Lose weight after childbirth

Geschatte leestijd: 9 minuten How soon after childbirth can you start training again and how intense? More importantly: Does it make sense to dive back into the gym quickly?

Weight gain due to pregnancy

In the previous section, I discussed studies that described the mental benefits of exercising during and after pregnancy. However, the motivation of most new mothers will likely be to simply shed those extra kilos. Some women can be physically classified into the period before and after childbirth. The last childbirth may have been a few years ago, and the pre-pregnancy shape is often never regained. Bearing children is a common reason cited for gaining a few extra pounds. Looking at it globally, it seems justified to mention it as a reason rather than simply dismissing it as an excuse. Epidemiological studies suggest that giving birth contributes to the development of obesity [1-5]. There are significant differences in the extent to which pregnancy increases weight. Depending on the study you look at, a single pregnancy ultimately results in 0.5 to 1.7 kilograms more than normal aging would [6-8]. However, these are averages. For some, this increase is much higher and may be permanent until, in some cases, another pregnancy occurs and the weight further increases. However, this also means that many succeed in regaining their pre-pregnancy weight.

Losing weight after pregnancy: Breast or bottle feeding

1. Bradley PJ. Conditions recalled to have been associated wit weight gain in adulthood. Appetite. 1985;6:235–41.
2. Rossner S. Pregnancy, weight cycling and weight gain in obesity. Int J Obes Relat Metab Disord. 1992;16:145–7.
3. Rissanen AM, Heliovaara M, Knekt P, Reunanen A, Aromaa A. Determinants of weight gain and overweight in adult Finns. Eur J Clin Nutr. 1991;45:419–30.
4. Heliovaara M, Aromaa A. Parity and obesity. J Epidemiol Comm Health. 1981;35:197–9.
5. Williamson D, Kahn H, Byers T. The 10-y incidence of obesity and major weight gain in black and white US women aged 30–55. Am J Clin Nutr. 1991;53:1515S–1518S.
6. Williamson DF, Madans J, Pamuk E, Flegal KM, Kendrick JS, Serdula MK. A prospective study of childbearing and 10-year weight gain in US white women 25 to 45 years of age. Int J Obes Relat Metab Disord. 1994;18:561–9.
7. Keppel KG, Taffel SM. Pregnancy-related weight gain and retention: implications of the 1990 Institute of Medicine guidelines. Am J Public Health. 1993;83:1100–3.
8. Ohlin A, Rossner S. Maternal body weight development after pregnancy. Int J Obes Relat Metab Disord. 1990;14:159–73.
9. Little KD, Clapp JF. Self-selected recreational exercise has no impact onearly postpartum lactation-induced bone loss. Med Sci Sports Exerc. 1998;30:831–6.
10. Lovelady C, Lonnerdal B, Dewey K. Lactation performance of exercising women. Am J Clin Nutr. 1990;52:103–9.
11. Walker LO, Freeland-Graves J. Lifestyle factors related to postpartum weight gain and body image in bottle- and breastfeeding women. J Obstet Gynecol Neonatal Nurs. 1998;27: 151–60.
12. Leermakers EA, Anglin K, Wing RR. Reducing postpartum weight retention through a correspondence intervention. Int J Obes Relat Metab Disord. 1998;22:1103–9.
13. Weimer J. The economic benefits of breast-feeding: a review and analysis. U.S. Department of agriculture, Food Assistance and Nutrition Research Report. Washington, DC: Food and Rural Economics Division, Economic Research Service; 2001, pp. 1–18.
14. Ohlin A, Rossner S. Factors related to body weight changes during and after pregnancy: the Stockholm Pregnancy and Weight Development Study. Obes Res. 1996;4:271–6.
15. Sampselle CM, Seng J, Yeo S, Killion C, Oakley D. Physical activity and postpartum well-being. J Obstet Gynecol. Neonatal Nurs. 1999;28:41–9.
16. Harris HE, Ellison GT, Clement S. Do the psychosocial and behavioral changes that accompany motherhood influence the impact of pregnancy on long-term weight gain? J Psychosom Obstet Gynaecol. 1999;20:65–79.
17. Boardley DJ, Sargent RG, Coker AL, Hussey JR, Sharpe PA. The relationship between diet, activity, and other factors, and postpartum weight change by race. Obstet Gynecol. 1995; 86:834–8.
18. Schauberger CW, Rooney BL, Brimer LM. Factors that influence weight loss in the puerperium. Obstet Gynecol. 1992;79:424–9.
19. Jarlenski MP, Bennett WL, Bleich SN, Barry CL, Stuart EA. Effects of breastfeeding on postpartum weight loss among U.S. women. Prev Med. 2014 Dec;69:146-50. doi: 10.1016/j.ypmed.2014.09.018. Epub 2014 Oct 5. PubMed PMID: 25284261; PubMed Central PMCID: PMC4312189.
20. American College of Obstetricians and Gynecologists. Exercise during Pregnancy and the Postpartum Period. Washington, DC: American College of Obstetricians and Gynecologists Press; 1994.
21. Clapp JF. Exercising through Your Pregnancy. Champaign, IL: Human Kinetics, 1998.
22. Dewey KG, Lovelady CA, Nommsen-Rivers LA, McCrory MA, Lonnerdal B. A randomized study of the effects of aerobic exercise by lactating women on breast-milk volume and composition. N Engl J Med. 1994;330:449–53.
23. Hammer R, Hinterman C. Exercise and dietary programming to promote maternal health fitness and weight management during lactation. The Journal of Perinatal Education. 1998;7:12–24.
24. McCrory MA, Nommsen-Rivers LA, Mole PA, LonnerdalB, Dewey KG. Randomized trial of the short-term effects of dieting compared with dieting plus aerobic exercise on lactation performance. Am J Clin Nutr. 1999;69:959–67.
25. McCrory MA. The role of diet and exercise in postpartum weight management. Nutrition Today. 2000; September 01.
26. Hammer RL, Perkins J, Parr R. Exercise During the Childbearing Year. The Journal of Perinatal Education. 2000;9(1):1-14. doi:10.1624/105812400X87455.
27. babycentre.co.uk/a196/when-can-i-start-to-exercise-after-giving-birth
28. maasstadziekenhuis.nl/media/1313/2059-bekkenbodemspier-oefeningen.pdf
29. mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/expert-answers/diastasis-recti/faq-20057825
30. Benjamin DR, van de Water AT, Peiris CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy. 2014 Mar;100(1):1-8. doi: 10.1016/j.physio.2013.08.005.Epub 2013 Oct 5. Review. PubMed PMID: 24268942.
31. Wallace JP, Inbar G, Ernsthausen K. “Infant acceptance of postexercise breast milk.” Pediatrics. 1992; 89(6 Pt 2):1245-7.
32. Dewey KG, McCrory MA. Effects of dieting and physical activity on pregnancy and lactation. Am J Clin Nutr 1994;59: 446S–453S.
33. Wright KS, Quinn TJ, Carey GB. “Infant acceptance of breast milk after maternal exercise.” Pediatrics. 2002;109(4):585-9.

Many studies have been conducted on the effect of exercise on the weight of pregnant and postpartum women. Most of these have been done with women breastfeeding due to perceived risks of acidifying breast milk (see further) [9,10]. Only a small number look at the effect on mothers who bottle-feed, although according to an American study, this accounts for 71% of cases [11-13]. This is difficult because it is not clear what effect breastfeeding has on metabolism and to what extent it influences the effect of exercise. Nevertheless, a few things are clear. A pregnancy is unique in terms of weight gain. As mentioned earlier, the advice to drink plenty of fluids also applies to pregnant women, as dehydration during pregnancy can be particularly harmful. A pregnant woman weighs on average 8-12 kilograms more than her pre-pregnancy weight. This weight does not all consist of the baby, placenta, amniotic fluid, and increased breast size. A pregnant woman also stores more water in her body. This increases the total amount of water in her body by 5-7 liters [14]. For comparison: a can of Coke holds 0.3 liters.

Training for weight loss after pregnancy?

But what about exercise? If you ask mothers whether exercise has any effect on weight loss after childbirth, the majority will answer yes. According to an Australian study, 63% of mothers surveyed believed that exercise helped them lose weight after childbirth [15]. There is also a lot of anecdotal evidence to support this. Even during pregnancy, many women gain less weight if they exercise. Despite these beliefs, it is not easy to find scientific support for the idea that exercise helps women lose weight after childbirth [16]. This is partly because exercise studies have often been conducted on women who also have dietary advice and/or medication [17-22]. The situation is further complicated by the fact that most women gain more weight during pregnancy than is necessary for the growth and development of the baby [23]. After childbirth, the body uses some of this excess weight as an energy source. In other words, breastfeeding women use fat cells as an energy source. And because breastfeeding burns 500-600 kilocalories a day, this often results in weight loss, especially in the first six months after childbirth [24-29].

“Preventing the baby fall”

Finally, we come to the elephant in the room: the fear of the baby fall. During pregnancy, the uterus becomes larger and heavier. As a result, the center of gravity shifts forward. The consequence is that it becomes increasingly difficult for a woman to maintain her balance. In addition, the joints and ligaments become looser due to the production of the hormone relaxin. This makes them more susceptible to stretching and injury [30-33]. Most of the research on exercise during pregnancy focuses on this. The question is whether exercise increases the risk of falling. A number of studies suggest that this is indeed the case. A study of 165 pregnant women in their first pregnancy, for example, found that 36% of the women who exercised regularly fell compared to 23% of the women who did not [34].

How soon after childbirth can you start training?

How soon after childbirth can you start exercising again? Most women are ready to start exercising again about six weeks after childbirth. However, it is important to listen to your body. If you have a difficult childbirth, you may need more time to recover. In general, it is recommended to start with gentle exercises such as walking or swimming. As your strength and endurance improve, you can gradually increase the intensity of your workouts. It’s also important to pay attention to your pelvic floor muscles. Pregnancy and childbirth can weaken these muscles, leading to problems such as urinary incontinence. Performing pelvic floor exercises, also known as Kegel exercises, can help strengthen these muscles and prevent issues. If you had a cesarean section, you may need to wait longer before starting exercise. It’s best to consult with your doctor before beginning any postpartum exercise program.

Fitness and training after childbirth: Recommendations

• Listen to your body and start slowly. Don’t push yourself too hard, especially in the beginning.
• Focus on exercises that strengthen your core and pelvic floor muscles.
• Include a variety of exercises in your routine, including cardio, strength training, and flexibility exercises.
• Stay hydrated and eat a healthy diet to support your postpartum recovery and energy levels.
• Get plenty of rest and prioritize self-care.

How long does it take to get back to my “old” figure?

Every woman’s body is different, so there’s no one-size-fits-all answer to this question. Some women may see changes in their body relatively quickly after childbirth, while others may take longer. It’s important to be patient with yourself and focus on your overall health and well-being rather than just your appearance. Remember that it took nine months for your body to change during pregnancy, so it’s unrealistic to expect it to bounce back immediately. Instead of focusing on achieving your pre-pregnancy body, focus on making healthy choices and giving your body the time it needs to recover.

Pelvic floor and incontinence

The pelvic floor is a group of muscles that support the organs in the pelvis, including the bladder, uterus, and rectum. During pregnancy and childbirth, these muscles can become weakened or stretched, leading to issues such as urinary incontinence. Performing pelvic floor exercises, also known as Kegel exercises, can help strengthen these muscles and improve bladder control. To do Kegel exercises, simply squeeze the muscles you would use to stop the flow of urine and hold for a few seconds, then release. Repeat this several times throughout the day. Here is the translation of the provided HTML content to English: There are various ways to train these muscles [28]. One simple way is to tighten these muscles for a few seconds and then relax them for the same amount of time. You start with a few seconds and gradually build up to, for example, ten seconds. How do you tighten them? Simple, think about the function. If you need to pee or poop but have to hold it, then you use these muscles. Often, the squeezed buttocks are part of this.

Diastasis Recti

During pregnancy, the abdominal muscles are stretched due to the growing uterus [29]. With a bit of bad luck, the linea alba, the line of connective tissue between the left and right muscle bellies of the rectus abdominis, can stretch and become thinner. This is recognizable by the fact that this line becomes wider and deeper so that you can, for example, put two fingers wide and deep into it. This is called diastasis recti. The loss of tension in the abdominal muscles must then be compensated by the muscles of the lower back, which can lead to back problems. In these cases, therapy aimed at restoring strength in the abdominal muscles is recommended. However, the results of this are variable. Just last year, Australian researchers compared the results of 8 different studies on the effectiveness of this therapy [30]. The presence of diastasis recti would be reduced by an average of 35%. However, the researchers note that the different studies they compared showed large differences and were often of moderate quality. Their conclusion was therefore:

Based on the available evidence and quality of this evidence, non-specific exercise may or may not help to prevent or reduce DRAM* during the ante- and postnatal periods. D.R. Benjamin, Angliss Hospital, Eastern Health

Well, that’s clear. In some persistent cases, surgical intervention may be advised for cosmetic reasons. *diastasis recti separation of the abdominal muscles

Training, Lactic Acid, and Breastfeeding

A study from 1992 concluded that it is not advisable to breastfeed within an hour and a half after an intensive workout [31]. The production of lactic acid during exercise could change the taste of breast milk, causing babies to like it less. However, in that study, the milk was given through a pipette, a method the children were not accustomed to. So it’s not clear at all whether their dislike was of the milk or the pipette. Two years later, in a study, when women did moderate cardio five times a week (45 minutes, 60%-70% maximum heart rate), this did not change the composition of lactic acid [32]. Given that most people won’t start off super intensively, this will apply to most people. But it could also be that as a professional athlete, you want to get back to your old level as quickly as possible and therefore work out more intensively than the average woman. In a study from 2002, women trained at high or moderate intensity [33]. Only high intensity increased lactic acid in breast milk, but in this case too, the babies had no problem with it. Moreover, there was no difference here in the weight and body fat that the ladies lost regardless of whether they trained intensively, moderately, or not at all. If you want to play it safe, you can always choose to breastfeed half an hour before training and only an hour after training, as advised by the professors from Wisconsin [23]. References

1. Bradley PJ. Conditions recalled to have been associated wit weight gain in adulthood. Appetite. 1985;6:235–41.
2. Rossner S. Pregnancy, weight cycling and weight gain in obesity. Int J Obes Relat Metab Disord. 1992;16:145–7.
3. Rissanen AM, Heliovaara M, Knekt P, Reunanen A, Aromaa A. Determinants of weight gain and overweight in adult Finns. Eur J Clin Nutr. 1991;45:419–30.
4. Heliovaara M, Aromaa A. Parity and obesity. J Epidemiol Comm Health. 1981;35:197–9.
5. Williamson D, Kahn H, Byers T. The 10-y incidence of obesity and major weight gain in black and white US women aged 30–55. Am J Clin Nutr. 1991;53:1515S–1518S.
6. Williamson DF, Madans J, Pamuk E, Flegal KM, Kendrick JS, Serdula MK. A prospective study of childbearing and 10-year weight gain in US white women 25 to 45 years of age. Int J Obes Relat Metab Disord. 1994;18:561–9.
7. Keppel KG, Taffel SM. Pregnancy-related weight gain and retention: implications of the 1990 Institute of Medicine guidelines. Am J Public Health. 1993;83:1100–3.
8. Ohlin A, Rossner S. Maternal body weight development after pregnancy. Int J Obes Relat Metab Disord. 1990;14:159–73.
9. Little KD, Clapp JF. Self-selected recreational exercise has no impact onearly postpartum lactation-induced bone loss. Med Sci Sports Exerc. 1998;30:831–6.
10. Lovelady C, Lonnerdal B, Dewey K. Lactation performance of exercising women. Am J Clin Nutr. 1990;52:103–9.
11. Walker LO, Freeland-Graves J. Lifestyle factors related to postpartum weight gain and body image in bottle- and breastfeeding women. J Obstet Gynecol Neonatal Nurs. 1998;27: 151–60.
12. Leermakers EA, Anglin K, Wing RR. Reducing postpartum weight retention through a correspondence intervention. Int J Obes Relat Metab Disord. 1998;22:1103–9.
13. Weimer J. The economic benefits of breast-feeding: a review and analysis. U.S. Department of agriculture, Food Assistance and Nutrition Research Report. Washington, DC: Food and Rural Economics Division, Economic Research Service; 2001, pp. 1–18.
14. Ohlin A, Rossner S. Factors related to body weight changes during and after pregnancy: the Stockholm Pregnancy and Weight Development Study. Obes Res. 1996;4:271–6.
15. Sampselle CM, Seng J, Yeo S, Killion C, Oakley D. Physical activity and postpartum well-being. J Obstet Gynecol. Neonatal Nurs. 1999;28:41–9.
16. Harris HE, Ellison GT, Clement S. Do the psychosocial and behavioral changes that accompany motherhood influence the impact of pregnancy on long-term weight gain? J Psychosom Obstet Gynaecol. 1999;20:65–79.
17. Boardley DJ, Sargent RG, Coker AL, Hussey JR, Sharpe PA. The relationship between diet, activity, and other factors, and postpartum weight change by race. Obstet Gynecol. 1995; 86:834–8.
18. Schauberger CW, Rooney BL, Brimer LM. Factors that influence weight loss in the puerperium. Obstet Gynecol. 1992;79:424–9.
19. Jarlenski MP, Bennett WL, Bleich SN, Barry CL, Stuart EA. Effects of breastfeeding on postpartum weight loss among U.S. women. Prev Med. 2014 Dec;69:146-50. doi: 10.1016/j.ypmed.2014.09.018. Epub 2014 Oct 5. PubMed PMID: 25284261; PubMed Central PMCID: PMC4312189.
20. American College of Obstetricians and Gynecologists. Exercise during Pregnancy and the Postpartum Period. Washington, DC: American College of Obstetricians and Gynecologists Press; 1994.
21. Clapp JF. Exercising through Your Pregnancy. Champaign, IL: Human Kinetics, 1998.
22. Dewey KG, Lovelady CA, Nommsen-Rivers LA, McCrory MA, Lonnerdal B. A randomized study of the effects of aerobic exercise by lactating women on breast-milk volume and composition. N Engl J Med. 1994;330:449–53.
23. Hammer R, Hinterman C. Exercise and dietary programming to promote maternal health fitness and weight management during lactation. The Journal of Perinatal Education. 1998;7:12–24.
24. McCrory MA, Nommsen-Rivers LA, Mole PA, LonnerdalB, Dewey KG. Randomized trial of the short-term effects of dieting compared with dieting plus aerobic exercise on lactation performance. Am J Clin Nutr. 1999;69:959–67.
25. McCrory MA. The role of diet and exercise in postpartum weight management. Nutrition Today. 2000; September 01.
26. Hammer RL, Perkins J, Parr R. Exercise During the Childbearing Year. The Journal of Perinatal Education. 2000;9(1):1-14. doi:10.1624/105812400X87455.
27. babycentre.co.uk/a196/when-can-i-start-to-exercise-after-giving-birth
28. maasstadziekenhuis.nl/media/1313/2059-bekkenbodemspier-oefeningen.pdf
29. mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/expert-answers/diastasis-recti/faq-20057825
30. Benjamin DR, van de Water AT, Peiris CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy. 2014 Mar;100(1):1-8. doi: 10.1016/j.physio.2013.08.005.Epub 2013 Oct 5. Review. PubMed PMID: 24268942.
31. Wallace JP, Inbar G, Ernsthausen K. “Infant acceptance of postexercise breast milk.” Pediatrics. 1992; 89(6 Pt 2):1245-7.
32. Dewey KG, McCrory MA. Effects of dieting and physical activity on pregnancy and lactation. Am J Clin Nutr 1994;59: 446S–453S.
33. Wright KS, Quinn TJ, Carey GB. “Infant acceptance of breast milk after maternal exercise.” Pediatrics. 2002;109(4):585-9.