Mothers can do Pilates right up to their delivery and may even want to do some gentle exercises during labor. But once that bundle of joy enters the world, and you enter postpartum, the mother should rest for several weeks and enjoy their new baby. This will allow their body to heal and their nursing relationship to be established. During this time they may be able to do some gentle “working out” if they have been coached ahead of time. Isometric pelvic floor (Kegels) and transversus contractions are wonderful for a new mom to practice within days of delivery. There is no special equipment needed or position that they need to practice these in and most doctors will likely encourage these as well. Pilates instructors can instruct pregnant clients before delivery on how to do this after their delivery. Be aware that they may not feel up to it for several days due to afterbirth contractions of the uterus as it returns to its former position.
Back in the Pilates studio, new moms should take it slow and just focus on core contractions (pelvic floor and transversus) and gentle movements as they ease back into their routine using pre-Pilates exercises. If the mom has a diastisi recti (see above to determine) then the authentic transversus contraction should be the main, if not only, focus. If this separation is not closed after the first baby it will continue to get larger with each subsequent baby which is why most women “show” faster in their second pregnancy. This can lead to chronic back pain and a “mummy tummy” that does not seem to go away no matter how many crunches they do. Instructors should take care to not do heavy abdominal work with a postpartum mom that has a diastasis recti because that will make it worse (see list of exercises above). For moms that had a cesarean section they should also work on transversus and pelvic floor contractions since those exercises will not affect the stitches and will actually help to pull the incision together. The same Pilates exercises that are beneficial for a woman who has had a cesarean section are beneficial for a woman who delivered vaginally. However, in the first four to six weeks following a c-section, long-lever leg lowering should be avoided as this places undue strain on the abdominals and lumbar spine (examples: Double Straight Leg Stretch, Feet in Straps, Leg Springs, etc.). For moms with either a diastasis recti or a cesarean section, the instructor should proceed slowly and watch carefully for any abdominal bulging. This needs to be carefully cued to be brought in with the transversus and care needs to be taken that the exercises are not so difficult that they cannot be executed correctly.
Instructors need to know if the mother is breastfeeding as that will affect the production of Relaxin in her body. Until the child is weaned there is still Relaxin in the mother’s body and therefore extreme ranges of motion and excessive adductor work should both still be avoided. In addition, inversions should be avoided until all vaginal tissues are healed at around 8-12 weeks postpartum. After this time they can be added back gradually. Be prepared that when the mom has not sufficiently strengthened her pelvic floor and she does an inversion, air can be sucked in to the uterus and then will be expelled out as she comes out of the inversion. This can be embarrassing for the mom if she is not anticipating it as there may be a slight noise when the gas escapes. As she strengthens up the pelvic floor this will cease to occur.
After delivery, pregnancy postural changes can become long-term if exercises are not applied to correct muscular imbalances such as increased lumbar lordosis, increased thoracic kyphosis and forward head posture. Women who have recently given birth will also most likely experience pelvic-floor weakness, transversus weakness and possibly pelvic girdle instability. Experienced Pilates instructors have a wide variety of Pilates exercises to choose from that would be appropriate to use to correct the individuals imbalances based on their strength and flexibility.