Whenever I screen a new mum client - either for group classes or personal training - I always ask her whether she is currently breastfeeding or pumping, regardless of when she had her baby. There are a few reasons for this, which I am going to run through in this blog. These will hopefully be helpful to anyone reading this in understanding the relevance of breastfeeding to postnatal exercise.
First and foremost, during pregnancy our bodies produce lots of hormones. These help to make the connective tissues and ligaments which support our bones and muscles softer. This is a great thing as it enables our babies to grow, our bodies to adapt to accommodate our growing babies and our bodies to prepare for childbirth. What lots of women don’t appreciate is that their bodies remain under the influence of these pregnancy hormones even after their baby has been born. This means their joints, connective tissue and muscles can remain softer and less stable for some time after the pregnancy ends. It is thought that these hormones will linger for some 3-6 months after birth if mum never breastfeeds or pumps, or 3-6 months after she stops breastfeeding or pumping. From an exercise perspective, this means that my client might feel less stable during this time and that her balance may also be off whack. This is especially relevant if she is looking to return to high impact exercise like running while still breastfeeding or pumping, as this sort of activity puts a high demand on the joints.
Next, and linked to the first point, if my client is working on rehab, for example for diastasis recti, it may well be that her progress plateaus until some time after she stops breastfeeding or pumping, when her hormones settle back to their pre-pregnancy levels. Diastasis recti is where the linea alba - the connective tissue between the rectus muscles - thins and widens. This is a totally normal and useful adaptation for pregnancy but, after the baby is born, we are looking for that tissue to regain tension so that our core cylinder can function well. The effect of the lingering pregnancy hormones may slow progress down. By no means a reason to quit breastfeeding but something for her to be aware of. That said, as my brilliant pelvic health physio Helen Keeble recently explained to me, some women don't appear to be affected by the hormonal recovery process in this way, and at the moment, we have no way of testing to identify those who are and those who aren’t.
Third, if my client is breastfeeding or pumping, her breast size is likely to be larger than normal. I therefore check that she has a properly fitting and supportive sports bra to wear for our session(s). Trying to squeeze her postnatal boobs into her pre-pregnancy sports bra most probably won’t be comfortable for her. What’s more, the hormones I described in the first point are effective systemically, so it is really important to ensure that the ligaments of the breasts are well supported so as to avoid causing them damage, particularly if partaking in higher impact activities.
Fourth, I would advise the client to try to pump or feed before exercising, as this is usually more comfortable than exercising with full breasts. And I’d make it clear that she should tell me during the session if anything I had programmed didn’t feel great for her boobs. This isn't something to be embarrassed about and it’s super important that clients feel able to flag this kind of thing to their personal trainer rather than push through discomfort.
Fifth, I would give my client plenty of reminders to stay hydrated during the session, and after too. Staying hydrated is important for all of us, but especially breastfeeding mums. And I've seen it (and experienced it) first hand - mums forget to drink. We are too busy doing everything else. As a guide, her urine should be pale. If it looks like apple juice, she needs to take some more fluid on board!
Sixth, clients are often concerned as to whether exercise will affect their milk supply. Research has shown that moderate exercise does not affect milk supply, milk composition, or baby's growth, so I would reassure her of this.
Last but not least, I would make it clear to the client that her baby is always welcome at our sessions, and that she must feel free to pause at any time to feed if that is what she needs to do. Postnatal PT sessions with breastfeeding mums can often be a bit stop-start, and that’s totally OK. She might feel frustrated if everything seems a bit disjointed, but I would remind her that this chapter is temporary and that it won’t always be this way.