Rebuilding Your Core after Pregnancy

A common concern among new mothers is how to get rid of their jelly bellies and regain flatter, more toned stomachs. For some women, re-strengthening their core seems an easy task, but for most it is an uphill battle that takes many months, even years. With proper exercise and diet the process is not as hard as many think. In fact, depending on your delivery method, there are specific exercises you can do to speed up your body’s recovery.

How Early Is Too Early?
Many women want to resume intense exercise as soon after birth as possible, before their abdominal muscles or pelvic floor are ready. This may lead to incontinence problems and prolonged back pain, sometimes due to diastisis recti (a stretching of the midline of the abdominal muscles) that was not corrected. With proper training, and beginning as early as 24-48 hours after birth, you can avoid many problems and work toward rebuilding and toning your body the right way. If you’ve done a good deal of abdominal work and exercised throughout your pregnancy, this process will be easier, but if you were sedentary, you can still achieve good results.

Proper nutrition and a gradual return to other forms of exercise (walking, jogging, weight lifting) are just as important in restoring the body to its pre-pregnancy state. You’ll never see a “six pack” if a layer of fat is overlays it. Weight loss and fitness take patience, time, and discipline; if things are pushed too soon, other problems can arise. It can take 6-12 weeks to return to a pre-pregnancy state – sometimes longer – so don’t give up!

Always check with your doctor before beginning this routine, since all mothers and all deliveries are different. Restrictions may apply to you that prevent your doing these exercises immediately. Begin only when your doctor clears you, and always remember that patience and time will help - so don’t get discouraged!

The Importance of Breathing
Once the baby is born, your body undergoes a dramatic change in a very short period of time. The skin and muscles that were so taut over the belly are now loose and jelly-like and can lack the neuromuscular awareness to work properly. This is why it is so important to use breathing techniques that shorten the abdominal wall to its previous length. As you inhale, your chest and abdomen should expand; as you exhale, your chest and abdominal wall should flatten. This concept is important when retraining your core after birth. The muscles in your belly must shorten before they can be strengthened. Exhaling while pulling your abs in shortens and strengthens with each outward breath.

What About Diastisis Recti?

A spreading of the midline of the abdominal wall, it is usually detected in later pregnancy, and is present if you can feel a separation of greater than three fingers. The extent of diastisis should be checked three days postpartum by lying on your back with knees bent, placing fingers in midline of abdominal wall and lifting your head up. Feel for the separation below your fingertips; if it's greater than three fingers, make the exercise modifications outlined below until the diastisis is corrected.
 

Below is a list of exercises to begin within 24 hours postpartum (from Essential Postpartum Exercises by Elizabeth Noble, Physical Therapist).

VAGINAL BIRTH
Begin with only a few repetitions of each and increase as tolerated.
Phase 1

• Diaphragmatic breathing (Abdominal tightening on outward breath): Lying on your back, place your hands over your abdomen. Inhale and allow your belly to rise as it fills with air. Exhale through your mouth as you tighten your abs, pulling them in towards your spine. Your stomach should flatten, not bulge, as you exhale.
• Kegels (Pelvic floor contractions): Can be done in any position. Tighten and hold for 5 seconds. Do several times a day.
• Pelvic Tilt: While lying on your back with your knees bent, tilt your pelvis backward as you tighten your abs and exhale. Try to bring your belly button to your backbone as you push your low back into the mattress/floor. Hold for 5 seconds, inhale, and relax.
• Stretch out the kinks: Lie on your back with arms and legs out straight, palms up. Bend at the ankles so toes are aiming for the ceiling, tighten thigh muscles and push knees into the bed. Pull your abdominal muscles in and flatten your back. Squeeze your shoulder blades together and elongate your neck. Press your hands back into the bed and hold this for a few seconds, then relax. This allows your muscles to contract isometrically (without changing length), which is safe on the body and provides an easy readjustment to normal posture after birth.
• Active posture check: Standing – tuck your chin in to elongate the neck, pull your shoulders down and back, tighten your abdominal muscles while pulling your belly into your backbone, tighten your pelvic floor, keep knees soft, and increase the arch in your foot.

Phase 2

• Bridges: Lying on your back with knees bent, contract your abdominal, buttock, and pelvic floor muscles, and raise hips up off the floor. Hold for 5 seconds and relax down slowly. The farther your feet are from your buttocks the more challenging it will be. Bridging can also be progressed by lifting one leg while up in bridge position – but you must be able to keep hips level to do this.
• Heel Sliding: Lying on your back, tighten your abdominal muscles and do a pelvic tilt. Slowly slide out one leg at a time while tying to maintain your pelvic tilt. You can progress to sliding both legs out together as long as you can keep the pelvic tilt and not allow the back to arch. Always bring legs back one at a time.

Phase 3
If diastisis is present after day 3 postpartum, do not move on to phase 3.

• Curl ups: Lying on your back, begin with arms outstretched, exhale, and pull your belly into your spine as you slowly reach with your hands towards your knees. Only roll up until your shoulder blades lift off, then inhale and slowly lower. Be sure your stomach flattens (not expands) as you rise. Also, do diagonal curl ups by reaching right arm past left knee as you curl up, and vice versa. Increase difficulty by changing arm positions, from easiest to hardest – arms outstretched, arms crossed across chest, and arms crossed behind head.

CESAREAN DELIVERY
*See instructions above

• Diaphragmatic breathing*
• Huffing: This is important if general anesthesia was used – it helps clear mucous out of the throat and lungs. Take quick forceful outward breaths while tightening the abdominal and pelvic floor muscles.
• Ankle/foot movements help prevent blood clots after anesthesia.
• Pelvic Tilt*
• Bridges with a twist*: While hips are elevated, drop one hip toward mat, then the other, so that you are gently twisting your hips. This helps alleviate gas pain as well as working your core.
• Kegels*
• Straight and diagonal curl ups* (if no diastisis present)
• Active posture check*

BOTH VAGINAL AND CESAREAN DELIVERIES
Move on to exercises listed below as tolerated.

• Single leg lowering: Lying on your back with knees bent, do a pelvic tilt and lift one leg up. Straighten out the leg, maintaining pelvic tilt as you return leg. Progress by lifting both legs and doing a bicycle motion. Your abdomen should be flattening with exhale, not bulging.
• Double leg lowering: Maintain pelvic tilt as you lower your legs, starting with knees bent and straightening legs out as you lower. Only lower as far as you can maintain your pelvic tilt. Once you feel your back begin to arch, return legs one at a time to starting position. Double leg raising will work your hip muscles and is too much pressure on your spine and abdominal muscles – LOWER with both legs but RAISE one at a time.