The 40-day postpartum quarentine is 40 days too long

Many women are still told not to exercise for 40 days (or 6 weeks) after birth. This well intended advice from medical professionals is unfortunately causing lots of problems for postpartum women such as incontinence, sexual dysfunction, back problems, “jelly bellies”, and poor body image.

The general consensus from gynaecologists and midwives is for women to adhere to a 40 day waiting period after giving birth before starting to exercise. These 40 days are meant to wait for lochia (postpartum bleeding) to stop, stitches to heal, and the uterus to shrink down to its normal size.

While the intention is good, this “rule” causes problems. How can all women, younger, older, first time moms, 10th time moms, with C-sections, with episiotomies, with water births, women who were fit before birth, women who have never exercised, professional athletes, fit into the same 40-day quarantine category?

Also, when told not to exercise, women are left to define exercise themselves. Does this include walking? What about Kegels? And once the 40 days are over, are women allowed to now start running and going to aerobics? Does the body magically recover in 40 days while avoiding exercise?

Women post partum are vulnerable physically and emotionally. It is a time when life is upside down and thinking of her own body becomes a last priority while learning to be a mom and taking care of the little one(s) 24-7. For some, the 40-day rule provides a nice “excuse” to not have to start doing something about the alien postpartum body she has been left with for 6 weeks. While it is great for a new mom to focus on being a mom, this long wait makes recovery MUCH longer and MUCH harder. The longer the wait, the harder it is to get the pelvic floor musculature to respond again. And in many cases, physical therapy machinery is needed to get the process started well. Being a great mom is a lot easier with a properly functioning body.

The other problem with this general guideline is that some women wait the required 40 days and then jump into their normal pre-pregnancy exercises (aerobics, weight training, tennis, etc.) without ever doing the necessary work to reactivate and strengthen the core. This can cause a slew of problems including incontinence, a protruding abdominal wall, and muscular compensations that can lead to back pain, knee pain, etc.

The solution is to give more specific advice. So, instead of this general advice, here are some more specific guidelines for exercise after birth:

1.) Start doing Kegels as soon as able. Ideally this means moments after birth and definitely before leaving the hospital. This actually speeds up perineal healing.

2.) As soon as you can, start walking around and doing some basic mobility exercises. For a normal non-medicated birth this could be within hours. For a medicated birth you may need a little more time to get moving due to the anaesthesia.

3.) Even with lochia, gentle exercises for core recovery can be started within those early days.

4.) Diaphragmatic suction exercises should wait until the uterus has shrunk. This varies from woman to woman. You can try them a month after birth and should definitely be able to do them after the 40 days.

5.) From here the progress should be constant towards brisk walks and core stability.

6.) The 40-day rule is probably a decent guide to follow before starting heavy lifting or other exercises with impact. And even then, a better gauge is for women to have first recovered the core before adding external loading or impact.

7.) The most often skipped step in this recovery series is RESISTANCE TRAINING. The best way to recover a pre-pregnancy slim body, is resistance training accompanied by a clean diet with adequate calories to support breastfeeding. As soon as the pelvic floor can hold its own again and the core is stronger, adding a few days of full body circuits can really speed up the recovery process and best of all, prevent achy backs and necks from all the forward bending that comes with taking care of a baby.

The old-fashioned 40-day guideline is too vague, very conservative, and in most cases harmful. Yes, women should ease back into exercise and should progress through pelvic floor recovery, abdominal reconditioning, and then general conditioning but they definitely should not spend the first 40 days after birth waiting to start exercising. Since after the birth of a mom, life can be quite complicated, it is good to remember that exercising and bonding with the baby are not mutually exclusive. Most postnatal recovery exercises can be done with baby!

Top 2 mistakes in post partum recovery

Top 2 mistakes in postpartum recovery:

1.) Waiting too long to get started

2.) Choosing inappropriate exercises

Waiting too long to get started

Finding time to exercise when you have a newborn is challenging. Yet, for optimal recovery of the pelvic floor and abdominals, the reconditioning program must start very soon after birth. Ideally, within a day or two of a normal delivery, women should start reconnecting with their pelvic floor (Kegel exercises).

Stimulus to the traumatized perineum immediate after birth helps re-establish neuromuscular control much better than waiting weeks or months to get started. Waiting too long to address the recovery of the abdominal wall that stretches immensely, and in many women separates at the midline, can be impossible if waiting longer than 6 months to get started.

The good news is that postnatal recovery programs are designed with a new mom in mind. Many of the exercises can be done while breastfeeding or in just a minute or two while the baby is a sleep.

Choosing inappropriate exercises

The most common misconception about abdominal recovery is that traditional crunches will help create a thinner waist and a smaller belly. This is very incorrect!

Postpartum women should avoid traditional abdominal work and be very careful of the exercises they choose. Many typical abdominal exercises (including Pilates) will worsen separated abdominals and can make the belly bigger.

Pelvic floor should be strengthened, the deep abdominal muscles re-toned, and the compensations left over from pregnancy should be corrected first before adding any load to the body. Corrective exercises and “diaphragmatic suction exercises” are the best methods for postpartum recovery.

A new mom needs time to recover. Her body has gone though an incredible journey of pregnancy and birth, and continues to have special needs for lactation and recovery. The hormonal soup within a postpartum mom’s body doesn’t stop with birth and joint laxity can last for months postpartum.

The very best method to aid postpartum recovery is thinking ahead and creating a fabulous connection to your pelvic floor and abdominal muscles before and during pregnancy.

Women who invest the time in prenatal fitness recover much faster postpartum as the neuromuscular connection is stronger, the muscles are more elastic and responsive, and the habit of exercise is more ingrained thus making it easier to get started again after giving birth to your precious child.

Diaphragmatic suction exercise to decrease intra-abdominal pressure

This method is all the rage in Spain for postpartum core reconditioning. It is a method used by physical therapists dealing with urinary incontinence and uterine prolapse and comes from France.

It involves exhaling all air, closing the glottis, and contracting the diaphragm to create a vacuum within the abdominal cavity. This exercise is done in apnea (without breathing).

The vacuum in turn creates an involuntary contraction of the pelvic floor and the transvers abdominus. The stronger the suction, the more muscle fibers and motor units are recruited of these two muscle groups. Different postures are used to change the emphasis to different areas of the pelvic floor and the difficulty of the exercise.

These exercises are contraindicated for pregnant women, people with untreated hypertension or problems with ocular pressure. For healthy people who want to (re)train their pelvic floor and deep core stabilizers, these exercises are fabulous. They are a little tricky to learn and teach, but once mastered the results are incredible.

This is one of the main methods I use in the postpartum recovery courses I teach to get the ladies back into awesome shape.

I filmed a video of this exercise today and as soon as I can figure out how to insert a video onto this blog, I will post it for your viewing pleasure. :)