Flex Time

From a brisk walk with baby to a solo strength workout, exercise can bring energy and stress relief to your wild and crazy new life with baby.

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For each of my pregnancies (I’m currently in my third), exercise and pregnancy have been a natural combination. The nine-month built-in goal always seems to spur me on: I run, walk and eventually waddle my way through a regular exercise routine so I can manage my weight gain and get ready for the rigors of labor.

But after each of my two babies was born, my motivation to get moving went kaput. Amid frequent feedings, diaper changes, endless loads of laundry and caring for the rest of my family, something in my sleep-deprived life had to give. Regular exercise was the first to go. But it should be at the top of your postpartum to-do list, health experts say. It boosts metabolism, helps you shed those extra pounds, provides energy to deal with your chaotic life, gives you a little time for yourself, and helps relieve stress and body tension.

Exercise also works to “re-educate” muscles that have become weak during pregnancy, says Carolyn Winuk. A licensed physical therapist, Winuk is president of Moms in Motion Physical Therapy, which specializes in care for prenatal and postpartum women in New York’s Westchester and Putnam counties. You need to strengthen the pelvic-floor muscles by doing Kegels to prevent urinary incontinence, a common problem for women right after childbirth. And you’ll need to regain strong abdominal muscles to get your body in gear for all the bending, kneeling and lifting that comes with having kids. (See our “Total Body Workout")

When to exercise

So when is it safe to start up again? If you had a vaginal delivery with no complications, your doctor will probably advise you to wait until your six-week postpartum checkup to resume high-impact aerobic activity. But many women feel up to walking and doing other light exercise as early as two weeks or less after delivery. If you had a Cesarean section, you might need more time to heal.

The key is to go slowly and drink at least 10 8-ounce glasses of fluids a day. In the early weeks, avoid any jarring movements, says Carole Kowalczyk, M.D., a reproductive endocrinologist at Detroit Medical Center. “Gauge how you feel,” she says. “If something hurts, stop and do something lighter.”

Because postpartum life can be so overwhelming (learning how to change diapers, breastfeed, get some sleep and still find time to relate to your husband, etc.) don’t pressure yourself to add one more major project to the mix. You can make exercise part of your daily life, even if for only 10 minutes at a time. Above all, don’t make exercise an all-or-nothing prospect, says exercise physiologist Geralyn Coopersmith, M.A., owner of Ener-G Unlimited Personal Training in New York City. “You are going through a transition phase,” she says. “Cut yourself some slack.”

OK, so maybe after this child is born, I’ll be able to make time for exercise. Exercise is a valuable part of what Ann Dunnewold, Ph.D., co-author of Postpartum Survival Guide (New Harbinger Publications, 1994), calls an emotional self-care plan. “You are like a pitcher of water pouring out,” she says. “Only if you fill the pitcher again will you have more to give.”

So what better motivation do I need?

The first exercises

If you’re feeling up to it and your doctor gives the go-ahead, you can begin these easy exercises just days after giving birth. Start with the first 2 exercises in the first 3 weeks; after that, add exercise 3. These will prepare you for a more rigorous workout by week 6.

1. Belly Breathing Lie in bed or on the floor, knees bent, feet flat. Inhale and expand abdomen; then contract abs as tightly as possible, pulling navel in toward your spine. At the same time, tilt pelvis upward, bringing hips toward lower ribs. Do 5 Kegels, building to 10. Release. Aim for at least 15 reps per day. When you can do 15 reps, begin to lift head, neck and shoulders with each ab contraction. Strengthens abdominals. (see "How to do Kegels" at left)

2. Hamstring Stretch Lying in bed or on the floor, bend one knee in toward your chest and wrap a towel around the arch of your foot. Holding a towel end in each hand, straighten leg in the air, stretching the rear of your thigh. Hold this position for approximately 20–30 seconds; then point and flex your foot 10 times to loosen calves. Stretches hamstrings and calves.

3. Wall Sit Lean your entire back against a wall with feet separated and out in front of you. Bend knees, slowly lowering thighs to a parallel position, knees in line with ankles. Hold this position for 10–15 seconds. You can add Kegel exercises here if you like. Strengthens quadriceps, calves and buttocks.

the total body workout

At six weeks postpartum you’ll probably be ready to resume a strengthening and toning workout. The following exercises can be done with an Xertube (an exercise tube with handles) or fitness band. They were designed by Debi Pillarella, M.Ed., mother of two and director of pre- and postpartum fitness programs at Fitness Points — a medically based fitness and wellness facility in northwestern Indiana. The lower-body moves she’s designed here will help you regain balance; the upper-body moves will help you gain strength for lifting and carrying your ever-growing bundle of love.

Workout schedule

About the equipment: Xertubes and fitness bands come in different strengths; choose the resistance that allows you to complete all recommended reps and sets for each exercise. The last 2 reps of each set should challenge you while still allowing you to use good form. (Note: Directions are given here for working out with an Xertube. To purchase an Xertube or a fitness band, call SPRI Products at 800-222-7774; prices for the Xertube range from about $5 to $8; for the fitness band, from about $1.50 to $3. If you use a fitness band for these exercises, wrap one end around each hand.)

Frequency and reps: Try to do this workout 2–4 times a week. Start by doing 1 set of 10–12 reps for each exercise, building to 3 sets. Rest 30 seconds between sets.

Warm-up: Do a rhythmic, limbering warm-up for at least 5 minutes. Include arm circles, shoulder rolls, low-back cat stretches, pliés, toe taps and marching. If you have stationary equipment such as a treadmill or bicycle, warm up at a low intensity.

Cool-down: Stretch the muscles in your legs, buttocks, back, chest, shoulders and arms. Hold each stretch for 20 seconds. Focus on breathing and relaxation while stretching.

The Exercises

1. Double Leg Squat Stand on the tube or band with feet hip-width apart, legs straight but not locked. Hold a handle of the tube in each hand and anchor your hands on your hips. Contract abs [A]. Keep body weight back on your heels as you bend both knees, lowering your body as if to sit down in a chair. Keep torso erect [B]. Straighten legs and resist the tube or band as you return to the starting position and do reps. Take 4 seconds for each phase of the exercise. Strengthens quadriceps, hamstrings and buttocks.

2. Split Lunge Stand with legs hip-width apart in a lunge position, right foot in front of left. Place the center of the tube under your right foot and hold a handle in each hand with hands at your hips [A]. Bend both knees, keeping right knee in line with right ankle and left knee pointing down [B]. Straighten legs and do reps. Switch legs and tube and repeat. Strengthens quadriceps, hamstrings, buttocks and calves.

3. Progressive Push-Up With feet slightly apart, stand approximately 12–15 inches from a wall or support, legs straight but not locked. Wrap the tube behind your back and under each arm; hold an end in each hand. Place hands on the support at chest height, shoulder-distance apart, arms straight but not locked. Choke up on the tube until you feel tension on it. Contract abdominals [A]. Looking straight ahead, inhale and bend elbows to bring chest toward the support [B]. Exhale and straighten arms. Repeat. Strengthens chest, front shoulders and triceps.

4. Seated Row Sit on the ground with knees slightly bent, toes pointing up. Wrap the tube around both feet; then grasp a handle of the tube in each hand, arms stretched out in front of you, palms facing in and wrists straight. Squeeze shoulder blades together and downward and contract abdominals [A]. Keeping shoulders and torso motionless, exhale and contract back muscles as you bend your elbows back and pull the band toward your waist [B]. Straighten arms to starting position and repeat. Strengthens upper and middle back, rear shoulders and biceps.

5. Seated Triceps Extension Sitting cross-legged on the ground, hold one end of the tube in your right hand behind your back at the base of your spine. Hold the other end in your left hand above your head, arm straight. Choke up on the end in your right hand until you feel tension on the tube. Keeping your torso lifted and abs contracted, look straight ahead. Bend your left elbow, palm facing in, pointing your elbow up [A]. Squeeze shoulder blades together, and then straighten your left arm without locking elbow or

moving at the shoulder [B]. Bend elbow to starting position and do reps; then switch arms and repeat. Strengthens triceps.

6. Ab Curl Lie face-up on the ground with knees bent and in line with your hips, calves parallel to the ground. Place fingertips behind head, elbows open and out to the sides. Inhale; contract abdominals [A]. As you exhale, draw ab muscles in and down toward your spine while you lift head, neck and shoulders up and forward in 4 counts. Keep legs motionless [B]. Hold for 4 counts; then lower to starting position in 4 counts. Repeat. Strengthens abdominals.

How to Do Kegels

Pelvic-floor muscle-strengthening exercises, also called Kegels, promote strength and elasticity in the pubococcygeus (PC) muscles. Having strong and elastic PC muscles can make delivery easier and speed postpartum healing. To find your PC muscles, stop the flow of urine the next time you’re emptying your bladder. To do a Kegel, squeeze and hold those same vaginal muscles for 10 seconds and then slowly release. Squeeze again and release quickly. Do 20 10-second holds 5 times a day.

Breastfeeding Basics

Q My milk has come in, and I’m engorged and uncomfortable. How long will this last?A According to Jan Riordan, Ed.D., R.N., I.B.C.L.C., associate professor of nursing at Wichita State University in Kansas, and author of Breastfeeding and Human Lactation (Jones & Bartlett, 1999), engorgement is a normal part of breastfeeding and is necessary for milk production, but it will diminish in a few days. The more your baby nurses, the more your body will get used to the supply and demand of breastfeeding. You can expect more regularity by the second week.

Q I’d like to lose my pregnancy weight, but I’m nursing and have heard that losing weight too quickly can cause my milk to dry up. What’s a realistic and safe goal? A After the first postpartum week, a lactating woman should plan on losing no more than 2 pounds a month, says Ruth Lawrence, M.D., a neonatologist and professor of pediatrics, gynecology and obstetrics at the University of Rochester School of Medicine in New York, and author of Breastfeeding: A Guide for the Medical Profession (C.V. Mosby, 1999). According to Lawrence, studies show that a breastfeeding woman needs a well-balanced diet with a minimum of 1,800 calories a day and plenty of fluid.

Mothers who consume less than this deplete their own nutritional stores and risk becoming ill or affecting their milk production.

Exercise is fine, Lawrence says, but don’t expect to lose the extra 5–8 pounds of fat that every woman carries for the entire lactating process. But do be aware that milk produced after strenuous exercise contains more lactic acid, which some babies dislike. If you tend to work up a sweat when exercising, make sure you nurse before your workout; afterward, you might want to postpone nursing for 30 minutes or discard the first teaspoon of milk from each breast.

Q How can I tell if my baby is getting enough milk? A “There are several indicators of adequate intake,” says Audrey Naylor, M.D., associate clinical professor of pediatrics at the University of California, San Diego, and co-founder of Wellstart International, an organization dedicated to educating health professionals about the science and management of lactation. In a newborn, look for four to six very wet diapers and several bowel movements a day. When the baby is at the breast, look and listen for the rhythm and sounds of swallowing. Also note how your breasts feel before and after nursing; most women find that their breasts feel full before feedings and more comfortable afterward. Your baby’s weight gain is another indicator, as are signs that he seems to be thriving and is satisfied after nursing. If you still have doubts, consult with your pediatrician or a lactation expert.

Q Can I use breastfeeding as a birth-control method?A Not with any certainty. According to Naylor, studies show that breastfeeding exclusively is 98 percent effective as birth control if some very specific guidelines are followed. For instance, your baby must be less than 6 months old and must be nursing at least every four hours around the clock. In addition, you cannot have started your period.

Because of these parameters and the risk of birth-control failure if they are not met, a better option might be to use a different type of contraception, such as condoms or a diaphragm. After six weeks, you can take birth-control pills that contain only progesterone, but avoid combination pills containing estrogen.

Q I’m pregnant but want to continue nursing my 1-year-old. Can I breastfeed both children once the baby is born?A Most pregnant women can continue nursing with no problem, but it depends on your obstetrical history, according to Naylor. Oxytocin, the hormone responsible for milk letdown, can also trigger labor. Women prone to miscarriages or preterm labor should therefore ask their doctor if they can continue nursing. Do keep in mind that some babies dislike the altered taste and texture of breast milk during pregnancy and stop nursing altogether.

Once the baby is born, you will likely be able to nurse both children. But it’s important to remember that while your older child is eating supplemental foods, breast milk is your newborn’s only nutrition. Breastfeeding the newborn should therefore take priority.

Q What if breastfeeding doesn’t work for me? How long should I try before giving up?A According to Riordan, studies show that successful breastfeeding depends largely on the mother’s commitment and motivation. That said, it can sometimes take several weeks to get into a comfortable routine. Don’t give up before talking to a lactation consultant, experienced breastfeeding mother or La Leche League member; most problems with nursing can usually be corrected.

Kathleen O. Ryan is a Houston-based writer specializing in health, fitness and family issues.

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