How do I start to exercise after baby loss?

Many women report that exercising helps with both these physical and emotional aspects of a grief journey after baby loss. Physio, Jenni Calcraft explores the physical and emotional benefits and how you can start exercising as part of your loss journey.

Exercise is an important part of physical postnatal recovery. As a physiotherapist working with women after baby loss, I gathered stories recently to raise awareness of the need for physical recovery and the benefits of exercise after a loss. 

“Following my son’s death, amongst the devastation, grief and shock I was also left with all the physical effects of a full term pregnancy. Postpartum when your baby dies is a cruel addition to the cruellest of circumstances.” Mim, Lenny’s Legacy 

Many women report that exercising helps with both these physical and emotional aspects of a grief journey after a loss. Let's explore the physical and emotional benefits and how you can start exercising as part of your loss journey. 

“There was anger and disgust towards my body because I felt it had failed me in one of the most natural and important things it had to do. Yet, I also felt so much love towards my body, for every mark and imperfection that reminded me of my beautiful daughter.” Hannah 

Physical benefits 

Pregnancy and birth bring a lot of physical changes. For example, pelvic floor and tummy muscles lengthen during pregnancy. During a vaginal birth, your pelvic floor muscles are stretched by over 250% and a C-Section involves seven layers of tissue. 

Our bodies are remarkable at healing themselves, but after any other significant physical event we would expect to need some rehabilitation to aid this healing process. Pregnancy and birth are no different. 

Postnatally, pelvic floor exercises help with bladder and bowel control and reduce the risk of prolapse, abdominal exercises increase core strength, reduce back pain and improve posture, and general exercise increases fitness and energy levels and promotes weight loss. 

Exercising after a loss can help to gently support your physical healing process and with the right approach you can become stronger and fitter than you’ve ever been. 

Emotional benefits 

The mental health benefits of exercising are well understood, and when you are experiencing the grief and trauma of baby loss, these emotional benefits can be really valuable. The endorphin release produced by exercise, improved sleep, spending time outside, creating routine and the opportunity for community can all be beneficial to mental health. 

In addition, the stories about exercising after a loss showed additional benefits: 

  • A way to get back in tune with your body and mind 
  • A gentle way to explore trauma held in the body 
  • An increased ability to carry the heavy weight of loss
  • An opportunity to have a short daily break from the feelings of grief 
  • Confidence in mental strength as physical strength is gained 
  • Having something positive to focus on plus a sense of achievement 

And yet, after baby loss, it can be difficult to find the support and guidance needed to recover physically, due to postnatal classes and information being emotionally triggering. So where do you start? 

Where do I start? With the pelvic floor 

After birth, it can be hard to know whether you are engaging your pelvic floor correctly so physical recovery begins with re-establishing an awareness of these muscles. 

You need to be able to switch on but also relax your pelvic floor. Here’s an exercise for you to try: 

Lie comfortably on your back or your side. 

  • Breathe in, expanding your rib cage in every direction like an umbrella opening. At the same time, relax through your pelvic floor muscles. 
  • You can focus on this sensation by imagining that you are breathing down into your pelvis and gently pushing apart your sit bones, pubic bone and tailbone with your breath. 
  • Next, as you breathe out, you are going to gently squeeze and lift your pelvic floor muscles, without tightening any other muscles in your thighs, buttocks or upper body. To do this, on the out-breath: 
  1. Squeeze gently around your back passage as if you’re stopping yourself from passing wind. 
  2. Next, lift and squeeze around your vaginal passage. 
  3. Lastly, tighten around your bladder opening, as if stopping yourself from passing urine. 
  • Hold this lift and squeeze gently as you continue to breathe gently. As your pelvic floor tires, make sure that you actively release the squeeze before it tapers off and ensure that your pelvic floor is fully relaxed before performing another lift and squeeze. 
  • You can download a leaflet titled Core Breathing and Pelvic Floor Exercises here. 

Once you have an awareness of your pelvic floor it is important to strengthen these muscles in sitting and standing. 

NICE guidelines tell us that we should aim for 10 squeezes of 10 seconds each followed by 10 strong quick squeezes and that we should aim to do these three times daily. If that sounds like too much of a challenge then just commit to doing them little and often - something is always better than nothing! 

You can also download an app such as the NHS Squeezy app to help you do these exercises. 

Introducing graded exercise 

woman lying down with legs lifted practising pilates

Pelvic floor squeezes are the initial part of your recovery but not very helpful on their own! You need to start moving gradually and to strengthen your pelvic floor and core so that it can handle the load and impact that comes with day-to-day life plus exercise.

Initially, this may involve gentle movements such as pelvic tilts and knee rolls while lying down and also gentle walking, increasing your distance and speed gradually.

Exercises such as squats, bridges, cat-cow and lunges all produce a better pelvic floor contraction than pelvic floor squeezes alone, so these are helpful exercises to start adding in when you feel ready. 

Make sure that you breathe out on any effort however, to avoid bearing down on your pelvic floor. 

As you gain strength, start adding in low impact exercise such as the static bike or cross trainer at the gym. 

Swimming is a great option, but you must wait until seven days after postpartum bleeding has stopped and all wounds are fully healed. This is usually after around 6-8 weeks postpartum. 

When can I start running or other high impact forms of exercise? 

This is a really common question, which is addressed brilliantly by the Return to Running Postnatal guidelines. 

  • The key point to highlight is that you should ideally not start running (or other impact activities) until 12 weeks after delivery. 
  • If you need to exercise for your mental health prior to this point, try to choose a low impact exercise such as the static bike, or work with a postnatal exercise specialist to ensure that you're working 'with' your body and not against it. 
  • The Return to Running guidelines also lay out prerequisites for running, such as pelvic floor endurance and body strength tests. 
  • You can download a trigger-free version of the Return to Running guidelines from The PABL Project here. 

When should I seek help? 

Postpartum recovery isn’t always easy and after a loss there can be additional challenges due to emotional triggers and feelings of grief. 

I would suggest finding support and guidance from a pelvic health physiotherapist or an exercise professional with postnatal experience. You could also use the resources available on The PABL Project website which are sensitive to the emotional aspects of exercising after a loss. 

If you have had a C-section then there will be extra considerations and you should be guided by the timescales given to you by the hospital. 

In addition, if you have any urinary or faecal leakage, if you feel like you have a separation in your tummy muscles or if you have low back pain or pelvic pain then you should see your GP for a referral to a pelvic health physiotherapist before you start exercising. 

The women that I have worked with after a loss have gained incredible physical and also emotional strength through exercise. I firmly feel that exercise can have a positive impact on any grief journey. 

“As I recover, I can see that exercise is what has really put me back together” Alexandra 

About the writer 

Hi, I'm Jenni – registered physiotherapist and passionate about ensuring that women who have experienced a loss are still able to access support and information for their physical recovery postpartum. I find it an absolute privilege to work with women following a loss and to see the benefits of guided exercise - both emotional and physical - that can be experienced. 

www.thepablproject.com 

www.instagram.com/thepablproject

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