After a woman has had a baby and is recovering at home, she might be concerned about her abdominal muscles and if they’ll return somewhat to their pre-pregnancy shape and how and when to return to exercising those abs.

Jade Elliott spoke with Janelle Hayes, a physical therapist with Intermountain Healthcare, to help new moms be patient with themselves, set realistic expectations and know the exercise do’s and don’ts for getting your abdominals back in shape safely.

After a vaginal delivery

First, it’s important to talk a little about postpartum recovery in general. After childbirth, gradually returning to exercise is the best strategy. For regular vaginal births, doctors and midwives who deliver babies, typically recommend that for the initial two weeks after childbirth, postpartum women limit their exercise to gentle walking as they feel up to it.

As a general guide, OB providers and midwives typically recommend women pay attention to their postpartum bleeding and not over-exert. And from two to six weeks postpartum, women can slowly integrate exercise like longer walks and gentle stretching or yoga.

“During pregnancy and childbirth, your uterus, abdominals, pelvic floor muscles and vaginal tissues have to stretch out to accommodate the baby. It takes time for a woman’s body and those various muscles to recover. An incremental increase in exercise over the first six weeks postpartum is preferred to being sedentary for six weeks and then abruptly beginning exercise,” said Janelle Hayes, DPT a physical therapist with Intermountain Healthcare who has helped treat women with postpartum conditions.

“Even if you exercised regularly before getting pregnant and during pregnancy, you should take a gradual approach to returning to exercise postpartum. For women who exercise frequently, it may take some mental discipline, to take it back a notch those first few weeks,” she added.

Every woman’s body and medical conditions are different, and every childbirth experience is unique. Be sure to go to the recommended postpartum check-ups. Typically, an OB/Gyn doctor or midwife will suggest a six-week postpartum visit and do an exam to assess healing. This is a great time to ask questions about resuming physical activities.

After a Caesarean delivery

OB/Gyn providers say women who deliver via Caesarean section need to keep in mind, it’s a major abdominal surgery that involves an incision with either staples or stitches. And they typically recommend no heavy lifting of over 20 pounds for six weeks. Women with a C-section need to take care of their incision site and call their provider if they have signs and symptoms of infection, including foul odor at site, excess bleeding, severe abdominal pain and fever.

Start with breathing exercises

Until a woman’s provider gives the ok for a full return to exercise, Hayes said simple breathing exercises are a good precursor to returning to exercise at their previous level.

“Sometimes pregnancy breathing habits – such as shallow breathing – stick around postpartum. Remember to breathe from the diaphragm, which helps to activate the deep abdominals and the pelvic floor muscles. Breathe from the belly, not the chest. When you breathe deeply, you can feel and see the lower part of your rib cage move when you breathe in and out,” she added.

Diastasis Recti

She said another condition to be aware of is the overstretching of the connective tissue that hold the abdominal muscles together or separation of the abdominals known as Diastasis Recti, that persists longer than 12 weeks postpartum.

“Diastasis Recti occurs in most pregnant women by the end of the third trimester. That’s the body’s normal way of accommodating the growing uterus and baby. At six weeks postpartum about 60 percent of women still have some degree of abdominal separation. Sometimes those abdominal muscles can take months or a year or longer to return to normal,” said Hayes.

Hayes said there are many factors that affect whether or not you have Diastasis Recti that persists, such as: genetics, pre-pregnancy level of strength and fitness, and what movement habits you have during pregnancy. Giving birth to a baby with a large birth weight may be a factor as well.

Women should ask their provider or a physical therapist to examine their abdominals if they notice a bulge form down the midline of the abdomen when they get up out of bed or change positions, or if they notice a gap in the middle of their abdomen that they can sink their fingers into.

For diastasis recti that doesn’t resolve on its own over time or with regular return to exercise, visit a physical therapist with experience treating postpartum women for an assessment and recommendations to see if therapy could help.

As far as what abdominal exercise to start with postpartum, there’s not a one-type fits all answer.

“If you are doing an exercise and you see or feel a bulging or a gap in your abdominals, you may need to modify the exercise by breathing deeply, moving through a smaller range of motion, or using less resistance,” said Hayes.

“Women should continue to monitor their abdominals for progress, and gradually progress the difficulty of the exercises based on how they’re feeling and how well they are able to control the abdominal muscles,” she added.

When to see a physical therapist

Hayes said women might want to see a physical therapist postpartum if they experience persisting diastasis recti, pelvic pain, back pain, feel weakness in the core muscles, or notice weakness in the pelvic floor muscles, such as urinary stress incontinence when they sneeze, cough, jump, run or do sudden movement.

For more information visit intermountainhealthcare.org. to find a physical therapy location close to you.

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.