Gentle tummy exercise
Pregnancy splits your abdominal muscles down the middle. It is important to make sure your muscles have healed before you do any vigorous abdominal exercises, such as crunches. In the meantime, you can tone your tummy by performing an exercise that strengthens the deepest muscle layer (transversus abdominus). Be guided by your doctor, but general guidelines include:
- You can perform these exercises lying down, sitting, standing, or on your hands and knees.
- Keep your lower back flat.
- Breathe out, and draw your belly button back towards your spine. Your lower back shouldn't flex or move.
- Hold this position and breathe lightly. Count to 10.
- Relax, and repeat up to 10 times per set.
- Do 10 sets, as many times per day as you can.
- You may like to perform your pelvic floor exercises at the same time.

Tummy exercise - stage two
Once the gap in your abdominal muscles has closed, you can progress to more demanding exercises. General guidelines include:
- Lie on your back, with bent knees and both feet on the floor. Put your hands on your thighs.
- Breathe out, contract your abdominal muscles and lift your head and shoulders off the floor. Slide your hands towards your knees. Only aim to get your shoulder blades off the floor.
- Keep your head and shoulders stable. Hold the position, then slowly ease your shoulders and head back to the floor.
- Repeat up to 10 times for one set.
- Perform around three sets per session
. - You may like to perform your pelvic floor exercises at the same time (see below).

Exercise for the lower abdominal muscles
The lower abdominal muscles are located below your belly button. To work these muscles gently, guidelines include:
- Make sure your abdominal muscles have healed. Until the gap is closed, only perform the 'gentle tummy exercise' option.
- Lie on your back with your knees bent and both feet flat on the floor.
- Contract your abdominal muscles.
- Slowly slide your feet away from you, aiming to straighten both legs. The idea is to straighten the legs without arching your lower back.
- If your back starts to arch, stop and slide your feet back towards your bottom.
- Aim for 10 repetitions per set.
- Perform around three sets per session.
- As your lower abdominal muscles get stronger, you'll be able to slide your feet further and further away.

Pelvic floor exercises
The pelvic floor muscles are tightly slung between the tailbone (coccyx) and the pubic bone, and support the bowel, bladder, uterus and vagina. Childbirth can weaken these muscles and cause problems such as incontinence. To exercise them, you must first direct your attention to these muscles. To help you identify these muscles, they are the ones that you contract to stop urinating. Try to relax your abdominal muscles. Don't bear down or hold your breath. Gradually squeeze and increase the tension until you have contracted the muscles as hard as you can. Release gently and slowly. Then perform the exercises, which include:
- Squeeze slowly and hold for between five and 10 seconds. Release slowly. Repeat 10 times.
- Perform quick, short and hard squeezes. Repeat 10 times.
- Squeeze, then clear your throat or cough lightly. Repeat three times.
- Aim for five or six sets each day.
- These exercises can be performed lying down, sitting or standing.

Types of aerobic exercise
Keep in mind that your ligaments and joints will be loose for at least three months following the birth, so avoid any high impact exercises or sports that require rapid direction changes. Vigorous stretching should be avoided too. Recommended postnatal exercise includes brisk walking, swimming, aquarobics, yoga, pilates, low impact aerobic workouts, light weight training, cycling etc.

See your doctor for further recommendations and cautions.

General suggestions for aerobic exercise
Be guided by your doctor, but general suggestions include:
- Give yourself sufficient time to heal, particularly if you have had a caesarean birth.
- Consult with your doctor before starting any postnatal exercise program - you may be advised to wait, or adapt your exercises.
- Aim for slow, gradual weight loss of around half a kilogram per week.
- Wear a supportive bra.
- Initially, exercise for only five to 10 minutes at a time. Increase the length of your workouts gradually.
- Ideally, your exercise sessions should eventually last between 30 and 50 minutes.
- Drink plenty of water before, during and after exercise.
- Don't push yourself too hard - if you feel breathless, slow down.
- If you experience pain, slow down or stop.
- Remember that it may take you months to return to your pre-pregnancy shape and weight, so don't be discouraged by slow progress.

Warning signs to slow down
Don't overexert yourself. Your body gives out warning signs if you are exercising too hard, and these signs may include:
- Increased fatigue
- Muscle aches and pains
- Color changes to lochia (post-partum vaginal flow) to pink or red
- Heavier lochia flow
- Lochia starts flowing again after it had stopped.
See your doctor for further information and advice.

Things to remember
- You should gently exercise your pelvic floor and abdominal muscles every day.
- Make sure your abdominal muscles have healed before you do any vigorous tummy exercises, such as crunches.

It is important to consult with your doctor before embarking on any postnatal exercise program, as you may need more time than you think to heal from the rigours of childbirth.

The writer is a physiotherapist at Gono Bishwabidyalay, Dhaka.