You’re Cleared for Exercise Postpartum

This blog was adapted from its original post on https://drlaurenkeller.com by the author.

Who wasn’t anxiously waiting to hear those four little words, “You’re cleared for exercise” after having a baby? I don’t know about you but after four to six weeks of not moving regularly, I was itching to get back to exercising. The thing is, just because I was cleared, doesn’t mean I was READY.

According to ACOG, the postpartum follow-up visit should address the following topics:

• Family planning and contraception
• Diabetes and hypertension management
• Thyroid management
• Medication use
• Mental health / postpartum mood disorders
• Healthy lifestyle and weight
• Breastfeeding
• Injury prevention
• Substance use, violence and abuse
• Continence
• Patient-specific conditions including: perineal or cesarean wound pain, fatigue

Let’s look at this from the outside in to see what this means. This is the follow-up that most mamas wait for BEFORE returning to exercise. That means that the follow-up is only monitoring a mama that has been relatively sedentary. It negates the fact that many mamas develop incontinence, fatigue, or perineal pain once they return to exercise and should be observed after returning to exercise.

The United States is one of the countries that does not recommend regular physiotherapy following birth. In fact, ACOG simply states that “women with uncomplicated pregnancies should be encouraged to engage in aerobic and strength – conditioning exercises before, during, and after pregnancy.” Great! I agree that everyone should be engaging in these activities, the thing is, just because we can do a movement doesn’t mean we should. Other considerations we want to pay attention to during postpartum include:

• Are there any exercises that cause pelvic pain or discomfort?
• Do I have any leakage with these movements?
• Do I have tenting or coning during any exercise?
• Are there any movements that create a diastasis recti?
• Are there any movements that create cesarean wound pain?
• How do I feel after I finish exercising?
• How will these exercises benefit me?

One thing BIRTHFIT highlights during the immediate postpartum time period is that slow is fast. We want to properly rehabilitate and stabilize our core and pelvic floor now so we don’t see postpartum symptoms in 20 years. Simply because we are cleared for exercise doesn’t mean our bodies can handle weightlifting or running without creating pain or causing urinary leakage. Just because we are cleared for exercise doesn’t mean certain movements won’t cause or worsen a diastasis recti or abdominal tenting/coning. Just because we are cleared for exercise doesn’t mean our body is ready to conquer the world. We need to step back, take it slow and figure out what our bodies can safely handle.

References:

1. https://www.acog.org/-/media/Committee-Opinions/Committee-on-Obstetric-Practice/co650.pdf?dmc=1
2. https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Optimizing-Postpartum-Care
3. http://www.wsha.org/wp-content/uploads/Safe-Deliveries_PostpartumBundle_7-8-15.pdf

Dr. Lauren Keller
BIRTHFIT Chicago: Western Suburbs @birthfit_chicago_western_burbs