Safe and Responsible Fitness Programming for the Postnatal Client

Working in the fitness world, I’m sure you’ve been approached by a new mom dying for you to help her get back into her pre-pregnancy skinny jeans.

We celebrate women who do amazing physical feats quickly after having a baby (running a marathon for example) without realizing we may be encouraging something that nature is not intending to happen so soon.

A woman getting her post-baby body toned and fit again is entirely possible. The problem with women rushing to the gym too soon to get that “sick body” is that they often speed through a vital stage of healing. It’s essential that the body have time to properly repair and strengthen muscles that go through immense changes through a pregnancy, namely the pelvic floor and transverse abdominals.

A baby is created over nine months, and yet there is this misconception that within a few months after giving birth, a woman’s body should immediately return to the state it was in was before pregnancy. More often than not, it is the client (rather than the trainer/yoga instructor/coach) requesting tons of abdominal work for fast results. Still, it is our job as the fitness professional to follow safe guidelines while ushering a postnatal woman back into a fitness routine.

A few questions to ask your client before creating a program:

When was the baby born? How many weeks/months postpartum is she?
C-section or vaginal delivery? This is vital information as a C-section birth has drastically different physiological side effects than a natural delivery.
What type of exercise was she doing prior to and during the pregnancy?
Has your doctor given you the green light for exercise? This question may seem obvious, but it is very important.

The standard clearance to workout again from doctors is 4-6 weeks postpartum for a vaginal birth, and 6-8 weeks or longer for C-section births.

Every woman and pregnancy is unique. Some may get the okay earlier or later. But simply because the doctor gives a woman the green light to exercise doesn’t mean should immediately return to her grueling Crossfit routine or sign up for a Spartan Race.

C-section childbirth is a major surgery and the recovery is more significant than a vaginal delivery. During a standard C-section (although not always with the advent of new technology) the surgeon actually cuts into the abdominal muscles. This requires rehabilitation like any other surgery. The mother often feels disconnected to her abdominals when she returns to working out and being on her belly can bring discomfort for several months due to the incision.

It goes without saying that a woman who was in excellent shape before getting pregnant and worked out consistently through the pregnancy is going to have an easier time transitioning back into exercise post-baby. Still, there are surprises that can be humbling to the client when returning to the gym. Loss of strength, flexibility, and endurance are common occurrences.

For the postnatal client who is new to working out, parenthood offers the perfect motivator to get healthy and in shape.

Swimming, walking, light to medium resistance training, Pilates and yoga are excellent choices for women to safely condition the body back into shape. Start with low impact exercise and gradually bring her back to pre-pregnancy levels of lifting and/or cardio.

The number one focus should be integrating the connection to deep core muscles – the transverse abdominals, multifidus, pelvic floor and obliques. This is the groundwork for all other exercises. Lunges and squats are fine as long as she is activating the core muscles throughout the exercise. It’s best to err on the side of caution, fewer repetitions with proper form.

Program design for early post-partum women should focus on:

Deep mindful core work
Chest openers (rowing for example)
Spinal extension (mini swans or cobras, no extreme extension as to not overstretch the abdominals)
Pelvic floor
Posture
Balancing out the body (compensatory patterns are common in new mothers, work to develop equally strong left and right sides and front and back)

Rebuilding the body from the inside out. Once the foundation is there, you can add more resistance to the exercises. It is important to hit the larger muscle groups of the back, arms, legs and glutes to prepare the new mother for carrying the baby without straining her back.

A nice way to begin (or conclude) the session is to have the client lie supine with knees bent and take a few breaths inhaling through the nose exhaling out of the mouth. As she exhales, cue her to press the shoulders away from the ears towards the hips, draw the ribs together like a corset and pull “up and in” from the pelvic floor to the abdominals. AKA = activate the Kegels. Think of the pelvic floor like a sling supporting the center of the body. Direct her to take a few deep breaths and feel the length of her spine and inward bracing of the abdominals.

Use extreme caution with these exercises for early postpartum clients: (2-3 months post delivery)

Running
Heavy lifting
Crunches
Planks (without modifications)
Prone work (especially for C-section mothers)

Running is not advisable in the first few months post-pregnancy as it poses risks to the pelvic floor. During pregnancy, the hormone relaxin softens joints and ligaments to prepare the body for childbirth. The bones in the pelvis physically move apart. This hormone can remain in the body for up to 4-5 months part partum.

Running during this delicate period (especially on pavement) essentially pounds on an unstable and malleable grouping of ligaments and bones and can potentially throw off the entire recovery of the pelvic floor. Just as you wouldn’t run on a sprained ankle before it’s healed, the same goes for a women’s pelvic floor healing post childbirth. Incontinence can affect women who run too soon.

Walking (even brisk) is fine because it does not place the same pressure on the joints. Encourage your client to stave off the running for the first 3-4 months and you’ll be doing them a favor in the long run.

Crunches or curling up from a supine position is not ideal for strengthening the abdominal muscles in early postpartum.

If she has a diastasis recti (when abdominal muscles separate due to the pressure of the baby) crunches can exacerbate the problem. It’s not uncommon for very fit women with taut rectus abdominal muscles (aka the “six-pack” muscles) to have diastasis recti during pregnancy. The tightly coiled muscles simply “break” or separate.

If there is a diastasis rectus you want to avoid flexion + rotation. For example standing or a seated rotation of the spine is ok, but doing an oblique criss-cross or bicycle on the mat could further complicate the diastasis.

Even when diastasis recti is not present, there are better ways to strengthen the core at the early stage. Airplane (extending opposite arm and leg out from the quadruped position) is excellent, and side-lying exercises can work the core without putting pressure on the healing pelvic floor and abdominals. (For instance, lying on the side lifting one leg at a time, then both and also side forearm planks.)

Seated roll-downs (posterior pelvic tilt) rolling halfway down to the mat, then holding and coming up are a safer way of strengthening the abdominals.

Other factors to be aware of when working with a postpartum client:

Sleep deprivation
Tight muscles – hip, hamstrings, adductors, traps
Emotional sensitivity (body image, hormones)

Understand that if a new mom is working out with you one-on-one, this quite possibly could be one of the few hours in that day she has to herself.

Incorporate a little TLC (via stretching and release work). The following muscles tend to be very tight for new moms: hamstrings, hips, adductors and trapezius muscles from carrying and nursing the baby.

Large physio-balls work well in releasing the upper body (think back bend, photo shown) and feel amazing to both pre and postnatal women.

Educate your client on realistic expectations, reassure her that she will get back into shape again, but to be patient with the timeline.

If your client is steadfast at working out and eating right, she will notice changes at the three, six, nine and twelve-month marks.

Three months she will no longer feel she still “looks” pregnant.

Six months, many will be back in their pre-pregnancy clothing.

The nine-month mark is significant. It took nine months to gain the weight, and for some, it will take nine months to lose the weight.

At one year (yes, a year!) she should feel like her body is hers again.

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Andrea White Marinas

Andrea White Marinas, PMA Certified Pilates Instructor at Andrea White Pilates

Andrea is a PMA Certified Pilates instructor and runs a private practice out of a boutique studio in Santa Monica, California. She received her complete Pilates certification through Balanced Body University at Core Conditioning, her prenatal Pilates certification through the Center for Women’s Fitness, and Bachelor of Arts degree from Luther College. Early in her Pilates career, she worked as a physical therapy aide and learned firsthand the healing power of Pilates. Andrea works with a wide range of clients, from active men and women looking to take their fitness to the next level, pre and post natal moms, to those rehabilitating injuries.

Andrea is passionate about the ability of Pilates to change lives. Andrea has studied movement her whole life. Prior to teaching Pilates, she danced professionally in New York and South Korea and has choreographed for musical theater, music videos & feature film. Andrea’s eye for detail and precision keeps clients focused and consistently challenged while having a fun workout! Andrea lives in Santa Monica with her husband Roberto and daughter Veronica.

To connect with Andrea and take advantage of her offerings, please visit www.andreawhitepilates.com