How to Start your Postpartum Recovery! - Weeks 0-3 Post Birth

Getting Started  

Before getting into specifics about movements and exercises- It is important to emphasize that giving birth is similar to a major athletic endurance event (though perhaps magnified many times) in regard to the musculoskeletal/physiological response and recovery required. Muscles stretch up to 115% so there is some weakness and general feeling of loss of coordination with those muscles..but strength and function can improve.

Your emphasis during the first week postpartum should be similar to the first week following a marathon- Resting, Refueling, and Rehydrating including gentle diaphragmatic breathing, walking and mobility

Understandably, it can be difficult to dedicate time and energy to your own needs when taking care of a newborn. When possible, enlist the help of willing family, friends and others around you to allow you to meet your body’s need to recover.

Let’s face it though… even early postpartum we have to lift and hold a baby, maybe pick up a toddler, squat and get up and down easily. There are some specific things you can do in the first few weeks postpartum (weeks 0-3)  that will set you up for an easier recovery musculoskeletally and aid your return to normal activity/exercise. In this article we will go over: Diaphragmatic Breathing, C-Section/Vaginal, Easy Walking, Basic Strength Exercises, Gentle Mobility, and Abdominal Supports!

Please note that you do not have to do everything on this list, or complete every exercise every single day in order to recover. This is simply a guideline to be shaped to your personal health, energy levels, and abilities postpartum. There will be days you do nothing on this list, and that is totally normal and expected!

In the Hospital (c-section or vaginal)

• Use an abdominal a support like the Post-Natal FITsplint (c-section or vaginal) If you have a c-section, the hospital should provide you with one, however the FITsplint is a favorite among physical therapist due to its level of support, flexibilty and ability to adjust.
• Roll to your side and use rails for extra support and to help get out of bed the first few days.
• You can start basic diaphragmatic breathing - (Video at 0:45-1:20) help restore core range of motion with basic deep breathing and then progress to engaging core and adding isometric holds. 
• Light massage to belly button/abdominal area -wait to do C-Section Massage  (scar mobilization until clearance from doctor)
• Walk a little more each day, but don't push through pain or do too much the first few days..keep it very light to avoid major soreness

It is recommended to wear an abdominal support for the first few weeks especially if you had a c-section but also very helpful for vaginal as well. This can help provide support as muscles regain their strength. You can wear during the day or night (most find it helpful when up moving around for light compression and support. If you have a c-section, usually the hospital will give you an abdominal support. If not, you can order a FITsplint (post-natal).  This is helpful for incision protection, provide abdominal support from surgery, support for those with diastasis recti and in general: light compression/support to the stretched out/weakened muscles from being pregnant.

RESEARCH on Abdominal Supports/Splints

Abdominal Supports can be helpful postpartum as it provides gentle compression to stretched out muscles as well as those with diastasis recti- while muscles heal and regain strength and stability. Wearing a gentle support can help align lateral sides of the abdominal muscles close together- which assists in tissue loading, as well as proprioceptive feedback (which can help with pressure management and better muscle engagement). This recent study found improved trunk flexion strength and body image in postpartum women who wore an abdominal support and completed a core strength program, compared with those who only completed core strengthening. Elastic abdominal binders are not likely to increase intra-abdominal pressure and will not cause or exacerbate pelvic floor symptoms (Keshwani, 2019).

When purchasing an abdominal support, it should not be stiff or restrict breathing while wearing. The ReCORE PostNatal FITsplint is known for its flexible, comfortable, fully adjustable material. See the video below for best practices on how to wear your Postnatal FITsplint.

After the Hospital (1 to 3 weeks postpartum)

C-Section Massage Video (video shows what you can do before 6 week incision healing and after 6 week incision healing to help reduce scar tissue buildup) 

Easy Walking

This is a great way to begin easy movement postpartum! Walks should start out very short and comfortable- begin with 5-10 minutes (and progress from there), you can get out multiple times a day if you feel up to it. Remember your purpose is gentle movement, not significantly pushing yourself. If you experience increased perineal bleeding or dizziness, scale the walks back.

Bonus points if you are able to walk outside, sunlight/natural light is a major boost for mental health!

Foundational Exercises

If anything causes pain or discomfort, stop and wait several more days to try that exercise again. These are meant to be gentle exercises to work on basic strength, coordination and mobility. If you feel like you are significantly pushing yourself you are doing too much.

Pelvic Floor Contraction/Relaxation

Start in weeks 0-2. Simply moving the muscles through their full range of motion is a great way to help wake them up. The pelvic floor experiences quite a bit of stretching and trauma throughout the birth process. As a result, there is significant loss with pelvic floor coordination, strength and control in the early postpartum period. You may have a hard time contracting or feeling these muscles to start, but that’s ok, keep trying- you will see improvement as you heal! To start, practice simply contracting (lifting) and relaxing (lowering) your pelvic floor. Being able to relax the pelvic floor is just as important as being able to contract it. It may help to try different body positions: laying on the floor with knees bent, sitting cross-legged on the floor or sitting in a chair. Once you can feel these muscles contract and relax, here are a few pelvic floor exercise to start with:

• Long Hold - Lift and hold a pelvic floor contraction for as long as you can, then fully relax. Work up to holding for 8-12 seconds.
• Quick Flicks - Practice a quick pelvic floor contraction and relaxation. See how many you can do in 10 seconds and work to improve

Diaphragmatic Breathing

Start in weeks 0-2. Diaphragmatic breathing is a powerhouse exercise! It gently works on core/ pelvic floor activation/coordination and helps restore full range of motion to the stretched-out core muscles, while also helping to calm the nervous system and increase body awareness.

This can be done in sitting, laying down or standing position but may be easiest to try laying down first. Lay on your back, with knees bent and feet on the floor. Place a hand on your belly to watch it’s movement. As you inhale, let your belly rise (chest may rise just slightly) and relax your core and pelvic floor. On your exhale, contract core down and contract (lift) pelvic floor- belly should lower. Repeat for several minutes.

• Diaphragmatic Breathing w/ Max Isometric Holds - After a few days of performing basic diaphragmatic breathing, try adding a max isometric contraction after inhale for 3-5 seconds, before releasing with exhale.

Strength & Mobility Exercises

Start in weeks 2-3. This is a great way to improve core control, muscular stiffness and endurance (gradually handle higher Intra-Abdominal Pressure).

Hip Openers

Start in weeks 2-3. This is a great exercise suggested by Emma Brockwell in her book “Why Did No One Tell Me?” (pg 266). (If you haven’t checked out this book, it is an invaluable postpartum resource!)

Lie on your back with knees bent. Inhale first to relax, then as you exhale and contract your core, leg one knee fall to the side. Don’t let your pelvis or other leg move! In this position, inhale to relax core, then exhale and engage core to draw knee back to start. Perform 3-5 reps.

Adduction Pillow Squeeze

Start in weeks 2-3. Lay on back with knees bent, feet on floor and a folded pillow between knees. Gently press knees together to squeeze pillow, and hold for 5 seconds before relaxing. Perform 3-5 reps.

Glute Bridge

Start in weeks 2-3. Lie on your back with knees bent, feet on floor. Squeeze glutes and lift abdomen into bridge position. Hold for 5 seconds, and then slowly lower to the ground. Perform 3-5 reps. Once comfortable with this, you can combine with adduction exercise, and squeeze pillow between knees while in bridge position!

Wall Squats

Start in Week 2-3. Squatting is an essential life movement, so it’s good to start early! Wall squats are a great way to slowly introduce increased intra-abdominal pressure demands and improve full body range of motion and leg strength. As long as you don’t feel heavy pelvic pressure or pain that increases with these, you can start doing repetitive (short) or isometric  (longer) squat holds. Adjust squat depth according to strength, less deep will be easier. Perform 3-5 reps.

Gentle Mobility and Stretches

This mobility sequence targets some of the common tight muscles postpartum- back, neck, chest and hips. If any feel pain, or if movements aggravate symptoms- do not complete them.

Cat Cow

• Recommended For - Thoracic and pelvic mobility.

Book Opener Stretch

• Recommended For - Thoracic mobility.

Neck and Chest Stretches

• Neck Rotation- Side to Side (keep shoulders back)
• Neck Rotation- Up and Down (keep shoulders back)
• Lateral Bends
• Protraction and Retraction (chin is going forward and back, like a turtle 🙂)
• Chest and Back Stretch
• Chest Corner Stretch (combats hunched over posture)

Our hope is that this gives you somewhere to start in the first few weeks postpartum!

LOOKING FOR MORE WORKOUTS after week 3?

Check out our self paced early postpartum strength program (ReCORE), and also online personalized training to help you return to lift, run, jump etc! Speed of progression varies with each person, but around week 3-4 is when we generally start adding more complex exercises to this list- including more range of motion, as well as strength and coordination challenges. 

We also recommend scheduling a visit with a pelvic floor therapist when you can. This can sometimes be done in the first few weeks postpartum. Don’t wait until you are in pain to visit. While it should be standard care, Pelvic PTs are able to make sure healing is going well, assist with issues contracting or relaxing the pelvic floor and diagnose pelvic injuries.