RETURNING TO FITNESS AFTER BIRTH
VAGINAL DELIVERIES AND CAESAREAN SECTIONS
WESTERN SUSSEX HOSPITALS TRUST
Women’s Health Physiotherapy Department,
Worthing Hospital, Worthing Tel: 01903 285014
Women’s Health Physiotherapy Department,
St Richard’s Hospital, Chichester Tel: 01243 831712
This leaflet offers guidance on safe and effective
exercises that will help you get back into shape
following the birth of your baby. The exercises are
also suitable for Caesarean deliveries. They are easy
to do and can fit into your daily routine. They will help
tone up your stomach and pelvic floor muscles and
help your posture return to your pre-pregnant
condition. By regaining your fitness you will feel
better and have more energy. You could also avoid
health problems in the future.
If you have had a Caesarean section then your return
to fitness will be a few weeks slower, so don’t expect
too much too soon.
POSTURE
Your posture has changed to
accommodate the growing
baby. Some muscles have
lengthened and stretched
whilst others have tightened
and shortened.
It is common for your tummy
muscles to separate slightly
during pregnancy. However, if
you are concerned about the
amount of separation following
birth then see the ward
physiotherapist or your GP. Do
not do sit ups for a few months
following birth.
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Regaining good posture after your baby’s birth is
very important and can help prevent back pain.
Strengthening your deep stomach muscles will
help maintain good posture and support your
back. Try to keep a small ‘natural’ curve in your
lower back, stand up tall and hold in your
stomach muscles.
If you have had a Caesarean section then
avoid walking with a stooped posture and try to
stand tall immediately. This will not harm your
wound. In the early days support your scar if you
need to cough, sneeze or laugh.
PELVIC FLOOR EXERCISES
Your pelvic floor muscles are supportive muscles attached
to the walls of your pelvis, which stretch like a sling from
your pubic bone at the front to the coccyx at the back.
They help support your bladder, womb and bowel and also
close the bladder outlet and back passage. They are
weakened by pregnancy and also stretched if your baby is
born vaginally. Exercises will help to strengthen them.
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If they remain weak then you may experience the
following:
 Lack of control of urine, wind or bowel motions
 Leaking a small amount of urine with exercise or when
you cough, sneeze or laugh
 Increased risk of prolapse
 Diminished sexual enjoyment
When to start exercising them: You can start from day
one. If you have a catheter in place do not do pelvic
floor exercises until it has been removed and you
have passed urine.
You can do the exercises in any position. Sitting with your
legs slightly apart may be a good position to start, but also
try other positions ie: lying, standing, lying on your side.
Even if you have stitches, bruising or haemorrhoids (piles)
you can start the exercises, since gentle rhythmic
tightening and relaxing of the muscles can help ease pain
and swelling.
How to do your Pelvic Floor Exercises
1. Draw up and tighten the muscles around your back
passage without squeezing your buttock or thigh
muscles as if trying to stop yourself passing wind,
and hold.
2. At the same time take this feeling forward and tighten
the muscles around the front passage, as if trying to
stop yourself passing urine. Lift up through the
vagina. Hold the squeeze for as long as you can
(build up to 10 seconds) then release and lower with
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control. Try not to overwork your tummy. Don’t hold
your breath.
3. Also try some ‘quick’ contractions of the pelvic floor.
Tighten and lift in one quick contraction and let go
immediately. This helps your muscles react quickly
when you cough, sneeze, lift etc.
4. Aim to do one set of slow holds and one set of quick
lifts a minimum of three times a day. Work to a level
you are comfortable with. During each set aim for a
maximum of 10 second hold, for a maximum of 10
times, followed by five to 10 quick lifts.
NB: In the first few weeks you may feel nothing – do not
panic! Keep practising and try to do the exercises often
every day for the first three months to help the muscles
regain their strength. Then aim for three sets a day for life.
Tightening these muscles before you cough, sneeze or lift
will help protect from bladder leakage.
Do not do your exercises by trying to stop midstream
when you are on the toilet as it is not good for the
bladder.
Further hints
 If you are having trouble controlling your bladder
and/or passing urine as normal, please ask to see a
the physiotherapist or mention it to your midwife.
 Avoid standing for long periods as this may increase
swelling and discomfort in your perineum, particularly
if you have stitches. If you find sitting uncomfortable
try resting on your side.
 Supporting your perineum/stitches with your hand or
toilet paper or pad will ease discomfort when you
have your bowels open. If you have had a
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Caesarean section you may also find it useful to
support your scar when you are opening your bowels.
 Avoid constipation. Drinking at least three to four
pints(approximately two litres) per day and eating
plenty of fresh fruit and vegetables will help to keep
you regular.
 If you are having difficulties passing a motion then
getting your feet up onto a foot stool or a box may
help when you are sitting on the toilet. Try not to
strain by holding your breath and pushing hard;
instead do three or four short sharp pushes on an
exhalation.
 Some women find having a short warm bath with a
few drops of tea tree or lavender oil helps, as it
soothes the perineum and acts as a mild antiseptic.
 Pain relief – as well as your normal painkillers ice
can be helpful if you are suffering from a painful
swollen perineum after labour. Wrap it in a damp
cloth and place the ice pack between you and the
pad. Remove after 10 to 20 minutes. This can be
done as often as you need.
STOMACH EXERCISES
Your stomach muscles have been greatly weakened and
stretched during pregnancy, and it is important to start
toning them up as soon as possible. Work the deep
muscles first (exercises one and two) as these important
muscles help reduce strain on your back and pelvic floor
by acting as a natural corset. They also help flatten your
stomach.
NB: Do not try strong exercises such as full sit-ups or
lifting both legs up straight when lying on your back –
these may be harmful.
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Try to do these exercises at least once a day.
Exercise 1 – deep stomach exercise
In any comfortable position, gently pull
in the lower part of your stomach below
your belly button whilst breathing
normally. Make sure your back remains
still. Hold your tummy in, for 10
seconds, then gently let go. Try to
repeat five to 10 times. Gradually
increase the hold time. As you improve,
pull in your pelvic floor muscles at the
same time. Also try this exercise during
day to day activities.
Exercise 2 – deep stomach exercise
This is similar to Exercise 1, but it is
a little harder as the muscles are
working against gravity. Try at first in
a kneeling forward or supported
leaning forward position. When you
are comfortable progress to all fours,
as in the picture (right). Hands under
shoulders and knees under hips,
keeping your back straight pull your
lower abdominal muscles up towards your spine as you
breathe out.
If you have a large separation of your tummy muscles,
seek advice from your physiotherapist before trying this
exercise.
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Exercise 3 – pelvic tilt
In a lying position with your knees
bent and feet on the floor, draw in
your abdomen and tilt your pelvis so
that the small of your back flattens
onto the floor. Hold for up to 10
seconds and release gently. Repeat five to 10 times. This
exercise may help ease wind and low back pain.
General Advice
Returning to your normal fitness level after birth is good for
general wellbeing.
Many women feel extremely tired after childbirth, so pace
your activities and get plenty of rest. Accept offers of help
and try to have a regular rest.
1. Circulation – avoid prolonged standing after delivery
and if your ankles are swollen, put your feet up with
your knees supported and move your ankles
regularly.
2. Walking is a good safe exercise for most people and
can help build up general fitness. Gradually increase
the speed and distance of your walk.
3. Swimming – it is recommended that you start this
after your six week post-natal check.
4. Returning to sports – do not attempt this until you feel
ready. For low impact exercise resume gently from
six to12 weeks. For high impact exercise resume
gently from about three to four months.
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LOOKING AFTER YOUR BACK
Your back and pelvic joints are vulnerable for up to three
to six months after the birth due to muscle and postural
changes during pregnancy, and the increase in the
number of activities that put strain on your back
postnatally (i.e. lifting, carrying, feeding and changing your
new baby). It is vital that you take care of your back.
Ensure your pram or buggy handles are at the appropriate
height, to avoid stooping.
Getting out of bed
 Roll over onto your side leading with your upper
body. Swing your legs over the edge of the bed and
sit up by pushing with your arms.
 This will help protect your back and abdomen while
your muscles remain weak.
 Do not do a sit-up to get out of bed.
Feeding
Ensure you have a good sitting position
every time you feed. Put a cushion in the
small of your back and the baby on a
pillow to bring him/her closer to you.
Putting your feet on a small stool may
help. You can also feed the baby lying on
your side – especially at night.
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Changing
Avoid stooping during nappy changes.
Change the baby at a sensible height eg:
Standing at a changing table, kneeling by the
bed.
Lifting
When you lift, tighten your pelvic
floor and deep abdominal muscles
(exercise 1). Use your legs and not
your back to take the strain. Bend
your knees and keep what you are
lifting close to you.
 Carrying the baby in the car
seat is not advised
 Avoid activities that may
cause strain until you’ve had your six week check.
Don’t lift anything heavier than your new baby ie:
small children, heavy shopping, baskets of washing.
Have help with vacuuming and jobs involving
prolonged standing. Try sitting when attending to
other children. This is especially important if you
have had a Caesarean section.
Driving
 Bear in mind disrupted sleep may impact on your
ability to drive comfortably, but after a normal delivery
there is no time limit on driving.
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 If you have a Caesarean section check with your
insurance company for any guidelines. Generally it
may take four to six weeks before you are ready.
Check you can look over your shoulder, wear a
seatbelt and do an emergency stop. Take another
driver with you on your first journey.
Sex
 Resume sexual intercourse when you are
comfortable. Start gently and use lubrication if
required. If you’ve had stitches or a Caesarean
section you may want to wait for at least six weeks
whilst tissue healing occurs. Some positions may be
more comfortable than others.
Six week check
 At your six week check mention any concerns to your
GP.
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by calling the team details below.
Women’s Health Physiotherapy Team, Western Sussex
Hospitals NHS Trust
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www.westernsussexhospitals.nhs.uk
Tel: Worthing 01903 285014 / Chichester 01243 831712
Leaflet produced April 2012
Reviewed April 2014
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