The immediate postpartum time is one of the hardest and most confusing times in the life of a mom.
There are so many different potential struggles, even with a healthy pregnancy and birth. You’re so tired, you’re adjusting to a larger family, possibly nursing or pumping, and your body doesn’t feel like your own.
In today's blog, you'll learn all of the various facets of the postpartum body and the different areas of focus for someone who wants to get back to their normal fitness routine.
[*DISCLAIMER: I’m going to focus on the moms who have had a vaginal birth and who have no postpartum depression or other physical or hormonal restrictions that are out of the scope of myself and this blog. If those things apply to you, consult your doctor, and/or a professional who specializes in your specific case.]
Postpartum Nutrition Guidelines
One mistake many moms make, myself included, is to jump into a deficit too quickly.
You’ve just spent the last 9 (really 10, nobody talks about that!) months pregnant, possibly feeling sick, and not able to exercise and eat like you normally do.
Your body hasn’t been your own and you’re ready to get back to “normal.” As I said, I did this too and I totally get it. The problem here is, a deficit is the last thing you need for a while.
You are expending a lot of energy to physically heal, and you are most likely also trying to produce breast milk.
(The amount of calories you burn to breastfeed is dependent on your milk supply and other factors, but a general guideline usually given is that you need about 500 calories per day for milk - so learning to fuel your body properly is important here!)
When you restrict calories, you produce less milk, and that number goes down. This increased need for calories to produce milk has created the myth that breastfeeding will melt off the baby fat, which is not the case for everyone.
Regardless if you’re nursing or bottle-feeding, you are still physically recovering from pregnancy and delivery, and you need the calories as a source of energy for recovery.
I suggest waiting at least 8-12 weeks if not longer before you attempt to lose fat. After that 8-12 week period has passed and you decide it is the right time for you to diet, this is a time in your life to be very conservative with a calorie deficit.
Your hormones won’t regulate for a while postpartum and being in a calorie deficit can prolong or exacerbate that. For most moms, you can likely experience body recomposition (building muscle & losing fat at the same time) at maintenance for quite a while when following smart macros.
—> SETTING YOUR MACROS POSTPARTUM
Generally, for the new moms we coach, we recommend pushing off a large deficit as long as possible, and focusing more on fueling your body, building muscle, and losing fat near maintenance.
When the time for a deficit does come, I suggest starting with a 300 calorie deficit, and not going any lower than about 12 times bodyweight in calories.
The longer postpartum you are, the safer it is to push lower than that... but also realize that everyone will be different, so this isn’t a hard and fast rule.
If you are very overweight, you may be able to take this a little lower, but if there was ever a time for a small deficit and lots of patience, this is it.
You need plenty of each macronutrient, so make sure your diet is balanced with a variety of protein, healthy fats, and carbs.
- STEP #1: Start the process of establishing macros by aiming for about .7-.8 grams per pound of bodyweight in protein.
This is just slightly lower than I normally set for someone who is not postpartum, to leave room for more carbs and fat. As you get further into postpartum you can shift the ratio of calories more toward protein.
- STEP #2: Next, set your fats. I suggest 0.4-0.5 grams per pound of body weight in fat. Skew toward the lower end if you have a lot of weight to lose, and to the higher end if not.
- STEP #3: Fill the remaining calories with carbs.
—> FOOD SELECTION POSTPARTUM
Food quality and smart food selection is always important, but it is especially so early postpartum when you need to heal and are possibly passing along many of your nutrients in milk.
A few guidelines we give our online clients in this situation:
- A variety of colorful vegetables is essential for micronutrients and fiber.
- It’s a good idea to include red meat to replete iron stores lost during birth. Make sure to avoid having your iron with calcium or tea, as they can inhibit absorption.
- A variety of healthy fats will ensure healthy breast milk, and help you absorb the nutrients you’re taking in. Plenty of nuts, seeds, fish and fish oil, flax, avocado, and olive oil are good sources.
- Lean meats like poultry, fish, lean beef, and eggs will help maintain breast milk supply and lean mass, and support recovery.
- High fiber carbs will help with breast milk production, and supply energy for your body.
It may be a good idea to set up a structure and little "goals" or "rules" for yourself in order to get the nutrients you need throughout the day. Something like...
1. For breakfast, I will have a smoothie that includes fruit, greens, and healthy fat, alongside eggs. -
2. For lunch, I will have a big salad with some colorful veggies on top with an olive oil dressing and a protein on top. Carb of choice on the side.
3. For dinner, I will make sure I include a lean protein and veggie in the family meal.
4. Snacks will be fruit and protein.
5. Each evening before bed I’ll take fish oil and a multivitamin.
These are just hypothetical and don’t need to be YOUR rules but guidelines like this leave flexibility for the exact ingredients in each meal but have enough structure to ensure you’re getting a variety of macro and micronutrients each day.
—> HYDRATION POSTPARTUM
Another thing your body needs a lot of at this time is water.
Most people under consume water anyway, so add nursing and healing on top of that and you need to place a big focus on hydration.
In my opinion, 1 oz per pound of body weight is a good start, and if you’re very light you may need more.
Now, I get it... it’s hard to drink enough to keep up, so here are my tips (from personal experience) for staying hydrated:
- If the hospital gives you one of those big plastic cups with a straw, use it! They usually give you one that has a pretty big capacity, and they have measurement markers on them, plus the straw makes it easy to drink more. Keep it next to you especially while you nurse, and keep it full of ice water.
- Flavor your water with fruit and/or electrolyte packets. There are a lot of hydration products on the market now that flavor your water without artificial sweeteners and add electrolytes. They mix up the flavors so it encourages you to drink more and the electrolytes may help you retain a little more of it.
- Set micro-goals through the day, like “I will drink 20 oz before I have any food or coffee for the day”, or “I will drink 1 glass each time I nurse.”
POSTPARTUM Core training
If you were active before having the baby, you’re probably eager to jump back into training postpartum.
As tempting as it can be to go do anything and everything you feel up to, it’s important to give your body time to heal.
Your core and pelvic floor have experienced months of trauma, and they need rehabilitation before diving back into your normal routine.
So what can you do?
You can start right away with breathing exercises to reconnect to your core and pelvic floor.
Your transverse abdominis (pictured below) has had to stretch to allow room for the baby to grow, and it takes some time and practice to feel a connection to that muscle again postpartum.
Your transverse abdominis (TA) is a deep abdominal muscle that sits underneath the rectus abdominis, which are the “6-pack” muscles you normally think of when you think abs.
The TA’s job is to brace the core and also has a role in breathing. If you hold your side, putting your fingers on your abs just inside your hip bone, when you blow your air all the way out you can feel your TA tighten up.
There are some beginning breathing exercises you can do to start to engage those muscles again, but which ones you do and how much you can overload will depend on the person.
This goes for every core exercise you do postpartum - you need to pay attention to what works for you at the time and make sure you’re not seeing any doming or coning in your abdominals.
(Doming or coning is what happens when your intra abdominal pressure exceeds your core strength.)
If you ever see this, you know you’re not ready for that exercise, or you need to see if you can properly engage your TA and try again.
Now, let's dive into the actual movements you can incorporate postpartum:
—> Diaphragmatic Breathing - The first exercise you can try postpartum is diaphragmatic breathing. This will help reconnect your breath and your core and helps your ribs, breath, core, and pelvic floor start to work together again.
—> Heel Slides: Another great early exercise is heel slides. Heel slides are done on your back in a sit-up position.
You start back taking a breath in, exhaling, and engaging your TA. You can help your TA engage by pressing your lower back down into the floor, closing that space that your natural curvature in your back creates. You then slowly slide one heel at a time out until your leg is extended, and then slowly slide it back in, back to the sit-up position.
—> Heel Drop: As you get stronger, you can start to implement exercises to overload the TVA. A good progression from the previous two exercises is a heel drop.
In a heel drop, you start in a tabletop position with knees up in the air at 90 degrees. You exhale to create the core tension just like in the heel slide exercise, but in this movement, you lower each heel, one side at a time to touch the floor, and then bring it back up.
—> Dead Bug: Once you are strong at the previous movements, you can add the arms and do a dead bug exercise.
The dead bug maintains a stable core while both arms and legs are extending. You’ll lie on your back in tabletop position just like the heel drops, but with arms up. Extend one arm and the opposite leg as far as you can while keeping ribs down and core engaged.
—> Bridges: One more exercise that is safe to do early on postpartum is a bridge. Bridges will strengthen your pelvic floor, and strengthen glutes to help correct the anterior pelvic tilt caused by pregnancy. To bridge just lay on your back with knees bent.
Press through your heels and squeeze your glutes to lift your hips, making sure to keep your back neutral and not anteriorly tilted.
All of these exercises will improve your TVA strength and encourage your pelvic floor, TVA, and breath to work synergistically. Strengthening your core and correcting the lower cross syndrome you’ve developed over pregnancy will prevent back pain.
[*Note: Pelvic floor strengthening may take longer than you think it will. If you experience any incontinence or heaviness in the pelvic region, you’re not ready to progress. Bladder incontinence is so common to the point it is joked about in most mom circles, but it is not normal. If these exercises don’t prevent any urine leaking and it’s been more than 6 months, find a women’s health physical therapist.]
When you feel confident that your TVA and pelvic floor are reasonably strong, you can begin to add in other traditional core movements. That will include a combination of rotation, anti-rotation, carrying, and flexion.
For each of these movements, just be very aware of how your core is functioning, and make sure there is no doming/coning in your core.
You also want to be aware of the pressure on your pelvic floor, and the space between your rectus abdominis. Some women can build back up to traditional exercises like sit up or crunches, planks, and woodchops fairly quickly without any issue.
If you suspect you might need to check for diastasis recti, watch this video and follow the instructions:
If you do have diastasis recti, or any pelvic floor issues not resolved by the breathing exercises, talk to a women’s health physical therapist.
Strength training postpartum
Once you have worked on these basic breathing and core movements, and are cleared by your doctor to start incorporating exercise, be sure you’re still taking it slowly.
I know for myself I was eager to get back into a training routine and pushed beyond what I should have which ultimately set me back. Slow is fast when it comes to postpartum training.
The first thing to start with is walking.
Walking is a great exercise to start with because it will help with circulation, bring your heart rate up gently, help you retrain your posture back to normal and away from the pregnancy posture. Plus you can take the baby with you!
When you’re ready to incorporate some resistance training, it’s important to keep in mind your core strength, your pelvic floor strength, and your posture.
To make sure you’re not overloading your core or pelvic floor strength, I like to start online clients out with mostly unilateral exercises. These allow overload for the muscles being targeted, but it can be done with a lower load, so it’s safer on the core and pelvic floor. An example here would be a split squat instead of a squat or a kickstand Romanian Deadlift instead of a traditional deadlift:
Another exercise I like a lot for new moms is a goblet squat. A goblet squat’s limiting factor will be upper back and core strength, not leg strength.
This allows you to work your legs sufficiently, but also work the upper back which is normally weak in new moms and doesn’t place too much pressure on the pelvic floor at the bottom of the movement like a traditional barbell squat.
Another area of focus should be upper back strength.
While pregnant it’s common to develop upper and lower cross syndrome. Lower cross means the lower back is overextended, glutes and core are weakened, the lower back is tight, and the hip flexors are tight. Upper cross means the shoulders and chest are tight and shortened, the neck is forward, and the upper back is weak.
Nursing or feeding a baby several times per day exacerbates this issue because you’re hunched forward while feeding. To combat this you will need to focus on upper back strength.
Some of my favorite exercises for upper back strength are:
—> Band Pull-Apart
And really, you can't go wrong with any rowing variation.
Postpartum mobility work
Another consideration is stretching and mobility exercises for the tightened areas. Areas to focus on would be hip flexors and chest.
Some great movements for mobilizing these areas are:
—> Half-Kneeling Hip Flexor Stretch
—> Doorway Stretch
—> Handcuff With Rotation
I can say from NOT doing these things leading up to and after the first pregnancy to then doing them the second time around, the difference in upper back pain from nursing was night and day.
With all of these exercises and whatever training you choose, the most important thing is listening to your body, and not continuing to push through if anything feels “off”.
Keep in mind this is a time that you’re healing from hopefully the largest trauma your body will have to go through. If you feel any looseness or weakness in your core, or any heaviness or weakness in your pelvic floor, back off of the intensity and consult your doctor or physical therapist.
—> Other experts to follow:
If you are interested in postpartum exercise, especially for the core, I recommend following a variety of experts on this topic.
These are physical therapists and trainers who have dedicated their whole practice to helping postpartum women rehab and strengthen their core and pelvic floor the proper way.
Here are some of the experts who I’ve personally learned a lot from and I recommend following:
—> Work with a coach:
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