Exercise after birth? Fitness experts agree that the exercise that new mothers dread is just what they need.

EXERCISE AFTER BIRTH?

Fitness experts agree that the exercise that new mothers dread is just what they need.

It's easy to feel sluggish about doing sit-ups just after you've had a baby. I remember scowling at my reflection in the mirror soon after my baby was born. My abdomen still protruded, and my face looked as lifeless as I felt. But six weeks after delivery I tried exercising, and was surprised to find that it not only tightened my tummy, but it also boosted my morale. Instead of draining me, it gave me more energy.

Fitness experts agree that the exercise we new mothers dread is just what we need. It helps us feel like ourselves again, physically, emotionally, and socially. Elaine Bowles, registered nurse with the maternal health/child unit at South Bay Hospital in Redondo Beach, California, notes that exercise equips new moms for their task. "It relieves aches and pains," she says. "It strengthens the back and abdominal muscles to help them with the additional bending, lifting, and carrying involved in caring for a baby. It fights exhaustion by raising the energy level. It keeps organs in place and prepares new mothers for sports and other physical activities they enjoy."

Bowles notes that exercise boosts spirits, too. "Exercise improves body image, which helps women get through postpartum blues. The better they feel about themselves, the easier their adjustment will be."

Cathy Ritter, Los Angeles-area manager of Jazzercise, Inc., and a new mother herself, notes that postpartum mothers need a break. "Having a baby requires giving so much attention to a helpless person. Taking time to exercise forces us to do something special for ourselves. We need to know that there's life after birth for us too."

In her postpartum classes Ritter notes how new moms enjoy being with each other. They appreciate patient instructors who understand a new mother's unusual physical condition.

Some postpartum women, however, overdo exercise. They feel so pressured by society to look attractive and to compete in athletics that they put performance goals before safety. For this reason, The American College of Obstetrics and Gynecologists (ACOG) advises caution in postpartum exercise. An "Arnold Swartzenegger" mentality can lead new mothers to resume their prepregnant exercise routine too soon. They forget that the postpartum body is not physiologically back to normal yet.

Here are some guidelines the ACOG, health professionals, and fitness instructors suggest.

Check with your doctor first. After receiving your obstetrician's go-ahead to begin exercising, ask for guidelines. No single exercise or program will meet the needs of all postpartum women. A physically fit mother's program will be more intense than that of an overweight person with a sedentary lifestyle. While most new mothers are advised to wait six weeks to exercise, Ritter's doctor allowed her to begin at three weeks. Teaching aerobic classes up to the day of her baby's delivery had put her in an unusually fit condition.

Exercise physiologist Greg Phillips, M.S., cautions new mothers not to simply resume the routine they used during pregnancy. If there were complications during delivery, the doctor might alter the approach.

Choose a medically sound postpartum exercise program. This may sound obvious, but the ACOG has found that most postpartum women who exercise do so without adequate supervision. Some programs are designed by persons who lack the scientific background to understand how potential problems can be prevented. And some exercise programs being marketed to pregnant and postpartum patients, warns the ACOG, are based on inaccurate or incomplete medical data.

Ask your doctor for recommendations. If he or she has none, ask the exercise instructor questions about workout guidelines for postpartum women. Do her answers reflect medical facts rather than intuition or "common sense"? Do they agree with what you have gleaned from your doctor and other medical personnel?

Remember these buzz words: SLOW and CAREFUL. Special risks for postpartum women dictate a slow and easy approach. Here are a few guidelines.

1. Exercise gently. The extra hormones in the postpartum body soften muscles and ligaments. The estrogen, progesterone, and elastin that were present during pregnancy are subsiding, but they leave your tissues lax and your joints unstable. This makes you more susceptible to injury.

You can protect yourself by not extending joints or stretching to maximum resistance. Greg Phillips, who is president of Speaking of Fitness, Inc., a fitness and weight management consulting service, cautions postpartum women never to exercise to the point of pain.

Avoid jerky, bouncy movements. Using a wooden floor or a tightly carpeted surface also reduces shock.

2. Avoid falls. Falls are a possibility because enlarged breasts and uterus disturb your sense of balance and change your body's center of gravity. Pelvic and hip joints strained by pregnancy are less stable. Be careful to rise gradually from the floor, and avoid rapid changes in direction.

3. Watch your heart rate. Keep it below 140 bpm (beats per minute). The new mother's heart rate is elevated at rest, since her volume of blood is still decreasing from the 30 percent-above-normal level of pregnancy.

Women whose oxygen-carrying capacity is compromised by anemia, or who are extremely sedentary or obese, should be particularly cautious. The ACOG stresses that these patients respond abnormally to even mild exercise.

4. Do low-impact movements, including aerobic exercises. That means keeping one foot on the floor at all times. For example, it's better to march than to hop. "Nursing mothers should consider wearing an athletic bra for adequate support," says Phillips.

5. Avoid competitive exercise. The enjoyment of a sport and the desire to win make it easy to overexert yourself. Even though your body begins to look normal, internal elements are still adjusting.

Typical exercise guidelines still apply. For example, regular exercise (three times per week) is always better than sporadic activity. Avoid vigorous exercise in hot, humid weather and always drink water before and after exercise to avoid dehydration.

The Exercise Routine

According to Phillips, the traditional pattern of exercise works well in the postpartum period:

* a gentle, low-intensity, five-minute warm-up period (slow walking or low-resistant stationary cycling);

* 15 to 30 minutes of low to moderate aerobic activity at the target heart rate; this may include dancing, walking, bicycling, swimming, rowing, and/or cross-country skiing;

* a less intense cool-down period;

* a variety of muscle-toning exercises for the abdomen, back, and legs.

Even though we may want to avoid abdominal exercises, they're important because they restore tone in the abdomen and back. "Do these exercises slowly and carefully, following the directions of an exercise instructor," says Ritter. "Monitor the intensity level, particularly if you've had a Caesarean section. You almost have to learn how to do abdominal exercises all over again because the muscles don't contract as well as they did before."

Sit-ups (curl-ups, actually) should be done with bent knees and with gradual curl up rather than coming all the way up. When done with legs straight out or with feet held in place, they're extremely stressful to the lower back. (This is true for anyone who exercises, not just postpartum women.)

"Avoid any exercise in which the back is arched, slouched, or bent far forward without support," says Phillips. Double leg lifts fit this category. It's better to lift one leg at a time.

The favorite of all specialists is the "pelvic tilt" or "pelvic rock," which eases back pain. Ritter recommends that women stand with legs shoulder width apart and slightly bent, and put their hands on their hips. The new mother squeezes muscles of the buttocks and abdomen so that the pelvis is thrust forward; hold this position for 10 seconds and release.

All the experts agree that the postpartum period is not a good time to begin a vigorous exercise program. Yet you may be tempted to do so because you're so demoralized by weight gain. Instead, start with a low-intensity exercise program and increase gradually.

Be on guard, says the ACOG, for the following symptoms: pain, bleeding, dizziness, shortness of breath, palpitations, faintness, back pain, pubic pain, or difficulty in walking. Contract the doctor if they occur.

You can find postpartum programs by checking with your pediatrician or obstetrician's office. Otherwise, ask at YMCAs, hospitals with active maternity floors, or family-centered health clubs. Here are some popular choices:

* Postpartum classes or "lighter side" classes.

* "Mommy and Me" exercise classes. "Besides helping yourself," says Bowles, "you have a special time with your baby. You become more aware of baby's normal body movements and you improve your baby's muscle tone."

* Regular exercise classes with modified routine. "A properly trained instructor can show you how to modify the movements," says Ritter. "Don't feel silly resting as needed. Take it easy on the abdominal exercises and don't compare yourself with the others."

* Home videos. Check reviews in fitness, women's, or parenting magazines, or rent one before you buy it. Then watch it first before you decide to use it. Check to see if the advisory board includes doctors, nurses, or exercise physiologists.

What if you're too tired to exercise? Bowles says to walk: "Take your baby in a stroller and start around the block. Enjoy being out in the air with your baby. Once the walking improves your energy level, you'll be ready for more."

Jan Johnson is a free-lance author who lives in Inglewood, California.