Meg Walker, post-natal exercise specialist, on safe routines for new mums who want to get back in shape

Though we can’t all look like Madonna a few months after childbirth, exercise can help to tone up the stretched muscles, promote good circulation and help with posture.

It's essential to take it easy at first

Exercises you might have sailed through before you were pregnant, can actually damage your joints and ligaments if you attempt them too soon after the birth. High-intensity workouts are not the answer. Your body needs time to adjust to the changes that have taken place during pregnancy.

Post-natal exercise classes are one way of ensuring safer exercise and also enable you to meet other mothers with babies of the same age. There’s usually a crèche and additional activities, such as baby massage, add to the experience and enjoyment.

After the birth

Weakening of the pelvic floor is common after childbirth. The pelvic floor is not a ‘floor’ at all. It's a hammock shape of muscles slung between your coccyx bone and your pubic bone. The muscles support your bladder and bowel. The effect of a weakened pelvic floor is that you tend to leak urine especially when you jump, cough or sneeze. Not good news – but for most people regular pelvic floor exercises cure the problem.

• Start pelvic floor exercises as soon as you can after the birth. They may feel weak at first but the more you do, the stronger the muscles will get (helping to prevent incontinence and prolapse of the uterus). It also has the added advantage of improving your love life later on.
• To locate the pelvic floor muscles imagine you are at the back of the queue for the loo, and desperate. You tighten up muscles to stop yourself from leaking. Or you are in a lift with someone special and you feel you are going to break wind. These are the muscles you tighten to stop yourself.
• To practice pelvic floor exercises imagine that you need to stop yourself from going to the toilet, pull the muscles up and in. Hold the position for five counts, then release back to the starting position. Repeat that as many times as you can until you feel the muscles being to tire. Try to breathe normally.
• Another exercise is to pull the muscles up and in as before, but to lift, squeeze and tighten the muscles quite quickly, as in the beat of a pulse and then release. Repeat five times. Again breathing normally.

• Practice the exercises regularly throughout the day. We used to advise exercising these muscles whilst passing urine, stopping, and then starting again, but this exercise SHOULD ONLY BE USED AS A TEST once a week.

Posture points

• Allow the weight to be evenly balanced through three points in the foot – the heel, the base of the big toe and the base of the little toe – felt mainly through the ball of the foot. Hips level and facing forward.
• Weight evenly balanced between the legs, bend knees slightly to ease body weight, pull up the muscles through the front of the thighs.
• Tuck buttocks under and tighten. Tilt pelvis and lengthen lower back. You can reduce backache by aligning the pelvic basin and the spine, which lengthens and straightens the muscles of the back.
• Encourage the return of a flatter abdomen by pulling in your deep tummy muscles (called transversus muscles) whenever you think about them, when walking along, when driving and stopping at the traffic lights, whenever you feed your baby.
• Lift up through the rib cage. Proper alignment of the spine and a lifted rib cage improve breathing.
• Shoulders back and down. Improved posture relieves the neck ache, dizziness & upper back tension that accompany a round-shouldered posture.
• Roll arms out, thumbs forward – this can help to open out the chest and counteract round shoulders.

Aim to do at least five short-hold pelvic floor lifts and five longer-hold lifts (4 – 6 seconds). Once they become easy, try and increase the number of repetitions and the length of the long hold building up the strength of these muscles.

Try and take the baby for a walk in the pram or carry papoose and ‘power’ walk, while thinking ‘tall’, and tightening your abdominal muscles in towards your spine as you walk, until you feel warm and your breathing is a little faster than normal.

At six weeks (after your post-natal check-up)

It's worth waiting for your post-natal check-up with your doctor before you start doing any structured exercise classes. If you've had a Caesarian section you may want to wait until eight to ten weeks.

• Start any exercise programme gradually, allowing yourself time to build up over a number of weeks.
• Remember to have some water handy to drink, especially if you're breastfeeding. If you're out and about, carry a water bottle in your baby’s changing bag to remind yourself to replace those fluids during the day.
• Add up what exercise you do in a day, since little and often is good. You’ll be amazed how many times you can go up and down stairs if you leave the nappy changing kit up there.
• Pain is a warning signal that should never be ignored. Make adaptations or stop altogether (always stop exercising when you feel your body has had enough).
• Try and keep the body in good alignment – hips and shoulders kept square, and when doing knee bends allow the knees to follow the line of the toes.
• When it comes to the abdominal work, ensure your rectus abdominal muscles have come back together before going on to more advanced exercises. (You can ask your midwife, physiotherapist or your postnatal exercise teacher to show you how to check on these muscles.)
• Remember to keep the abdominal muscles as ‘flat’ as possible (drawing them towards the spine as you work). Try to do this in everyday life but especially when working the abdominals in a class situation or at home with a video.

It’s a good idea to leave anything that creates ‘impact’ on your body until at least five months after the birth. Impact can be defined as taking both feet off the floor at the same time and includes activities like jogging. This is to allow the effects of the hormone relaxin to lessen. This hormone loosens the ligaments to allow the baby to come through the pelvis and birth canal more easily. But relaxin affects every joint in the body (even the little finger) and although it is no longer secreted in the same way following the birth, the effect on the joints lingers on and may aggravate back and knee pain.

Find a post-natal exercise teacher near you

The Guild of Post-natal Exercise Teachers has a register of qualified people on their website.

If you can't find a class near you, investigate a ‘low impact’ class. Arrive early and let the teacher know you have just had a baby. He or she should encourage you not to jump, bounce or use jerky movements. Only do what feels right for your body, make sure the music doesn’t feel too fast, and build up your strength gradually.

A useful book:

The Complete Guide to Post-natal Fitness by Judy DiFiore £13.99 ISBN 0 7136 4852 X