Postpartum Return to Exercise

ACOG Committee Opinion 804 (2020, reaffirmed 2023): the postpartum period is a good time to resume or start exercise. Routines may be resumed gradually as soon as medically safe, depending on mode of delivery (vaginal or caesarean) and any medical or surgical complications; some women can resume activity within days of delivery. Pelvic-floor exercises can begin in the immediate postpartum period. ACOG also notes that physical activity can be an important factor in preventing postpartum depressive disorders.

• Check-ins: ACOG Committee Opinion 736 (2018, reaffirmed 2025) moved away from a single six-week visit: contact with the obstetric provider within the first 3 weeks, then ongoing care as needed, ending with a comprehensive postpartum visit no later than 12 weeks after birth. Return to higher-intensity or impact training is a reasonable topic for those visits, and later after a caesarean or complicated delivery.
• Target: the U.S. Physical Activity Guidelines (2018) and WHO 2020 apply the ≥150 min/week moderate aerobic recommendation to the postpartum period too, with WHO adding muscle-strengthening and advising a gradual return, in consultation with a health care provider after a caesarean section.

Progression priorities (rehab-style continuum, see Return From Injury / Rehab-to-Performance Continuum):

1. Breathing + pelvic-floor activation and gentle deep-core work (Pelvic-Floor Considerations in Exercise).
2. Restore movement, posture, low-load strength.
3. Reintroduce impact and heavy loading once pelvic floor and core tolerate it without symptoms.

• Assess and manage diastasis recti (Diastasis Recti Abdominis). ACOG 804 notes that abdominal strengthening — including crunches and the drawing-in manoeuvre — has been shown to reduce the incidence of diastasis and the inter-rectus distance after vaginal or caesarean birth.

• Breastfeeding: regular aerobic exercise improves fitness without affecting milk production, composition or infant growth (ACOG 804). Feeding or expressing before exercise avoids discomfort from engorged breasts; hydrate before starting.
• Relaxin / joint laxity may persist for a period postpartum (and longer while breastfeeding) → progress impact and end-range loading conservatively.
• Sleep deprivation and recovery demands are high — manage load and rest (Recovery — Overview).

• Get medical clearance, especially after caesarean, perineal trauma, or complications.
• Red flags to pause and seek care: heavy or increasing vaginal bleeding, pain, urinary/faecal incontinence, pelvic heaviness/bulging (possible prolapse), wound issues, signs of infection, or persistent abdominal doming.

• Resume gradually as soon as medically safe; some can start within days of an uncomplicated vaginal birth (ACOG 804).
• Pelvic-floor exercises can start immediately postpartum.
• Provider contact within 3 weeks; comprehensive visit by 12 weeks (ACOG 736) — not a single "6-week" gate.
• Work back toward ≥150 min/week moderate activity (PAGA 2018, WHO 2020); later and more gradually after caesarean.
• Breastfeeding is compatible with exercise; milk supply and composition are not affected.
• Seek care for heavy bleeding, incontinence, pelvic bulging/heaviness, wound problems.