“UFFDA, this is challenging and MAN, am I hungry!” I was doing my first postpartum hill workout, and I was really struggling on a hill that I used to float up without issue. I wished I’d brought double the calories on that workout, though it was “short” compared to what I was used to doing. I’ve learned a lot of lessons in my return to running after pregnancy, and am hoping that sharing my experience can help a fellow postpartum person in their return to running. I discovered trail running while in medical school and started doing more competitive races during graduate school. By the time I was pregnant, I’d done over 15 ultramarathons and was having a blast getting faster each year. I’m now about 4 months postpartum and am enjoying slowing building back my running mileage and intensity.
What does the data say?
As someone who has spent over a decade learning how to conduct literature searches and understand research articles, I was eager to see what I could find regarding recommendations for returning to running postpartum. I was disappointed to find a paucity of data, but plenty of dialogue (largely anecdotal) around the subject ranging from starting to run a few days postpartum to no running until 12 weeks postpartum.
The best resource I found was this guidelinepublished by a consortium of pelvic physical therapists, running specific physical therapists and women’s health experts from the United Kingdom (Goom, Donnelly and Brockwell). The publication is intended for health professionals managing the postpartum population, but I found it insightful and comprehensive.
Running is considered a high impact sport, especially downhill running one might experience in ultramarathons, and can subject the pelvic floor to load from increased intraabdominal pressure. In general, when planning a return to running postpartum, the mode of delivery must be taken into consideration, with caesarean deliveries requiring more recovery time. Experts also agree that the 6-week postnatal check (as is standard medical practice) is too long to wait to begin some degree of exercise (walking, pelvic floor and core work). Finally, consultation with a pelvic floor physical therapist (ideally one who also works with runners) is optimal. This allows personalized evaluation and a suitable program to target the muscles needed to run safely and efficiently. If you are unable to see a pelvic floor physical therapist, there is a whole library of excellent postpartum exercise videos on YouTube with modifications depending on where you are in your recovery.
It is also important to point out that postpartum women are at increased risk for relative energy deficiency in sport (RED-S) and related bone injuries secondary to diminished energy availability. RED-S is a constellation of symptoms including fatigue, weight loss, loss of menstrual cycles and diminished athletic performance that reflects insufficient fuel intake to support the energy demands of training and living life. Part of the challenge here, aside from continuing to nourish your baby after they’re born should you choose to breastfeed, is the absence of menstrual cycles as a gauge for sufficient energy availability.
On a more optimistic note, this study investigated the effect of pregnancy on athletic performance in 43 elite runners and found that all athletes returning to competition postpartum showed no decrease in performance, and 56% showed improvements in their performances 1-to-3-years postpartum.
I resolved to take my running, and my pregnancy journey as a whole, one step at a time. There is no lack of reading materials or unsolicited advice from parents. I found this overwhelming and wanted a more streamlined and straightforward approach. I resolved to consult with trusted experts, listen to my new body (and be very kind to it) and remain conservative with my approach.
As suggested in the aforementioned guidelines, I found a pelvic floor physical therapist in my area and made an appointment for 3 weeks postpartum. At this appointment, the PT assessed the interrectus distance (degree of separation of my rectus abdominis muscles – the “6-pack” ab muscle) and gave me some biofeedback using ultrasound while I learned how to engage my transverse abdominus muscles. This is accomplished by envisioning your belly button being drawn closer to your spine. Ideally, you engage this muscle each time you sit up (for example: picking up your baby, getting out of bed, or standing up from sitting down), doing this can help reestablish the connection between your nerves and muscles that will eventually become involuntary as the muscles activate without you having to think about it.
At 3 weeks, my physical therapist gave me the “go ahead” to do some gentle physical therapy and begin low impact exercise like cycling and elliptical. At my 6-week appointment, we did a more comprehensive assessment and she cleared me to begin running with a conservative program. My first run was the following: 10-minute walking warm up, (1-minute easy jog, 2-minute walk) x 10, 10-minute walk cool down. I slowly increased the amount of time that I was running versus walking over the next 2 weeks, and the cycling and elliptical helped condition my cardiovascular system to handle higher volumes of running once my body caught up.
In thinking about your return to running, it’s also necessary to consider your pre-pregnancy or pre-giving birth level of exercise. I was glad that I was able to continue running safely throughout my pregnancy (of course much slower and shorter as I got further along), but I think even continuing brisk walks helps make things smoother postpartum.
During my return to training, I paid close attention to my energy levels and was on the lookout for that “I need a 3-hour nap and 4th breakfast” feeling. If I felt tired, I’d back it off and work on recovery. This meant focusing on increasing my caloric intake, trying to nap, and taking baths. Being an athlete is already metabolically demanding, but acknowledging that I’m the sole source of food for my child meant that I needed to factor that into my food intake.
- THE HUNGER: Don’t be surprised if you’re insatiably hungry. I don’t think I’ve ever been as ravenous as I am postpartum. I’m rivalling my partner, Tyler (who was running around 90 miles a week at the time) at the dinner table. Have lots of snacks on hand, and bring at least double what you usually bring on runs. For example, I did a hill workout (4 x 5 minutes) and brought two Awesome Sauce gels, thinking that would be more than enough for the 70-minute run (including warm up and cool down), but I’d consumed both gels halfway through the workout and really wished I’d brought a couple more!
- THE THIRST: I’ve always been really bad at drinking water; my brother and I are the same that way. Breastmilk is >80% water, and I calculated that I’ve been producing over 800 milliliters of milk each day! Needless to say, I’m very thirsty and bring a soft flask with me even on easy runs.
- NEW BODY: My body feels completely different. I’ve been asked whether I felt like I was “back to normal,” but I’m not sure how to respond. My body will never be the same as it was before I grew my little guy, and that’s to be expected! I’m trying to see my postpartum running and exercise as an opportunity to get to know my new body and learn what it needs to be strong and healthy.
- HETEROGENEITY OF EXPERIENCE: Like everything in pregnancy, everyone has a different experience. Some pregnant people get morning sickness, others do not. Some of us have a lot of trouble with breastfeeding while it’s easy for others. When it comes to running, some run sooner than others after delivering their babies. Acknowledging that we’re all different and it’s all “normal” is critical so that we don’t compare our journey to others. My college coach used to say “focus on your own mat,” and I think that’s especially pertinent here. We will all have different trajectories and while we shouldn’t compare ours against another’s, we can use our experiences to help our friends on their journeys.
How you can support your pregnant or postpartum person
- Make them a MealTrain, or sign up for their MealTrain! One of the biggest challenges for me postpartum was making sure I was consuming enough calories. I almost never felt satiated and as I began my return to running at around 6 weeks, this became even more of a challenge. A parent of one of Tyler’s high school cross country athletes made us a bunch of pumpkin bread, already sliced, frozen and aliquoted. We both mowed through that when we were up with the baby at night (Thanks, Caroline!). If you’re not a cooker or baker, consider sending a restaurant giftcard or dropping off snacks on their stoop! One of our neighbors has left pastries on our stoop multiple times and it’s just so heartwarming. (Thanks, Pollee!)
- Offer to go on easy runs or walks with them! Having friends join you when you’re starting to run again is so heartening. It’s also a reminder that the sport is about much more than winning races or running fast times, but rather connecting with our magical community.
- Lend them your bike! Cycling is a wonderful low impact way to get in sustained aerobic work.
About the author: Rachel Drake lives in Portland, Oregon with her husband Tyler Green, baby Lewis and dog Teddy. She is in her final year of medical school and has her PhD in Physiology and Pharmacology. She is 4 months postpartum and is a trail runner for Nike, Osprey and Spring Energy.
You can follow Rachel on Instagram: @rachelraedrake