Postpartum Ab Workouts - When and How to Safely Start

Have you heard the comparison between giving birth and running a marathon? A 2019 study indeed confirmed that giving birth and running a marathon are similar in how far their bodies are pushed to the limit of endurance and human potential (UofM). Read that again. Recovery for marathoners is widely understood and recognized. Recovery after birth, though? Frequently underestimated - leading some mothers to resume activity prematurely and potentially lead to more issues down the road. 

Understanding Postpartum Body Changes

During pregnancy, the abdominal muscles stretch to accommodate the growing uterus. This can often lead to a condition called diastasis recti, where the rectus abdominis muscles separate. This separation can impair core strength and stability, and overall pressure management throughout the body. Additionally, hormonal changes increase levels of relaxin, which loosens ligaments and joints, potentially affecting muscle contractility and increasing the risk of injury during postpartum exercise.

Hydration, Nutrient Depletion, and Muscle Strength

Postpartum women often experience dehydration and nutrient depletion in the postpartum phase. More-so if they are breastfeeding. This depletion does not allow the body to focus it’s energy on building muscle strength and endurance, but rather goes into fight or flight mode, protecting only those organs vital and necessary to survive. Because, let’s face it, that’s what we’re doing in this early postpartum phase, surviving. Without proper nutrients and hydration, muscle strengthening takes a backseat.

Cesarean section considerations

For mothers who undergo a cesarean section, recovery involves healing from major abdominal surgery. The procedure requires incisions through multiple layers of tissue, including skin, fat, fascia, muscle, and the uterus . This extensive surgical intervention necessitates a cautious and gradual return to physical activity to allow proper healing.

C-Section Recovery vs. ACL Rehab: A Double Standard

Let's compare:

C-Section: Major Abdominal Surgery

• A cesarean section involves cutting through seven to nine layers of tissue (skin, fat, fascia, muscle, uterus, etc.).

• The core and pelvic floor — foundational muscles for every movement you do — are impacted.

• Most women are given zero formal rehab.

• At 6 weeks, many are “cleared” to resume all normal activities, including lifting, running, and exercise… often with no assessment, plan, or follow-up.

ACL Repair: One Ligament in One Joint

• ACL reconstruction involves repairing a torn ligament in the knee — a very specific, localized injury.

• Patients immediately begin a structured, months-long rehab protocol with physical therapy often 2–3x/week.

• The return to sport or running is not even considered until at least 4–6 months, often longer.

• There are criteria-based progressions — strength, mobility, proprioception, running mechanics — all tracked closely before return.

Procedure	Tissues Affected	Rehab Provided	Return to Activity
C-Section	Multiple layers, core & pelvic floor	Usually none	Cleared at 6 weeks
ACL Reconstruction	One ligament in one joint	Structured for 6–9+ mo	Cleared ~6–12 mo

A C-section is a major abdominal surgery that impacts core integrity, pelvic floor function, and movement patterns—yet most women are given no rehab plan. In contrast, ACL repair patients (a localized knee injury) receive immediate, intensive, criteria-based rehab for months. They're not cleared to jog until they've met strength, mobility, and stability milestones.

Postpartum women deserve the same level of care and attention. Returning to chasing toddlers, lifting baby carriers, or resuming running without guidance isn't just unfair—it's unsafe.

The 6-week postpartum clearance: A misconception

The 6-week postpartum clearance check is generally a way for your OB to check basic healing. This tissue healing check typically does not account for an individual characteristics that could make your overall healing different. In general, we walk away from that “clearance” understanding this means we could begin running, lifting, and maybe even cliff diving. Relying solely on this milestone can be misleading and potentially detrimental.

The American College of Obstetricians and Gynecologists (ACOG) recommends a more personalized approach to postpartum care, emphasizing ongoing assessments and tailored guidance (acog.org).

General Timeline for Postpartum Core Exercises

Weeks 0–4: Rest and Gentle Movement

• Focus on rest, hydration, and nutrition.

• Engage in light activities like walking, as tolerated.

• Begin gentle pelvic floor, core mobility, and diaphragmatic breathing exercises. 

Weeks 4-8: Reintroducing Core Engagement

• Core activation exercises.

• Avoid high-impact activities and heavy lifting.

• Consult with a physical therapist specializing in postpartum recovery for personalized guidance.

Weeks 8–12: Progressing Core Strength

• Incorporate exercises that target core stability, such as:

  • Modified planks

  • Bridge exercises

  • Bird-dog variations

• Monitor for any signs of discomfort or strain, adjusting intensity accordingly.

Beyond 12 Weeks: Advanced Core Training

• Gradually reintroduce more challenging core exercises, ensuring proper form and control.

• Continue to prioritize pelvic floor health and overall stability.

• Maintain regular check-ins with healthcare providers to assess progress and address any concerns.

  
  

Sample Core Exercises for Weeks 8–12

Heel Slides with Core Engagement

Lying on your back with your knees bent, slowly extend one leg out straight while keeping other leg bent and core zipped up.

• 2 sets of 10 per side

• Focus: Keep pelvis stable, exhale with movement.

Marching with Posterior Pelvic Tilt (on back)

Lying on your back with knees bent, core zipped up, slowly lift one leg at a time such as in a marching motion.

• 2 sets of 10 alternating

• Keep ribcage down and low back connected to the floor.

Modified Side Plank (from knees)

Lying on your side with your knees bent, place your forearm on the ground directly underneath your shoulder, Press your hips up by pushing down into your forearm and through your knees to lift up into a side plank.

• Hold 15–30 sec each side, 2–3 rounds

• Progress to longer holds or full side plank as tolerated.

Dead Bug (with or without arms)Lying on your back, zip up your abdominals. Keeping your abdominals tight, and your back flat against the ground, lift one leg at time until they are both in the air in a tabletop position. Place your arms straight up toward the ceiling. Begin by just straightening one leg out at a time, while keeping the other one in the air and the core tight. When able to advance, add in an extension of the opposite arm at the same time.

• 2 sets of 6–8 per side

• Keep the back flat and core braced throughout.

Bird Dog

In a 4 point position, with your hands and knees on the ground, begin by squeezing your abdominals up toward your spine. Keep your pelvis neutral, and reach one leg straight out behind you. When able to advance, add in a reach of the opposite arm at the same time.

• 2 sets of 10 (5 per side)

• Slow and controlled, avoid arching the low back.

Remember, every postpartum journey is unique. Your body just did an incredible thing and needs time to heal properly. Taking a slow, intentional approach to returning to exercise postpartum can give you the advantages you need to regain your strength and confidence. Always remember to seek guidance from a professional if returning to exercise feels overwhelming or uncertain. Remember, you are more than enough.