or bed.  Hold this position for a maximum of 10 seconds, then release gently. Ensure you keep your stomach flat. If it bulges out, then go back practising the abdominal exercise.

Head lift exercise

Lie with a neutral spine and engage the abdominal and pelvic floor muscles. Gently squeeze your pelvic floor and buttocks, tilt your pelvis up and flatten your back on to the floor or bed. Keeping your neck long lift your head and shoulders, hold for a few seconds, then release gently.

Stand with your feet hip width apart facing forward.  Check weight is balanced between inside and outside of each foot as well as front and back of each foot and equal left and right.  Knees straight, not locked.  Pelvis neutral, place the heels of your hands lightly on the front of your hip bones and extend your fingers to your pubic bone.  These bony points should line up.  Relax your shoulders down, gently drawing the shoulder blades down and towards each other.  Stretch the back of your neck by thinking of lifting the crown of your head towards the ceiling. When working in standing, try to keep work close to you and work at waist height to avoid leaning e.g. nappy changing, bathing baby, food preparation, washing up.

Walking

Try to maintain the upright posture developed in standing, think about “walking tall”, maintaining gentle tension in your pelvic floor and abdominal muscles (belly button to spine) to hold your hips level.  If using a baby sling, keep the baby snug and central.  Avoid leaning back to compensate for the weight of the baby or rounding shoulders.  When pushing a buggy or shopping trolley, keep elbows bent with the buggy or trolley close, adjust the handle if possible to waist height.  Pushing up hill requires a stronger contraction through the abdominal muscles to maintain the best possible posture.

Sitting posture

Feet hip width apart, facing forward, heels positioned under knees.  Try to position the hips at a right angle, with weight equal between left and right sit bones.  Use a small rolled towel about waist height to help support the natural curve of your lower back.  Shoulders should be relaxed with shoulder blades gently pulling back and down towards each other. Stretch the back of your neck by lifting the crown of your head towards the ceiling and drawing the chin back.

Whilst holding this posture, lift the pelvic floor and gently draw navel to spine. If you are feeding your baby support baby on pillows and maintain your upright posture.  Avoid twisting body or rounding shoulders.

Getting out of a chair

Remember to bring your weight to the front of the chair before attempting to stand.  Shuffle bottom forward, and then lean to bring your nose over your toes before pushing up with the legs. Avoid twisting whilst standing up, especially if holding any type of load e.g. baby

Bed Manoeuvres

When turning over in bed, keep knees together and reach arm over in the same direction. Hold the abdominal and pelvic floor muscles firmly throughout any rolling or twisting movements. When getting out of bed, roll onto side, lower legs over side at same time as pushing up with arm. Keep your legs bent to aid in the motion of getting up

Bending and Stretching

When securing a child in to a car seat, or a car seat in to a car, bend from the hips and knees not the waist, whilst contracting the abdominal and pelvic floor muscles to support the back.  Take care not to over stretch.

Lifting and carrying

When lifting get as close as possible to the load to be lifted e.g. toddler, washing basket, Moses basket, vacuum, buggy and use the strong muscles of the legs to push up with whilst keeping the back straight and drawing in the abdominal and pelvic floor muscles. 

Everything should be held centrally, close to the body e.g. baby, toddler, shopping, car seat, buggies.  Alternatively, where possible, split the load so it can be managed equally left and right, e.g. shopping bags, or use a rucksack.  Avoid leaning to compensate for the altered weight distribution, or rounding the shoulders.              

Exercising for life

Many women choose to go back to swimming and non-contact sports after their six week check. If you participate in contact sport or activities it is advisable to wait until three months after the birth before returning to these activities.  If you have any questions on what you should or should not be doing, ask your Women’s Health Physiotherapist (telephone number below).