When is it safe to go back to exercise? And how do I do it? These are the most common questions mums who’ve recently had babies ask women’s health physiotherapist Fiona Healy.

Healy works in private practice in Killarney and also gives postnatal exercise classes online with The Bump Room, a team of physiotherapists offering online and in-person support, motivation and reassurance to new and expectant mothers – it’s done through movement, education and advice.

“Women, particularly those who were quite active pre-pregnancy, realise that after being pregnant and having a baby their body isn’t what it was. They’re trying to understand how to get back to what they were,” says Healy.

Women come with a variety of birth experiences, which directly affect how soon they can resume their normal exercise. “Women who’ve had a straightforward delivery, where everything went according to plan, will probably recover quicker than the woman who had a forceps birth, a long pushing stage or a big baby.”

Pointing out that there’s a 30% risk of some degree of prolapse in the first year postnatal – most commonly of the bladder – Healy says these women need support and guidance getting back to exercise.

And then there’s diastasis rectus abdominis (DRA) – separation of the tummy muscles, a quite natural occurrence that happens to “pretty much everybody at the end of pregnancy”, says Healy. “For most, it heals naturally within the first two months, but for some it lingers and they need rehab, support and strengthening of the abdominal muscles.”

Other issues too can plague women in the postnatal phase, putting exercise firmly on the back burner. A 2021-published systematic review of 24 studies found that, one year post-partum, urinary incontinence was present for 32% of women. And an Australian study published last year found pelvic floor symptoms – including urinary incontinence – a substantial barrier to exercise.

Meanwhile, about 25% of all women postpartum suffer from pregnancy-related pelvic girdle pain (PGP) and/or pregnancy-related low back pain (PLBP), according to a 2004 study

And a Danish study (exa.mn/pelvic-girdle-pain) found 8.5% of women with PGP post-delivery still had pain two years after giving birth.

PGP can linger in 10% of women, says Healy, explaining that it commonly affects the pubic bone in front or the sacrum at the back. “It’s quite a sharp pain and typically activity-dependent. Women usually feel it when moving, or after moving – it can be a real barrier to getting back to exercise.”

Free rehab

Healy wishes women in Ireland could get a “proper postnatal physical check”, as women in France do. “Here, the six-week GP check screens the baby – and the woman for post-natal depression. In France, women get eight postnatal visits to a women’s health physiotherapist – after each baby – paid for by the State. There are also free rehab classes. In the first three to six months post-birth women are well looked after.”

Attending a woman’s health physiotherapist at the six-week mark provides an opportunity for assessment and picking up any issues. But some women get caught in what Healy calls “the fog of having a newborn”. Motherhood is so overwhelming and they’re often sleep-deprived.

“They can lose themselves – and their connection to themselves. Some women come after their second or third baby. Usually by then they’ll have a few problems stacked on top of each other.”

These problems, explains Healy, will have built up gradually. “Maybe it started with a bit of incontinence when they coughed or sneezed. They let that go. Then they got a bit of back pain – and let that go. By the time you meet them the back pain has developed. They’re not engaging in any exercise. And the stress incontinence has become more severe – they’re leaking when walking.”

Yet, identifying and resolving problems is vital, says Healy, because you need to be strong for motherhood. “Mothers’ bodies need to be able to tolerate the demands of a baby. You need muscle strength. Your baby’s going to get heavier. You need flexibility to be able to lift a heavy baby, to lift buggies in and out of cars.”

While women can start walking straightaway after the birth – or as soon as their body feels comfortable – aerobic exercise has to wait 12 weeks. So does running or any jumping-type sport. “Some women take longer. If they’ve had a forceps – or difficult – birth, it’s going to take longer, like with any injury.”

Prior to the 12-week milestone, she says women need to prepare for returning to impact exercise. “At the six-week stage, we’d get them started on a programme that would include squats, lunges, pelvic floor strengthening. Single leg strength is really important for example.”

She points out that women, who were unable to exercise during pregnancy because of nausea or pain, will need more strengthening because they’ll have become deconditioned.

Running on empty

Mum-of-one Rachel Fanning was surprised at how long it took her body to heal following the birth of now nine-month-old Fiachra. Particularly as she’d had a straightforward pregnancy, a natural birth and no epidural. “I was surprised I couldn’t go back running, even after six weeks.

“It was surprising how long it took for me to honour this huge thing my body had gone through. Society puts pressure on you, we want to hurry it all up – ‘when are you going back to work’ – but your body needs to heal. It’s the biggest thing that happens to a woman.”

In her late 30s, Rachel “absolutely loves” running. “Pre-baby I did the park run on Saturdays. I had a personal best of 22 minutes and eight seconds. Running was very important to me. It gave me energy, made me appreciate nature, got the adrenalin pumping – I’d feel wonderful after it.”

A teacher from Donoughmore, Co Cork, Rachel stopped running halfway through pregnancy. “Some fitness instructors don’t know what to say to pregnant people so they err on the side of caution. They tell you to be careful and you don’t know what that is so you end up not exercising. I walked a lot through the second phase of my pregnancy and I did an online prenatal yoga class.”

Eleven weeks after having Fiachra, she tried to start back running. “I knew nothing about postpartum exercise or how to get back to exercising. I had a bit of incontinence. I didn’t know this was a problem that could happen after having a baby. No one talks about it, so when it occurs, you don’t know it’s a problem for anyone else.

“There’s shame, embarrassment attached to incontinence, which there shouldn’t – it’s a natural thing that can happen.”

Recommended by the Bump Room to attend a women’s health physiotherapist – and armed also with a GP referral – Fiona met the physiotherapist and had her problem resolved after two sessions.

“She looked at my posture and showed me where I was holding onto stress – in my stomach. She showed me how to untuck my pelvic floor to relieve stress. She gave me techniques on how to hold my posture properly.

“I returned gradually to running about three months ago. I’m back running now, but my speed’s much slower. I don’t time myself anymore – I just run.”

Rachel compares looking after a baby to being at a gym session. “If I’d known the gym would help me after having a baby, I’d have said there’s a point to all these squats. With a baby, you’re always squatting whether you like it or not.

“But no gym instructor tells you this will help in motherhood. Because everything’s heavy – the pram’s heavy, the baby seat. You’re constantly securing the baby seat, lifting it out of the car, attaching it onto wheels – often with just one arm because you’re holding the baby as well.”

Rachel’s advice to other postpartum mums is not to feel you’re being “precious or dramatic” by attending a women’s health physiotherapist, even if everything feels OK. “It’s not in our culture to go but they’re the experts in this field.”

  • The Bump Room offers online classes as well as in-person classes in counties Clare, Cork, Dublin, Kerry, Limerick, Mayo, Tipperary and Waterford with further locations in Sligo, Westmeath and Cork set to open soon. Visit thebumproom.ie.

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