Wondering how to safely return to exercise after pregnancy? You're not alone

When Fan* gave birth to her first child almost two years ago, she was given little direction about how to return to exercise.

After a 20-minute session with a physio, they remember being given an A4 sheet of exercises to follow at home.

"It was all a bit of a blur, because I was sleep-deprived, and over-excited," they said.

"For the first six weeks, those exercises were enough. But after that, I didn't know what to do. 

"I had heard about people going back to sport after a few months, and others who didn't do certain exercises for years, or ever.

"It was pretty confusing."

(*Fan uses she/they pronouns, and asks us to mix them up throughout the article).

As is common among women who have given birth, Fan also experienced urinary incontinence.

She was referred to a pelvic floor physiotherapist while in hospital, who gave her some exercises to strengthen her pelvic floor muscles.

But after being discharged from the hospital, there was no follow up:

Australian postpartum exercise guidelines 'fall short'

Dr Melanie Hayman, an expert on exercise and pregnancy, says experiences like Fan's are not unusual.

As she explains it, the regular six-week postpartum check-up typically focuses on the health of the newborn baby.

"There are usually a couple of questions about mum's health, but it can be quite superficial," Dr Hayman said.

"[Topics like] returning to exercise, or the physiological changes that occur throughout pregnancy, or as a result of birthing, are not assessed."

That's despite the fact approximately one in two people who give birth experience symptoms like urinary incontinence (47 per cent), and pelvic organ prolapse (50 per cent), which can increase fear of exercising. An additional 17 per cent experience faecal incontinence.

Current Australian guidelines, however, do not provide specific advice for returning to exercise after pregnancy.

Instead, those who are "healthy" are encouraged to meet the existing Australian adult exercise guidelines (for non-pregnant people).

Adult exercise guidelines

Adults should be active most days, preferably every day. Each week, adults should do either:

• 2.5 to 5 hours of moderate intensity physical activity – such as a brisk walk, golf, mowing the lawn or swimming
• 1.25 to 2.5 hours of vigorous intensity physical activity – such as jogging, aerobics, fast cycling, soccer or netball
• An equivalent combination of moderate and vigorous activities

Include muscle-strengthening activities as part of your daily physical activity on at least 2 days each week.

Source: Australian Government Department of Health and Aged Care

"That's where our current guidelines fall short," Dr Hayman said.

"Someone who is five or six weeks postpartum is not your general population … [but] the issue is that we only have a certain body of literature at the moment.

"So while the current recommendations are still accurate, there are some absences in them, and it would be great to able to provide more guidance, especially in the early phases of the postpartum period."

She said one reason it was difficult to provide 'one-size-fits-all' guidelines is that individual experiences vary:

"Every birthing and postpartum experience is different, so one of the most important things is that return to exercise has to be individualised."

Any form of activity, however, is better than none, with Dr Hayman advising starting with some gentle walking, even if this is just five minutes a day.

"Traditionally, pregnancy was considered a 'delicate' period in a woman's life where they were advised to take it easy, because of fear that any sort of exertion might harm the mother and/or fetus," she said.

"The more women can be active in accordance with our guidelines, the better."

Gyms with childcare and flexible times are hard to find

Finding a place to exercise is another reason many struggle to get active postpartum.

When Fan reached three months postpartum, they were determined to find a gym where they could return to greater levels of fitness.

But it was a task that proved more difficult than anticipated.

Most commercial gyms wouldn't allow Fan to bring her child, or if they did have a crèche, they had long registration waitlists, or were full at the times that suited her.

Eventually, Fan turned to local Preston gym 23W, a women-only strength and conditioning community with a specific focus on postpartum mums.

23W employs a full-time nanny, while the on-site creche is situated in the same room as other gym equipment, allowing parents to keep an eye on their child while exercising.

"It just means our members can come in knowing they've got that support, whether it's emotional support, [or just] knowing someone's looking after their baby. It makes a big difference," owner Ange Drake said.

Drake also runs classes at different times throughout the day, to provide greater flexibility for her clients.

"In that first 12 months [postpartum], you're probably not going to be training first thing in the morning, because you're going to be pretty tired, or last thing at night.

"There's some great postpartum programs out there, but where a lot of women come unstuck is that they're only offered on one day, at one time in the week, and if you miss it, it's gone.

"So having flexibility with timing is really important."

Important to 'normalise' common postpartum symptoms

Drake, who has two children of her own, says one of the biggest barriers women face when returning to exercise is the "disconnect a lot of them feel with their body":

"After giving birth, things have stretched out, or moved and don't feel the way they used to. A lot of women feel like whole muscle groups have gone offline.

"This includes how they can rebuild it, and make it stronger while looking after the needs of a little one."

For many, this includes pelvic floor complaints, lower back pain and issues to do with abdominal separation.

"When you're in the moment, it's really scary to think, 'am I going to be able to run again?' Or, 'I'm leaking when I'm going grocery shopping,'" Drake said.

"These experiences can be really alienating … and a lot of women think 'it's just me'.

"So we try and help them understand that what they're experiencing is not uncommon, and that women have been able to rehab whatever it is they're going through."