Postnatal Exercise 411

POSTNATAL EXERCISE
You are asked to gain 15-35 lbs. over the course of nine months. That is a significant amount of weight to lose. Women have a much higher blood volume during pregnancy, and that does not vanish overnight. Within the first four to six weeks your postnatal body is considered “normal” in the fact that all systems are back to normal. But you are left with loose muscles, extra fat, fluid retention for breastfeeding and sometimes some cellulite that did not reside on your thighs prior to getting pregnant.

10-20 pounds usually goes within the first four to six weeks (based on a 30 pound weight gain). That comes from: baby, amniotic fluid, placenta, blood volume, breast tissue, fat storage urination and the uterus involution. With all of this in mind, notice how hard your body is working in the first few weeks postpartum, it is a delicate time for your body! If you are exercising, expect your body to be back at its pre-pregnancy weight around nine months postpartum. Anything before that is simply unrealistic.

THE LONG-AWAITED BIRTH
You might be surprised to discover that you retain your baby belly for days, even weeks or months, after giving birth. But if I might point out that your body has just housed a human being who demanded luxurious living quarters for nine months, and now your muscles and skin must adjust to the baby’s absence. The uterus needs a little while to contract into its pre-pregnancy size, and the organs—such as the stomach, intestines, and bladder— must shift back to their original locations, having been nudged out of place by the growing womb. On top of these changes, the increased blood flow from pregnancy needs time to wane. Women who gain around 30 pounds can lose anywhere from 10-20 pounds in the first month.

THE FIRST DAYS: POSTPARTUM CARE
The nursing staff at the hospital where you deliver should play a central role in teaching you how to care for your body and your infant after birth. All instructions should go home with you so that you encounter few surprises, and also remain on file at the hospital so that your doctors can adjust treatment if necessary. Topics for nurses to discuss with you before discharge include: Lochia (postpartum vaginal discharge) appearance and frequency, acceptable physical activities, attendance to the breasts, perineum, bladder, and/or C-section incision, nutritional needs, recommended exercise, emotional and psychological reactions to the major life change of having a baby, and signs of complications.

SO JUST WHEN SHOULD YOU START EXERCISING?
If you delivered without complications or surgery and your Ob-Gyn has given you permission, resumption of exercise is encouraged. This usually happens around 4 weeks postpartum at your postpartum check-up. According to ACOG pelvic floor exercises like the Kegel are encouraged immediately postpartum (again given your Ob-Gyn is on board).

C-SECTION
C-section is a surgical procedure so there will always be some scarring. Your doctor will not be cutting through muscle with the exception of the uterus. When a C-section is performed two sets of abdominal muscles are separated from one another but are usually not cut. A transverse (horizontal) cut—the so-called Bikini Cut C-Section—actually causes fewer complications. Since it is below your bikini line it will be far less noticeable than a longitudinal (vertical) incision.

Your Ob-Gyn will release you to exercise around the six or eight week mark. A C-Section is a surgical procedure so you will need to be cautious and listen to your body as you begin exercising. You will want to use the Postnatal SlimDown 360 Program, with they key foundation core exercises. They are not your traditional ab exercises, you will be recruiting your transverse abdominis and pelvic floor to create a healthy core. You will also find these core exercises cued throughout all workouts.

VAGINAL DELIVERY
We are not going to get into all the medically dialogue surrounding delivery. What I want to provide is some advice on exercising during this postpartum phase! Vaginal deliveries with midline episiotomies, especially 4th degree (1st being smallest) can create dysfunction of the pelvic floor, which also interrupts core function. Several of the tools and instruments that doctors use to assist you in giving birth, vacuums and forceps, for example, can cause PF dysfunction.

Whether you have a vaginal delivery or a c-section the Pelvic Floor and the TA act as a sling to your baby. Which is why you need to train these specific muscles to get back the integrity and strength of your core before returning to traditional abdominal exercises.

POSTPARTUM DEPRESSION
You will not only need time for physical healing after delivery, but also emotional healing. Doctors take postpartum depression very seriously; the condition affects 20% of patients. And it affects a higher rate of patients who undergo In Vitro Fertilization. New mothers can feel so low that they are unable to get out of bed to tend to their babies, to feed them, bathe them, change them, or dress them. They might feel no connection to their infants at all, and even consider suicide. If you have mild or intense signs of PPD you should seek medical advice as soon as possible. There are optional hotlines and anonymous chat groups at www.apa.org and www.nimh.nih. gov.

WHAT TYPE OF EXERCISE IS BEST?
What type of exercise is best? Your workouts need to include these three main components; strength, cardio and flexibility. You should always warm-up and cool-down, especially during pregnancy & postpartum. Although we all wish that we could spot train or spot reduce our bodies, there is no such thing as spot reduction. You gotta do it all!

The muffin top, the baby belly, whatever ugly name you might have for it…will go away! Your body is remarkably adaptable, and your core muscles are just as adaptable. But you cannot expect them to bounce back unless you initiate the muscle fibers – by, you guessed it, doing core exercises.

You could do 600 crunches and never achieve a flat stomach. The key is learning how to activate the transverse abdominis during a crunch and other ab exercises. This muscle is often undercued. The TA is a thick layer of muscle that runs from hip to hip, wrapping around the torso from front to back. The muscle fibers of the TA run horizontally, similar to a corset or a weight belt. These muscles are your true core muscles, and strengthening them will give you power.

During pregnancy your transverse abdominis and pelvic floor support that baby. So, wouldn’t it be wise to work those muscles to get your stomach back? Think of it this way, you don’t train for a 5K by not running. ☺ So, you cannot expect to flatten your stomach muscles by not using them.

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